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273 Cards in this Set
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|
how can acyclovir nephrotoxicity be prevented
|
aggressive hydration
|
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how does acyclovir cause nephrotoxicity
|
precipitates in tubules, causing obstruction through crystalization
|
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MCC of death in dialysis px
|
CV disease
|
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cancers a/w increased EPO
|
RCC
HCC Pheo Hemangioblastoma |
|
|
how is a urinary fistula Dx
|
dye leaking on IV pyelography
|
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|
causes of UTI with pyuria but without nitrates
|
enterococcus
saprophyticus GBS |
|
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what are the normal proteins that appear in urine
|
tamm horsfall protein
|
|
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what is a normal amount of tamm horsfall protein
|
30-50 mg in 24 hours
|
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|
what can cause transient proteinuria
|
fever
exercise seizure stress volume depletion prolonged standing |
|
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what should be done if persistant proteinuria is found and is not related to prolonged standing
|
kidney biopsy
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how can the total amount of protein in a day be assessed
|
protein Cr ratio
24 hour urine collection |
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what are some limitation of urine dipstick
|
only detects albumin
doesnt detect micro amounts doesnt detect bence jones proteins |
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how are bence jones proteins detected
|
UPEP
|
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what is the workup for proteinuria
|
UA
Protein : Cr or 24 hour urine biopsy |
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|
best initial Rx for diabetic with proteinuria
|
ACEI/ARBs
|
|
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how are eosinophils detected in urine
|
wright and hansel stain
|
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what is hematuria
|
>3 RBC on UA
|
|
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what is the cause of blood in urine if only in the beginning
|
lesion to urethra
|
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what is the cause of blood in urine if only at end
|
prostate or bladder problem
|
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what is the cause of blood in urine if found in entire stream
|
ureter or kidney problem
|
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what should be suspected in an elderly smoker with hematuria
|
cancer
|
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what is the next step if hematuria is found on UA
|
microscopic examination looking for erythrocytes
|
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what is considered a false positive hematuria on UA
|
red urine, positive for blood, but no RBC
|
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what may cause false positive hematuria on UA
|
hemoglobin or myoglobin
|
|
|
what are dysmorphic RBC a/w
|
glomerulonephritis
|
|
|
when is cystoscopy done when hematuria is found
|
no prior infection or trauma with:
-imaging not showing etiology or -mass is found |
|
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Dx
RBC cast |
glomerulonephritis
|
|
|
Dx
WBC cast |
pyelonephritis
|
|
|
Dx
eosinophilic cast |
AIN
|
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Dx
