Renal Uworld Flashcards
(186 cards)
1
Q
in whatMVA scenario is it okay to do bladder catheterization
A
on obvious pelvic fracture or blood from urethral meatus
2
Q
what happens with inclusion body myositis
A
adult onset distal muscular weakness and atrophy
3
Q
Tx for severe hypovolemic hypernatremia
A
isotonic 0.9% saline
4
Q
rate for plasma sodium correction
A
1mEq/L/h
5
Q
Tx for less severe hypovolemic hypernatremia
A
5% dextrose in 0.45% saline
6
Q
cascade of decreased renal blood flow
A
RAAS activated. constricts efferent arteriole more than afferent to maintain GFR
7
Q
what factors aggravate prerenal azotemia
A
decreased fluid intake, ACEI, aspirin
8
Q
edema, hypoalbuminemia, elvated urine protein
A
nephrotic syndrome
9
Q
what are the nephrotic syndromes
A
minimal change in kids
FSGS in adults and membranouse nephropathy in adults
10
Q
Significant risk factor for membranous nephropathy
A
hep B
11
Q
labs in Heb B related membranous nephropathy
A
low C3
protein excretion over 24 hours > 3g/day
12
Q
all patients with epidural anesthesia require what
A
bladder catheterization from overflow incontinence
13
Q
child with abdominal pain, lower extremity purpura, arthritis, hematuria
A
HSP, IgA mediated vasculitis of small vessels
14
Q
arthralgias in IgA nephropathy (HSP)
A
knees and ankles, transient
15
Q
renal involvement in HSP IgA nephropathy
A
microscopic hematuria, RBC casts, mild to mod proteinuria
slightly elevated Cr
16
Q
what drugs cause interstitial nephritis
A
penicillins, cephalosporins, sulfonamides
17
Q
clinical features of durg induced cephalosporins
A
patient will have fever, rash, arthralgias. can have darker urine (hematuria) sterile pyuria and eosinophiluria
18
Q
Tx drug induced interstitial nephritis
A
remove causative agent
19
Q
what drugs can you use for UTI in pregnancy
A
Nitrofurantoin
amoxicillin or augmentin
fosfomycin single dose
20
Q
when to avoid TMP-SMX in pregnancy
A
1st and 3rd trimester
21
Q
what not to Tx UTI with in pregnancy
A
fluoroquinolones
TMP-SMX
22
Q
when to screen for aSx bacteriruia
A
12-16 weeks
23
Q
What are common causes of early post op renal transplant dyfunction
A
ureteral obstruction
acute rejection
cyclosporine toxicity
vascular obstruction and ATN
24
Q
Biopsy of kidney transplant 3 days later shows heavy lymphocyte infiltration and vascular involvement with swelling of intima? what is it and how to Tx?
A
acute rejection
IV steroids
25
Leukocye esterase
significant pyuria
26
nitrates
presence of enterobacteriaceae
27
expected dipstick for acute pyelonephritis
+ nitrites and leukocyte esterase
28
which drug is known to increase risk bladder CA
cyclophosphamide
29
how do you know if metabolic alkalosis is from vomiting or prior diuretic use
low urine Cl
30
metabolic alkalosis with high urine Cl and hypervolemia
primary hyperaldosteronism
cushing
ACTH production
31
pretibial myxedema
graves
32
edema in nephritis is caused how
decreased GFR and retention Na and water
33
vomiting causes what acid base
metabolic alkalosis because lose H+ and K+
34
how to decrease Ca oxalate stones
minimize Na intake
35
most common drug induced chrnoic renal failure in US
analgesic nephropathy
36
what happens in analgesic nephropathy
papillary necrosis and chronic tubulointerstitial nephritis
| HTN, mild proteinuria, impaired concentration of urine
37
WBC casts are seen in
allergic interstitial nephritis
38
Adult with proteinuria and transient gross hematuria following acute pharyngitis
IgA nephropathy
39
asterixis causes
hepatic encephalopathy
| uremic encephalopathy and hypercapnia
40
alkalotic urine
| pH >5.5
RTA I
| problem with H secretion into urine
41
infant with normal anion gap acidosis and failure to thrive
renal or GI acidosis likely
42
fanconi syndrome
glucosuria, aminoaciduria, phosphaturia
43
Renal tubular acidosis presentation in infants
growth failure
low serum bicarb
hyperCl
44
What drugs cause increased potassium
```
nonselective beta blockers
ACEI, ARB
digitalis
cyclosporine
heparin
NSAIDs
succinylcholine
TMP-SMX
```
45
how does TMP SMX cause hyperkalemia
blocks epithelial Na channels in collecting tubules like amiloride does
can also cause small increase in Cr
46
how do ACEI work
dilate the efferent arterioles
47
signs of aspirin intoxication
tinnitus, fever and tachypnea
| nausea, GI irritation
48
why acid base happens with aspirin OD
respiratory alkalosis
high respirations blowing CO2 off
then causes metabolic acidosis by uncoupling ox phos in mitochondira resulting in low HCO3 from high acid buildup
49
pH in aspirin OD
near normal from mixed acid base
| resp alkalosis and metabolic acidosis
50
Tx aspirin OD
alkalinization or dialysis
51
skin rash, joint pains, myalgias and fatigue
past IV drug abuser
palpable purpura and HSM
UA show hematuria, RBC cast and proteinuria
BUN 30 Cr 2.0 C' low and + anti HCV
mixed essential cryoglobulinemia
52
triad mixed essential cryoglobulinemia
palpable purpura, proteinuria, hematuria
53
HCV is related to what renal dysfunction
mixed essential cryoglobulinemia
54
pathogenesis contrast induced nephropathy
renal vasoconstriction and tubular injury
55
weight gain, facial edema HTN
4+ proteinuria no glucose in urine
no RBC and some fatty casts
greatest risk for?
