USMLE Step 3 Master the board > Nephrology > Flashcards

Nephrology Flashcards

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1
Q

hypOvolemic hypOnatremia causes (3)

A
  1. diuretics (urine Na+ ELEVATED)
  2. GI loss of fluids (vomiting, diarrhea) (urine Na+ LOW)
  3. skin loss of fluids (burns, sweating) (urine Na+ LOW)

lose water and a little salt, but patient replaces free water only

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2
Q

causes of metabolic alkalosis (6)

A
  1. volume contraction
  2. Conn syndrome
  3. Cushing syndrome
  4. hypOkalemia
  5. milk-alkali syndrome (too much liquid antacid)
  6. vomiting
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3
Q

MOST ACCURATE test for nephrOtic syndrome

A

kidney biopsy

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4
Q

first step when patient presents with mild proteinuria

can occur in 2-10% of population at any given time

A

REPEAT UA

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5
Q

treatment for SIADH: moderate to severe hypOnatremia (confusion, seizures)

A
  • SALINE INFUSION with loop diuretics
  • HYPERTONIC (3%) saline
  • check serum Na+ frequently
  • ADH blockers (conivaptan, tolvaptan)
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6
Q

treatment for HTN, AND: CHF

A

BB, or ACEI/ARB

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7
Q

treatment for orthostatic proteinuria

A

none; does not need to be treated

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8
Q

MOST ACCURATE test for PSGN

A

kidney biopsy = SUBepithelial IgG and C3 deposits

but should NOT always be done; blood test are usually enough

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9
Q

aspirin overdose mechanism of metabolic acidosis

A
  • respiratory alkalosis from hyperventilation

- metabolic acidosis (loss of aerobic metabolism from mitochondrial poisoning leading to lactic acidosis)

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10
Q

MOST ACCURATE test for rhabdomyolysis

A

urine myoglobin

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11
Q

how does volume contraction cause metabolic alkalosis?

A

secondary hypERaldosteronism, causes increased urinary acid loss

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12
Q

test for proximal RTA (type 2)

A

administer bicarbonate

  • normal person with metabolic acidosis = will absorb bicarbonate, and will still have low urine pH
  • proximal RTA patient = cannot absorb bicarbonate, URINE pH WILL RISE
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13
Q

FIRST STEP in management of hypOnatremia

A

ASSESS VOLUME STATUS

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14
Q

treatment for HUS

A

supportive; do NOT treat with antibiotics

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15
Q

clues renal failure is ACUTE

A
  1. normal kidney size
  2. normal hematocrit
  3. normal Ca2+
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16
Q

causes of SIADH

A
  • any CNS abnormalities
  • any lung disease
  • medications (sulfonylureas, SSRIs, carbamazepine)
  • cancer
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17
Q

treatment for PRErenal azotemia

A

treat UNDERLYING cause

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18
Q

what will you see in the urine in ethylene glycol poisoning?

A

oxalate crystals

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19
Q

pseudohypERkalemia

A
  • hemolysis of RBCs

- prolonged tourniquet placement

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20
Q

diagnostic clues for Wegener granulomatosis (now known as, granulomatosis with polyangiitis)

A
  • SINUSITIS, or OTITIS (biggest clues to diagnosis, and main distinguishing factor between Goodpasture syndrome)
  • lung findings (e.g. nodules)
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21
Q

MOST ACCURATE test for primary renal d/o with NO specific PE findings (only associations)

A

kidney biopsy

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22
Q

causes of AGN (acute glomerulonephritis)

name 11

A
  • Goodpasture’s syndrome
  • Churg-Strauss syndrome
  • Wegener’s granulomatosis
  • polyarteritis nodosa
  • IgA nephropathy (Berger’s disease)
  • Henoch-Schonlein purpura
  • poststreptococcal glomerulonephritis
  • cryoglobulinemia
  • lupus nephritis
  • Alport syndrome
  • TTP/HUS
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23
Q

diagnostic clues for IgA nephropathy (Berger’s disease)

A
  • PAINLESS RECURRENT HEMATURIA
  • Asian
  • recent viral respiratory tract infection
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24
Q

causes of secondary HTN based on age: middle-aged adults (ages 40-69)