hyaline cast |
dehydration
|
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|
Dx
broad waxy cast |
chronic renal disease (dialysis)
|
|
|
Dx
granular cast |
ATN
|
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|
Dx
muddy brown cast |
ATN
|
|
|
MCC of acute kidney injury
|
ATN
|
|
|
what is azotemia
|
rise in BUN and Cr
|
|
|
acute kidney injury a/w BUN:Cr >20:1
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prerenal and postrenal
|
|
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acute kidney injury a/w BUN:Cr 10:1
|
intrinsic renal disease
|
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|
MCC of intrinsic renal disease
|
ATN
|
|
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best initial test in acute kidney injury
|
BUN and Cr
|
|
|
best initial imaging study for acute kidney injury
|
sonogram
|
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what is the next step in Dx if acute kidney injury cause is unclear
|
urinalysis
UNa FeNa urine osmolality |
|
|
what is the only significant manifestation of sickle cell trait
|
isosthenuria
|
|
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BUN:Cr in prerenal azotemia
|
>20:1
|
|
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BUN:Cr in ATN
|
10:1
|
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UNa in prerenal azotemia
|
<20
|
|
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UNa in ATN
|
>20
|
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FeNa in prerenal azotemia
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<1%
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FeNa in ATN
|
>1%
|
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urine osm in prerenal azotemia
|
>500
|
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urine osm in ATN
|
<300
|
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how can contrast induced nephropathy be prevented
|
using non ionic contrast dye
and using saline hydration |
|
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what causes the damage in contrast induced nephropathy
|
renal vasoconstriction and tubular injury
|
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what is a cause of ATN that causes complete opposite levels in laboratory testing
|
contrast
|
|
|
how is renal failure from tumor lysis syndrome prevented
|
before chemo, give:
allopurinol hydration rasburicase |
|
|
what is a/w envelope shaped crystals
|
ethylene glycol (oxalate)
|
|
|
what increases the likelihood of developing ATN
|
hypoperfusion of the kidney
underlying renal insufficiency (HTN, DM, etc) older px |
|
|
what are some causes of ATN
|
Drugs
Calcium oxalate Contrast Rhabdomyolysis Bence Jones proteins Hyperuricemia |
|
|
what can increase the likelihood of ATN in a px on aminoglycosides of cisplatin
|
hypomagnesemia
|
|
|
what are some causes of rhabdomyolysis
|
trauma
immobility snake bite seizures crush injury |
|
|
what test is used to confirm rabdomyolysis
|
UA
|
|
|
what are the abnormal lab levels in rhabdomyolysis
|
increased
-CPK -K -Urate -P decreased Ca |
|
|
Rx for Rhabdomyolysis
|
hydration
mannitol bicarb |
|
|
Rx for ATN
|
hydration
correct electrolyte abnormality |
|
|
Rx for hepatorenal syndrome
|
albumin
midodrine octreotide |
|
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Dx
px with cirrhosis presents with signs of prerenal azotemia |
hepatorenal syndrome
|
|
|
what is the cause of hepatorenal syndrome
|
renal hypoperfusion
-portal HTN -> increased NO in splanchnic circulation |
|
|
what are some ways atheroemboli can present
|
AKI
blue.purple skin lesion livedo reticularis ocular lesions |
|
|
MCC of atheroemboli
