Internal Medicine > Nephrology > Flashcards

Nephrology Flashcards

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1
Q

___

affects the Efferent arteriole causing increase in GFR but with compensatory Na reabsorption

A

Angiotensin = responds due to decrease BP

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2
Q

____ facilitate dilation of Afferent arteriole causing increase in GFR but no Na reabsorption

A

ANP = responds due to increase atrial pressure

Na loss and volume loss

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3
Q

Parathyroid hormone is secreted in response to a decrease in [Ca], increase [PO4], or decrease 1,25OH D3. in response, ___

A
  1. Increase Ca reabsorption in DCT
  2. Decrease PO4 reabsorption in PCT
  3. Increase 1,25-OHD3 production
  4. Increase Ca and PO4 absorption from the gut
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4
Q

Most frequent cause of hyperkalemia

A

decrease in renal K excretion

  1. RAAS system
  2. Hyporeninemic, hypoaldosteronism
  3. Addison disease
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5
Q

What is the most urgent step if hyperkalemia is suspected?

A

ECG

since hyperkalemia can lead to life threatening arrythmia

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6
Q

[Hyperkalemia ECG changes]

Tall, peaked T waves

A

5.5 - 6.5

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7
Q

[Hyperkalemia ECG changes]

Loss of P waves

A

6.5 - 7.5

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8
Q

[Hyperkalemia ECG changes]

widened QRS

A

7-8

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9
Q

[Hyperkalemia]

Used for immediate antagonism of the cardiac effects

A
  1. IV calcium gluconate
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10
Q

[Transcellular Potassium Shift]

K enters the cell due to

A
  1. Insulin
  2. Beta agonist
  3. Alkalosis
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11
Q

[Transcellular Potassium Shift]

K exits the cell due to

A
  1. Hyperosmolarity
  2. Exercise
  3. Cell lysis
  4. Acidosis
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12
Q

[Bartter vs Gitelman]

Mimics loop diuretic

A

Bartter

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13
Q

[Bartter vs Gitelman]

(+) Polyuria
(+) polydipsia
(-) HPN
Hypokalemia
normal Mg
Increased urinary Ca excreation
A

Bartter Syndrome

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14
Q

[Bartter vs Gitelman]

(-) polyuria
(-) polydipsia
(+) tetany
(-) growth retardation

Low urinary CA
Low serum Mg

A

Gitelmann

Low MG due to TPMR 6 defect

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15
Q

[Bartter vs Gitelman]

mimic Na-Cl co transporter

A

Gitelman

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16
Q

What is the first step in diagnostic evaluation of hypercalcemia?

A

Check albumin

Corrected Ca = 40 - albumin x 0.02 + measure Ca

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17
Q

What is the main hormone that regulates Ca levels in the body

A

Parathyroid hormone

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18
Q

What are the effects of parathyroid hormone in the body?

A
  1. Bone resorption to increase serum Ca and P
  2. Increase Vit D synthesis
  3. Increase Ca reuptake but increase P excretion in the kidneys
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19
Q

Hypercalcemia in malignancy is usually due to overproduction of what hormone?

A

PTHrp

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20
Q

Most common PTHrp secreting tumor

A
  1. Squamous cell tumors
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21
Q

Vitamin D secreting tumor

A

Lymphoma

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22
Q

Granulomatous diseases like TB, Fungal infections and sarcoidosis increase Ca absorption in the gut by ___

A

ectopic production of alpha-1 hydroxylase that converts calcidiol to 1,25OHD3

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23
Q

Paget Disease causes hypercalcemia by ___

A

abnormal production of RANKL by osteoblast

High RANKL increases osteoclast activity

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24
Q

What is the defect in Familial Hypocalciuric Hypercalcemia which is a cause of hyperparathyroidism leading to hypercalcemia?

