Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
72 Cards in this Set
- Front
- Back
|
Best initial and 2nd line therapy for nephrotic syndrome
|
Initial: Steroids
2nd: Cyclophosphamide mycophenolate |
|
|
First treatment for uremia induced platelet dysfunction
|
desmopressin
|
|
|
What should be your next step to evaluate proteinuria?
|
Urine protein/creatinine ratio
|
|
|
How do you diagnose acute/allergic interstitial nephritis?
|
Wright or Hansel stain to detect eosinophils in urine
|
|
|
What causes false positives for hematuria on urine dipstick?
|
Hemoglobin and myoglobin
|
|
|
What should you do if there is hematuria in the absence of infection or trauma and renal ultrasound is negative?
|
Cystoscopy
|
|
|
What disorders are associated with theses findings on UA:
Red cell casts White cell casts Eosinophil Hyaline casts Broad, waxy casts Granular, muddy brown casts |
Red cell casts - Glomerulonephritis
White cell casts - Pyelonephritis Eosinophil - Allergic/acute interstitial nephritis Hyaline casts - Dehydration Broad, waxy casts - Chronic renal disease Granular, muddy brown casts - ATN |
|
|
Rising BUN and creatinine, ratio > 20:1
Distended bladder or massive diuresis with catheterization Hydronephrosis |
Post-renal azotemia
|
|
|
What is isosthenuria and what causes it?
|
When urine and serum osmolality are similar
Caused by acute tubular necrosis (urine concentrating defect) |
|
|
What toxins cause acute tubular necrosis within a few days and which are more delayed?
|
Within a day:
Contrast Tumor lysis syndrome Delayed: Aminoglycosides (e.g., gentamicin) Vancomycin Acyclovir Amphotericin Cisplatin Cyclosporine |
|
|
What is the best way to prevent contrast induced nephrotoxicity?
|
Saline
|
|
|
How are the urine sodium and specific gravity in contrast induced ATN different from other toxins?
|
Contrast:
Low urine sodium, high specific gravity Other toxins: High urine sodium, low specific gravity |
|
|
What 3 things should you do to prevent renal failure from tumor lysis syndrome?
|
Before chemo, give:
Allopurinol Rasburicase Hydration |
|
|
What causes ATN with hypocalcemia
|
Ethylene glycol (--> calcium oxalate crystals)
|
|
|
Name that disease:
Patient with trauma, prolonged immobility, or seizures Positive urine dipstick but no cells seen on microscopy Elevated CPK |
Rhabdomyolsis
|
|
|
What are 4 lab abnormalities in rhabdomyolsis?
|
High CPK
Hyperuricemia Hyperkalemia HypOcalcemia |
|
|
How do you treat ATN caused by rhabdomyolysis?
|
Saline
Mannitol Bicarbonate |
|
|
What are the 5 indications for dialysis in a patient with renal failure?
|
Fluid overload
Pericarditis Hyperkalemia Metabolic acidosis Encephalopathy |
|
|
What type of renal failure does hepatorenal syndrome cause?
What is the treatment? (3) |
Pre-renal
Treatment: Midodrine Octreotide Albumin |
|
|
Patient undergoes cardiac cath and develops AKI, livedo reticularis, and eye lesions.
High eosinophils in blood and urine. What is the disease and what is the most accurate test? |
Atheroembili
Accurate test: Biopsy the purplish skin lesions |
|
|
Drugs that cause allergic interstitial nephritis, rash, stevens johnson syndrome, toxic epidermal necrosis, and hemolysis
|
Penicillins
Cephalosporins Sulfa drugs (including furosemide and thiazides) Phenytoin Rifampin Quinolones Allopurinol PPIs |
|
|
Patient has rising BUN and creatinine, fever, rash, and eosinophils in urine (positive hansel and wright stain)
|
Acute interstitial nephritis
|
|
|
Do NSAIDs cause eosinophils in the urine?
|
NO
|
|
|
How do you treat allergic interstitial nephritis?
|
1. Stop the drug
2. If BUN and Cr are still rising, give steroids 3. If severe, dialysis |
|
|
What is the most accurate diagnostic test and the treatment for papillary necrosis?
|
Test - CT scan
There is no treatment |
|
|
Sudden onset flank pain, fever, and hematuria
Patient has a history of diabetes, sickle cell, urinary obstruction, or chronic pyelonephritis and may have taken NSAIDs |
Papillary necrosis
|
|
|
Tubular = AcuTe = Toxin
Glomerular = Slow = Sample = Steroids and immunoSuppressives |
Remember this
|
|
|
Asian patient has pharyngitis and then hematuria within a day or two
|
IgA nephropathy
|
|
|
Post-streptococcal glomerulonephritis presentation
|
Sore throat, face bloat, pee coke
1-2 weeks after pharyngitis or impetigo |
|
|
Treatment for hyperkalemia when there are EKG changes
|
Calcium chloride or calcium gluconate
|
|
|
What are the 2 causes of normal anion gap metabolic acidosis?
|
RTA
Diarrhea |
|
|
Treatment for hypertension due to primary hyperaldosteronism
|
Spironolactone
Remove tumor |
|
|
How do you correct calcium for abnormal albumin levels
|
Add 0.8(4-albumin)
|
|
|
Patient with peripheral edema, low albumin, and more than 3 grams of protein in urine over 24 hrs
|
Nephrotic syndrome
|
|
|
Treatment for gastric outlet obstruction
|
NG suctioning
Saline Potassium |
|
|
ADVERSE effects of cyclosporine and tacrolimus
|
Cyclosporine:
Nephrotoxicity Hyperkalemia Hypertension CNS toxicity Gum hypertophy Hirsutism Tacrolimus is the same minus gums and hirsuitism |
|
|
Adverse effect of mycophenolate
|
Marrow suppression
|
|
|
Adverse effects of azothioprine
|
Leukopenia
Hepatotoxicity Diarrhea |
|
|
What are the only 2 causes of concordant decreases in calcium and phosphorus?