|
cardiac catheterization
|
|
|
what is the most accurate test for atheroembli
|
biopsy of purple skin lesions
|
|
|
what is seen on biopsy in atheroemboli
|
cholesterol crystals
|
|
|
what is seen on histology of AIN
|
papillary necrosis and chronic tubulointerstitial nephritis
|
|
|
what are the causes of AIN
|
medications
infections autoimmune disease |
|
|
how does AIN present
|
fever
rash eosinophiluria BUN:Cr >20 |
|
|
most accurate test for AIN
|
hansel or wright stain showing eosinophils
|
|
|
Rx for AIN
|
usually resolves spontaneously
severe disease is treated with dialysis |
|
|
Rx for AIN if Cr continues to rise after medications have been stopped
|
glucocorticoids
|
|
|
how can analgesic nephropathy present
|
ATN
AIN membranous glomerulonephritis papillary necrosis |
|
|
how does papillary necrosis present
|
NSAID use with history of:
-sickle cell -DM -urinary obstruction -chronic pyelonephritis |
|
|
best initial test for papillary necrosis
|
UA
|
|
|
what is seen on UA of papillary necrosis
|
RBC
WBC necrotic tissue |
|
|
what is the most accurate test for papillary necrosis
|
CT
|
|
|
what is seen on CT of papillary necrosis
|
abnormal internal structures of the kidney form loss of the papillae
|
|
|
what kidney diseases are treated with steroids and cyclophosphamide
|
good pastures
PAN lupus nephritis nephrotic syndrome |
|
|
presentation of cryoglobulinemia
|
palpable purpura
proteinuria hematuria HCV |
|
|
best initial test for good pastures
|
anti GBM Ab
|
|
|
most accurate test for good pastures
|
lung or kidney biopsy
|
|
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what is seen on kidney biopsy of good pastures
|
linear deposits
|
|
|
what type of hypersensitivity is good pastures
|
2
|
|
|
MCC of acute glomerulonephritis
|
IgA nephropathy (berger)
|
|
|
how long after URI does IgA nephropathy (berger) present
|
1-2 days
|
|
|
most accurate test for IgA nephropathy (berger)
|
biopsy
|
|
|
what is seen on kidney biopsy of IgA nephropathy (berger)
|
IgA deposition in mesangium
|
|
|
Rx for IgA nephropathy
|
nothing
only for severe proteinuria do you give ACEI and steroids |
|
|
how long after skin or throat infection does PSGN develop
|
1-3 weeks
|
|
|
best initial test for PSGN
|
UA
then ASO and anti DNAse Ab |
|
|
most accurate test for PSGN
|
kidney biopsy
|
|
|
what is seen on kidney biopsy in PSGN
|
hypercellular and crescents
|
|
|
Rx for PSGN
|
supportive with:
-antibiotics -diuretics |
|
|
complication of renal transplant in alports syndrome
|
good pastures
|
|
|
what is seen on EM in alports syndrome
|
alternating areas of thin and thick capillary loops
splitting of GBM |
|
|
what is spared by PAN
|
lung
|
|
|
what disease is PAN a/w
|
hep B
|
|
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why does PAN cause pain when eating
|
mesenteric vasculitis
|
|
|
Dx
young patient develops a stroke or MI |
PAN
|
|
|
what skin findings are seen in PAN
|
digital gangrene
livedo reticularis |
|
|
what is the best initial test for PAN
|
angiography
-renal -mesenteric -hepatic artery |
|
|
what is seen on angiography of PAN
|
aneurysms
|
|
|
most accurate test for PAN
|
biopsy
|
|
|
Rx for PAN
|
steroids and cyclophosphamide
|
|
|
what do patients with severe lupus nephritis develop
|
membranous glomerulonephritis
|
|
|
what do patients with long standing lupus nephritis develop
|
glomerulosclerosis
|
|
|
most accurate test for lupus nephritis
|
biopsy
|
|
|
Rx for mild lupus nephritis
|
steroids
|
|
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Rx for severe lupus nephritis
|
steroids with cyclophosphamide or mycophenolate
|
|
|