A
  • aldosteronism
  • thyroid dysfunction
  • obstructive sleep apnea
  • Cushing syndrome
  • pheochromocytoma
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25
what must be true in order for postobstructive uropathy to cause renal failure?
MUST BE BILATERAL | UNIlateral obstructive cannot cause renal failure
26
characteristic diagnostic tests for INTRArenal renal failure
- BUN:Cr ratio of 10:1 - urinary sodium more than 40 - urine osmolality less than 350
27
primary renal d/o with NO specific PE findings (only associations): hepatitis C
membranoproliferative
28
best NEXT test if SMALL kidney is seen in patient suspected to have RAS
- MRA - duplex ultrasonogram - nuclear renogram
29
treatment for lupus nephritis: sclerosis ONLY
NO treatment
30
best INITIAL treatment for RAS
renal artery angioplasty and stenting
31
causes of secondary HTN based on age: older adults (age greater than 65)
- atherosclerotic renal artery stenosis | - renal failure
32
what should be tested for in PAN?
hepatitis B and C (30% association)
33
stress incontinence - presentation - testing - treatment
- NO pain - COUGHING, and LAUGHING - observe leakage with coughing - Kegel exercise/exercise cream
34
what result indicates a patient has orthostatic proteinuria?
protein in AFTERNOON urine ONLY, and NOT in the morning
35
treatment for hypOreninemic hypOaldosteronism (type 4)
fludrocortisone
36
treatment for lupus nephritis: mild disease, early stage, nonproliferative
steroids
37
metabolic acidosis with increased anion gap (HAGMA) causes
MUDPILES ``` Methanol Uremia DKA Propylene glycol Isoniazid Lactic acidosis Ethylene glycol Salicylates ```
38
treatment for SIADH: mild hypOnatremia (no symptoms)
fluid restriction
39
causes of secondary HTN based on age: children and adolescents (birth to age 18)
- renal parenchymal disease | - coarctation of aorta
40
hypOreninemic hypOaldosteronism (type 4) - urine pH - serum K+ - stones? - test - treatment
- LOW urine pH - HIGH K+ - NO - urine Na+ loss - fludrocortisone
41
NEXT best test for nephrOtic syndrome
spot urine for protein:creatinine ratio; more than 3.5:1 | equal in efficacy to 24H urine protein collection
42
if proteinuria is PERSISTENT and not orthostatic, next step is
24H urine, OR spot protein:creatinine ratio
43
treatment for rhabdomyolysis
1. NS bolus 2. mannitol (decrease contact time of myoglobin with the tubules) 3. alkalinization of urine (decreases precipitation of myoglobin in the tubules)
44
causes of rhabdomyolysis
- crush injury - seizure - cocaine toxicity - prolonged immobility - hypOkalemia resulting in muscle necrosis - recent initiation of STATIN
45
first step in evaluating renal failure
1. PRErenal (perfusion) 2. RENAL (parenchymal) 3. POSTrenal (drainage)
46
manifestation of uremia and treatment: hypocalcemia
vitamin D replacement
47
best INITIAL test for lupus nephritis
- ANA and anti-dsDNA Ab
48
treatment for HTN, AND: CAD
BB
49
hypOnatremia presents with
NEUROLOGICAL ABNORMALITIES: - CONFUSION - DISORIENTATION - SEIZURES - COMA
50
MOST ACCURATE test for RAS
renal angiogram
51
hypOreninemic hypOaldosteronism (type 4)
- decreased aldosterone production - diabetic patient with NAGMA - ELEVATED K+
52
if NO response to steroids AFTER 12 WEEKS for primary renal d/o with NO specific PE findings (only associations), then next in treatment
cyclophosphamide
53
treatment for HTN, AND: asthma
AVOID BB
54
which hormone needs magnesium to function
PTH (parathyroid hormone)
55
first step to CONFIRM orthostatic proteinuria
SPLIT THE URINE: morning urine AND afternoon urine
56
treatment for lupus nephritis: severe disease, advanced, proliferative
mycophenolate mofetil AND steroids
57
findings for SIADH
- inappropriately HIGH urine Na+ (more than 20meq/L) - inappropriately HIGH urine osmolality (more than 100mOsm/kg) - LOW serum osmolality (less than 290mOsm/kg) - LOW serum uric acid - normal BUN, creatinine, and bicarbonate
58
diagnostic clues for polyarteritis nodosa (PAN)
