Mksap Nephro Chapter

Front 1

Creatinine

Back 1

metabolism of creatine is muscles, and is a measure for GFR because for most part is neither secreted nor reabsorbed (slight secretion in PCT)

Front 2

Antibiotic that blocks creatinine secretion?

Back 2

Trimethoprim

Front 3

GFR

Back 3

measure of volume of plasma thats cleared of a solute (Creatinine) per unit of time

Front 4

Specific Gravity

Back 4

Compares density of urine to density of water. Normal value is 1.01.

Increased values indicate dehydration

Front 5

Bilirubin in urine

Back 5

suggests liver disease or obstructive or obstructive jaundice

Front 6

urobilinogen

Back 6

usually from hemolytic anemia

Front 7

sterile pyruria

Back 7

Usually from Acute Interstitial Nephritis, can also be from kidney stones, mycobacterium TB

Front 8

best test for nephrolithiasis

Back 8

Non-con CT

Front 9

risk with gadolinium with Cr > 1.5

Back 9

Nephrogenic Systemic Fibrosis

Front 10

plasma osmolallty calculation

Back 10

2(Na) + Glucose/18 + BUN/2.8

Front 11

causes of hypernatremia

Back 11

osmotic diarrhea, DI, mannitol, post-obstructive diuresis,

Front 12

K and acid-base status

Back 12

usually hyperkalemia assocaited with acidosis

hypokalemia assocaited with alkalosis

Front 13

corrected anion gap formula

Back 13

2.5(4-albumin)

Front 14

delta delta

Back 14

Used in all AG metabolic acidosis:

difference in anion gap (assume normal is 10) + measured serum bicarb

If value >24 you have concurrent metabolic alkalosis

If < 24 have concurrent NG acidosis

Front 15

Osmolar Gap

Back 15

Normal Osmolality: 285

2(Na) + Glucose/18 + BUN/2.8

When measured is > 10 from calculated, there is osmolar gap

Causes: Ethylene glycol, Methanol, lactate, ethanol, contrast dye

Front 16

Causes of decreased anion gap

Back 16

Low Albumin, Hypercalemia, paraproteinemia, hypermagnesemia, hyperkalemia

Front 17

types of lactic acidoosis

Back 17

A: tissue hypoperfusion

B: Propofol, metformin (mitochondrial dysfunction)

D: Short bowel syndrome, bacterial overgrowth produces lactate

Front 18

fomepizole

Back 18

alcohol dehydrogenase inhibitor that is used for ethylene glycol and methanol toxicity

Front 19

urinary anion gap

Back 19

urinary Na + K - urinary Chloride

**Titrable acids are excreted in urine with ammonium which cannot be measured directly, however because ammonium has a positive charge, chloride is excreted with it

If kidneys are functioning, there will be a lot of chloride in the urine, and urinary AG will be negative

Front 20

Type 2 RTA

and causes

treatment

Back 20

Proximal defect resulting in inability to reabsorb bicarb

**Urinary pH varies because initially HCO3 is lost in urine causing it to be basic, but once total body stores are depleted, distal tubules reabsorb the HCO3

Causes: Fanconi syndrome (will see elevated amino acids, phosphate, glucose in urine), paraproteinemias, tenofovir, tacrolimus,cyclosporine

Treatment: alkali therapy alone insufficient, but given with a thiazide diuretic help enhances hco3 reabsorption because of volume contraction

Front 21

Type 1 RTA

Causes

Treatment

Back 21

Inability to secrete H ions distally. Acidosis stimulates reabosoprtion of citrate, so there are low levels of citrate in urine, leading to calcium phosphate stones

Causes: SJOGRENS, SLE, RA, hypercalcicuria,

Responds well to NaHCO3

Urinary pH ALWAYS > 5.5

Front 22

Saline Responsive Metabolic Alkalosis

Back 22

Alkalosis due to volume depletion (Vomiting, NG Suction, Diurectics)

Will see low urine Cl <15 mEQ

Front 23

Saline Resistant Metabolic Alkalosis

Back 23

Alkalosis due to mineralocorticoid excess

Also Barter's Gittelmans (both have features of saline responsive metabolic alkalosis, but will have urinary Cl >15)