what diseases are known to develop amyloidosis
|
MM
RA IBD chronic infections |
|
|
what diseases are known to show large kidneys on CT
|
amyloid
HIV nephropathy PCKD DM |
|
|
most accurate test for amyloidosis
|
biopsy
|
|
|
Rx for amyloidosis
|
Rx underlying disease
if unsuccessful give melphalan and steroids |
|
|
what protein loss is a/w nephrotic syndrome
|
>3.5g/24 hours
|
|
|
what is anasarca
|
generalized edema
|
|
|
what are some causes of non pitting edema
|
lymphatic obstruction
increased interstitial proteins |
|
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what are some causes of pitting edema
|
increased IV hydrostatic pressure
decreased plasma proteins increased capillary leakage |
|
|
what are some complications of nephrotic syndrome
|
hyperlipidemia (increased atherosclerosis)
thrombosis (lose anticoagulants) hypocalcemia (lose cholecalciferol binding protein) decreased thyroxin (decreased TBG) iron def anemia (lose transferrin) infections (lose Ig and complement) |
|
|
best initial test for nephrotic syndrome
|
UA
then protein:Cr |
|
|
most accurate test for nephrotic syndrome
|
biopsy
|
|
|
nephrotic syndrome:
MCC in adults |
focal segmental
|
|
|
nephrotic syndrome:
MCC in children |
minimal change
|
|
|
nephrotic syndrome:
a/w HIV and IVDA |
focal segmental
|
|
|
nephrotic syndrome:
a/w spike and dome |
membranous
|
|
|
nephrotic syndrome:
a/w Hepatitis |
membranous
|
|
|
nephrotic syndrome:
tram track (double layer) |
membranoproliferative
|
|
|
nephrotic syndrome:
a/w cancer |
membranous
|
|
|
nephrotic syndrome:
a/w hidgkins |
minimal change
|
|
|
nephrotic syndrome:
microangiopathy |
diabetic
|
|
|
nephrotic syndrome:
increased compliment |
membranoproliferative
|
|
|
how does membranoproliferative increase compliment
|
IgG Ab (C3 nephritic factor)
increased C3 convertase |
|
|
where is edema from nephrotic syndrome classicly seen
|
periorbital
|
|
|
best initial Rx for nephrotic syndrome
|
steroids
|
|
|
how is proteinuria in nephropathy Rx
|
ACEI or ARBs
|
|
|
how is hyperlipidemia in nephrotic syndrome Rx
|
statins
|
|
|
how is edema in nephrotic syndrome Rx
|
salt restriction and diuretics
|
|
|
what is uremia
|
increased BUN and Cr with (one):
-met acid -fluid overload -encephalopathy -hyperkalemia -pericarditis |
|
|
MCC of ESRD
|
DM
HTN |
|
|
what toxin stops platelets form working in ESRD
|
guanidino succinic acid
|
|
|
Rx for non working platelets in ESRD
|
DDAVP
|
|
|
Rx for anemia in ESRD
|
EPO and iron
|
|
|
Rx for hypocalcemia and osteomalacia in ESRD
|
vit D and Ca
|
|
|
Rx fro pruritis in ESRD
|
dialysis and UV light
|
|
|
what can aluminum toxicity cause
|
dementia
|
|
|
Rx for hyperphosphatemia
|
oral phosphate binders
correct hypocalcemia -vit D -calcium if Ca is increased use: -sevelamer -lanthanum |
|
|
what is the best kidney to transplant
|
living, related donor
|
|
|
what is the pathophys of HUS
|
destruction of colonic epithelial lining with subsequent activation of coagulation system and RBC hemolysis
|
|
|
what is the pathophys of TTP
|
Ab against ADAMTS 13
|
|
|
what is a/w causing TTP
|
HIV
cancer drugs |
|
|
what is a/w causing HUS
|
e coli
shigella |
|
|
best test for TTP/HUS
|
blood smear
|
|
|
what is seen on blood smear of TTP/HUS
|
schistocytes
helmet cells fragmented red cells |
|
|
what are the symptoms of HUS
|
hemolysis
renal insufficiency thrombocytopenia |
|
|
what are the symtoms of TTP
|
hemolysis
renal insufficiency thrombocytopenia neuro symptoms fever |
|
|
Rx for TTP/HUS
|
plasmaphoresis
if not FFP |
|
|
MCC of death in PCKD
|
renal failure
|
|
|
what are some extra renal finding in PCKD
|
liver cysts
