Flashcards in UWorld - GU Deck (56):
Patient on dialysis most likely to die from?
Cardiovascular disease >Infection >dialysis withdrawal
Patient with nephrotic syndrome has an increased risk of developing?
Stroke or MI because they are hypercoagulable
Complicated cystitis versus uncomplicated?
Very young, very old, diabetic, immunocompromised, pregnant, abnormal anatomy
When are you worried about contrast induced nephropathy? Consider using?
Diabetes or baseline creatinine >1.5.
Consider using non-ionic contrast
FSGS associated with?
African-American, HIV heroin use, obesity
Patient history of rheumatoid arthritis presents with proteinuria. Likely kidney pathology?
Treatment of Goodpasture's?
Think of rhabdomyolysis with this lab finding?
CPK > 20,000
Lab findings suggest ATN?
1. Urine osmolality < 350
2. Urine sodium > 40
3. FEna> 2%
Side effects of EPO?
4. RBC aplasia
Crystalloid vs colloid solutions?
Saline vs albumin
Signs of RCC?
Triad: hematuria, flank pain, palpable abdominal mass
Also can see: scrotal varicocele, ectopic EPO
Pt with C3 deposition in kidneys? Mech?
Membranoproliferative GN type II (IgG antibodies aka C3 nephritic factor against C3 convertase)
Causes of euvolemic hypoNa?
SIADH, hypothyroid, hypoadrenal, psychogenic polydipsia
Drug that causes ADH resistance?
Drug that sensitized kidneys to ADH?
Tx of psychogenic polydipsia?
ways to correct hyperK? (Quickest first)
2. Glucose + insulin (15-20 min)
3. Kayexalate takes 1-2 hours
4. Beta-2 agonists
Hypophosphatemia can cause?
Rhabdo, paresthesias, respiratory failure
Possible cause of difficult to correct hypoK?
Smoke inhalation can cause what acid-base disorder?
Met acidosis: CO binds to heme, decreased O2 to tissues, lactic acidosis
Met alk - formula to assess compensation?
PaCO2 = .9*bicarb +16 +/-2
Vomiting - mech of alk?
Volume loss triggers RAAS
Na/H antiporter activated
Tx of euvolemic hyperNa vs hypovolemic hyperNa?
D5W vs NS then D5W
Adrenal tumor causing virilization releases?
DHEA-S (-S variant only comes from adrenal gland)
(4/5) (4.0- albumin) + Ca
Types of met alk?
1. Cl sensitive - hypocloremic (urine Cl<20) and hypovolemic. Give saline.
2. Cl resistant - normal Cl. Normal volume. Saline ineffective.
Causes of Cl resistant metabolic alkalosis?
Bartter syndrome (defect in TAL Na resorption)
Renal vein thrombosis leading to pain and gross hematuria most commonly associated with what finding on kidney biopsy?
GN post infection - possibilities? Distinguishing features?
1. IgA nephropathy - ~5 days after infection, normal complement levels.
2. Post-strep GN 10-20 days post infection. Low complement
Most common type of GN related to cancer? Exception?
Membranous. Hogkin's related to MCD
Pt with chronic renal failure - effect on bleeding time, PT, PTT? Cause? Tx?
increased, no change, no change
due to platelet dysfunction from uremic coagulopathy.
Immunosupressant side effects: cyclosporine vs tacrolimus vs azathioprine vs mycophenylate?
Neuro, Nephro, GI, HTN, gingival hyperplasia, hirstutism
as above without gingival hyperplasia and hirstutism
diarrhea, leukopenia, hepatotoxicity
Symptoms of allergic interstitial nephritis? Causes?
AKI, arthralgias, WBC casts with eosinophils
rifampin, penicillian, cephalosporin, bactrim
Types of kidney stones:
Normal pt? if has a family hx? If has cancer (high cell turnover)? with hx of UTIs?
Ca oxalate; cystene; uric acid; struvite
Acylovir - adverse effect on kidney?
renal tubular obstruction
tx for uric acid stone?
urine alkylization with potassium citrate
Epididymitis in younger vs older males?
Chamydia and gonorrhea
UA shows: deformed RBCs and casts vs unchanged RBCs?
glomerular vs tubular injury
Management of nephrolithiasis?
1. Imaging scan – CT
2. Narcaotics and NSAIDs
3. If stone 2 L per day
4. Consult Uro if anuria, urosepsis or ARF
Dietary recommendations for patients with renal calculi?
1. Decrease protein abd oxalate intake
2. Decrease sodium intake
3. Increased fluid intake
4. Increase calcium intake
Management of a patient with suspected pyelonephritis?
Blood cultures followed by IV antibiotics
Patient with acute prostatitis – Next step?
Culture mid-stream urine sample
Cause of renal artery stenosis in lung vs old?
Fibromuscular dysplasa vs artgeromatous plaque
Acute interstitial nephritis vs acute renal failure - UA findings? Antibiotics that cause each?
Eosinophils and WBC casts vs epithelial cell casts
Aminoglycosides vs penicillins
Analgesic abuse - effect on kidneys?
HIV - effect on kidneys?
Causes of priapism?
1. Children - Sickle cell and leukemia
3. Neurogenic (SC injury and cauda equina)
4. Meds - trazadone and prazosin
Possibilities if radiograph doesn't show a stone in a pt with a typical renal colic? (and Tx)
1. If urine pH< 3 mm (HCT)
3. Non-stone causes (clots)
First change in diabetic nephropathy? First quantifiable change?
Hyperfiltration; basement membrane thickening
Indications for cystoscopy?
#Hematuria without signs of infection of glomerular disease, or with risk of malignancy
#Obstructive symptoms (signs of bladder stone)
#abnormal bladder imagine of urine cytology
Membranous Nephropathy Associated with?
Membranoproliferative GN associated with?
Minimal Change Disorder associated with?
IgA Nephropathy associated with?
Pt with Ca Oxalate stones - recommendations?
#Increase Ca intake
#decrease Na and oxalate (no chocolate, vit C)
#Decrease protein intake