- systemic vasculitis with involvement of every organ EXCEPT the lungs - MULTIPLE MOTOR DEFICITS - SENSORY NEUROPATHY WITH PAIN (are key to diagnosis)
59
treatment for distal RTA (type 1)
bicarbonate
60
proximal RTA (type 2)
inability to REABSORB bicarbonate in PROXIMAL tubule
61
proximal RTA (type 2) - urine pH - serum K+ - stones? - test - treatment
- LOW urine pH - LOW K+ - NO - give bicarbonate - thiazide diuretic and high dose bicarbonate
62
what will the urine osmolality, urine Na+, and urine volume be in BOTH central and nephrogenic DI, and what will happen to the urine osmolality with water deprivation?
- LOW urine osmolality - LOW urine sodium - INCREASED urine volume - NO change in urine osmolality with water deprivation
63
what is the difference between vasopressin and DDAVP?
- vasopressin aka ADH = natural de novo hormone | - DDAVP is the trade name for desmopressin = synthetic ADH replacement
64
MCC of death in ADPKD
ESRD
65
treatment for AIN
no specific therapy, resolves on its own
66
metabolic acidosis with normal anion gap (NAGMA) causes
- diarrhea (bicarbonate loss) | - RTA
67
manifestation of uremia and treatment: anemia
erythropoietin replacement
68
treatment for moderate hypERkalemia (NO EKG abnormalities)
1. IV insulin and glucose 2. bicarbonate 3. kayexalate
69
key to diagnosis of Addison's disease (primary adrenal insufficiency)
hypOnatremia with hypERkalemia, and mild metabolic acidosis
70
how do you distinguish between diarrhea and RTA?
URINE ANION GAP
71
best INITIAL test for cryoglobulinemia
- serum cryoglobulin component levels | - LOW complement levels (especially C4)
72
what does UA show in ATN?
"muddy brown," or granular casts
73
absolute indications for dialysis (3)
1. uremic pericarditis 2. uremic pleuritis 3. uremic encephalopathy
74
clues renal failure is CHRONIC
1. smaller kidneys 2. renal failure of more than 2 weeks will drop Hct (decreased erythropoietin production) 3. Ca2+ levels drop (decreased vitamin D hydroxylation)
75
EKG changes from hypERkalemia in order
1. peaked T waves 2. prolonged P waves 3. widening of QRS complexes
76
what happens in CENTRAL DI to urine volume, and urine osmolality when you give DDAVP/vasopressin?
- DECREASE in urine volume | - INCREASE in urine osmolality
77
best INITIAL test for primary renal d/o with NO specific PE findings (only associations)
UA, then spot urine
78
best INITIAL test for PAN
ESR
79
test for distal RTA (type 1)
administer IV acid (AlCl; should lower urine pH secondary to increased H+ formation) urine will stay abnormally basic
80
how does hypokalemia cause metabolic alkalosis?
K+ shifts OUT of cells to correct hypOkalemia; H+ shift INTO cells
81
how is acid excreted from the kidneys?
NH4Cl
82
what is methanol metabolized into?
formaldehyde than formic acid
83
reason Addison's disease (primary adrenal insufficiency) causes hypOnatremia
insufficient ALDOSTERONE production
84
best INITIAL treatment for ALL primary renal d/o with NO specific PE findings (only associations)
steroids
85
treatment for HTN, AND: osteoporosis
thiazide
86
treatment for tumor lysis syndrome
1. hydration 2. allopurinol 3. rasburicase
87
best INITIAL treatment for granulomatosis with polyangiitis
cyclophosphamide and steroids
88
best INITIAL test for nephrOtic syndrome
UA; shows markedly elevated protein level
89
treatment for HTN, AND: depression
AVOID BB
90
diagnostic clues for lupus nephritis
- h/o SLE
91
when evaluating for persistent proteinuria, if 24H urine, OR spot protein:creatinine ratio is elevated next step is
kidney biopsy
92
best INITIAL treatment for ethylene glycol poisoning
- ethanol or fomepizole | - with IMMEDIATE dialysis
93
best INITIAL test for IgA nephropathy
NO specific test (IgA may be elevated...) | complement levels are normal
94
diagnostic clues for Alport syndrome
- congenital - eye and ear problems (deafness) - renal failure in second/third decade of life
95
treatment for severe hypERkalemia (EKG abnormalities, such as peaked T waves)
1. IV calcium gluconate/calcium chloride 2. IV insulin and glucose 3. kayexalate
