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101 Cards in this Set
- Front
- Back
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When should patients with progressive chronic kidney disease should be referred for creation of a permanent vascular dialysis access?
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when the glomerular filtration rate decreases below 30 mL/min
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Which osmotic agents can cause acute renal failure?
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- dextran 40
- mannitol - sucrose-containing preparations of intravenous immune globulin |
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What does urinary sediment of acute tubular necrosis show?
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muddy brown casts
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When should dialysis be initiated in patients with tumor lysis syndrome?
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When medical therapy has failed, especially if there is renal failure
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In whom is Rasburicase contraindicated?
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glucose-6-phosphate dehydrogenase deficiency
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When should patients with progressive chronic kidney disease should be referred for creation of a permanent vascular dialysis access?
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when the glomerular filtration rate decreases below 30 mL/min
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When should patients with progressive chronic kidney disease should be referred for creation of a permanent vascular dialysis access?
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when the glomerular filtration rate decreases below 30 mL/min
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Which osmotic agents can cause acute renal failure?
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- dextran 40
- mannitol - sucrose-containing preparations of intravenous immune globulin |
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Which osmotic agents can cause acute renal failure?
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- dextran 40
- mannitol - sucrose-containing preparations of intravenous immune globulin |
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What does urinary sediment of acute tubular necrosis show?
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muddy brown casts
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What does urinary sediment of acute tubular necrosis show?
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muddy brown casts
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When should dialysis be initiated in patients with tumor lysis syndrome?
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When medical therapy has failed, especially if there is renal failure
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When should dialysis be initiated in patients with tumor lysis syndrome?
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When medical therapy has failed, especially if there is renal failure
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In whom is Rasburicase contraindicated?
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glucose-6-phosphate dehydrogenase deficiency
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In whom is Rasburicase contraindicated?
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glucose-6-phosphate dehydrogenase deficiency
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When should patients with progressive chronic kidney disease should be referred for creation of a permanent vascular dialysis access?
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when the glomerular filtration rate decreases below 30 mL/min
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When should patients with progressive chronic kidney disease should be referred for creation of a permanent vascular dialysis access?
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when the glomerular filtration rate decreases below 30 mL/min
|
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Which osmotic agents can cause acute renal failure?
|
- dextran 40
- mannitol - sucrose-containing preparations of intravenous immune globulin |
|
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Which osmotic agents can cause acute renal failure?
|
- dextran 40
- mannitol - sucrose-containing preparations of intravenous immune globulin |
|
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What does urinary sediment of acute tubular necrosis show?
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muddy brown casts
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What does urinary sediment of acute tubular necrosis show?
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muddy brown casts
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When should dialysis be initiated in patients with tumor lysis syndrome?
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When medical therapy has failed, especially if there is renal failure
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When should dialysis be initiated in patients with tumor lysis syndrome?
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When medical therapy has failed, especially if there is renal failure
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In whom is Rasburicase contraindicated?
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glucose-6-phosphate dehydrogenase deficiency
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In whom is Rasburicase contraindicated?
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glucose-6-phosphate dehydrogenase deficiency
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What are adverse events related to Rasburicase?
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- Anaphylaxis has been reported
- hemolysis - hemoglobinuria, - methemoglobinemia (all even in the absence of G-6-PD deficiency) |
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how would you test for Goodpasture's syndrome?
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anti-glomerular basement membrane antibodies
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What is the classical triad of acute interstitial nephritis?
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- fever
- athralgias - skin rash Will also see serile pyuria and eosinophiluria |
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What does the presence of a slowly progressive nephrotic syndrome suggest?
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solid tumor-associated membraneous nephropathy
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What are patients with membranous nephropathy at increased risk for? How do you diagnose?
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- renal vein thrombosis
- CT, MRI, or venography |
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What are the symptoms of hyponatremic encephalopathy?
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- headache
- nausea - cerebral edema - seizures --> brain stem herniation --> death |
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When should 3% saline be used for hyponatremia?
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when patient is symptomatic from hyponatremic encephalopathy
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What can be used to treat hyponatremia when patient is not having hyponatremic encephalopathy?
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Demeclocycline
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What is the most common cause of the nephrotic syndrome in black patients, particularly those of younger age?
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focal segmental glomerulosclerosis
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Who does membranous nephropathy usually affect?
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older white people
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How do you treat patients with HIV infection and thrombotic thrombocytopenic purpura?
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plasmaphoresis and antiretroviral therapy
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If plasmapheresis is not available to treat TTP, what therapy can be initiated?
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infusions of cryoprecipitate-free fresh frozen plasma (until plasmaphoresis available)
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Why are infusions of cryoprecipitate are contraindicated in TTP?
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this fraction of plasma is enriched with von Willebrand factor, which activated platelet aggregation & endocapillary thrombosis
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What plays an important role in the pathogenesis of TTP–hemolytic uremic syndrome?
