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Flashcards in Renal Uworld Deck (186):
1

in whatMVA scenario is it okay to do bladder catheterization

on obvious pelvic fracture or blood from urethral meatus

2

what happens with inclusion body myositis

adult onset distal muscular weakness and atrophy

3

Tx for severe hypovolemic hypernatremia

isotonic 0.9% saline

4

rate for plasma sodium correction

1mEq/L/h

5

Tx for less severe hypovolemic hypernatremia

5% dextrose in 0.45% saline

6

cascade of decreased renal blood flow

RAAS activated. constricts efferent arteriole more than afferent to maintain GFR

7

what factors aggravate prerenal azotemia

decreased fluid intake, ACEI, aspirin

8

edema, hypoalbuminemia, elvated urine protein

nephrotic syndrome

9

what are the nephrotic syndromes

minimal change in kids
FSGS in adults and membranouse nephropathy in adults

10

Significant risk factor for membranous nephropathy

hep B

11

labs in Heb B related membranous nephropathy

low C3
protein excretion over 24 hours > 3g/day

12

all patients with epidural anesthesia require what

bladder catheterization from overflow incontinence

13

child with abdominal pain, lower extremity purpura, arthritis, hematuria

HSP, IgA mediated vasculitis of small vessels

14

arthralgias in IgA nephropathy (HSP)

knees and ankles, transient

15

renal involvement in HSP IgA nephropathy

microscopic hematuria, RBC casts, mild to mod proteinuria
slightly elevated Cr

16

what drugs cause interstitial nephritis

penicillins, cephalosporins, sulfonamides

17

clinical features of durg induced cephalosporins

patient will have fever, rash, arthralgias. can have darker urine (hematuria) sterile pyuria and eosinophiluria

18

Tx drug induced interstitial nephritis

remove causative agent

19

what drugs can you use for UTI in pregnancy

Nitrofurantoin
amoxicillin or augmentin
fosfomycin single dose

20

when to avoid TMP-SMX in pregnancy

1st and 3rd trimester

21

what not to Tx UTI with in pregnancy

fluoroquinolones
TMP-SMX

22

when to screen for aSx bacteriruia

12-16 weeks

23

What are common causes of early post op renal transplant dyfunction

ureteral obstruction
acute rejection
cyclosporine toxicity
vascular obstruction and ATN

24

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?

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