96
hypOkalemia causes
dietary insufficiency
97
treatment for HTN, AND: pregnancy
a-methyldopa, or labetalol
98
cause of renal failure from rhabdomyolysis
direct TOXIC effect of MYOGLOBIN on kidney tubule
99
what do you do for Churg-Strauss syndrome if NO response to prednisone?
ADD cyclophosphamide
100
what test for PAN can spare the need for biopsy?
angiography showing "beading"
101
treatment for HTN, AND: DM
ACEI/ARB
102
treatment for HTN, AND: BPH
a-blocker
103
INTRArenal causes of renal failure
- ATN (acute tubular necrosis) - AGN (acute glomerulonephritis) - AIN (acute interstitial nephritis)
104
treatment for Alport syndrome
- NO specific treatment
105
at what rate should you correct hypOnatremia?
- 4-6 meq/L in the FIRST 24 HOURS | - SHOULD NOT BE RAISED MORE THAN 9 meq/L within 24H
106
diagnostic clues for post-streptococcal glomerulonephritis (PSGN)
- dark, "tea," or "cola" colored urine - PERIORBITAL EDEMA - HTN - can occur after throat and skin infections
107
diagnostic clues for cryoglobulinemia
- h/o hepatitis C with renal involvement - joint pain - purpuric skin lesions
108
rasburicase MOA
breaks down uric acid
109
hypERmagnesemia leads to
- muscle weakness | - loss of deep tendon reflexes
110
mechanism of hypOcalcemia in rhabdomyolysis
damaged sarcolemma outside of SER can bind as much Ca2+ as it wants
111
primary renal d/o with NO specific PE findings (only associations): HIV/heroin use
focal segmental
112
treatment for central DI
desmopressin or vasopressin
113
best INITIAL test for ethylene glycol poisoning
UA (envelope-shaped oxalate crystals)
114
treatment for CHRONIC SIADH (from malignancy)
- demeclocycline (blocks ADH at kidney) | - conivaptan/tolvaptan (inhibit ADH at V2 receptor of collecting duct)
115
the other main cause of hypERnatremia
diabetes insipidus (DI)
116
hypERnatremia always implies
free water deficit
117
treatment for Henoch-Schonlein purpura
NO specific therapy; RESOLVES SPONTANEOUSLY
118
initial treatment for HTN
lifestyle modifications: - Na+ restriction - weight loss - dietary modification - exercise - relaxation techniques
119
sodium disorders are NOT associated with
cardiac arrhythmias
120
finding in congenital adrenal hyperplasia (CAH)
hirsutism
121
best INITIAL treatment for Churg-Strauss syndrome
glucocorticoids (e.g. prednisone)
122
cause of lactic acidosis
any form of hypoperfusion resulting in anaerobic metabolism
123
distal RTA (type 1) - urine pH - serum K+ - stones? - test - treatment
- HIGH urine pH - LOW K+ - YES - give acid (aluminum chloride) - bicarbonate
124
how many days of use does it usually take for aminoglycosides to cause kidney damage?
4-5 days
125
nephrOtic syndrome has the following:
1. hypERproteinuria (more than 3.5G/day) 2. hypOproteinemia 3. hypERlipidemia 4. edema 5. HTN 6. thrombosis
126
rhabdomyolysis labs: - CPK level - potassium level - calcium level - serum bicarbonate level
- ELEVATED CPK - hypERkalemia - hypOcalcemia - decreased bicarb
127
finding in pheochromocytoma
EPISODIC HTN
128
mechanism of hypERkalemia with beta blockers
block Na+/K+ ATPase channels
129
primary renal d/o with NO specific PE findings (only associations): seen in adults with cancer such as lymphoma
membranous
130
hypERkalemia can lead to
cardiac arrhythmia
131
if proteinuria persists on repeat UA, what are 4 possibilities that need to be ruled out?
1. CHF 2. fever 3. exercise 4. infection
132
best INITIAL test for Goodpasture syndrome
anti-basement membrane Abs
133
mechanism of how bicarbonate lower potassium
bicarbonate pulls H+ CATIONS out of cells so K+ goes IN
134
treatment for Addison's disease (primary adrenal insufficiency)
fludrocortisone
135
adverse effect of distal RTA (type 1)
alkaline urine = kidney stones
136
treatment for dehydration, even in hypERnatremia
normal saline
137
treatment for ATN
NO specific therapy
138
MOST ACCURATE test for eosinophils in UA
Wright stain or Hansel's stain
139
tumor lysis syndrome
uric acid crystals
140
