251110
Description
Flashcards by Jaimie Shah, updated more than 1 year ago
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Created by Jaimie Shah
over 10 years ago
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| Question | Answer |
| Prerenal azotemia on labs | BUN:Cre >15:1 or >20:1; urine Na<20, FeNA<1% (renal is >1 and post>4%), Urine osmo>500 (still concentrates urine); may see hyaline casts; treat the cause |
| post renal obs bun:Cre | >15:1 |
| intrarenal azotemia on labs | Bun:Cre close to 10:1, Urine sodium >40 and Urine osmo <350 |
| Causes of intrarenal acute failure | ATN (hypoperfusion or toxin); Toxins (aminoglycosides-look for low mag, Ampho, Contrast agents, Chemo)-see muddy brown casts; allergic intersitial nephritis (pcn, sulfa, phenytoin, allopurinol, cyclosporin, quinidine, quinolones, rifampin)- check UA for WBC but do wright stain for eosinophils; Rhabdo |
| what renal injury does cyclophosphamide cause | hemorrhagic cystitis, not renal failure. |
| electrolytes that are altered in rhabdo | Hypokalemia can cause it; but once there you can see hyperkalemia, hypocalcemia and hyperphosphatemia |
| rhabdo tx | bolus of fluids, mannitol/diuresis, alkalinization of urine |
| what is it that kills a patient with rhabdo | hyperkalemia causing arrythmia...check an EKG first! |
| oxalate crystal basics | consider suicide by antifreze ingestion; look at a UA with enveloped shaped crystals; tx is ethanol/fomepizole and dialysis |
| uric acid cystal basics | look for tumor lysis syndrome and treat with hydration and allopurinol |
| what kind of renal failure can NSAIDs cause | Direct/ATN, AIN, Nephrotic syndrome, Aff arteriolar vasoconstriction so decrease perfusion of glomeruli and worsen kidney function |
| what is generally seen in most glomerularnephritis cases? | RBC in urine, RBC casts, protienuria <2g/24h, Edema, can lead to nephrotic syndrome, dx best with kidney bx |
| pt with GN, cough, hemoptysis, SOB and lung findings? | Good pastures (check Anti BM abs, bx shows linear deposits, tx with plasmapheresis and steroids) |
| pt with renal issues, asthma, cough, eosinophilia | Churg-strauss (CBC shows eosinophilia, check Bx; tx with prednisone and add cyclophosphamide if no response) |
| pt with kidney issues, UR problems like sinusitis and otitis, cough, hempotysis, joint, skin and eye problems | Wegener's (usu C-ANCA pos, check bx, tx with cyclophosphamide and steroids) |
| presentation of PAN | present with renal, myalgias, GI bleed and abd pain, purpuric skin lesion, stroke, uveitis, neuropathy (multiple motor and sensory), NO lung involvement |
| tx and dx of PAN | Check ESR; bx sural nerve or kidney bx, tx hep B and C, and angiography will show beading so can avoid biopsy; tx is cyclophosphamide and steroids |
| IgA nephropathy basics | see painless recurrent hematuria, after viral URI and asian patients; need a renal bx; to proven tx but can try steroids, ace, fish oil |
| HSP presentation | raised, nontender purpuric lesion, abd pain, possible bleeding, joint pain, renal involvement |
| dx and tx of HSP | best initial dx is clinical presentation; bx spp for IGA depositon but not necessary; no tx resolves on its own |
| cola or tea colored urine, periorbital edema, htn, prior throat and skin infections | PSGN |
| dx of PSGN | antistreptolysin O, Anti DNAase, antihyaluronidase, low complement levels; bx shows subepi depot of IgG and C3 but no necessary for dx |
| tx PSGN | PCN for infection but no clear tx for kidney dz; control htn and fluid overload with diuretics |
| pts with hep C, joint pain, purpuric skin lesions | cryoglobulinemia |
| dx and tx of cryoglobulinemia | IgM elevated, low C4, most accurate bx; tx hep C with interferon and ribivarin |
| drug induced lupus spares what parts of the body | brain and kidney |
| dx of lupus nephritis | need a bx not for presence but for extent of dz to guide therapy |
| tx of lupus nephritis | sclerosis (no tx), mild dz (steroids), severe dz (mycophenolate mofetil and steroids) |
| tx of alports | none |
| intravascular hemolysis, increased cre, thrombocytopenia | HUS triad |
| IV hemolysis, elevated Cre, low plts, fever, neuro abn | TTP (tx plasmapheresis)--dont give abx or plts |
| s/s of nephrotic syndrome | proteniuria >3.5g/24h, low alb, edema, hyperlipidemia, loss of pro C/S (thrombosis) |
| dx test of nephrotic syndrome | UA; spot urine pro to Cre ratio (3.5:1); 24 hr U pro collection ; most accurate is renal bx |
| nephrotic syndrome common in kids | MCD |
| common nephrotic syndrome in adults with Cancer (lymphoma) | MN |
| nephrotic syndrome assoc with hep C | MPGN |
| Nephrotic syndrome in HIV and Heroine Use | FSGS |
| unclear cause of this type of nephrotic syndrome | Mesangial GN |
| tx of nephrotic syndromes | steroids; and if no decrease in pro:cre ratio in 12 weeks try cyclophosphamide |