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A deficiency or decreased activity of the von Willebrand factor–cleaving protease ADAMTS13
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What is a common cause of meningitis in renal transplant recipients? How should it be treated?
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- Listeria (gram-positive bacilli)
- ampicillin and gentamicin |
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What can be done to decrease the risk for recurrent calcium oxalate stones?
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- increasing dietary calcium to 1 g/d to 4 g/d
- restricting oxalate-rich foods ( nuts, chocolate, rhubarb, and spinach) - increasing fluid intake to >2 L/d. |
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Why does increasing calcium intake reduce risk of calcium oxalate stones?
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higher amounts of dietary calcium bind to oxalate in the gastrointestinal tract, which prevents absorption
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Which diuretics can be recommended to prevent stones in patients with hypercalciuria?
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thiazide diuretics (hydrochlorothiazide or chlorthalidone) - decrease calcium excretion
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What laboratory abnormalities do you see in patients with primary hyperaldosteronism?
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- hypokalemia (absence of diuretic)
- hypernatremia - mild metabolic alkalosis |
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What do you see on dipstick urinalysis with acute rhabdomyolysis renal failure?
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dipstick-positive hematuria but no intact erythrocytes on microscopic analysis of the urine sediment
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What does aldosterone do to potassium levels?
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decreases it
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Why does heparin therapy cause hyperkalemia?
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because it inhibits aldosterone synthesis and impairs potassium secretion in the distal tubule
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What is the development of the nephrotic syndrome in the setting of urinary reflux most likely due to?
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Focal segmental glomerulosclerosis
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Which organisms can cause Staghorn calculi?
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Proteus & Klebsiella
both convert urea to ammonia causeing alkaline urine & struvite stones |
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What is the initial treatment of struvite calculi?
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ridding of infection with antibiotics. May need to refer for stone removal
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What is the leading cause of interstitial nephritis among white patients in the United States?
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Sjögren's syndrome
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What are renal manifestations of Sjögren's syndrome?
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- interstitial nephritis
- Type I distal renal tubular acidosis - nephrogenic diabetes insipidus - glomerular lesions, such as membranous nephropathy and membranoproliferative glomerulonephritis. |
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What is the most likely diagnosis in black patients with HIV infection who have the nephrotic syndrome?
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collapsing form of focal segmental glomerulosclerosis
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What can be used to improve renal function in patients with hepatorenal syndrome?
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Octreotide and midodrine
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What can decrease the risk for acute renal failure in patients undergoing paracentesis with >5 L of volume removed and in patients with spontaneous bacterial peritonitis?
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albumin infusion
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What are clinical manifestations of autosomal dominant polycystic kidney disease?
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- renal, hepatic, and pancreatic cysts
- intracranial, thoracic, and abdominal aortic aneurysms - colonic diverticulae. |
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Which gene and chromosome are responsible for autosomal dominant PCKD?
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- ADPKD 1 on chromosome 16 (85-90% of cases)
- ADPKD2 on Chromosome 4 (10-15%) |
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What is seen with autosomal recessive polycystic kidney disease?
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- oligohydramnios and large echogenic kidneys in utero
- hepatic fibrosis with biliary dysgenesis |
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What is associated with the highest likelihood of relapsing disease in antinuclear cytoplasmic antibody–associated small-vessel vasculitis?
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combination of upper and/or lower respiratory tract disease and proteinase-3 antinuclear cytoplasmic antibody positivity at the time of diagnosis
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What is a common cause of hyponatremia in the outpatient setting?
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hydrochlorothiazide
Thiazide diuretics do not have diluting capacity. |
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Which diuretics are potassium sparing?
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spironolactone & amiloride
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Which diuretic is often associated with hypokalemia and metabolic acidosis?
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acetozolamide (acts on proximal tubule as carbonic anhydrase IV inhibitor)
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How is Cryoglobulinemia characterized?
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- Raynaud's phenomenon
- a purpuric rash - abnormal findings on liver function studies - presence of glomerulonephritis |
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What should be done for patients with acute glomerulonephritis of unknown cause?
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renal biopsy
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What should be evaluated in a patinet with asymptomatic hypercalcemia in a patient with a history of calcium stones?
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Primary hyperparathyroidism
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What suggests a diagnosis of atheroembolic disease?
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- livedo reticularis
- Hollenhorst plaque - cyanotic toe - low C3 levels - peripheral eosinophilia |
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What is Alport's syndrome?
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inherited condition (X-linked) that may present with high-frequency sensorineural hearing loss and/or ocular abnormalities
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What causes Alport's syndrome?
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mutations in basement membrane collagen that result in persistent microscopic hematuria, progressive nephritis with proteinuria, and progressive decline in renal function to end-stage renal disease
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How is thin basement membrane disease 9benign familial hemoglobinuria) inherited? Diagnosed?
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- autosomal dominant
- pathognomonic renal biopsy finding is irregular thinning of the glomerular basement membrane on electron microscopy with attenuation of the lamina densa |
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Which renal masses/cysts require follow-up imaging with CT or MRI?
