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110 Cards in this Set
- Front
- Back
- 3rd side (hint)
Among all ethnic groups the number of pts who develop kidney failure is from what?
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Diabetes
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What is the #1 cause of Renal Failure?
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Diabetes
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What is the best overall measure of kidney function?
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GFR
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Normal GFR
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about 120
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Normal Serum Creatinine levels?
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Male < 1.5
Female < 1.2 |
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Is serum Creatinine reliable to measure kidney function?
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No.
very unrealiable esp in elderly females. Usually decreased with decreased muscle mass |
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What critical Creatinine value can indicate serious impairment in renal fxn?
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>4mg/dl
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What is Creatinine?
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Catabolic byproduct of creatinine phosphate, which is used in skeletal muscle contraction.
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Why is Creatinine not considered
reliable? |
The elderly and young normally have lower Creatinine levels as a result of reduced muscle mass. This may potentially mask renal disease in pts of these age groups.
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Correlation (reason why it can't be reliable) between SCr and GFR?
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-SCr can be int he normal range even with GFR close to 60cc/min/
-In early renal disease, the initial drop in GFR will be missed if only the SCr is considered* |
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What is the Gold Standard for GFR calculation?
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Inulin Clearance,
not done much though, requires a big lab...Creatinine is the easiest predictor of GFR |
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What else is used to measure fxn of the kidney?
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Creatinine Clearance.
requires a 24 hour urine collection and is a hassle, not done much. |
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What 2 equations are used in assesing GFR?
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Cockroft-Gault Equation
MDRD Equation (MDRD may be more helpful in with African American Pts.) |
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What do you do if you suspect low GFR?
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Watch BP
Watch for infxn May have to be dialized |
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Creatine does not go up until you have lost a lot of----
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Kidney function
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Pt with slightly high creatinine calls c/o of stomach flu, diahrrea, what do you do?
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Make sure they are hydrated, can't have more nephrons die.
May need IV fluids in hospital. |
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Almost 85% of pts with CKD will have....
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Hypertension
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What is the single most important factor in slowing the progression of renal disease?
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BP!
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What should BP control tx include?
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Asides from lifestyle change
It should include: 1) ACEI or ARB 2) a diuretic also |
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What is the goal BP in all pts with kidney disease?
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<130/80
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What is a major cause of morbidity in pts with chronic kidney disease?
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Anemia-it is a major cause of morbidity with pts with CKD
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What is anemia in CKD defined as?
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<11 in females
< 12 in males |
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Anemia is primarily a deficiency in?
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Erythropoietin, made in the kidney
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Anemia increases as what goes down?
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GFR
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If GFR<60, Hgb<12 in males and <11 in females requires a...
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Initial workup
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What should be evaluated with initial workup?
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-Hgb or Hct
-Fe studies -Reticulocyte count - Stool Guaiac - Erythropoietin is not useful and not recommended* |
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What is the target Hgb with pts with CKD?
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11-12
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What needs to be done to get vascular access when the GFR<25?
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Preserve the Non-Dominant Hand
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What else with a GFR<25?
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Refer to a vascular surgeon!
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What is the vascular access of choice?
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Fistulas:
1) Radiocephalic fistula 2) Brachiocephalic fustula |
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What is the concern with vascular access via grafts?
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Higher infxn and clotting rates compared with fistula, but far superior to a hemodialysis catheter.
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What is the most common cause of mortality in CKD and dialysis pts?
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Cardiovascular disease
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Anemial of renal failure and hypertension can lead to what?
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LVH
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Hyperlipidemia should be treated....
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Aggressively.
All CKD pts should have a goal LDL<100 |
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Diet?
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Appropriate protein intake
Restriction of dietary Na, K, and Phosporous. |
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CKD causes hypo....
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hypocalcemia and hyperphosphatemia
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Should intact PTH levels be checked for CKD pts?
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Yes!
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What kind of binder be avoided with CKD pts...
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Aluminum based binders.
due to chronic aluminum toxicity in CKD pts. |
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What kind of acidosis happens when the kidney's can't excrete the daily adic load?
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Metabolic Acidosis
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When should you refer to a Nephrologist?
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1) GFR<30
2) Stage III CKD 3) CKD pts with difficult to control htn 4) pts with nephrotic proteinuria regardless of renal fxn. |
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Specific Gravity?
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weight of urine vs wt. of distilled water
1.010=equivalent to plasma |
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<= 1.005?
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Dilute
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1.015-1.030
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Increasing osmolarity
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RBC in Urine?
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acute glomerular nephritis
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WBC in urine?