ovarian cysts MVP diverticulitis |
|
|
Rx for PCKD
|
drain large cysts
ARBs amiloride |
|
|
what is hypernatremia
|
>155
|
|
|
Rx for hypernatremia
|
mild = 5% dextrose with .45 saline
severe = .9 saline |
|
|
what problems do sodium disorders cause
|
CNS
|
|
|
best initial test for DI
|
prevent px from drinking fluids
|
|
|
what should be suspected if px stops drinking fluids and urine volume decrease and urine osm increases
|
psychogenic polydipsia
|
|
|
most accurate test for DI
|
ADH level
|
|
|
which DI responds to ADH
|
CDI
|
|
|
which DI has a high ADH level
|
NDI
|
|
|
Rx for CDI
|
vasopressin
|
|
|
Rx for NDI
|
correct K and Ca
give hydrochlorothiazide or endomethacin if caused by lithium give amiloride |
|
|
what happens if hypernatremia is corrected too quickly
|
cerebral edema
|
|
|
Dx
px with psychiatric problems develops polyuria |
psychogenic polydipsia
|
|
|
what is hyponatremia
|
<135
|
|
|
what are some causes of SIADH
|
lung or brain disease
drugs pain |
|
|
most accurate test in SIADH
|
ADH levels (high)
|
|
|
symptoms of mild hyponatremia
|
none
|
|
|
symptoms of moderate hyponatremia
|
confusion
|
|
|
symptoms of severe hyponatremia
|
seizures and coma
|
|
|
Rx for mild hyponatremia
|
restrict fluids
|
|
|
Rx for moderate hyponatremia
|
saline and loop diuretics
|
|
|
Rx for severe hyponatremia
|
hypertonic saline, conivaptan, tolvaptan
|
|
|
Rx for chronic SIADH
|
demcocycline
|
|
|
what happens if hyponatremia is corrected too quickly
|
central pontine myelinolysis
(osmotic demyelinization) |
|
|
what is seen on imagine of central pontine myelinolysis
|
white area in the center of the pons
|
|
|
what is hyperkalemia
|
>5
|
|
|
what does potassium abnormalities affect
|
muscle contractions
|
|
|
what may be seen on EKG of hyperkalemia
|
sine wave
Vfib asystole |
|
|
what is a sine wave
|
widening of the QRS and merging of T waves
|
|
|
Rx for hyperkalemia with abnormal EKG
|
Ca
insulin/glucose B+ bicarb |
|
|
Rx for hyperkalemia with normal EKG
|
kayexalate
loops |
|
|
what is hypokalemia
|
<3.5
|
|
|
what should be suspected in a px with hypokalemia who is Rx with vigorous IVF and no change in K
|
low Mg
|
|
|
what patients should have the Mg levels checked when Rx hypokalemia
|
alcoholic
those on diuretics |
|
|
EKG findings a/w hypokalemia
|
U wave
ventricular ectopy (PVC) flattened T waves ST depression |
|
|
Rx for hypokalemia
|
Oral doesnt matter
IV must be slow |
|
|
complication of correcting potassium levels too quickly via IV
|
arrhythmia
|
|
|
what is acidosis
|
<7.3
|
|
|
what is alkalosis
|
>7.42
|
|
|
what is a normal anion gap
|
6-12
|
|
|
how is anion gap calculated
|
Na - (Cl + HCO3)
|
|
|
what allows an anion gap to be normal
|
increased Cl levels
|
|
|
what is the defect in RTA 1
|
defect in hydrogen secretion
|
|
|
what is the defect in RTA 2
|
defect in bicarb reabsorption
distal tubule |
|
|
what is the defect in RTA 4
|
Na/K exchange (aldosterone)
proximal tubule |
|
|
complication of RTA 1
|
calcium oxalate stones
|
|
|
complication of RTA 2
|
osteomyelitis
|
|
|
complication of RTA 4
|
decreased aldosterone
|
|
|
best initial test for RTA 1
|
UA
|
|
|
most accurate test for RTA 1
|
acid infusion (ammonium Cl)
urine pH remains basic |
|
|
Rx for RTA 1
|
bicarb
|
|
|
Causes of RTA 1
|
drugs (amphoteracin) and autoimmune diseases
|
|
|
causes of RTA 2
|
amyloidosis
myeloma fanconis acetozolamide metals |
|
|
most accurate test for RTA 2
|
give bicarb
urine pH will rise |
|
|
Rx for RTA 2
|
thiazide and bicarb
|
|
|
what electrolyte abnormalities are seen in RTA 4
|
decreased Na
increased K, H, Cl |
|
|
Rx for RTA 4
|
fludrocortisone
|
|
|
RTA a/w pH > 5.5