hypercoagulability-- nephrotic syndrome
56
nephrotic syndrome
proteinuria >4.5
hypoalbuminemia
edema
hyperlipidemia and lipiduria
57
why does nephrotic syndrome cause hypercoagulability
increased urinary loss antithrombin 3, altered levels protein C and S, increased platelet aggregation, hyperfibrinogenemia form increased hepatic synthesis and impaired fibrinolysis
58
complications nephrotic syndrome
protein malnutrition, iron resistent microcytic hypochromic anemia, increased infections
vit D deficiency
59
low complement levels with nephritic syndrome
postinfectious, lupus, MPGN or mixed cryoglobulinemia with HepC
60
What are depositied in mixed cryoglobulinemia
IC of IgM Ab and IgG anti Hep C Ab
61
Dx of mixed cryoglobulinemia
viral serology
62
Tx mixed cryoglobulinemia
plasmapheresis to remove cryoglobulins and immunosuppressants
63
ADAMTS13
thrombotic thrombocytopenia purpura
| fever, microangiopathic hemolytic anemia, renal fialure and neuro signs.
64
what to check for in antiphospholipid Ab syndrome
anti cardiolipin Ab
65
clinical assocations with minimal change disease
NSAIDs and lymphoma
66
clinical associations with FSGS
african american and hispanics
obesity
HIV
heroin use
67
clinical associations with membranous nephropathy
adenocarcinoma
NSAIDs
hep B
SLE
68
clinical associations with Membranoproliferative glomerulonephritis
Hep B and C
| lipodystrophy
69
clinical associations with IgA nephropathy
URI
70
Hepatorenal syndrome
severe liver cirrhosis can increase NO and cause systemic vasodilation causeing decreased vascular resistance and BP which will cause renal hypoperfusion which then activates RAAS
patients do not respond to fluids or removal of diuretics
71
Tx hepatorenal syndrome
splanchnic vasoconstrictores like midodrine, octreotide and norepi
72
FeNa
hepatorenal syndrome
73
patient came into hospital acidemic, 3 days later now mildy alkalemic
loop diuretic
74
electrolyte abnormality in addisons
hyponatremia
| hyperkalemia
75
what drugs can induce urinary retention
TCAs
76
recurrent gross hematuria, proteinuria, sensorineural deafness with splitting of GBM
alports
77
causes of non anion gap acidosis
```
diarrhea
fistulas
acetazolamide
RTA
ureteral diversion
iatrogenic
```
78
hyperkalemic RTA
type 4 RTA
| seen in elderly with poorly controlled DM
79
needle shaped crystals in urine
Uric acid, need CT because radiolucent
80
complication of ureteral colic
ileus
81
oliguria, azotemia and elevated BUN/Cr >20 in post op patient
acute prerenal failure from hypovolemia
| give IV fluids
82
when do you do renal and bladder US for children
infants
83
hypovolemic hypernatremic - not Sx
5% dextrose
84
euvolemic hypernatremia Tx
free water
85
amikacin is what type Antibiotic
aminoglycoside
86
which part of urethra when damaged causes inability to void
posterior
87
clinical presentation of interstitial cystitis
bladder pain with filling, relief with voiding
increased frequency, urgency
dyspareunia
88
Tx for recurrent interstitial cystitis
TCAs
analgesics
trigger avoidance
89
immediate Tx for hyperkalemia with EKG changes
Ca carbonate
90
Tx for hyperkalemia without EKG changes in patients with CKD
diuretics, cation exchange resins and hemodialysis
| want emphasis on removing K
91
how to correct metabolic alkalosis in patient with bulimia
normal saline
92
comlication of Vesicoureteral reflux
renal scarring
93
HTN
bilateral abdominal masses
microhematuria
ADPKD
94
complications constipation in children
anal fissures, hemorrhoids, encopresis
enuresis/UTIs
vomiting
95
risk factors for constipation in children
initiation solid food and cows milk
toilet training
school entry
96
nephrosclerosis
hypertrophy and intimal medial fibrosis of renal arterioles
97
glomerulosclerosis
progressive loss gomerular capillary surface with glomerular and peritubular fibrosis
98
gross hematuria
bladder- cystitis or cancer
renal- glomerulonephritis
ureteral- nephrolithiasis
prostate-BPH
99
gross hematuria with normal RBC