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UTI, pyelonepthiris
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Casts in Urine?
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Pathology in the KIDNEY
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What is Renal Failure?
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-reduction of GFR that is expressed as retention of nitrogenous wastes (BUN, CR)
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What is Azotemia?
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Increased BUN/Creatinine
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What are the lab abnormalities in RF?
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-Azotemia
-Hyperkalemis -Hyperphosphatemia -Acidemia |
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Clinical abnorm of RF?
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-Uremia
-Volume overload with loss of UOP |
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Pre-renal failure?
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Prerenal: Anything that’s influencing flow to the kidney (the person who’s terribly dehydrated or in CHF with low C.O., or renal artery stenosis
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-volume depletion
-hypotension -Third space loss -CHF |
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Intrinsic Renal failure?
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Intrinsic: Post streptococcal glomerulnephritis (antibodies that attack renal), lupus, acute tubular necrosis
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*Most common cause of intrinsic RF is *ATN
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Post Renal falilure?
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Postrenal: Obstruction some place after the kidney. The guy with BPH. Bladder fills up and there’s back pressure up to the kidney. Can also be a woman post radiation for cervical cancer. The radiation down the road can cause scar tissue that obstructs ureter. Back pressure on the kidney.
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Think Obstruction.
Tumor, prostate. |
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Thiazide diuretic?
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25mg to 50mg only a little improvement in BP but side effects go way up. Stay 25 mg and below.
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Glomerular Nephropathies?
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Abnormalities of glomerular fxn.
Damage to glomerulus and its |
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Nephritic Syndrome?
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-Proteinuria
-hematuria -reduced GFR -Edema -Hypertension -Hematuria (with or without casts) |
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Nephrotic Syndrome?
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-Significant Proteinuria (>3.5/24 hours)**
-hypoalbuminemia(<3) - hyperlipidemia -peripheral edema |
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What is the hallmark of Nephrotic syndrome?
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Peripheral Edema!
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Acute tubular necrosis?
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-Acute Renal insufficiency
-Urine segment or pigmented granualr casts and renal tubular epithelial cells. |
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What are the two major causes of ATN?
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1) Ischemia: shock/sepsis
2) Toxin Exposure: NSAIDS/Iodinated IV contrast/ACEI/ARB Aminoglycosides/Ampho B, etc... |
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Non-anion gap metabolic acidosis?
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-loss of HC03 from body
Renal losses(Renal tubular acidosis) GI losses: Diarrhea, vomitting, pancreatic or biliary secretions |
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If anion gap is elevated a ? is present?
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metabolic anion-gap acidosis is prestent
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Anion gap metabolic acidosis=think?
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Acute renal failure
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Causes of Metabolic Alkalosis?
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-Acid loss from stomach
-Diuretics -Mineralocorticoid excess -Congenital Syndromes |
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Calculate Anion Gap?
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NA - CL + HC03
Example: 140-104+(-15) = 21 |
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Things that will give an anion gap?
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-ASA overdose will have an anion gap.
-Diabetic ketoacidosis: Metabolic byproduct of fat/protein digestion. These will have an increased anion gap. |
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What is the single most important factor in slowing the progression of renal dz?
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BP control!!
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What is the goal BP with kidney dz pts?
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<130/80
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Kidney failure tx should include ?
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ACE1 or an ARB as long as is tolerated. A diuretic is needed
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Anemia with CKD?
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-deficiency in EPO
-slowly** give EPO |
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which renal disease can have Eosinophils in the urine?
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Interstitial Nephritis
Triad: Eosinophilia,Fever, Rash! |
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Which renal disease has hematuria and proteinuria?
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Nephrotic Syndrome
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Pts that present with heavy proteinuria but few formed elements(casts, cells, etc..) in their urine?
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Nephrotic syndrome
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What is the most common form of glomerulonephritis Worldide?
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IgA Neuropathy
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Once again, Nephrotic Syndrome?
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-Heavy Proteinuria > 3.5
-peripheral edema -hypoalbuminemia -hyperlipidemia -hypercoaguable state(maybe) |
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Which of the following is the most common cause of Intrinsic Renal Failure?
A. Prerenal Azotemia B. Glomerulonephritis C. Interstitial Nephritis D. Acute Tubular Necrosis E. Obstructive Neuropathy |
D. Acute Tubular Necrosis**
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The leading cause of chronic renal failure is?
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Diabetes mellitus!!!!
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What are the common fluid or electrolyte abnormalities seen in chronic renal failure?