treatment for TTP
plasmapheresis in SEVERE cases; do NOT treat with platelets
141
MOST ACCURATE test for PAN
SURAL nerve biopsy, or kidney biopsy
142
hypOkalemia can lead to
- cardiac rhythm disturbance | - muscle weakness
143
finding in Conn syndrome (primary hypERaldosteronism)
hypOkalemia
144
common indications for dialysis (8)
1. declining nutritional status (MC reason to initiate dialysis) 2. volume overload 3. fatigue and malaise 4. mild cognitive impairment 5. refractory metabolic acidosis 6. refractory hyperkalemia 7. refractory hyperphosphatemia 8. toxicity with dialyzable drug (lithium/ethylene glycol/aspirin)
145
MOST ACCURATE test for cryoglobulinemia
kidney biopsy
146
treatment for aspirin overdose
bicarbonate
147
hypERnatremia leads to
NEUROLOGICAL ABNORMALITIES: - confusion - disorientation - seizures - COMA
148
check for secondary HTN, when?
- less than 30 yoa, or more than 60 yoa - uncontrolled HTN with 3 medications - specific findings on history and PE
149
diagnostic clues for distal RTA (type 1)
- LOW serum K+ (since body can't excrete H+) - LOW serum bicarbonate - metabolic acidosis - alkaline urine
150
how do you calculate the urine anion gap (UAG)?
UAG = urine Na+ - urine Cl-
151
treatment for hypOvolemic hypOnatremia
correct underlying cause, and replace with NORMAL (ISOTONIC) SALINE
152
treatment for ADPKD
NO specific treatment
153
best INITIAL test for RAS
renal US with DOPPLER
154
MOST ACCURATE test for GN (but not always necessary)
kidney biopsy
155
MOST ACCURATE test for lupus nephritis
kidney biopsy | very important; not for diagnosis, used to determine extent of disease, which determines therapy
156
treatment for hypERvolemic hypOnatremia
correct/manage underlying cause
157
diagnostic clues for proximal RTA (type 2)
- initially urine pH is elevated, bc of bicarbonate loss, but then becomes acidic
158
finding in RAS
bruit
159
hypERmagnesemia causes
- magnesium-containing laxative abuse | - iatrogenic administration
160
what happens in NEPHROGENIC DI to urine volume, and urine osmolality when you give DDAVP/vasopressin?
- NO CHANGE in urine volume | - NO CHANGE in urine osmolality
161
how does vomiting cause metabolic alkalosis?
(acid loss from stomach, AND volume contraction leading to secondary hypERaldosteronism
162
best INITIAL test for Henoch-Schonlein purpura
clinical
163
treatment for HTN, AND: migraine
BB, or CCB
164
BUN:Cr ratio seen in POSTrenal azotemia
also more than 15:1
165
causes of PRErenal azotemia
- ANY cause of hypOperfusion - hypOtension (SBP less than 90) - hypOvolemia (dehydration or blood loss) - low oncotic pressure (low albumin) - CHF (heart can't PUMP) - constrictive pericarditis (heart can't FILL) - RAS
166
suicide by antifreeze ingestion (ethylene glycol) HAGMA
oxalate crystals
167
treatment for IgA nephropathy
NO proven effective therapy - steroids: for sudden worsening of proteinuria - ACEIs: used for all patients with proteinuria
168
primary renal d/o with NO specific PE findings (only associations): MC in children
minimal change disease
169
treatment for methanol poisoning
fomepizole or ethanol
170
treatment for hypOkalemia
- replace K+ - avoid glucose-containing fluids (will increase insulin release worsening hypOkalemia) (NO maximum rate on ORAL K+; bowel will regulate rate of absorption)
171
best INITIAL test for granulomatosis with polyangiitis
c-ANCA (antineutrophil cytoplasmic Abs)
172
what routine tests should be done in a pt with HTN?
- UA - EKG - eye exam (retinopathy) - cardiac exam (murmur/S4 gallop)
173
distal RTA (type 1)
inability to EXCRETE acid of hydrogen ions in DISTAL tubule
174
hypOmagnesemia presents with
hypOcalcemia and cardiac arrhythmias
175
diagnostic clues for Goodpasture syndrome
- COUGH - HEMOPTYSIS - SOB - lung findings (e.g. diffuse infiltrates)
176
treatment for ethylene glycol poisoning
fomepizole or ethanol
177
treatment for HTN, AND: hyperthyroidism
BB
178
what does drug-induced lupus spare?
kidney and brain
179
