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105 Cards in this Set
- Front
- Back
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causes of hypernatremia: 6 D's |
Diuretics
Dehydration DI Docs (iatrogenic) Diarrhea Disease (eg. kidney, sickle cell) |
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hypervolemic hyponatremia is caused by the -osis
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nephrosis
cirrhosis cardiosis |
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treatment of hyperkalemia
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C BIG K
Calcium Bicarb Insulin Glucose Kayexelate |
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effect of loop diuretics on K+?
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loOP: Out Potassium
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what causes hypovolemic hyponatremia?
tx? |
diuretics
vomiting diarrhea third spacing dehydration nl saline |
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what causes euvolemic hyponatremia?
tx? |
SIADH
hypothyroidism renal failure drugs psychogenic polydipsia adrenal insufficiency water restriction |
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are most cases hyper-, iso-, or hypotonic hypo natremia?
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hypotonic
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what EKG changes due to hyperkalemia?
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prolonged PR
peaked T wave prolonged QRS |
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effect of insulin on K+ to cells?
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K+ goes INto cells
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what are reasons for less K+ excretion?
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spironolactone
triamterene ACEIs trimethoprim (Bactrim) NSAIDs low aldosterone type 4 RTA |
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what are the effects of RTA 4 on K+ and what are the effects of RTA 1?
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RTA 4 = HYPERkalemia
RTA 1 = HYPOkalemia |
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in hypokalemia and metabolic acidosis, what dx should you consider?
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RTA
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EKG changes due to hypokalemia?
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T-wave flattening
U-wave ST segment depression |
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loop diuretics cause what 2 electrolytes to exit the kidney?
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K+
Ca++ |
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what are causes of hypercalcemia?
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CHIMPANZEES
Calcium supplement Hyperparathyroidism Iatrogenic/Immobility Milk-alkali syndrome Paget's disease Addison's/Acromegaly Neoplasm Zollinger-Ellison (eg. MEN I) Excess vitamin A Excess vitamin D Sarcoidosis and other granulomatous disease |
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what do thiazides do to calcium? what happens to potassium?
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calcium stays inZIDE
K+ goes OUT (K+ goes out in loops and thiazides) |
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biggest causes of hypercalcemia?
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hyperparathyroidism
cancers (breast cancer, squamous cell, MM) |
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hi Ca++ leads to what sx and EKG findings?
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bones, stones, groans, and psychiatric overtones
short QT interval |
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what drugs are used for severe cases of hypercalcemia?
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calcitonin
bisphosphonates (eg. pamidronate) glucocorticoids dialysis |
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what happens to Ca++ in acute pancreatitis?
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goes down
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what is the normal anion gap?
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8 to 12
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what causes ++ anion gap?
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MUDPILES
Methanol Uremia DKA Paraldehyde Intoxication Lactic acidosis Ethylene glycol Salicylates |
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what is the definition of acute renal failure?
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abrupt decline in renal function
retention of creatinine and BUN |
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define oliguria
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urine output of <500 cc/day
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what are intrinsic causes of renal failure?
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ATN
acute/allergic interstitial nephritis glomerulonephritis thromboembolism |
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signs of prerenal ARF?
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Fe(Na) <1%
urine sp gr >1.020 BUN/Cr >20 |
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physical exam shows what with uremia?
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- pericardial rub
- asterixis - hypertension - decr urine output - increased resp rate |
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what are some external causes of intrinsic-based renal failure?
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drug exposure (aminoglycosides, NSAIDs), contrast or toxin (myoglobin, myeloma protein)
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in acute renal failure, first rule out....
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obstruction
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what can the Fe(Na) help determine?
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differntiate prerenal cause from intrinsic
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ARF: hyaline casts
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normal finding, but lots of it suggests volume depletion (prerenal)
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ARF: red cell casts, dysmorphic RBCs
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glomerulonephritis (intrinsic)
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ARF: white cells, eosinophils
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allergic interstitial nephritis, atheroembolic disease (intrinsic)
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ARF: granular casts, renal tubular cells, "muddy brown cast"
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ATN (intrinsic)
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ARF: white cells, white cell casts
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pyelonephritis (postrenal)
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indication for dialysis?