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-metabolic acidosis
-hyperkalemia -hyperphosphatemia -hypocalcemia M.H.H.H. |
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What are findings that may indicate the chronicity of renal failure?
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-Azotemia for 3-6 months
-bilaterally small kidneys by sonogram -broad casts in urinary sediment -anemia |
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Urine output of <400ml/day is defined as?
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-Oliguria
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The most common electrolyte imbalance in a hospitalized population is?
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Hyponatremia
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What is the most important complication of peritoneal dialysis?
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Peritonitis
-Organism responsible=Staphylococcus |
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Calculation of anion gap is helpful in determining the cause of?
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Metabolic acidosis
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Normal Anion Gap?
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8-16
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Increased anion gap in these?
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-Ketoacidosis
-lactic acidosis -renal failure -Salicylate overdose |
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Pt with Abrupt onset of edema, proteinuria, and Cola colored urine has?
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Acute Glomerulonephritis
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Methicillin hypersensitivity
Fever Rash** Eosinophilia Pyuria WBC casts Hematuria |
Think Interstitial Nephritis
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All of the following renal stones are radiopaque except?
A. Calcium Oxylate B. Uric Acid C. Cystine D. Stuvite E. Calcium Phosphate |
B. Uric Acid
They are Radioluscent |
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The most serious consequence of rapid correction of hyponatremia is?
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Severe Brain Damage
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factors associated with adverse prognosis in HTN?
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-Black Males
-Diabetes Mellitus -Cardiomegaly |
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Single dose antibiotic therapy in acute uncomplicated cystitis is not good for?
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Male pts with urinary tract infections, males UTI are considered complicated and require more than a single dose abx.
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Hypertonic saline is indicated for the tx of?
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Fever, symptomatic Hyponatremia
ex: Na of 115 Normals are 135-145 |
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What can cause hypercalcemia?
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-Primary hyperthyroidism
-Thyroxicosis -Malignancy -Thiazide diuretics |
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Clinical signs of hypoclacemia?
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-positive Chovstek's sign
-Cramps and tingling -Tetany -Siezures |
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What may suggest that the pt does not have non-glomerular source of bleeding?
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-Hematuria and PYURIA(usu urinary tract stuff)
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What is the tx for RCIN?
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-Acetylcsteine
-Hydration with D5W -3 ambs bicarb Stop diuretics/NSAIDs/ACE1/ARB |
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Vasculature Atheroembolic dz?
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Renal failure 2ndary to occlusion of renal arteries, arterioles, and glomerular capillaries.
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AED see notes many symptoms,
The Great Masquerader, many problems |
-course is usu progressive over weeks to months
-prognosis is very poor -unlikely to recover renal fxn -affects multiple organs -can be recurrant or intermittant. |
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Hyperkalemia
Acidemia Hyponatremia Azotemia Reduced GFR Anuria Oligura?? |
All sxms of Acute renal failure...
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Three primary mechanisms by which a nephritic state can be induced?
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-Cirlculating antibodies directed against the glomerular basement membrane
-immune complex formation -circulation antibodies directed against neutrophil cytoplasmic agents |
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Secondary hyperparathyroidism with CKD?
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CKD causes:
-hypocalcemia -hyperphosphatemia -decreased Vit D synthesis by kidney -Secondary hyperparathyroidism occurs Check PTH levels** |
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Causes of AG Metabolic Acidosis
MUDPALES |
Causes of an AG Metabolic Acidosis (MUDPALES)
Methanol (Wood alcohol) Uremia Diabetic Ketoacidosis Paraldehyde Alcoholic Ketoacidosis Lactic Acidosis Ethylene Glycol (anti-freeze) Salicylates (Aspirin overdose) |
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Prerenal Azotemia?
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Prerenal Azotemia: is the most common cause of acute renal failure
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True or False:
The MDRD equation used to predict GFR is more accurate for advanced dz and for African Americans? |
True
*results debatable though |
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Signs of Azotemia in ARF are?
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-Nausea
-Vomitting -Malaise -Altered sensorium |
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What accounts for 85% of acute renal failure?
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Acute Tubular Necrosis
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Azotemia over months to years is known as?
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Chronic Renal Failure
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The highest anion gap acidoses are seen with?
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-Lactic Acidosis
-Ketoacidosis -Toxins |
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Non-anion gap acidosis
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-HCO3 loss -GI (diarrhea, pancreatic)
-Renal/tubular(renal tubular acidosis) |
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Causes of metabolic acidosis
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Acid loss from stomach
Cong. syndromes Diuretics Mineralocorticoid excess |
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