Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/184

Click to flip

184 Cards in this Set

  • Front
  • Back
"doughy skin"
hypernatremia
when may serum calcium be falsely low?
hypoalbuminemia
how is oliguria defined?
<500 cc/day
cause of prerenal acute renal failure
decreased renal perfusion
cause of postrenal acute renal failure
urinary outflow obstruction
symptom of uremia
mlaise, fatigue, confusion, oliguria, anorexia
pericardial rub, asterixis, hypertension
acute renal failure
causes of prerenal failure
hypovolemia, cardiogenic shock, sepsis, anaphylaxis, drugs, renal artery stenosis, cirrhosis with ascites
causes of intrinsic renal failure
ATN, acute/allergic interstitial nephritis, glomerulonephritis, thromboembolism
causes of postrenal failure
prostate disease, nephrolithiasis, pelvic tumors, recent pelvic surgery, retroperitoneal fibrosis
what drug is classically associated with intrinsic renal failure?
methicillin
what kind of renal failure should you think of when you hear history of drug exposure (aminoglycosides, NSAIDs), contrast, myoglobin, myeloma protein
intrinsic renal failure
renal failure and subcutaneous nodules, livedo reticularis, digital ischemia
intrinsic disease - atheroemboli
what does FeNa <1% suggest?
prerenal etiology
what does UNa <20 suggest?
prerenal
a specific gravity above what suggests a prerenal etiology?
1.020
a BUN/Cr ratio above what suggests a prerenal etiology?
20
increased amount of hyaline casts suggests what type of ATN?
prerenal/volume depletion
red cell casts, dysmorphic red cells suggests what?
glomerulonephritis
white cells and eosinophils suggest what?
allergic interstitial nephritis, atheroembolic disease
granular casts, renal tubular cells, "muddy brown cast" indicates what?
ATN - hb, myoglobin, toxins, ischemia
white cells, white cell casts
pyelonephritis
what are the indications for urgent dialysis?
AEIOU
Acidosis,
Electrolyte abnormalities (e.g. hyperkalemia)
Ingestions (salicylates, theophylline, methanol, barbituates, lithium, ethylene glycol)
Overload (fluid)
Uremic symptoms (pericarditis, encephalopathy, bleeding, nausea, pruritis, myoclonus)
oliguria, macro/microscopic hematura (smoky brown urine), hypertension, and edema
nephritic syndrome
what should you check in a patient with suspected nephritic syndrome?
complement, ANA, ANCA, and anti-GBM antibody levels
treatment for nephritic syndrome?
treat HTN, fluid overload, and uremia with salt and water restriction, diuretics, and dialysis if necessary; corticosteriods are sometimes useful
proteinuria, generalized edema, hypoalbuminemia, hyperlipidemia
nephrotic syndrome
level of proteinuria in nephrotic syndrome?
>3.5 g/day
1/3 of cases of nephrotic syndrome are due to what?
systemic disease (DM, SLE, amyloidosis)
patient who presents with edema and foamy urine
nephrotic syndrome
lumpy-bumpy immunofluorescence
postinfectious glomerulonephritis
level of C3 in post-strep GN
low
what do you check in suspected post-strep GN
ASO titer
treatment for post-strep GN?
supportive
level of C3 in Berger's disease
normal
most common cause of nephritic syndrome
IgA nephropathy (Berger's)
with what disease is IgA nephropathy sometimes associated?
HSP
young man wiht upper respiratory or GI infection and glomerulonephritis
IgA nephropathy
treatment for Berger's?
glucocorticoids; ACEIs if have proteinuria
what percent of patients with Berger's progress to end-stage renal disease?
