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U World Step 2 > Renal, Urinary Systems, and Electrolytes > Flashcards

Renal, Urinary Systems, and Electrolytes Flashcards

(70 cards)

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1
Q

Glomerular versus nonglomerular hematuria

  1. Type of hematuria
  2. Common etiologies
  3. Clinical presentation
  4. Urinalysis
A
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2
Q
A

Red cell casts

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3
Q
A

Granular, muddy-brown casts

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4
Q

Renal osteodystrophy pathway

A
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5
Q

Differential diagnosis of urinary incontinence

  1. Etiology
  2. Symptoms
A
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6
Q

Neuroanatomy of urinary voiding

A
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7
Q

Hypovolemic hyponatremia

  1. Extrenal losses
  2. Renal losses
  3. Decreased effective circulating volume
A
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8
Q
  1. Calculating serum osmolality
  2. Normal serum osmolality
A
  1. (2 x Na) + (BUN/2.8) + (Glucose/18)
  2. 275-295 mOsm/kg H2O
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9
Q

Nephrotic syndrome classic features

A

Edema

Proteinuria (>3.5 g/day)

Hypoalbuminemia

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10
Q

Most common cause of nephrotic syndrome in adults

A

Focal segmental glomerulosclerosis

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11
Q

Risks associated with nephrotic syndrome

A

Infection (loss of immunoglobulins)

Thrombosis (loss of antithrombin and plasminogen)

Protein malnutrition

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12
Q

IgA nephropathy

A

Can present with nephrotic or nephritic symptoms

Gross hematuria following an upper respiratory tract infection

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13
Q

Rapidly progressive glomerulonephritis (RPGN)

A

Nephritic syndrome

Rapidly worsening renal function

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14
Q

Primary renal causes of nephrotic syndrome

  1. Etiology
  2. Clinical Associations
A
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15
Q

Treaments for urge incontinence

A

Bladder training (first line): Delaying micturition and resisting the urge to void

Antimuscarinic: Oxybutynin

Beta 3 adrenergic agonist: Mirabegron

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16
Q

Natural history of diabetic nephropathy

A
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17
Q

Single most effective intervention for slowing the progression of diabetic nephropathy

A

Tight blood pressure control

  1. Drug therapy to lower blood pressure <140/90 mm Hg
  2. Additional lifestyle measures (weight loss, sodium restriction)

First-line medications: ACE inhibitors, ARBs

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18
Q

JNC 8 recommendations for treatment hypertension

A
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19
Q

False positive dipstick test for blood

A

Tests for hemoglobin, which is structurally similar to myoglobin

Will be falsely positive in a patient with myoglobinuria (secondary to rhabdomyolysis)

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20
Q

Bladder catheterization in patients with traumatic spinal cord injuries

A

Urinary catheter placement can assess for urinary retention and prevent acute bladder distension and damage.