Front 24

TubuloInterstitial Diseases

Back 24

Autoimmune: SLE, Sarcoid, sjogren,

Infectious: CMV, BK Virus, EBV, TB

Malignancy: MM, Lymphoma,

Meds: B-lactams, Sulfa, NSAIDs, PPI

Front 25

Back 25

J wave, seen in hypothermia (osbourne wave)

represents abnormality in repolarization

Front 26

nephrotic range proteinuria and associated labs

Back 26

> 3.5 g in 24 hours or protein/Cr ratio > 3500 mg/g

hypoalbuminemia, hyperlipidemia, HTN,

Front 27

Examples of nephrotic syndrome

Back 27

Minimal Change Disease, FSGS, Membranous Glomerulonephritis, Diabetic Nephropathy,

Front 28

Minimal Change Disease

Back 28

Most common cause of nephrotic syndrome in children, but not adults.

Biopsy is normal except for defacement of podocytes

*** Associated with hodkgkin lymphoma

Front 29

Focal Segmental Glomerularsclerosis Causes

Back 29

HIV/HEP B/ Heroin

Front 30

Membranous Glomerularnephritis Causes

Back 30

Hep B, Malignancy, Mixed Connective TIssue disorders

Front 31

Biopsy of Membranous Glomerulonephrits

Back 31

Deposits of IgG and complement, SubEpithelial deposits,

Front 32

Nephritic Syndrome

Back 32

Hypertension, RBC casts, pyuria, mild proteinuria

Front 33

Causes of nephritic syndrome

Back 33

post-streptrococcal glomerularnephritis, rapidly progressive GN, Lupus nephritis, IgA Nephropathy, ANCA Vasculitis, Membranoproliferative Glomerularnephritis,

Front 34

Post Streptococcal Glomerulonephritis

+ Renal Biopsy

Back 34

Usually from skin or throat infections, typically 2-6 weeks after infection.

Sub Epithelial humps

Front 35

Goodpastures Syndrome

Back 35

Autoimmune disease where antibodies develop against the basement membrane of the glomerulus and lungs. Present with glomerulonephritis, and hemoptysis

Front 36

IgA Nephropathy

Back 36

Will see a glomerularnephritis picture with concurrent URI (Different than PSGN in that PSGN takes a while for nephritis to develop)

Front 37

Granulomatosis with Polyangitis (Wegener's)

Back 37

C ANCA vasculitis where patient presents with purulent rhinorrhea, hemopytsis, nasal ulceration, glomerulonephritis,

EFFECTS LUNGS AND SINUSES

Front 38

Churg Strauss

Back 38

P-ANCA vasculitis, associated with asthma, IgE, eosinophilia and glomerulonephritis

Front 39

Membranoproliferative glomerulonephritis

Back 39

Associated with Hep C, low complement levels

Front 40

Extrarenal manifestations of PCKD

Back 40

diverticulosis, hernias, mitral valve prolapse, aortic regurg, intracranial aneurysm

Front 41

Fe Urea

Back 41

Used to try an identify AKI in patient on diuretics

< 35% indicative of Pre Renal etiology

Front 42

causes of ATN

Back 42

Vancomycin, Aminoglycocides (Gentamycin, Tobramycin, Amikacin), Amphotericin, contrast

Front 43

acute interstitial nephritis

Back 43

Caused by drugs (Penicillins, PPI) Autoimmune (SLE, Sjogrens) malignancy (Lymphoma)

Will see rash, fever, eosinophila (UA will have sterile pyuria)

Front 44

Which conditions are complement levels low in glomerulonephritis?

Back 44

Lupus, endocarditis, post infectious, cryoglobins

Front 45

Types of Kidney stones

Back 45

Calcium Oxalate, Calcium Phosphate

Struvite: Magnesium,Ammonium, Phosphate

Uric Acid

Front 46

Kidney Stone size to dictate treatment

Back 46

If 10mm or less, can me managed medically, if > 10mm need urology