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complex renal cysts on ultrasound imaging
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What are features of malignant cysts or mass lesions in the kidney?
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- enhancement after contrast
- size > 3 cm - areas of necrosis - marginal irregularities |
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What is a likely cause of the nephrotic syndrome in older patients?
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paraprotein (systemic amyloidosis or multiple myeloma)
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What increase in creatinine is generally acceptable after initiating ACEI or ARB?
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30% increase in creatinine
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Sarcoidosis causes which renal problems?
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- nephrolithiasis
- nephrocalcinosis - interstitial nephritis |
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What are two rare presentation of sarcoidosis?
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- tubulointerstital nephritis
- uveitis (ciliary flushing) |
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What does light microscopy in IgA nephropathy reveal?
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varying degrees of mesangial cell proliferation and possibly areas of glomerular scarring
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What are risk factors for contrast nephropathy?
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- diabetic nephropathy
- dehydration - heart failure - age >70 years - impaired kidney function - and concurrent use of nephrotoxic drugs and high-osmolar or high doses of radiocontrast medium |
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What should be suspected in patients with anemia, hypercalcemia, a low serum anion gap, and renal failure?
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myeloma kidney
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What is associated with a discrepancy in proteinuria detection between the dipstick urinalysis and a spot urine collection?
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myeloma kidney (dipstick only measures albumin and not light chains)
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What can be added to a urine specimen to precipitate all proteins, including light chains?
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sulfosalicylic acid
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What do beta blockers do to renin levels?
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decrease them
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What is Winter's formula?
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1.5 x HCO3 + 8 +/- 2
Estimates expected CO2 |
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What do you see with salicylate intoxication?
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anion gap metabolic acidosis and respiratory alkalosis
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How is Thin basement membrane disease characterized?
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- microscopic hematuria with dysmorphic erythrocytes
- no proteinuria |
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What is the presence of acute renal failure associated with an increased anion gap metabolic acidosis and an increased osmolar gap highly suggestive of?
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ethylene glycol poisoning
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How is ethylene glycol poisoning treated?
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Hemodialysis and Fomepizole or Ethanol
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How can you differentiate ethylene glycol poisoning from methanol poisoning?
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- methanol toxicity has papilledema
- ethylene glycol has oxalate crystals in the urine |
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How can you determine an extrarenal cause of acidosis?
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Calculate urine anion gap: [K+] + [Na+] - [Cl-]
If negative, then kidneys excreting ammonium which is normal response to systemic acidosis |
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What is Alport's syndrome is associated with?
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- glomerulonephritis with dysmorphic erythrocytes
- mild proteinuria, - high-frequency hearing loss. |
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How is Wegener's granulomatosis characterized?
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- upper and lower airway disease
- glomerulonephritis - positive findings on a proteinase-3 antineutrophil cytoplasmic antibody assay. |
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What is microscopic polyangiitis?
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nongranulomatous or small-vessel vasculitis occasionally accompanied by medium-sized vessel involvement that causes a pulmonary–renal syndrome. Will have pulmonary infiltrates of alveolar bleeding, anemia and elevated Cr.
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What is the therapy for post-transplant lymphoproliferative disease?
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- Polyclonal lymphoproliferative disease usually is managed with a reduction in immunosuppression and ganciclovir.
- combination therapy with rituximab and chemotherapy such as CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) is generally indicated for patients with monoclonal lymphoma and more advanced visceral involvement. - Radiation therapy is indicated for patients with central nervous system involvement, as well as those with localized disease. |
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What derangements in complement levels is seen with postinfectious glomerulonephritis?
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low C3 and normal C4
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What acid-base disturbance develops with end-stage liver disease?
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respiratory alkalosis (can be misdiagnosed as metabolic acidosis if pH not checked)
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What is a potential complication in malnourished patients who suddenly receive a large calorie load?
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refeeding syndrome, which can be associated with rhabdomyolysis
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What antibiotics should be used for peritonitis?
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- Gram positive coverage: Cefazolin or vancomycin
- Gram negative coverage: ceftazidime, aminoglycosides, or fluoroquinolones |
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What is the most common cause of acute renal failure after acetaminophen poisoning?
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Acute tubular necrosis
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what laboratory findings is Hepatorenal syndrome generally associated with?
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- bland urine sediment
- 24 our urinary protein excretion < 500 mg - urine sodium level < 20 meg/L |
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What acid-base abnormality can you see with acetazolamide?
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nonanion gap metabolic acidosis
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What the most appropriate treatment for lupus nephritis?
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intravenous cyclophosphamide followed by maintenance mycophenolate mofetil once remission is achieved (in addition to corticosteroids)
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What evaluation is indicated for young adults with proteinuria and no other evidence of kidney disease?
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Quantification of urinary protein in upright and recumbent positions to evaluate for orthostatic proteinuria
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