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21
Q

Palpable purpura

Proteinuria

Hematuria

HCV

Low complement

A

Mixed cryoglobulinemia

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22
Q

Potter sequence

A
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23
Q
A

Posterior urethral valves

Most common cause of urinary tract obstruction in newborn boys

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24
Q

Iga Nephropathy versus Postinfectious Glomerulonephritis

  1. Clinical presentation
  2. Diagnosis
  3. Prognosis
A

IgA nephropathy is the most common cause of glomerulonephritis in adults

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25
Initial treatment for severe hypovolemic hyponatremia
0.9% Saline The most common cause of hypernatremia is hypovolemia. Mild cases can be treated with 5% dextrose in 0.45% saline.
26
Treatment for euvolemic hypernatremia
5% dextrose in water (D5W)
27
Dietary recommendations for patients with renal calculi
1. Increased fluid intake 2. Decreased sodium intake 3. Normal dietary calcium intake
28
Sickle cell trait 1. Clinical features 2. Laboratory findings 3. Complications
29
Differential diagnosis of metabolic alkalosis
30
Simple renal cyst
31
Characteristics of renal cysts 1. Simple renal cyst 2. Malignant cystic mass
32
Hydronephrosis
33
Cause of refractory hypokalemia (difficult to correct with potassium replacement) in alcoholics
Hypomagnesemia
34
Diagnostic tests in urinary tract infections 1. Serum BUN and creatinine 2. Urine dipstick 3. Urinalysis 4. Urine culture
Patients in diapers should undergo straight catheterization to obtain a steril specimen and avoid contamination with stool or skin flora
35
Cystinuria
Inherited disease causing recurrent renal stone formation Group of disorders characterized by **impaired amino acid transport** -- Defective transport of dibasic amino acids Stones are hard and radioopaque with hexagonal crystals Urinary cyanide nitroprusside test is used to screen
36
Side effects of loop diuretics in cirrhotic patients with volume overload and ascites
Hypokalemia Metabolic alkalosis Prerenal kidney injury Loop diuretics inhibit Na-K-2Cl carrier in the loop of Henle, increasing sodium delivery to distal tubule, producing elevated hydrogen and potassium secretion in the urine.
37
Management of hypercalcemia 1. Severe 2. Moderate 3. Asymptomatic or mild
38
Most important intervention for preventing contast nephropathy
Adequate pre-CT hydration Contrast-induced nephropathy presents as a transient spike in creatinine within 24 hours of contrast administration, with a return to normal renal function within 5-7 days
39
Treatment of acute cystitis and pyelonephritis in nonpregnant women 1. Uncomplicated cystitis 2. Complicated cystitis 3. Pyelonephritis
Uncomplicated cystitis has a low chance of treatment failure and can be treated without a culture
40
Management of acute oliguria
41
Cause of coagulopathy in chronic kidney disease
Platelet dysfunction PT, PTT, and platelet count are normal Bleeding time is prolonged DDAVP is the treatment of choice, if needed: Increases release of factor VIII: von Willebrand factor multimers from endothelial storage sites. Platelet transfusion not indicated bc transfused platelets become inactive.
42
Aminoglycosides
E.g. Amikacin Used to treat serious (multi-drug resistant) gram negative infections. Potentially nephrotoxic
43
Pre-renal azotemia
BUN: creatinine ratio \> 20:1 Due to volume depletion with hypoperfusion to kidneys
44
Clinical features of crystal-induced acute kidney injury **1. Common etiologies** 2. Clinical presentation 3. Treatment
Drug precipitates in renal tubules, causing **intratubular obstruction** and direct renal tubular toxicity
45
Acute interstitial nephritis 1. Common etiologies 2. Timing 3. Clinical presentation
1. Associated with beta lactams and proton pump inhibitors 2. 7-10 days after drug exposure 3. Skin rash, eosinophilia, eosinophiluria, and pyruria
46
Nephrotic versus nephritis syndrome 1. Clinical features 2. Pediatric etiologies 3. Adult etiologies
47
Symptoms consistent with typical renal colic but no stones identified on conventional X rays.
1. Radiolucent stones (uric acid stones, xanthine stones) 2. Calcium stones \<1-3 mm diameter 3. Non-stone ureteral obstruction (e.g., blood clot, tumor)
48
Treatment for uric acid kidney stones
Highly soluble in alkaline urine Alkalinization of the urine to pH 6.0-6.5 with **potassium citrate** Radiolucent but may be seen on US or CT
49
Diuretic used in managment of recurrent hypercalciuric renal stones
Hydrochlorothiazide Decreases urinary calcium
50
Muddy brown granular cast
Acute tubular necrosis
51
RBC casts
Glomerulonephritis
52
WBC casts
Interstitial nephritis and pyelonephritis
53
Fatty casts
Nephrotic syndrome
54
Broad and waxy casts
Chronic renal failure
55
Acute interstitial nephritis Presentation: Caused by: Treatment:
**Presentation**: Fever, rash, arthralgias Peripheral eosinophilia, hematuria, sterile pyuria, eosinophiluria **Caused by:** Cephalosporins Penicillins Sulfonamides Sulfonamide-containing diuretics NSAIDs Rifampin Phenytoin Allopurinol **Treatment**: discontinue offending agent
56
Clinical clues to renovascular disease (renal artery stenosis) 1. HTN-related symptoms 2. Supporting evidence
57
Management of patients with hypertension and renal artery stenosis
ACE or ARB Renal artery stenting or surgical revascularization is reserved for patients with **resistant hypertension** or **recurrent flash pulmonary edema** and/or **refractory heart failure** due to severe hypertension.
58
Sodium nitroprusside
Potent arterial and venous vasodilator often used for hypertensive emergencies. Prolonged influsion can lead to **cyanide toxicity**, especially in patients with CKD. Treatment includes sodium thiosulfate
59
Manifestations of cyanide accumulation & toxicity Skin: CNS: Cadiovascular: Respiratory: GI: Renal:
Combustion of carbon and nitrogen contaning compounds (wool, silk) Industrial exposure (metal extraction in mining) Medications (**sodium nitroprusside**)
60
Site of bladder rupture causing peritonitis
Bladder dome (only peritoneal structure) WIll cause referred shoulder pain
61
Clinical features of analgesic nephropathy 1. Clinical presentation 2. Diagnosis
62
Asymptomatic bacteriuria 1. Risk factors 2. Common pathogens 3. First-line treatment
Associated with an increased risk of preterm labor and low birth weight
63
Metformin in acutely ill patients
Metforming should not be given to acutely ill patients with **acute renal failure**, **liver failure**, or **sepsis**, as these conditions increase the risk of lactic acidosis.
64
Effect of hypovolemia on the renin-angiotensin-aldosterone system
65
Prerenal acute kidney injury 1. Etiology 2. Clinical features 3. Treatment
66
Stimuli for secretion of antidiuretic hormone 1. Osmotic 2. Nonosmotic
67
Acid Base Disorders (Primary disorder, appropriate compensation) 1. Metabolic acidosis 2. Metabolic alkalosis 3. Acute respiratory acidosis 4. Acute respiratory alkalosis
68
Most common type of kidney stone
Calcium oxalate | (70-95% of kidney stones)
69
Alport's syndrome
Recurrent episodes of hematuria Sensorineural deafness Family hx of renal failure
70
Medications that can cause hyperkalemia 1. Medication 2. Mechanism

U World Step 2 (22 decks)

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