abotu 20%
hemoptysis and nephritic syndrome
Wegener's or goodpastures
segmental necrotizing glomerulonephritis with few Ig deposits
wegener's
check what lab in suspected Wegener's
C-ANCA
glomerulonephritis with pulmonary hemorrhage
anti-GBM disease/Goodpasture's
linear anti-GBM deposits on immunofluorescence
Goodpasture's
glomerulonephritis with iron deficiency anemia hemosiderin-filled macrophages in sputum; pulmonary infiltrates on CXR
Goodpasture's
treatment for Goodpasture's
plasma exchange; pulsed steroids
asymptomatic hematuria with nerve deafness and eye disorders
Alport's syndrome
hereditary glomerulonephritis that presents in boys 5-20
Alport's
GBM splitting on EM
Alport's
prognosis of Alport's
progresses to renal failure; anti-GBM nephritis may recur after transplant
what does light microscopy show in minimal change disease?
appears normal
what does EM show in minimal change disease?
fusion of epithelial foot processes with lipid-laden renal cortices
causes of minimal change disease?
usually idiopathic; NSAIDs, hematologic malignancies
treatment for minimal change disease?
steriods
prognosis for minimal change disease
excellent
typical patient with focal segmental glomerular sclerosis
young black male with uncontrolled HTN
causes of focal segmental glomerular sclerosis
idiopathic, IV drug use, HIV infection, obesity
sclerosis in capillary tufts on renal biopsy
focal segmental glomerular sclerosis
treatment for focal segmental glomerular sclerosis
prednisone, cytotoxic therapy
most common nephropathy in caucasian adults
membranous nephropathy
nephrotic syndrome associated iwth HBV, syphillis, malaria, and gold
membranous nephropathy
secondary causes for membranous nephropathy
solid tumor, immune complex disease
spike and dome appearance
membranous nephropathy - due to granular deposits of IgG and C3 at the basement membrane
treatment for membranous nephropathy
prednisone and cytotoxic therapy for severe disease
thickened GBM, increased mesangial matrix
diabetic nephropathhy
nodular glomerulosclerosis
Kimmelstiel-Wilson lesions (in diabetic nephropathy)
2 forms of diabetic nephropathy
diffuse hyalinization and nodular glomerulosclerosis
seen with congo red stain; apple-green birefringence under polarized light
renal amyloidosis
patients with renal amyloidosis may have what other conditions
multiple myeloma or chronic inflammatory disease, e.g. RA
treatment for renal amyloidosis
prednisone
histology classic for membranoproliferative nephropathy
tram-track double-layered basement membrane; type I has subendothelial deposits and mesangial deposits
level of C3 in membranoproliferative nephropathy
low (type II by way of C3 nephritic factor)
what is associated with HCV, cryoglobulinemia, lupus, and SBE
membranoproliferative nephropathy
level of albumin in nephrotic syndrome
less than 3.5g/dL
what are patients with nephrotic syndrome at increased risk for?
infection with strep pneumo - give vaccine
with drug is used in nephrotic syndrome
ACEIs - decrease proteinuria and diminish progression of renal disease in pts with diabetic nephropathy
risk factors for nephrolithiasis
family hx, low fluid intake, gout, post-colectomy/ileostomy, specific enzyme disorders, RTA, and hyperPTH
what does UA commonly show in nephrolithiasis
gross or microscopic hematuria and altered urine pH
treatment for nephrolithiasis
initially: hydration and analgesia
what size stones can pass through the urethra?
<5mm
in what other organs are cysts found in PKD?
spleen, liver, pancreas
renal failure, liver fibrosis, portal HTN in infants/young children
PKD (autosomal recessive form)
most common presenting symptoms of PKD
pain and hematuria
additional findings in PKD
HTN, hepatic cysts, cerebral berry aneurysms, diverticulosis, and MV prolapse
most common form of RTA
type IV
defect in type I RTA
decreased H+ secretion
defect in type II RTA
increased HCO3- reabsorption
defect in Type IV RTA
aldosterone deficiency or resitstance that leads to defects in Na+ reabsorption, H+ and K+ excretion
serum K+ in type I RTA
high or low
serum K+ in type II RTA
low
serum K+ in type IV RTA
high
urinary pH in type I RTA
>5.3
urinary pH in type II RTA
5.3 initially, then <5.3 once serum is acidic
urinary pH in type IV RTA
<5.3
amphotericin, dirrhosis, AI disorders, sickle cell, lithium are all causes of what type of RTA
type I
carbonic anhydrase inhibitors, Fanconi's syndrome, and multiple myeloma are all causes of what type of RTA?