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AEIOU
Acidosis Electrolyte abnormalities (hyperkalemia) Ingestions (salicylates, theophylline, methanol, barbiturates, lithium, ethylene glycol) Overload (fluid) Uremic symptoms (pericarditis, encephalopathy, bleeding, nausea, pruritis, myoclonus) |
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triad of nephritic syndrome?
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HTN
hematuria oliguria |
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what is mannitol, an osmotic agent, used for?
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pulmonary edema due to CHF and anuria
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what 2 diuretic classes cause metabolic alkalosis?
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loop diuretics
thiazide diuretics |
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what diuretic causes increase in serum uric acid?
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thiazide diuretics
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what type of diuretic has antiandrogen effects (gynecomastia)?
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K+ sparing diuretics
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how do you define nephrotic syndrome?
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proteinuria (>= 3.5g/day)
generalized edema hypoalbuminemia hyperlipidemia |
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1/3 of nephrotic syndrome cases are due to what?
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DM
SLE amyloidosis |
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are pts with nephrotic syndrome hypercoagulable?
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yes!
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what tests should be run in suspected nephritic syndrome?
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complement
ANA ANCA anti-GBM antibody levels |
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pt presents with generalized edema and foamy urine. likely kidney disease?
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nephrotic syndrome
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nephritic: smoky-brown urine, low C3, incr ASO titer, lumpy-bumpy immunofluorescence
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post-infectious glomerulonephritis; recent group A beta-hemolytic streptococcal infection (w/in 2 wks)
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nephritic: most common type, associated with upper resp or GI infections; may be seen in Henoch Schonlein Purpura.
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IgA Nephropathy (Berger's Disease)
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nephritic: hemoptysis, c-ANCA, segmental necrotizing glomerulonephritis, wt loss, hearing disturbances, respiratory and sinus sx.
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Wegener's granulomatosis
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nephritic: glomerulonephritis with pulmonary hemorrhage; peak incidence in men in 20's; hemoptysis, possible respiratory failure; linear anti-GBM deposits on immunofluorescence; hemosiderin-filled macrophages in sputum.
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Goodpasture's syndrome
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nephrotic: fusion of epithelial foot processes with lipid-laden cortices; secondary causes can be NSAIDs and hemotologic malignancies.
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minimal change disease
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nephrotic: idiopathic, IV drug use, HIV infection, obesity; typical pt is young black male with uncontrolled HTN; sclerosis in capillary tufts.
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focal segmental glomerular sclerosis
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nephrotic: "spike and dome" appearance due to IgG and C3 deposits at basement membrane; associated with HBV, syphilis and malaria.
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membranous nephropathy
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nephrotic: thickened GBM, thickened mesangial matrix, Kimmelstein Wilson lesions.
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diabetic nephropathy
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nephrotic: both nephritic and nephrotic; severity of renal disease helps determine overall prognosis.
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Lupus nephritis
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nephrotic: primary (plasma cell dyscrasia) and secondary (infectious or inflammatory) are most common; pts have MM or chronic inflammatory disease (eg. RA); Congo red stain; apple-green birefringence under polarized light.
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renal amyloidosis
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nephrotic: can also be nephritic; "tram track" double layered basement membrane.
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membranoproliferative nephropathy
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what happens to the kidney in sickle cell anemia?
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papillary necrosis in renal pelvis
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what are some causes of papillary necrosis (decreased perfusion of renal pelvis)?
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sickle cell anemia
DM pyelonephritis analgesic abuse |
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if you suspect Lupus nephritis, what tests do you order?
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complement
anti ds DNA |
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what do you do in woman with recurrent UTIs presenting with WBC casts?
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IV abx and voiding cystourethrogram
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pt presents with marked fullness of flanks; FH of HTN, renal failure and SAH. dx?
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polycystic kidney disease
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mnemonic for hematuria?
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SHITTT
Stones Hemoglobinopathy Inflammation Tumors Trauma TB |
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how do you study a suspected GU tumor?
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CT scan
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what does maltese cross under polarized light mean when examining urine?
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lipids
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pts with nephrotic syndrome are hypercoagulable. what can happen as a result?
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PE
renal vein thrombosis |
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how do you treat a pt with diabetic nephropathy?
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tight glucose control
BP control ACEI and ARB |
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what is orthostatic proteinuria?
