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Flashcards

Nephrology - 1

Vamsi Ahobila English 47 cards

Cards in this deck (47)

  1. 1Chronic renal failure will have the following effects:It makes the kidneys smaller
    With renal failure of more than 2 weeks, the hematocrit will drop from loss of erythropoietin production
    Calcium levels drop from the loss of vitamin D hydroxylation (i.e., activation)
  2. 2Prerenal azotemiaBUN to creatinine ratio of > 15:1 and often > 20:1
    Urinary sodium is low (< 20)
    Fractional excretion of sodium < 1%
    Urine osmolality > 500
    May have hyaline casts on urinalysis
  3. 3Mechanism of BUN elevation in prerenal azotemiaLow volume status increases ADH --> ADH increases urea absorption at the collecting duct --> There is a urea transporter that brings urea in --> ADH increases the activity of the urea transporter
  4. 4___ uropathy will give an elevated BUN-to-creatinine ratio of > 15:1, similar to that seen in prerenal azotemiaObstructive
  5. 5BUN-to-creatinine ratio closer to 10:1 Urinary sodium > 40 Urine osmolality < 350Intrarenal renal failure
  6. 6Causes of Toxin-Induced Renal InsufficiencyAminoglycosides (gentamicin, tobramycin, or amikacin)
    Amphotericin
    Contrast agents
    Chemotherapy (cisplatin)
  7. 7Rapid rise in creatinine Low urine sodium (<20)Contrast-induced renal failure
  8. 8Most accurate test for allergic interstitial nephritisWright stain or Hansel’s stain of the urine
    that will show eosinophils
  9. 9Cyclophosphamide causes ___, not renal failureHemorrhagic cystitis
  10. 10Most accurate test for rhabdomyolysisUrine myoglobin
  11. 11Metabolic acidosis with an elevated anion gap Envelope-shaped oxalate crystalsAntifreeze ingestion (ethylene glycol)
  12. 12Best initial treatment of ethylene glycol intoxicationEthanol or fomepizole with immediate dialysis
  13. 13Kidney Damage Caused by NSAIDs- Direct toxicity and papillary necrosis
    - Allergic interstitial nephritis with eosinophils in the urine
    - Nephrotic syndrome
    - Afferent arteriolar vasoconstriction and decreased perfusion of the glomerulus, worsening renal function
  14. 14Painless recurrent hematuria, particularly in an Asian patient after a very recent viral respiratory tract or GI tract infectionIgA nephropathy (Berger's disease)
  15. 15Treatment for Henoch-Schönlein purpuraNo treatment; resolves spontaneously over time
  16. 16History of hepatitis C with renal involvement Joint pain and purpuric skin lesions Complement levels (especially C4) are lowCryoglobulinemia
  17. 17Best initial test for cryoglobulinemiaSerum cryoglobulin component levels (immunoglobulins and light chains, IgM)
  18. 18Reason for biopsy in lupus (SLE) nephritisTo determine the extent of disease to guide
    therapy
  19. 19Treatment of lupus (SLE) nephritis with sclerosis only ("scar" of kidney)No treatment
  20. 20Treatment of mild, early stage, nonproliferative lupus (SLE) nephritisSteroids
  21. 21Treatment of severe, advanced, proliferative lupus (SLE) nephritisMycophenolate mofetil and steroids
  22. 22Do not give ___ or ___ for TPP or HUSPlatelets or antibiotics
  23. 23Loss of more than 3.5 g per day of protein in the urine Decreased albumin levels in the blood Edema Hyperlipidemia ThrombosisNephrotic syndrome
  24. 24Mechanism of thrombosis in nephrotic syndromeLoss of antithrombin III, protein C, and protein S in the urine
  25. 25Hyperproteinuria Hypoproteinemia Hyperlipidemia EdemaNephrotic syndrome
  26. 26Nephrotic syndrome Adults, Cancer such as LymphomaMembranous
  27. 27Nephrotic syndrome Hepatitis CMembranoproliferative
  28. 28Reasons for transient mild proteinuriaCHF
    Fever
    Exercise
    Infection
  29. 29First step to confirm orthostatic proteinuriaSplit urine
    Do a morning urine for protein and
    then one in the afternoon
  30. 30Steps for proteinuria evaluation:1. Repeat the UA.
    2. Evaluate for orthostatic proteinuria.
    3. Get a protein/creatinine ratio.
    4. Perform a renal biopsy.
  31. 31Elevated serum sodium always implies a ___?Free water deficit
  32. 32Hypervolemic causes of hyponatremia are the following:Congestive heart failure (CHF)
    Nephrotic syndrome
    Cirrhosis
  33. 33Hypovolemic causes of hyponatremia are the following:Diuretics (urine sodium elevated)
    GI loss of fluids (vomiting, diarrhea) (urine sodium low)
    Skin loss of fluids (burns, sweating) (urine sodium low)
  34. 34Causes of euvolemic (normal) hyponatremiaSIADH
    Hypothyroidism
    Psychogenic polydipsia
    Hyperglycemia
  35. 35Hyperglycemia causes an artificial drop in sodium by ___ points of sodium for each 100 points of glucose1.6
  36. 36Inappropriately high urine sodium (> 20 mEq/L) Inappropriately high urine osmolality (> 100 mOsm/kg) Low serum osmolality (< 290 mOsm/kg) Low serum uric acid Normal BUN, creatinine, and bicarbonateSIADH
  37. 37Treatment of moderate to severe hyponatremia (confused, seizures)Saline infusion with loop diuretics
    Hypertonic (3%) saline
    Check serum sodium frequently
    ADH blockers (conivaptan, tolvaptan)
  38. 38Treatment of chronic SIADH (as from malignancy)Demeclocycline blocks the effect of ADH at the kidney
    Conivaptan and tolvaptan are inhibitors of ADH at the V2 receptor of the collecting duct
  39. 39Mechanism of hyperkalemia with beta blocker useBeta blockers decrease the activity of the
    sodium/potassium ATPase
    Normal Na/K ATPase activity lowers blood potassium
    Inhibit Na/K ATPase potassium levels can go up
  40. 40Hyperkalemia changes on EKGFirst peaked T-waves occur, then loss of the P-wave, and then the widened QRS
    complex occurs
  41. 41Causes of hypokalemiaDietary insufficiency
    Diuretics
    High-aldosterone states (Conn syndrome)
    Vomiting
    Proximal and distal RTA
    Amphotericin
    Bartter syndrome
  42. 42Avoid glucose-containing fluids in cases of hypokalemia because?They will increase insulin release and worsen the hypokalemia
  43. 43Leads to muscular weakness and loss of deep tendon reflexesHypermagnesemia
  44. 44Hypomagnesemia is caused by the following:Loop diuretics
    Alcohol withdrawal, starvation
    Gentamicin, amphotericin, diuretics
    Cisplatin
    Parathyroid surgery
    Pancreatitis
  45. 45Presents with hypocalcemia and cardiac arrhythmiasHypomagnesemia
  46. 46A ___ is the fastest single test to tell if a patient’s hyperglycemia is life threatening in DKALow serum bicarbonate
  47. 47—

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Flashcards on Nephrology - 1, created by Vamsi Ahobila on 17/05/2017.
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