| causes of mild transient proteinuria | CHF, Fever, Exercise, Infection |
| steps to evaluate proteinuria | repeat UA, evaluate for orthostatic proteinuria, get pro:cre ratio, check renal bx |
| when is dialysis needed | hyperkalemia, metabolic acidosis, uremia with encephalopathy, fluid oveload, uremia with pericarditis, toxin (Li, ASA, ethylene glycol) |
| causes of hypernatremia | DI and dehydration |
| labs in central and nephrogenic DI | low urine osmo, low urine sodium, inc urine vol; no change in urine osmo with water deprivation |
| tx of central DI | DDAVP |
| tx of nephrogenic DI | correct underlying cause (correct low potassium and elevated Ca) and use thiazides |
| causes of hypervol hyponatermia | CHF, nephrotic syndrome, Cirrhosis |
| hypovol hyponatermia | diuretics, GI loss of fluids (vomit, diarrhea), skin loss (burns, sweating)--this is most water loss but if only water is replaced then Na in serum drops |
| addison's disease basics | primary adrenal insuff (hyponatremia with hyperkalemia and met acidosis); tx with fludricortisone |
| euvolemic hyponatremia | SIADH, Hypothyroid, Psychogenic Polydipsia, Hyperglycemia |
| SIADH lab findings | high urine sodium, high urine osmo, low serum osmo, low serum uric acid, normal BUN/Cre/bicarb |
| causes of hyperkalemia | metabolic acidosis, addison's, beta blockers, dig toxicity, insulin def, diuretics (spironolactone), ACE/ARB, rhabdo from immobility or crush or sezures, type 4 RTA (dont respond to aldo), renal failure |
| SE of hyperkalemia | arrythmia (not seziure or abn neuro) |
| SE of hyperkalemia | arrythmia (not seziure or abn neuro) |
| causes of hypokalemia | dietary insufficency, diuretics, High aldo state (Conn syndrome), vomitting leading to metabolic alkalosis, vol deplete leads to inc aldo, Proximal and distal RTA, Ampho that causes RTA, Bartter syndrome (so can't abs NaCl in loop so creates secondary hyper aldo) |
| intervals on an EKG | PR int 3-5 small blocks QRS less than 3 little blocks QT normal .42s 1 small square is 0.04sec/0.1mV |
| replace potassium tips | no max oral replacement amount, avoid glucose cont solution that cause insulin release and worsen hypokalemia |
| causes of hypermag | overuse of mag laxitive, iatrogenic, labor, hard to have without renal insuff |
| tx hyper mag | restrict intake, saline, dialysis |
| hypomag cuases | loops, ETOH Wd, gentamicin, cisplatin; will present with low Ca and cause arrythmia---Mag is needed to release PTH |
| causes of metabolic acidosis with elevated anion gap | lactic acidosis, ASA overdose (also resp alkalosis and tx with bicarb that corrects acidosis and secretes ASA), Methanol, uremia, DKA, INH tox, ethylene glycol |
| metabolic acidosis with a normal anion gap | Diarrhea (low bicarb and low K and inc Cl-so nl anion gap) or RTA |
| Distal RTA basics (type 1) | cant excrete H ions in distal tubes, urine PH is high, stones will form, serum K and bicarb are low; give acid IV (ammonium chloride) and bicarb |
| Proximal RTA (type 2) | dont reabs bicarb proximally, so inc urine PH later drops, no stones, low bicarb leaches Ca out of bones so see osteomalcia; tx if give bicarb urine PH will increase, tx with thiazide to vol contract |
| hyporenimic hypoaldo (type 4) | dec aldo effect, in a diabetic with met acidosis; elevated K, replace MC to treat |
| urine AG | tells diff between diarrhea and RTA; UNa-UCl; if you excrete lots of acid you excrete Cl with it so UAG is neg and that is with Diarrhea (kidney works), UAG positive in RTA |
| causes of metabolic alkalosis | vol contraction causes secondary hyperaldo and inc Acid excretion; Conn syn (hyperaldo); Cushing syn; Hypokalemia (shifts H ions into cells); milk alkali syn; vomitting |
| cystic disease basics | recurrent hematuria, stones and infection, cysts in liver/ovary/ circle of willis; seen with MVP and diverticulosis; common cause of death ESRD, no tx |
| trigger for stress incontinece | cough or sneeze |
| tx of urge incontinence | behavior, Antiach (tolterodine, trospium, darfenacin, solifenacin, oxybutynin) |
| tx of stress incont | kegel and estrogen cream |
| most effective lifestyle modification on HTN | weight loss |
| if adding a third drug for HTN or suddenly uncontrolled HTN what do you need to do? | look for secondary causes |
| HTN used in preg | alpha methyldopa |
| what HTN not to use in Depression or asthma | beta blockers |
| what HTN med to use in osteroperosis | thiazides |
| what HTN med to use in hyperthyroid | beta block |
| causes of secondary HTN | renal artery steosis (bruit and hypokalemia), pheo, Conn's, Cushings, Corarctation of aorta, congenital adrenal hyperplasia (see hirsutism) |
| Dx and tx RAS | US with doppler first, then MRA, duplex, nuclear study; most accurate renal angiogram; tx is angioplasty and stenting |
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