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pt wakes up with no protein in urine, 8hrs later has protein in urine
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pt with nephrotic syndrome presents with orthostatic hypotension, macroglossia, scattered eccymoses, elevated serum globulins, low albumin. dx?
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amyloidosis
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in pt with refractory HTN and gets ACEI, serum creatinin rises. what could be happening?
how do you test? |
renal artery stenosis
MRA |
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young female presenting with malignant HTN, papilledema in the eyes, diastolic & systolic bruit of the left abdomen. dx?
what does imaging show? |
fibrodysplasia
distal stenosis and 'beading'; tx with angioplasty |
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how do you diagnose hyperaldosteronism?
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aldo/renin ratio
check 24hr aldosterone in urine |
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what are 2 possible findings on imaging you may see in hyperaldosteronism?
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1. one adenoma
2. 2 big adrenal glands |
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18yo presents with HA and HTN; there is a marked delay in femoral pulses. dx?
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coarctation of aorta
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what is acetazolamide?
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carbonic anhydrase inhibitor (diuretic)
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what diuretic is used for pulmonary edema due to CHF and anuria?
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mannitol
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can furosemide cause a sulfa allergy?
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yes
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what diuretic can cause uremia and pancreatitis?
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thiazide diuretics
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how much proteinuria is present in glomerulonephritis?
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< 1.5g/day
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tx for nephrotic syndrome?
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ACEIs
protein and salt restriction diuretics antihyperlipidemic vaccinate with pneumococcal vaccine |
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young child has renal failure, liver fibrosis and portal hypertension. what is a possible dx?
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autosomal recessive PCKD
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possible presenting sx of PCKD? can there be sharp, localized pain?
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pain and hematuria
yes: cyst rupture, infection, or passage of renal calculi |
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other findings in PCKD?
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- HTN
- hepatic cysts - cerebral berry aneurysms |
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what metabolic d/o is found in RTA?
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non-anion gap metabolic acidosis
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most common RTA?
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RTA IV
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problem with RTA I?
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distal H+ secretion
hypo- or hyperkalemia nephrolithiasis |
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problem with RTA II?
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proximal HCO3- absorption
hypokalemia rickets, osteomalacia |
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problem with RTA IV?
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distal: low aldo or insensitive to aldo; problem with H+ and K+ secretion
hyperkalemia |
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ddx for hematuria?
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S2I3T3
Strictures Stones Infection Inflammation Infarction Tumor Trauma TB |
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classic triad of renal cell carcinoma is...
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hematuria
flank pain palpable flank mass |
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what is Sheehan's syndrome?
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ischemia of the posterior pituitary leads to decr. ADH secretion
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how do you tell the difference between central and nephrogenic DI?
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DDAVP challenge (synthetic analogue of ADH)
if urine concentrates -> central if urine dilute -> nephrogenic |
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tx of central DI? nephrogenic DI?
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central: nasal DDAVP
nephrogenic: salt restriction, increase water, thiazide diuretic to boost salt and water uptake in proximal tubule |
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what is cornerstone of SIADH tx?
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fluid restriction
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what can help block ADH action in the collecting duct?
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demeclocycline
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how do you diagnose SIADH?
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urine osmolarity > 50-100 mOsm/kg with concurrent serum hyposmolarity (with no good physiologic reason for increased ADH)
you're not holding on to sodium when you should be! |
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if prostate is hard or has irregular lesions, what is suspected?
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cancer
it should be uniformly enlarged with rubbery texture in BPH |
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how do you treat BPH medically in mild sx?
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alpha blockers (terazosin) and 5-alpha-reductase inhibitors (finasteride) to reduce mild or moderate sx
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risk factors for prostate CA in men?
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old age and + FH
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a tender prostate suggests...
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prostatitis
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why would you have back pain with prostate CA?
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bone mets
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what happens to PSA in prostate cancer? what is definitive dx?
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markedly high (>4ng/ml)
u/s guided transrectal biopsy |
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how do you treat prostate cancer mets?
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androgen ablation
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pt presents with hematuria, flank pain and palpable flank mass. dx?
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renal cell carcinoma
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male gender, smoking, obesity, acquired cystic kidney disease in end stage renal disease, von Hippel Lindau disease...risk factors for what?
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renal cell carcinoma
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