A

Calcium sensing receptor dysfunction

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25
Increased urine volume associated with hypercalcemia is due to
Ca directly inhibits insertion of aquaporin channels in the collecting duct membrane
26
Inhibition of ROMK in the TAL luminal membrane increases urine volume leading to polyuria and the polydipsia is due to
Osmotic drag of water by increase NaCl in tubule lumen ROMK facilitates movement of K to the tubule lumen. K drives NaKCl cotransported. Without this, NaCl accumulates in the tubule lumen
27
[Hypocalcemia] QT prolongation is due to
Delay in repolarization due to increased myocyte depolarization since myocyte is very permeable to Na influx
28
[Hypocalcemia] Laryngospasm, Chvostek sign, Trosseau sign, associated with hypocalcemia is due to
skeletal muscle tetany due to spontaneous action potential. Hypocalcemia makes the cell permeable to Na influx thereby increasing excitability.
29
[Hypocalcemia] Eliciting the Trosseau sign is due to spontaneous action potential in what nerve?
Median nerve first tetanic sign to develop with hypocalcemia
30
[Diagnosis] Low ADH secretion H2O deprivation test Positive AVP response
Central DI
31
[Diagnosis] increased renal resistance to ADH, H2O deprivation test no AVP response
Nephrogenic DI
32
What regulates the plasma [Na] level
Water intake or excretion
33
Chronic hyponatremia can lead to ___-
Osmotic demyelination syndrome
34
[Acid-base disorders] What are the normal ABG values. Cite all
``` pH = 7.4 H = 40 pCO2 = 40 HCO3 = 24 ```
35
What is the formula to calculate AG
AG = Na - (Cl + HCO3)
36
What are the 4 principal causes of HAGMA?
1. Lactic Acidosis 2. Ketoacidosis 3. Toxins 4. Renal failure
37
What are the causes of HAGMA?
``` Methanol Uremia DKA Paraldehyde Iron, INH Lactate Ethylene glycol Salicylates ```
38
What are the 2 causes of NAGMA?
1. Bicarbonate loss from GIT | 2. RTA
39
What are the causes of NAGMA?
``` Hyperalimentation/ Hyperventilation Acetazolamide RTA Diarrhea Ureteral divesion Pancreatic fistula ```
40
What is the best treatment for Sjogren's Syndrome presenting as RTA I?
HCO3 and Potassium replacement
41
[RTA type] Basic urine pH Present urine stone Low serum K
Type I - Distal Dx: Acid load by giving NH4Cl Tx: HCO3 + K tabs
42
[RTA type] Acidic urine pH Absent stones Low serum K
Type II - Proximal Dx: Bicarb load by giving HCO3 Tx: HCO3 + K tabs + diuretics (HCTZ)
43
RTA type II is associated with what diseases
1. Amyloidosis | 2. Multiple myeloma
44
[RTA type] Acidic urine pH Absent urine stones High serum K Patient is diabetic
Type IV (Hypoaldosteronism Dx: Na restriction since high urine Na Tx: Fludrocortisone (highest mineralocorticoid effect)
45
What is the RTA with ELEVATED potassium?
RTA IV Look for a DM patient with NAGMA
46
Increase in Crea that is suggestive of AKI
1. At least 0.3mg/dL in 48 hours | 2. 50% or higher in 1 week
47
AKI can be inferred if there is a reduction of UO of
<0.5mL/kg/hr for >6 hours
48
Complete anuria in the early course of AKI can be seen in ____
1. Complete UTO 2. Renal artery occlusion 3. Overwhelming shock 4. Severe proliferative GN
49
Combining NSAID with what antihypertensive medications poses a high risk for AKI
ACEI or ARBs
50
What are the most common causes of intrinsic AKI?
1. Sepsis 2. Ischemia 3. Nephrotoxin
51
Congestive heart failure can cause AKI since there is ____
decreased effective circulating volume
52
Drugs that can cause impairment of renal autoregulation leading to prerenal AKI.
1. NSAID 2. ACEI/ARB 3. Cyclosporine
53
Drugs that can cause Intrinsic AKI
1. Aminoglycosides 2. Cisplatin 3. Amphotericin B
54
What are the electrolyte disturbances in rhabdomyolysis?
1. Hyperkalemia 2. Hyperphosphatemia 3. Hyperuricemia 4. Hypocalcemia 5. Elevated CPK
55
Hypocalcemia from rhabdomyolysis is due to
Damaged muscle binds to calcium lowering its blood level
56
What is the best initial test for rhabdomyolysis?
Urinalysis
57
What is the most accurate test to diagnose rhabdomyolysis?
Urine myoglobin
58
Recovery due to iodinated contrast nephropathy happens within ___
7 days
59
Contrast nephropathy peaks within ____
3-5 days
60
Kidney damage for ___ months can suggest CKD
>/ 3 months
61
What is the most common cause of CKD?
DM nephropathy
62
What disease entities presents with CKD but has normal-sized kidneys
1. DM nephropathy 2. Amyloidosis 3. HIV nephropathy 4. PKCD
63
What disease entities presents with CKD but has normal-sized kidneys
1. DM nephropathy 2. Amyloidosis 3. HIV nephropathy 4. PKCD
64
Normocytic, normochromic anemia can be seen as early as what CKD stage?
Stage 3 CKD
65
What are the absolute indications for maintenance dialysis?
1. Acidosis 2. Electrolytes 3. Intoxication 4. Overload 5. Uremia Uremia, Intractable hyperkalemia, persistent volume expansion despite diuretics, refractory acidosis, bleeding diathesis, eGF 10
66
[UTI] Premenopausal, non-pregnant women with acute onset dysuria, frequency, urgency without vaginal discharge
Acute uncomplicated cystitis Tx: empiric tx UA is not a prerequisite
67
[UTI] Healthy women, fever, chills, flank pain, CVA tenderness, nausea and vomiting
AUC Dx: UA and urine culture recommended Tx: FQ x 14 days
68
[UTI] Renal transpant, significant bacteriuria with urologic abnormality, renal transplant, diabetes, sepsis, older male
Complicated UTI
69
What are the drugs safe for UTI in pregnancy
1. Amoxicillin 2. Cephalosporin 3. Nitrofurantoin
70
What is the length of treatment for UTI in men
7 to 14 days of a FQ
71
What is the length of treatment for acute bacterial prostatitis
2-4 weeks
72
What is the length of treatment for chronic bacterial prostatitis?
4-6 weeks
73
What is the length of treatment for recurrent UTI in men?
12 weeks
74
[Diagnose] sudden onset unilateral flank pain, painless gross hematuria
nephrolithiasis
75
What is the most common type of stone that causes nephrolithiasis?
calcium oxalate
76
What is the most common site of impaction of nephrolith?
Ureterovesivular junction
77
What is the gold standard in diagnosing nephrolithiasis?
Helical CT without contrast
78
What is the most urgent step needed in an acute case of rhabdomyolysis
ECG to check for hyperkalemia
79
What are the cardiac arrythmias associated with hyperkalemia?
1. Sinus bradycardia 2. Sinus arrest 3. Slow idioventricular rhythmns 4. Ventricular tachycardia 5. Ventricular fibrillation 6. Asystole
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