|
Acute pancreatitis
Vitamin D deficiency |
|
|
What type of nephrotic syndrome is associated with:
Cancer (except Hodgkin's) Children IVDA and AIDS NSAIDs Lupus Hepatitis B Most common overall in adults After URI |
Cancer: Membranous glomerulonephritis
Hodgkin's: Minimal change disease Children: Minimal change disease IVDA and AIDS: Focal-segmental NSAIDs: Minimal change or membranous Lupus: Any of them Hepatitis B: Membranous Most common in adults: Focal-segmental After URI: IgA nephropathy |
|
|
Treatment of hyperphosphatemia if calcium is low (2) or high (2)
|
Low calcium:
Calcium acetate Calcium carbonate High calcium: Severlamer Lananthum |
|
|
Causes of anion gap metabolic acidosis
|
MUDPILERS
Methanol Uremia DKA/alcoholic KA Paraldehyde INH, iron Lactic acidosis Ethylene glycol Rhabdomyalosis, renal failure Salicylates |
|
|
Treatment for granulomatosis with polyangitis (aka wegener's)
|
Cyclophosphamide and steroids
|
|
|
What are the main causes of metabolic alkalosis
|
GI loss of H+ (vomiting or NG suction)
Renal H+ loss (Excess aldsoterone) |
|
|
What is winters formula and when do u use it?
|
To determine if there is respiratory compensation in a patient with metabolic acidosis
PaCO2 = 1.5 (HCO3) + 8 |
|
|
What are 4 features that suggest a renal cysts needs more aspiration to rule out cancer?
|
1. Multilocular
2. Thick, irregular walls 3. Thick septae 4. Contrast enhancing |
|
|
Palpable purpura, proteinuria, hematuria, low complement
|
Cryoglobulinemia /Hepatitis C
|
|
|
Medications that cause hyperkalemia (4)
|
ACE/ARB
Spironolactone TMP |
|
|
Recurrent kidney stones since childhood, hexagonal crystals on UA, positive urinary cyanide nitroprusside test
|
Cystinuria
|
|
|
Arterial/venous thrombosis and thrombocytopenia in a patient on anti-coagulation
|
Heparin induced thrombocytopenia
|
|
|
Dietary recommendations to prevent kidney stones (4)
|
1. Limit protein and oxalate
2. Limit sodium 3. Increased fluids 4. Increased calcium |
|
|
What is the best treatment for metastatic non-small cell lung cancer to the brain?
|
Surgical resection, then radiation (the other kinds of lung cancer respond to chemo)
|
|
|
Treatment for mild, moderate, and severe hyponatremia
|
Mild: Fluid restriction
Moderate: Normal saline + loop diuretic Severe: 3% hypertonic saline |
|
|
In what condition is urine osmolality greater than serum osmolality, and urine sodium is high in the presence of hyponatremia
|
SIADH
|
|
|
A patient who overdosed on a drug presents with fever, tinnitus, and tachypnea.
What was the drug and what is the acid base disturbance? |
Aspirin
Mixed respiratory alkalosis and anion gap metabolic acidosis |
|
|
Contraindications for succinylcholine
|
At risk for hyperkalemia
Prolonged demyelination |
|
|
Urine loss with coughing, exercising in an obese, multi-parous female
Diagnosis and treatment |
Diagnosis: Stress incontinence
Treatment: Weight loss Kegels Surgical tightening in urethra |
|
|
Cause of urge incontinence
|
Detrusor overactivity
|
|
|
Cause of overflow incontinence and diagnostic test
|
Caused by bladder outlet obstruction
Diagnosis: Increased post-void residual volume |
|
|
Asthma and increased eosinophils, glomerulonephritis
|
Churg-Strauss
|
|
|
Best initial tests for:
Goodpastures Wegeners |
Goodpastures: Anti-GBM
Wegeners: c-ANCA |
|
|
When should you order anti-streptolysin O, DNAase, antihyaluronic acid
|
post-streptococcal glomerulonephritis
|
|
|
What is the difference between IgA nephropathy and HSP?
|
IgA nephropathy - 1-2 days after streptococcal infection
HSP also has GI, joints, skin |
|
|
What is the difference between polyarteritis nodosa and wegener's?
|
polyarteritis nodosa spares the lung
|
|
|
Treatment for wegeners, churg-strauss, polyarteritis nodosa
|
Cyclophosphamide and steroids
|
|
|
Treatment for HSP
|
Nothing, steroids only if severe or progressive
|
|
|
Treatment for proliferative and sclerotic lupus nephritis
|
Proliferative: Steroids + mycophenalate
Sclerotic: Nothing |
|
|
What is the biggest difference between cryoglobulins and cold agglutinins in the presentation and the associated diseases?
|
Cryoglobulins:
Cause renal disease, purpura Associated with hep C Cold agglutinins: Cause hemolysis Associated with EBV and mycoplasma |
|
|
Treatment for IgA nephropathy
|
Mild proteinuria: ACE or ARB
Severe proteinuria: Steroids |
|
|
What are ARBs?
|
Sartans
|
|
|
Anemia, low platelets, elevated creatinine
|
HUS
|
|
|
Anemia, low platelets, elevated creatinine, neurologic problems, fever
|
TTP
|