causes of secondary HTN based on age: young adults (ages 19-39)
- thyroid dysfunction - fibromuscular dysplasia - renal parenchymal disease
180
clues to obstructive uropathy
- distended bladder on exam - large volume diuresis after Foley catheter placement - B/L hydronephrosis on US
181
how do Conn syndrome and Cushing syndrome cause metabolic alkalosis?
primary hypERaldosteronism, causes increased urinary acid loss
182
what can happen if you correct hypOnatremia too rapidly?
CENTRAL PONTINE MYELINOLYSIS
183
diagnostic clues for AIN
- medication ingestion - fever and rash - UA shows white cells (can't discern between neutrophils and eosinophils)
184
what is the UAG in diarrhea?
NEGATIVE, bc kidneys are working (able to excrete acid)
185
what to do in a patient who MUST have a radiologic procedure with contrast and renal insufficiency
hydrate with NS, and give bicarbonate and N-acetylcysteine
186
finding in coarctation of aorta
upper extremity pressure greater than lower extremity pressure
187
treatment for Goodpasture syndrome
plasmapheresis and steroids
188
other causes of hypOkalemia
- increased urinary loss caused by diuretics - Conn syndrome (high aldosterone) - vomiting (leads to metabolic alkalosis; shifts K+ INTO cells [and volume depletion; increases aldosterone]) - proximal (type 2) and distal (type 1) RTA - amphotericin (causes RTA) - Bartter syndrome (LOH can't absorb Na+ or K+; causes secondary hypERaldosteronism)
189
characteristic diagnostic tests for PRErenal azotemia
- BUN:Cr ratio of more than 15:1, and often more than 20:1 - LOW urinary Na+ (less than 20) - urine osmolality more than 500 - may have hyaline casts on UA
190
causes of ATN (acute tubular necrosis)
- either hypOperfusion or toxic injury - surgery - severe burns - aminoglycosides/amphotericin/contrast/chemotherapy - rhabdomyolysis
191
treatment for PSGN
- PCN or other antibiotics for infection | - diuretics for HTN and edema
192
EKG changes in hypOkalemia
U waves (Purkinje fiber repolarization)
193
how does radius affect flow?
flow increases as radius increases | to the fourth power
194
MOST ACCURATE test for IgA nephropathy
kidney biopsy is ESSENTIAL
195
hyperlipidemia mechanism in nephrOtic syndrome
LDL and VLDL are removed from serum by lipoproteins; lipoproteins are lost in urine
196
best INITIAL test for rhabdomyolysis
UA (large blood)
197
hypERvolemic hypOnatremia causes (3)
1. CHF 2. nephrotic syndrome 3. cirrhosis
198
best INITIAL test for PSGN
- antistreptolysin O (ASLO) - anti-DNase - antihyaluronidase - LOW complement levels
199
best INITIAL test for Churg-Strauss syndrome
CBC (check eosinophil count)
200
causes of POSTrenal azotemia (postobstructive uropathy)
- stones - strictures - cancer - neurogenic bladder (MS or DM)
201
MOST ACCURATE test for Churg-Strauss syndrome
kidney biopsy
202
MOST ACCURATE test for granulomatosis with polyangiitis
kidney biopsy
203
adverse effect of methanol poisoning
visual disturbance
204
ALL forms of glomerulonephritis (GN) can have the following: | 5 findings
- RBCs in urine - red cell casts in urine - mild proteinuria (less than 2G/24H) - may lead to nephrOtic - edema
205
manifestation of uremia and treatment: hypermagnesemia
dietary magnesium restriction
206
what is the MOST effective lifestyle modification for HTN?
WEIGHT LOSS
207
mechanism of BUN elevation in PRErenal azotemia
low volume status, increases ADH, and ADH increases urea transporter activity in collecting duct
208
adverse effect of cyclophosphamide
hemorrhagic cystitis
209
treatment for nephrogenic DI
correct underlying cause
210
possible causes of hypERnatremia, aside from dehydration
- poor oral intake - fever - pneumonia - other insensible losses
211
if there is no apparent reason for proteinuria, what is the next possibility?
ORTHOSTATIC proteinuria | h/o patient standing all day; waiter/teacher/security guard
212
HUS triad (think about the name)
1. intravascular hemolysis 2. elevated creatinine 3. thrombocytopenia (h/o E. coli O157:H7)
213
TTP findings (again, think about the name)
