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CK - IM > SUM - CH7 - Renal > Flashcards

SUM - CH7 - Renal Flashcards

1
Q

Acute Kidney Injury: RIFLE Criteria

A

Risk: GFR 4 weeks
ESRD: Loss of function > 3 months

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2
Q

NSAIDS –> AKI: how

A

Prostaglandins dilate afferent arteriole

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3
Q

ACE inhibitors –> AKI: how

A

Angiotensin constricts efferent

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4
Q

Rhabdomyolysis: K+, Ca++, urea

A

Hyperkalemia, Hypocalcemia, hyperuricemia

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5
Q

Rhabdo: treat

A

Mannitol (osmotic diuretic), IV fluids, Bicarb (drives K+ into cells)

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6
Q

Prerenal AKI: casts

A

Hyaline

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7
Q

AKI: Complications: K+ eitiology

A

Hyperkalemia:

Dt/ decreased excretion, and decreased uptake into cells due to acidosis and tissue destruction

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8
Q

AKI: Most common early mortal complication (2)

A

Pulmonary oedema

Hyperkalemic cardiac arrest

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9
Q

AKI: most common late complication

A

Infection:

dt/ uremia disrupting normal WBC function (cellular and humoral immunity)

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10
Q

Radiographic contrast –> ATN (how?)

A

vasospasm of afferent arteriole

prevent with saline hydration

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11
Q

Chronic renal insufficiency

A

Kidney function is irreversibly comprimised but not failed.

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12
Q

Calciphylaxis

A

Hyperphosphatemia –> PHosphate binding Ca++ –> vascular calcifications –> necrotic skin lesions

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13
Q

CKD: treatment: Diet

A

Low protein, low Potassium, low phosphate, low magnesium

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14
Q

CKD: treatment: Blood pressure

A

ACEi: also dilate efferent arteriole –> less progression of proteinuria

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15
Q

CKD: treatment: Hyperphosphatemia

A

Calcium citrate (potassium binder)

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16
Q

CKD: treatment: Secondary hyperparathyroidism

A

Calcium, and vitamin D

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17
Q

CKD: treatment: Anemia

A

Erythropoetin

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18
Q

CKD: treatment: Pruritis

A

Cholestyramine, capsaicin cream, UV light

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19
Q

Dialysis: absolute indications

A 
Acidosis
Electrolytes
Intoxications - methanol, ethylene glycol, lithium, aspirin
Overload - hypervolemia (unmanagable)
Uremia
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20
Q

Best form of permanent dialysis access

A

Arteriovenous fistula (or implantable graft)

