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36 Cards in this Set

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Retention of what (3) things causes anion gap increase w/ CRF?
Phosphates

H+

Sulfates
PHS
what does the ultrasound show w/:
1. CRF
2. Diabetes
3. Amyloidosis
4. Poylcyctic Kidney Dz
1. shrunken kidneys

2 - 4. Enlarged kidneys
What (3) endocrine functions are lost w/ CRF?

what is the result of each on the patient?
Synthesis of:
1. Vitamin D - hypocalcemia;

2. Ammonia - anion-gap met acidosis;

3. Erythropoietin - anemia
Tx for Chronic renal failure
(3)
ACEi;

low-protein diet;

Dialysis
Dx:
pale complexion, wasting, purpura, N/V, itching, tubular casts in urine
Uremic syndrome
Waxy casts in urine
Chronic Renal Failure
CNS problems from Uremia
(5)
Foot drop;
Carpal tunnel;
Clonus;
Asterixis;
Seziures
Cardiac / Pulmonary problems from Uremia
(5)
HTN;
Pericarditis;
Valve calcification;
Pulmonary edema;
Pulmonary effusions
Hematologic problems from Uremia
(3)
Normochromic, normocytic anemia;
Low platelet function (prolonged bleeding time);
low WBC - increased infections
(2) metabolic problems from Uremia
High triglyerides;

Insulin resistance
Dx:
Inability for kidney to concentrate urine
(stays fixed w/ specific gravity = 1.010)
Isostheuria
Dx:
enlarged kidneys w/ multiple cysts presenting in mid 30's to 40's w/ flank pain

what can it lead to?
ADPKD

Berry aneurysms
Dx:
Metabolic acidosis w/ normal anion gap
Renal Tubular Acidosis
Renal Tubular Acidosis Type I:
1. Defect
2. bicarb level
3. Urine pH
4. Plasma K
5. where in kidney
1. H+ secretion causing Acidosis
2. Low
3. pH > 5.3
4. Low
5. DT defect
Renal Tubular Acidosis Type II:
1. Defect
2. bicarb level
3. Urine pH
4. Plasma K
5. where in kidney
1. Dec. Bicarb reabsorp
2. 12 - 20
3. pH > 5.3
4. Low - normal
5. PCT defect
Renal Tubular Acidosis Type IV:
1. Defect
2. bicarb level
3. Urine pH
4. Plasma K
5. where in kidney
1. Decreased Aldosterone
2. > 17
3. pH < 5.3*
4. High*
5. DT
Etiology of Renal Tubular Acidosis Type I
(4)
Lithium;

Amphotericin B;

SLE;

Sarcoidosis
LASS
Etiology of Renal Tubular Acidosis Type II
(3)
Heavy Metals;

Acetazolamide;

Multiple myeloma
HAM
Etiology of Renal Tubular Acidosis Type IV
(3)
Renal transplant;

Obstructive uropathy;

Diabetic nephropathy;
causes a 4" ROD
Dx:
Radiopaque stone seen in inflammatory bowel diseases, decreased citrate & uricourea

Tx?
Calcium Oxalate stone

Tx:
Thiazides
Dx:
moderately readiopaque stone common in Proteus or staph Saprophyticus UTI due to high urinary pH

Tx?
Struvite (ammonium, magnesium, phosphate) stone

Tx:
lower urine pH
Dx:
Radiolucent stone caused by myeloproliferative diseases and gout

Tx?
Uric Acid stone

Tx:
raise urine pH
Dx:
moderately radiopague stone that has hexagonal crystals and is positively birefringent
What congenital disorder is cause?

Tx?
Cystine Stones

Disorder:
Cystinuria

Tx:
raise urine pH
Dx:
39-yo man w/ severe back pain and hematuria, nausea and unable to find a comfortable position.
Renal stone
(Urolithiasis)
Dx:
sudden HTN w/ low K+

How do you do a screening Dx?

Tx?
Renal artery stenosis

give oral captopril to induce increase of renin

Tx: surgery or angioplasty
Etiology of renal artery stenosis
(2)
Plaque

Fibromuscular dysplasia
Dx:
hematuria, palpable mass, flank pain, fever, secondary polycythemia
Renal Cell Tumor
MC person to get Renal cell CA

Where does it disseminate to?

Tx? (2)
50-70 yo Male smoker

moves to:
Renal veins and Vena cava

Tx:
resection
IL-2 immunotherapy
(3) causes of Ketones in the urine
1. DKA

2. Alcohol intox

3. starvation
SAD
What does Nitrite in urine indicate?
Gram negative rods
What does a positive Leukocyte esterase in urine indicate?
White cells and infection
What do eosinophils in the urine indicate?
Allergic Interstitial Nephritis
What do Squamous cells in the urine indicate?
contaminated specimen
What does Bilirubin in the urine indicate?
Extravascular hemolysis
What does Hemoglobin in the urine indicate?
Intravascular hemolysis
What do Hyaline casts in the urine indicate?
Pre-renal azotemia