type II
hyporeninemic hypoaldosteronism, chronic kidney disease from DM, HTN, and HIV can call cause which type of RTA
type IV
treatment for types I and II RTA
potassium citrate
treatment for type IV RTA
furosemide, fludrocortisone, low K diet in patients with aldosterone deficiency
major complication of type I RTA
nephrolithiasis
major complications of type II RTA
rickts, osteomalacia
major complication of type IV RTA
hyperkalemia
what is diabetes insipidus?
failure to concentrate urine through central or nephrogenic dysfunction of ADH
causes of central DI
(posterior pituitary fails to secrete ADH) tumor, ischemia (Sheehan's syndrome), traumatic cerebral injury, infection, and AI disorders
causes of nephrogenic DI
(kidneys fail to respond to ADH) renal diseases and drugs - lithium and demeclocycline
how does DI present
polydipsia, polyuria, and persistent thirst with dilute urine
how do you make the diagnosis of DI?
during water deprivation test, pts excrete high volume of dilute urine
what happens with a DDAVP challenge in central DI? in nephrogenic DI?
cental: decreased urine output and increased urine osmolarity
nephrogenic: won't decrease urine output significantly
(DDAVP is an ADH analog)
treatment for central DI
intranasal DDAVP
treatment for nephrogenic DI
salt restriction and increased water intake; thiazides can be used to promote mild volume depletion and to promote proximal absorption of salt and water
what is SIADH
common cause of euvolemic hyponatremia that results from nonosmotically stimulated ADH release
with what is SIADH associated?
CNS disease (head injury, tumor), pulmonary disease (sarcoid, PNA, ectopic tumor production/paraneoplastic syndromes), drugs (antipsychotics, antidepressants), or surgery
how do you diagnose SIADH?
urine osmolality or greater than 50-100 wth concurrent serum hyposmolarity in absence of physiologic reason for increased ADH
what are some physiologic reasons for increased ADH?
CHF, cirrhosis, hypovolemia
what is urinary sodium in SIADH?
greater than 20 - demonstrates that patietn is not hypovolemic
treatment of SIADH
fluid restriction; demeclocycline (antagonizes action of ADH in collecting duct)
what do you do if a patient with SIADH has severe hyponatremia (less than 110)
cautiosuly give hypertonic saline
what can elevated PSA be due to?
BPH, prostatitis, UTI, prostatic trauma, carcinoma
what is considered a markedly elevated PSA?
>4
risk factors for bladder CA
smoking, diets rich in meat/fat, schistosomiasis, chronic treatment with cyclophosphamide, and exposure to aniline dye
most common presenting symptom of bladder CA
gross hematuria
treatment for bladder carcinoma in situ?
intravesicular chemo
treatment for superficial bladder CA
complete transurethral resection or initravesiuclar chemo with mitomycin C or BCG
treatment for large, high grade recurrent bladder CA
intravesicular chemo
treatment for invasive bladder CA without metastases
radical cystectomy or radiotherapy for patients who are poor candidates for radical cystectomy
treatment for bladder CA with distant mets
chemo alone
what is the classic triad of renal cell carcinoma?
hematuria, flank pain, and palpable flank mass
risk factors for testicular cancer?
cryptorchidism and Klinefelters
peak incidence of seminomas
40-50 years
elevation of B-HCG in what testicular CA
choriocarcinoma; also elevated in 10% of seminomas
elevation of AFP in what testicular CA
nonseminomatous germ cell tumors, especially endodermal sinus (yolk sac) tumors
which type of testicular CA is sensitive to XRT and chemo
seminomas
for what type of testicular caners is platinum-based chemo used?
nonseminomatous germ cell tumors
what is bilateral cryptorcidism associated with?
oligospermia and infertility
treatment for cryptorchidism?
orchiopexy after age one (in all but 1%, testes will have descended)but before age 5 to preserve fertility
what if cryptorchidism is discovered later in life?
treat with orchiectomy to avoid the risk of testicular cancer
risk factors for ED?