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21
Q

Advantage of hemodialysis

A

High flow rates and efficient dialyzers = Quick

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22
Q

Disadvantage of hemodialysis

A

Can cause fluid compartment shifts

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23
Q

Advantage of peritoneal dialysis

A

Can be taught to patient to do on their own

Mimics normal kidney function more accurately

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24
Q

Disadvantage of peritoneal dialysis

A

Risk of peritonitis

Risk of hyperglycemia / hypertriglyceridemia dt/ high osmolar solution

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25
Diagnosis of proteinuria
1. Urine dipstick test (for albumin) | 2. If positive, Urinalysis
26
Test for microalbuminuria
1. Special dipstick 2. If positive, perform radioimmunoassay (most sensitive and specific test for microalbuminuria) (early sign of diabetes)
27
Treatment of symptomatic proteinuria
1. Treat underlying disease 2. ACEi - especially diabetics w HTN 3. Diuretics - edema 4. Antihyperlipidemics 5. Limit dietary sodium and protein 6. Vaccinate
28
Tamm-Horsfall protein
Protein secreted by tubules
29
Orthostatic proteinuria
transient, dt/ standing for too long
30
Microalbuminuria =
30 - 300 mg / 24h
31
Eosinophils in urine
Acute interstitial nephritis (non-nsaid induced) | Eosinophils detected by wright and hansel stains
32
dysmorphic RBCs in urine
glomerulonephritis
33
Cytoscopy: when?
Hematuria (w/o h of infection or trauma) + normal renal ultrasound / CT + bladder sonography shows mass
34
AKI: Best initial imaging test
Renal sonogram. Avoid contrast studies
35
AKI: BUN:Creatinine ratio
Prerenal / post renal = 20:1 | Intrinsic = 10:1
36
AKI: Unknown etiology followup
1. Urinalysis | 2. UNa, FeNa, [U]
37
Isosthenuria
[Urine] = [plasma]
38
Rhabdo Diagnosis
Blood on dipstick, no cells on microscopy
39
Rhabdo: K+, Ca++, PO4-, Urea
Hyperkalemia - released from cells Hypocalcemia - binding damaged muscle Hyperphosphatemia Hyperuricemia - nuclei chromatin lysis
40
Rhabdo: treatment (3)
Saline Mannitol - osmotic diuretic --> quicker passage of MB = less time for damage Bicarb - Drives K+ back into cells / prevents precipitation of MB in urine
41
Hepatorenal syndrome (labs, dt/)
Lab values: Mimic Pre-renal azotemia | Dt/ severe liver disease
42
Hepatorenal syndrome treatment
Midodrine, ocreotide, albumin
43
Atheroemboli: AKI - S/S
Livedo reticularis - blue/purplish skin lesions in fingers and toes Ocular lesions
44
Atheroemboli: AKI - Diagnosis
Eosinophillia, low Compliment levels, Eosinophiluria, Elevated ESR
45
Atheroemboli: AKI - Most accurate diagnostic test
Biopsy of purplish skin lesion = cholesterol crystals | unneccessary because there is no specific treatment for this
46
Gross, Painless, Hematuria (2)
RCCa, or bladder cancer
47
Hematuria: Diagnosis (3)
1. Dipstick 2. Urinalysis 3. If pyuria; send for urine culture ...
48
Membranoproliferative glomerlulonephritis: eitiology
Hep C, | Hep B, Syphilis, lupus, cryoglobulinemia
49
Post strep GN: timeframe
10-14 days
50
Post strep GN: treatment
Supportive: anti-HTN, Loop diuretics for edema
51
Goodpastures: treatment
Plasmaphoresis for Ab, cyclophosphamide and steroids block new Ab formation
52
Renal papillary necrosis: diagnosis
Excretory urogram
53
Renal tubular Acidosis: Broad Def
Inability to lose H+ in urine --> non-anion gap hyperchloremic metabolic acidosis
54
RTA: Type 1: Pathophys
Inability to secrete H+ ions in distal tubule
55
RTA: Type 1: Urinalysis / Blood
pH>6, increased excretion of Na+, Ca++, PO4-, K+, SO4-,
56
RTA: Type 1: Problems / s/s
1. Decreased ECF 2. Hypokalemia 3. Renal stones, nephrocalcinosis 4. Rickets, osteomalacia in children
57
RTA: Type 1: Causes
COngenital, multiple myeloma, nephrotoxicity, autoimmune disease, medullary sponge kidney, analgesic nephropathy
58
RTA: Type 1: Treatment
Correct acidosis with sodium Bicarb (also prevent kidney stones) Administer phosphate salts (promotes excretion of acid)
59
RTA: Type 2: Pathophys
Inability to reabsorb HCO3- in PCT
60
RTA: Type 2: Urinalysis / blood
K+ Loss, Na+ loss
61
RTA: Type 2: Causes
1. Fanconi syndrome | 2. Cystinosis, Wilson disease, Lead toxicity, MM, Nephrotic syndrome, Amyloidosis
62
RTA: Type 2: S / S
Hypokalemia | No Nephrolithiasis, nephrocalcinosis
63
RTA: Type 4: Pathophys
Inability to reabsorb Na+, | Decreased K+/H+ secretion
64
RTA: Type 4: Cause
Any condition that causes Hypoaldosteronism
65
RTA: Type 4: urinalysis / blood
Hyperkalemia, acidic urine
66
Hartnup syndrome: Defect
Neutral amino acid Transporter
67
Hartnup syndrome: Deficiency
Tryptophan, (NAD; niacin)
68
Hartnup syndrome: S / s
Pellagra: dementia, diarrhea, ataxia, psychiatric disturbances
69
Hartnup syndrome: Treat
Supplement nicotinamide
70
Fanconi syndrome treatment
``` Phosphate Potassium Alkali Salt Hydration ```
71
Renal failure in ADPKD: cause
Recurrent pyelonephritis and nephrolithiasis
72
ADPKD: treatment (3)
Drain cysts if symptomatic Treat infection Control HTN
73
AIN: Clinical features
Rash, Fever, Eosinophils, | Pyuria and hematuria may be present
74
Risk Factor for Nephrolithiasis: Gender?
Male
75
Risk Factor for nephrolithiasis: Diet
Low Ca++ / High Oxalate
76
Calcium stones: Content
Calcium oxalate or calcium phosphate
77
Calcium stones: appearance
Bipyramidal (envelope) or biconcave ovals (dumbell)
78
Calcium sotnes: X-Ray
Radiopaque
79
Calcium stones: cause
Secondary to hypercalciuria and hyperoxaluria
80
Uric Acid stones: Precipitation
Acidic urine, hyperuricemia
81
Uric Acid stones: Appearance
Flat square plates, rhomboid or rossette
82
Uric acid stones: X-Ray
Radiolucent (require CT, ultrasound, or IVP for detection)
83
Struvite stones: X-Ray
Radiodense
84
Struvite stones: Appearance
Rectangular prisms Coffin lid
85
Struvite stones: precipitation factors
UTI (urease producing organisms), High pH in urine,
86
Struvite stones: Composition
Ammonium / magnesium or Ammonium / phosphate
87
Cystine stones: Appearance
Hexagonal shaped crystals (radioluscent)
88
Kidney stones: Size to pass
89
Kidney stone: S/S
Renal colic, Hematuria, UTI
90
Kidney stone Diagnosis:
Urinalysis, Urine culture, 24h urine, serum chemistry. X-Ray, CT, IVP, renal ultrasoundography if can't have radiation (pregnancy
91
Kidney stone: Treatment - Mild to moderate pain
High fluid intake, | oral analgesia while waiting for stone to pass
92
Kidney stone: Treatment - Severe pain (with vomiting)
IV fluids and pain control, Obtain KUB and IVP, If no stone after 3 days consider urology
93
Kidney stone: Treatment - Surgery neccesary
(when pain not controlled by narcotics) | Extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy
94
Kidney stone: Indications for admission
- Pain not controlled with oral meds - Anuria - Renal colic + UTI / Fever - Large stone > 1cm

CK - IM (7 decks)

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