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42 Cards in this Set
- Front
- Back
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Best method to determine kidney fx in diabetic pt?
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Microablumin: Cr ratio
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Nephritic syndromes:
Common presentations? Pneumonic? |
most often present w/ oliguria, hematuria, HTN, edema
o PIG WAIL - Post-infectious glomerulonephritis - IgA nephropathy (Bergers) - Goodpasture’s - Wegener’s Granulomatosis - Alport’s syndrome - Idiopathic Crescentric Glomerulonephritis - Lupus nephritis |
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o Post-infectious glomerulonephritis:
Cause? MC population? Micro? Tx? |
- MC strep infx
- MC in children • Micro: bumpy deposits of IgG in renal basement membrane • Tx w/ supportive care, self-limiting |
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IgA nephropathy (Bergers):
Cause? MC population? Micro? Tx? |
- increased IgA, associated w/ URI or GI infx
- commonly in young males, Henoch Schlonlein purpura sometimes seen • Micro: IgA deposits in mesangial cells • Tx w/ ACEi’s, glucocorticoids |
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Goodpasture’s:
Cause? Micro? Tx? |
antiglomerular and antiavleolar basement membrane antibodies
• Micro: linear IgG antibody deposits in glomeruli, Cxray for pulm infiltrates • Tx w/ steroids and plasmapheresis |
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Wegener’s Granulomatosis:
Cause? Common Associations? Tx? |
- look for pulm and upper oral involvement,
- +c-ANCA • Tx w/ steroids |
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Alport’s syndrome:
Cause? MC population? Micro? Tx? |
- hereditary nephritic syndrome
- seen boys 5-20, usually see hearing/visual disturbances (hearing loss) • Micro: glomerular basememt membrane splitting • Tx w/ ACEi to decrease proteinuria, usually leads to renal transplant |
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Idiopathic Crescentric Glomerulonephritis:
Cause? Micro? Tx? |
- rapidly progresses to renal failure
- MC idiopathic • Micro: crescent formation in Bowman’s capsule “wrinkling” • Tx w/ steroids, plasmapheresis, poor prognosis |
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Lupus nephritis:
Cause? Micro? Tx? |
- SLE present
- can lead to HTN or renal failure, ANA - anti-ds DNA antibodies • Micro: “wire loop”=SLE • Tx w/ steroids/immunosuppression, ACEi for proteinuria |
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MC overall nephritic syndrome?
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Bergers (IgA nephropathy)
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Nephrotic syndromes:
Common Presentation? Pneumonic? |
- Frothy, foamy urine (fatty casts)
Most Dogs Find Meat Mesmerizing - Minimal change disease - Diabetic Nephropathy - Focal Segmental Glomerular Sclerosis - Membranous Glomerulonephritis - Membranoproliferative Nephritis |
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Minimal change disease:
Cause? MC population? Micro? Tx? |
- idiopathic
- young children • Micro: flattening of basement membrane foot processes • Associated w/ thrombosis (hypercoagulable state) • Tx w/ steroids |
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Diabetic Nephropathy:
Cause? MC population? Micro? Tx? |
hx DM, HTN, progressive
- Kimmelstiel-Wilson nodules on biopsy pathopneumonic • Micro: basement membrane thickening and mesangial thickening • ACEi 1st line tx to slow progression of disease |
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Focal Segmental Glomerular Sclerosis:
Cause? MC population? Micro? Tx? |
- idiopathic or IV drug use or HIV in adults
• Typically a young African American male with HIV or HTN, showing hematuria, • Sclerosis of the renal capillaries • Tx with prednisone and ACEi |
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Membranous Glomerulonephritis:
Cause? MC population? Micro? |
- idiopathic or infx, SLE, syphilis, or drug use
• Associated w/ Hep B • Micro: spike and dome basement membrane thickening |
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Membranoproliferative Nephritis:
Cause? Micro? Associated Diseases? |
- idiopathic or infx or AI
• Micro: basement membrane thickening w/ doube-layer “train track” appearance - associated w/ Hep C |
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Cause of Psedohyponatremia?