1. intravascular hemolysis 2. elevated creatinine 3. thrombocytopenia PLUS 4. fever 5. neurological abnormalities
214
EUvolemic hypOnatremia causes (4)
1. syndrome of inappropriate ADH release (SIADH) 2. hypothyroidism 3. psychogenic polydipsia 4. hypERglycemia (Na+ drops by 1.6-2.4 for every 100mg of glucose above normal) 5. Addison's disease (primary adrenal insufficiency)
215
treatment for proximal RTA (type 2)
- thiazide diuretic (causes volume contraction which concentrates serum bicarbonate) - large quantities of bicarbonate
216
best INITIAL treatment for PAN
steroids and cyclophosphamide
217
hypOmagnesemia causes
- loop diuretics - alcohol withdrawal/starvation - gentamicin/amphotericin/diuretics - cisplatin - parathyroid surgery - pancreatitis
218
primary renal d/o with NO specific PE findings (only associations): unclear
mesangial
219
urge incontinence - presentation - testing - treatment
- PAIN followed by urge to urinate - urodynamic pressure monitoring - behavior modification/anticholinergic medications
220
next step in management in a patient presenting with HTN
repeat BP measurement
221
manifestation of uremia and treatment: hyperphosphatemia
- calcium acetate | - calcium carbonate
222
what are the 2 types of DI?
1. central = failure to produce antidiuretic hormone (ADH) in the brain 2. nephrogenic = insensitivity of the kidney to ADH (can result from hypOkalemia, hypERcalcemia, or lithium toxicity)
223
treatment for cryoglobulinemia
- hepatitis C genotype 1: ledipasvir and sofosbuvir - for treatment-experienced pts: add ribavirin - for other genotypes: sofosbuvir and ribavirin
224
finding in Cushing syndrome
- buffalo hump - truncal obesity - striae
225
ANY of the glomerulonephritides can lead to?
nephrOtic syndrome
226
MOST ACCURATE test for Goodpasture syndrome
kidney biopsy = LINEAR DEPOSITS
227
mechanism of rapid onset of renal failure with contrast agent
- directly toxic to kidney tubules - also, causes intense vasoconstriction of Afferent arterioles (decreased perfusion) (hypOperfusion = LOW urine sodium)
228
2 medications should be started if baseline BP is >?
160/100
229
- recurrent hematuria - stones - infections - CYSTS THROUGHOUT THE BODY (liver, ovaries, circle of Willis) - MVP - diverticulosis
autosomal dominant polycystic kidney disease (ADPKD)
230
phosphate binders
- sevelamer - lanthanum - calcium acetate - calcium carbonate
231
treatment for hypERmagnesemia
- restrict intake - saline administration (provoke diuresis) - maybe dialysis
232
diagnostic clues for Churg-Strauss syndrome
- ASTHMA - COUGH - EOSINOPHILIA
233
diagnostic clues for Henoch-Schonlein purpura
- child or adolescent - RAISED, NONTENDER, PURPURIC SKIN LESIONS (especially on buttocks and LE's) - abdominal pain - possible bleeding - joint pain
234
other causes of hypERkalemia
- metabolic acidosis (transcellular shift out of cells) - adrenal aldosterone deficiency (Addison's disease) - beta blockers - digoxin toxicity - insulin deficiency (DKA) - spironolactone - ACEIs/ARBs (inhibit aldosterone) - prolonged immobility - RTA type 4 (decreased aldosterone effect) - renal failure (decreased excretion)
235
causes of AIN (acute interstitial nephritis)
- antibiotics - NSAIDs - infection (e.g. Streptococcus, viral, Legionella)
236
what is the UAG in RTA?
POSITIVE, bc kidneys CANNOT excrete acid (urine Cl- decreases)
237
when do you initiate medical therapy for HTN?
3-6 months if lifestyle modifications don't work
238
potassium disorders are NOT associated with
seizures, or neurological disorders
239
MOST ACCURATE test for Henoch-Schonlein purpura
kidney biopsy = IgA deposition | not necessary though
240
hypERkalemia causes
(predominantly caused by release from tissues) - muscles = rhabdomyolysis, or crush injury - RBCs = hemolysis - dietary K+ ONLY in renal insufficiency
241
what 3 substances lead to an increased anion gap in DKA?
1. acetone 2. acetoacetate 3. beta hydroxybutyric acid
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