|
1
|
|
|
RTA a/w pH < 5.5
|
4
|
|
|
RTA a/w high K levels
|
4
|
|
|
RTA a/w low K levels
|
1
2 |
|
|
how is urine anion gap calculated
|
Na - Cl
|
|
|
best initial test for metabolic acidosis
|
ABG
|
|
|
Dx test for ketoacids met acid
|
acetone levels
|
|
|
Dx test for oxalic acid met acid
|
crystals on UA (envelope crystals)
|
|
|
Dx test for formic acid met acid
|
inflamed retina
|
|
|
symptoms of aspirin toxicity
|
tinnitus
fever nausea resp alk -> met acid with anion gap |
|
|
how is minute ventilation calculated
|
RR x TV
|
|
|
why does pregnancy cause met acid
|
anemia causes decreased tissue perfusion and increased lactic acid
|
|
|
what is the best next step in a px with clear nephrolithiasis
|
pain relief
|
|
|
most accurate diagnostic test for nephrolithiasis
|
CT
|
|
|
what stones are not detectable in x ray
|
uric acid
|
|
|
how are cystine stones managed
|
surgical removal
alkalinizing the urine |
|
|
a/w hexagonal crystals
|
cystine stones
|
|
|
what is the defect in cyteinuria
|
dibasic AA transport
-cystein -lysine -arginine -ornithine |
|
|
how is stone etiology determined
|
analysis of:
stone serum 24 hour urine |
|
|
Rx for <.5cm sized stone
|
hydrate and observe
|
|
|
Rx for .5-2cm sized stone
|
lithotripsy
|
|
|
Rx for >2cm sized stone
|
surgery
|
|
|
Rx for struvite stones
|
surgery
|
|
|
what increases the chances of stone formation
|
dietary decrease in Ca
increased oxalate decreased citrate met acid |
|
|
MCC of secondary HTN
|
renal artery stenosis
|
|
|
Dx for renal artery stenosis
|
captopril renal sacn
|
|
|
Rx for renal artery stenosis
|
angioplasty
if not surgeyr |
|
|
physical finding in renal artery stenosis
|
continuous systolic and diastolic murmur in the periumbilical area and flanks
|
|
|
what is hypertension
|
140/90
if diabetic or chronic renal disease 130/80 |
|
|
next step in a px who was normotensive in the past have a high BP reading
|
recheck in 2 months
|
|
|
what should be checked in a hypertensive px
|
EKG
urinalysis glucose cholesterol |
|
|
best initial Rx for HTN
|
life style changes (weigh loss is most effective)
done for 3-6 months then switched to meds |
|
|
best initial drug Rx for HTN
|
thiazides
|
|
|
when should a second drug be added to Rx HTN
|
if over 160/100
|
|
|
what are the other drugs to Rx HTN
|
ACEI/ARBs
BB CCB |
|
|
initial Rx for newly Dx HTN with CAD
|
life style changes with BB, ACE or ARB
|
|
|
initial Rx for newly Dx HTN with DM
|
life style changes with ACEI/ARBs
|
|
|
initial Rx for newly Dx HTN with BPH
|
life style changes with a-
|
|
|
initial Rx for newly Dx HTN with hyperthyroidism
|
life style changes with BB
|
|
|
initial Rx for newly Dx HTN with osteoporosis
|
life style changes with thiazides
|
|
|
what is responsible for the damage in HTN
|
fibrinoid necrosis of small vessels
|
|
|
what is HTN crisis
|
HTN with
-confusion -blurry vision -dyspnea -chest pain |
|
|
best initial Rx for HTN crisis
|
labetolol or nitroprusside
|
|
|
what happens if you correct BP too quickly in HTN crisis
|
stroke
|
|
|
Triad of renal cell carcinoma
|
hematuria
abdominal mass flank pain |
|
|
what is oliguria
|
<400 cc a day
|
|
|
Rx for oliguria
|
change foley
careful fluid challenge |
|
|
MC primary renal malignancy
|
RCC
|
|
|
Rx for RCC
|
immediate resection
|
|
|
Rx for bladder cancer
|
transurethral cystoscopic resection
|
|
|
MCC of bladder cancer in 3rd world
|
schistosoma
|
|
|
what trauma commonly causes ED
|
pelvic fracture
urethral injury |
|
|
what can increase the half life of sildenafil
|
erythromycin
cimetidine |
|
|
common cause of HTN in elderly
|
isolated systolic HTN
(decreased elasticity) |