DM, atherosclersis, meds (B blockers, SSRIs), HTN, heart disease, surgery/XRT for prostate CA, spinal cord injury
what should you look for on PE in a patient complaining of ED?
neurologic dysfunction (anal tone, lower ext. sensation) and hypogonadism (small testes, loss of secondary sex characteristics)
waht labs should you check in pt with ED?
testosterone and gonadotropin levels; also check prolactin
why should you check prolactin in a patient with ED?
elevated prolactin can decrease androgen activity
treatment for patients with psychological ED?
psychotherapy or sex therapy
how do sildenafil and vardenafil work?
phosphodiesterase-5 inhibitors that lead to prolonged activation fo cGMP-mediated smooth muscle relaxation and increase blood flow in hte corpora cavernosa
preferred test for suspected kidney stone
non-contrast CT
hematuria, HTN, RBC casts, mild proteinuria after skin infection
post-strep GN
elderly patient with bone pain, renal failure, elevated Ca2+
multiple myeloma until proven otherwise
what type of hypersensitivity reaction is acute allergic interstitial nephritis?
type 4
fever, petechial rash, and peripheral eosinophilia in azotemic patient
allergic interstitial nephritis
positive leukocyte esterase
pyuria
positive nitrites
enterobacteracae
hexagonal crystals on UA
cystinuria
positive cyanide nitroprusside test
cystinuria
cystinuria is the result of what?
impaired AA transport
how does renal vein thrombosis present?
sudden onset of pain, fever, hematuria
with what type of nephrotic syndrome is renal vein thrombosis most common?
membranous glomerulonephritis
pathologies of analgesic nephropathy
papillary necrosis and tubulointerstitial nephritis
what can chronic analgesic abuse cause in addition to renal failure
premature aging, atherosclerosis, urinary tract CA
class of drugs notorius for causing acute renal failure
aminoglycosides (amikacin, gentamycin, neomycin, tobramycin, streptomycin)
classes of drugs known to cause interstitial nephritis
cephalosporins, sulfonamides, NSAIDs, rifampin, phenytoin, allopurinol
arthralgias, rash, renal failure, eosinophila
drug-induced interstitial nephritis
treatment for problems with renal transplant post-op
IV steroids
four hallmark warning signs of urethral injury?
boggy, movable prostate on exam, blood at urethral meatus, severe pelvic fracture, scrotal/perineal ecchymosis
what do you order to rule out urethral injury before placing a Foley?
retrograde urethrogram
remnant of the processus vaginalis
hydrocoele
dilatation of pampminiform venous plexus
varicocele
which side is a varicocele usually on?
left
bag of worms that does not transilluminate, disappears in supine position, and becomes prominent with standing or valsalva
varicocele
treatment for hydrocele
usually none needed
where is a transplanted kidney placed?
in the iliac fossa or pelvis
what causes hyperacute rejection?
preformed cytotoxic antibodies against donor kidney; occurs with ABO mismatch and other preformed Abs
what type of rejection: kidney turns bluish black after vascular clamps are released
hyperacute
how do you treat hyperacute rejection
remove transplant
what causes acute rejection
T-cell mediated
how does acute rejection present?
days to weeks after transplant with fever, oliguria, weight gain, tenderness/enlargement of graft, HTN
treatment for acute rejection?
increase corticosteroiids or use antithymocyte gloulin
what causes chronic rejection
T-cell or Ab mediated
how does chronic rejection present
gradual decline in kidney function, proteinuria, HTN
what do steroids inhibit?
IL-1 production
what does cyclosporine inhibit?
IL-2 production
mechanism of azathioprine
antineoplastic that is cleaved into mercaptopurine and inhibits DNA/RNA synthesis
how does antithymocyte globulin work?
antibody vs. T cells
how does OKT3 work?
antibody to CD3 receptor on T cells
what is epispadias associated with?
exstrophy of the bladder
bilateral renal agenesis, limb deformities, abnormal facies, lung hypoplasia
potter's syndrome