extra-glomerular
100
renal complication sickle cell trait
painless hematuria from renal papillary necrosis or ischemia
or
inability to concentrate urine from vasa rectae damage and distal renal tubular acidosis
renal medullary cancer
101
GU complications DM
erectile dysfunction and retrograde ejaculation
decrased libido and dysparenunia in women
--Neurogenic: decreased ability to sense bladder causing incomplete emptying and decreased urination
recurrent UTIs and overflow incontinence
can get diabetic nephropathy
102
in a cocaine abuser, greatest GU complication
acute renal failure from rhabdomyolysis
103
urine dip + for blood but no RBC on microscopy
myoglobin in the urine from muscle breakdown
104
signs of acute renal injury from diuretic therapy
elevated Cr
elevated BUN with ratio>20
elevated anion gap
105
presenting features of post strep glomerulonephrtiis
periorbital swelling, hematuria and oliguria
106
Complement levels in post strep glomerulonephritis
low
107
WBC cast
tubulo interstitital nephritis
108
RBC casts
post strep glomerulonephritis
109
low complement levels
post strep GN
| membranoproliferative GN
110
goal in patient with EKG findings and hyperkalemia. also has Hx of active coronary artery disease
give insulin with glucose
| beta 2 agonists could cause angina and tachycardia
111
isolated proteinuria in child
if around 1-2+ and all other values normal
| repeat urine dip on 2 subsequent occasions
112
glomerulonpehritis: post strep vs IgA
post strep happens 10-21 days post infection
| IgA 5 days post infection
113
post obstructive diuresis
obstruction causing difficulty urinating and occasionally having intermettent episodes of high volume urination because obstruction is temporarily relieved
114
bleeding at end of urination
prostatic or bladder cause
115
post seizure angion gap metabolic acidosis
results from lactic acidosis
116
Tx lactic acidosis in seizure patient
observation and repeat Chem P in 2 hours to check acidosis
117
Tx uric acid stones
hydration, alkalinization with potassium citrate and low purine diet
118
most common cause of AA amyloidosis in US
rheumatoid arthritis
119
envelope shaped stones
Ca oxalate
120
hyperPTH likely to have what kidney stones
calcium phosphate
121
signs BPH but also worsening Cr
do a renal US to look for hydronephrosis secondary to obstruction
122
signs of cyanide toxicity
```
flushing, cyanosis
headache, altered mental status, seizures
arrhythmias
tachypnea and pulmonary edema
abdominal pain, nausea, vomiting
metabolic acidosis from lactic acidosis
```
123
how does Na nitroprusside work
vaso and veno dilates
124
Tx for cyanide toxicity
Na thiosulfate
125
if K is greater than 6.5 and have EKG changes
Ca gluconate
126
Dx for posterior urethral injury
retrograde urethrogram
127
what happens to BUN and Cr in pregnancy
decrease because renal plasma flow and GFR increase
128
girl who was potty trained starts wetting bed and drinking alot uncontrollably
Diabetes I
129
metabolic effect of chlorthalidone
hyperglycemia
| thiazide diuretic
130
how do thiazides cause hyperglycemia
impair insulin release from pancreas and glucose utilization in peripheral tissues
131
what diseases haveCa oxalate stones
fat malabsorption syndromes
| increase absorption of oxalate
132
urine Ca Cr ratio in familial hypocalciuric hypercalcemia
133
lab finding in acude tubular necrosis
muddy brown casts
134
large blood on UA but none on microscopy
rhabdomyolysis
135
urinary cyanide nitroprusside test
cystine stones
136
hexagonal crystals stones
cystine stones
137
patient is becoming septic. discontinue what metabolic drug
metformin because can cause lactic acidosis in AKI
138
effect of beta agonists on K
decrease it
139
HIV kidney disease
FSGS
140
when given metabolic acidosis with high anion gam if given osmolality (osmolal gap) >10 high
ethylene glycol
methanol
propylene glycol
141
high anion gap metabolic acidosis with rectangular envelop shaped Ca oxalate crystals!!!