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hyperlipidemia can cause false low sodium
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Bladder obstruction frequently caused by BPH?
Dx? |
- Bladder divirticuli
- Voiding Cystourethrography used to detect bladder divirtuculi |
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Adult Dominant Polycystic Kidney Disease (ADPKD):
Presentation? RF for? |
o Presents w/ flank pain, hematuria, UTA, nephrolithiasis
o Palpable kidneys, R>>L, Liver possibly enlarged due to cystic involvement o Increased risk association for berry aneurism and sub-arachnoid hemorrhage, hepatic cysts, heart valve defects and thoracic aortic aneurysm |
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Best study for Dx of urethral injury?
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Retrograde Urethrogram
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Kidney stones:
Presentation? RF for? Tx? |
- nausea, abd pain, met acidosis, alkolotic urine (>6)
- predispose to RTA type 1 o <5mm stone will pass, ACEi will aid in passage o A low protein diet is recommended for those w/ stones |
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Course for suspected testicular torsion?
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bedside US to make sure then emergent surgery is needed
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MC site of renal stone impaction?
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Uretero-vesical junction
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Persistent UTI cause and Tx?
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sexually active female after adequate Tx urethritis secondary to Gonorrhea or MC Chlamydia
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RTA type 1:
Cause? Electrolyte changes? Tx? Associated diseases? |
- defect in H+ secretion
- hypokalemia, UA pH >5.3 o Tx w/ potassium citrate o Common in Sjogrens and Kidney Stones |
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RTA type 2:
Cause? Electrolyte changes? Tx? |
- defect in NaHCO3 reabsorption
- hypokalemia, UA pH <5.3 o Tx w/ potassium citrate |
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RTA type 4:
Cause? Electrolyte changes? Tx? Associated diseases? |
- defect in Na reabsorption and H+ and potassium secretion
- hyperkalemia, hyponatremia, pH <5.3 o Tx w/ furosemide and mineralcoricoid and glucocorticoid replacement o Common in DM |
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Area of prostate affected by BPH?
Tx? |
- MC found in transition zone of prostate
- tx w/ alpha Antagonist |
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Area of prostate affected by prostate CA?
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- MC found in peripheral zone
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causes of high anion-gap acidosis?
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• MUDPILES
- Methanol - Uremia - DKA - Paraldehyde - Isoniazid - Lactic Acidosis - Ethanol - Salicylates |
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+ Anion gap acidosis disorders:
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RTA, toxins
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non-gapped acidosis disorders:
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GI loss
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Microabluminuria Tx?
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o Tx w/ ACEi, then to dual ACEi/ARB therapy
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Reasons for acute dialization:
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- uremic pericarditis
- hyperkalemia refractory to tx - acidosis refractory to tx - uremic encephalopathy - toxicities - fluid overload |
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High BUN can mask what?
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fever
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SiADH tx?
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hypertonic saline, fluid restriction, if no help then demecacycline
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Hypercalcemia Tx:
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volume, loop diuretics, then bisphosphonates, then dialize
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What is the first step in workup of known SLE pt that has begun to have kidney problems?
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Kidney biopsy to determine extent of involvement, Tx, and for further comparison
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Pt has flank discomfort w/ decreased urination and occasional episodes of high urine output, minor RBC and WBC in urine w/ trace protein?
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Urinary outflow obstruction 2nd to renal calculi
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Elderly pt w/ syncopal episode and decreased intake/increased output through diarrhea, what is best way to determine volume status (dehydration)?
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BUN/Creatinine ratio
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Lab that should be ordered in all suspected cases of BPH?
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Urinalysis to determine if kidneys are being damaged due to obstruction
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Elderly Pt’s w/ poor PO intake and taking ACEi or Diuretics have a risk for what renal condition?
Cause? |
Pre-renal Azotemia due to Volume Depletion an Poor Renal Perfusion
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