ethylene glycol
142
methylene glycol can lead to
blindness
143
CI to using succinylcholine in rapid induction
hyperkalemia
144
SLE
HA, photosensitive skin
thrombocytopenia
glomerulonephritis with low C3 and C4
145
HUS
usually with shiga toxin E coli making microangiopathic hemolytic anemia, thrombocytpenia and renal failure
146
Tx severe Sx hypercalcemia
IV normal saline
147
long term management hypercalcemia of malignancy
bisphosphonates
148
what med helps to pass a idney stone
tamsulosin
149
nephrotic syndrome increases risk for what
atherosclerosis. because low oncotic pressure causes holding onto cholesterol and TG to keep pressure
150
steril pyruia and WBC casts
tubulointerstitial nephritis
151
Tx for dehydration in elderly
IV crystalloid- usually normal saline
152
risk of correcting hyponatremia too quickly
osmotic demyelination
153
pH PaCO2 HCO3 K and Cl in oyloric stenosis
inc pH, PaCO2, HCO3
| dec K and Cl
154
what causes hypovolemic hyponatremia
acute blood loss, renal (diuretics) diarrhea and vomiting and primary adrenal insufficiency
155
Heb B GN
membranous nephropathy
156
lymphoma renal disease
minimal change
157
adenocarcinoma related renal pathology
membranous nephropathy
158
drug therapy to preven calcium stones
thiazides to lower Ca excretion
159
Tx for recurring uric acid stones
allopurinol
160
bleeding with chronic renal failure
common. from platelet dysfunction
BT is prolonged
normal aPTT and PT
161
abrnomal bleeding in chronic renal failure
from platelet dysfunciton.
normal count
normal PT and PTT
long BT
162
how does DDAVP help with platelet dysfunction
increases release of factor VIII, Vw multimers from endothelial sites
163
nephrotic range proteinuria with hematuria
membranoproliferative GN
164
finding in membranoproliferative GN
dense intramembranous deposits that stain for C3
| dense deposit disease
165
what causes memrbanoproliferative GN
IgG Ab for C3 "nephritic factor" directed against C3 convertase
leads to persistent C' activation and kidney damage
166
what are the IC GN
SLE, post strep
167
cell mediated injury Glomerulonephritis
crescenteric
168
what are the non immunoogic kidney GN
diabetic nephropathy
| HTN nephropathy
169
Tx uncomplicated cystitis in non pregnant
nitrofurantoin
TMP-SMX
fosfomycin
170
Tx complicated cystitis
fluoroquinolones
171
Tx outpatient pyelonephritis
fluoros
172
Tx inpatient pyelo
IV fluoro or aminoglycoside and ampicillin
173
hyponatremic
euvolemic
after bolus of saline and urine Na increases while serum Na does not change
SIADH
174
why in alcoholics is K hard to correct
hypoMg
175
Tx SIADH with moderate Sx of confusion
hypertonic saline
176
Tx severe SIADH having seizures
bolus hypertonic saline with Vasopressin antagonists like conivaptan
177
first renal abnormality in diabetic nephropathy
glomerular hyperinfiltration
178
first renal change that can be quantified for diabetic nephropathy
thickeness of GBM
179
what cuase crystal induced acute kidney injury
```
acyclovir
sulfonamides
MTX
ethylene glycol
protease inhibitors
```
180
what is crystal induced acute kidney injury
crystal obstruction and direct renal tubular toxicity
181
Tx for cushing like syndrome
spironolactone, aldosterone antagonist
182
cause of potter sequence
posterior urethral valve
183
Renal vein thrombosis is a complciation of what
nephrotic syndrome from loss of antithrombin III
184
patient with nephropathy but on salt restriction and diuretics then suddenly develops severe sided pain with fever and gross hematuria
membranous nephropathy causing renal vein thrombosis
185
most sensitive test to screen for diabetic nephropathy
random urine for microalbumin/Cr ratio
186
electrolyte abnormality in TB
well if causing primary adrenal insufficiency then can cause hyperkalemia, hypoglycemia and also will cause decreased aldosterone secretion so lose Na save K and H causing normal anion gap with hyperkalemia and hyponatremic metabolic acidosis
