Renal - IM Quick Notes

arold001's version from 2015-06-29 02:59

Section 1

Question Answer
FENa? BUN/Cr? for prerenal vs renalPrerenal: FENa <1% and BUN/Cr > 15
Renal: FENa >2%, BUN/Cr <15
What are some common causes of postrenal AKI?either bilateral ureters (nephrolithiasis, retroperitoneal mass/fibrosis) or bladder/urethra (bladder cancer, BPH, anticholinergic meds in elderly pt)
What are the 2 most common causes of chronic renal failure?HTN or DM
whats the definition of nephrotic syndrome?proteinuria (>3.5 g/day)
hypoalbuminemia (pitting edema)
hypogammaglobulinemia (increased risk for infection)
hypercoagulable state (due to loss of antithrombin III)
hyperlipidemia and hypercholesterolemia
what are the 6 neprhotic syndromes1) minimal change disease
2) focal segmental glomerulosclerosis
3) membranous nephropathy
4) membranoproliferative glomerulonephritis
5) diabetes
6) systemic amyloidosis
which nephrotic syndrome: pt with nodule glomerulosclerosis and kimmelstein lesionsDM
which nephrotic syndrome: pt with HIVFSGS
which nephrotic syndrome: “spike and dome” pattern on LM, subepithelial immune complex deposition on EM/IFmembranous nephropathy
which nephrotic syndrome is a.w HCV, cryoglobulinemiamembranoproliferative glomerulonephritis
thick glomerular BM with tram track appearancemembranoproliferative glomerulonephritis
whats the criteria for nephritic syndrome?glomerular inflammation and bleeding with limited proteinuria (<3.5 g/day), oliguria and azotemia, salt retention with periorbital edema and HTN, RBC cast and dysmorphic RBCs in urine
pt with hematuria a week after sore throat (or cellulitis)...diagnosis?poststreptococcal glomerulonephritis = a/w group A strept
pt with hematuria and positive C-ANCAWegeners granulomatosis = negative IF (pauci immune)
what are the 3 negative IF (pauci immune) rapidly progressing glomerulonephritis?wegeners granulomatosis, microscopic polyangitis, churg-strauss syndrome
rapidly progressive glomerulonephritis a.w LINEAR anti-basement membrane antibodygoodpasture sydnrome = antibody against collagen in glomerular and alveolar basement membrane
pt presents with hematuria and HEMOPTYSISgoodpasture syndrome
pt presents with hematuria after gastroenteritisIgA nephropathy (berger disease)
hematuria after URIIgA nephropathy (berger disease)

Section 2

Question Answer
what are the 4 causes of EUVOLEMIC hyponatremiaSIADH, hypothyroidism, adrenal insufficiency, primary polydypsia
what are the 3 causes of HYPERVOLEMIA hyponatremia?cirrhosis, CHF, renal failure
name 2 cause of pseudohyponatremia vs hyperosmotic hyponatremiaPseudohyponatremia: hyperproteinemia and hyperlipidemia.
Hyperosmotic hyponatremia: hyperglycemia, hypertonic infusion with mannitol
young male presents with severe polyuria, polydypsia with mild HYPERNATRMIA...diabetes inspidus
what nephrogenic DI?ADH has no effect on kidneys
what 3 drugs cause nephrogenic DI?lithium, demeclocycline, amphotericin
whats the most common causes of nephrogenic DI?meds (lithium, demeclocycline, amphotericin), ATN with post-obstruction diuresis, electrolyte disturbance (hypercalcemia, hypokalemia), sickle cell anemia
whats the tx for nephrogenic DI?low sodium diet and THIAZIDES
how do you treat hypernatremia?replace free water with D5W or 1/2NS
what are common cause of hyperkalemia?acidemia, ESRD, massive cellular necrosis (eg, tumor lysis syndrome, rhabdo, hemolysis), meds (beta blockers, succinylcholine)
what 2 medications causes hyperkalemia?beta-blockers and succinylcholine
how do you treat hyperkalemia?immediately with calcium to stabilize cardiac membrane;
insulin + glucose will shift K intracellularly; other options are sodium bicarbonate, kayexalate (sodium polystyrene), albuterol; dialysis always an option if previous methods fail
EKG for hyperkalemiapeaked T waves, prolonged PR and QRS,
what are the most common causes of HYPOkalemia?vomiting, diarrhea, alkalemia, renal losses (diuretics, DKA, RTA), hypomagnesium, hyperaldosteronism
EKG shows U-waves and increased QT intervalHYPOkalemia
what are the most common causes of hypercalcemiahyperparathyroidism, Paget’s, cancer, excess supplements (Ca or Vit D), sarcoidosis

Section 3

Question Answer
formula for anion gapNa- (Cl +HCO3)
what does MUDPILERS represent for anion gap metabolic acidosis?Methanol, Uremia, DKA, Paraldehyde, INH/Iron, Lactic acidosis, Ethylene glycol/EtOH ketoacidosis, Rhabdo, Salicylates/Starvation ketoacidosis
what does HARDPUT represent for non-anion gap metabolic acidosis?Hyperalimentation, Acetazolamide, RTA/Renal failure, Diarrhea, Pancreatic fistula, Ureteral diversion, Toluene
what are common causes of respiratory acidosis?hypoventilation, COPD, pleural effusions, pneumothorax, pulm edema
what are common causes of respiratory alkalosis (breath off CO2 fast)respiratory distress, salicylates, pregnancy, anxiety
what acid base disturbance do you see with ASA overdose?primary metabolic acidosis and primary respiratory alkalosis
presents as hematuria with flank pain radiating to the groinnephrolithasis
what type of kidney stones do pts with Crohns disease have?calcium oxalate
can you see uric acid kidney stones on CXR?NO! radiolucent
pt with recurrent UTIs, Proteus isolated from last urine culture presents with what type of kidney stone?struvite stones = ammonium magnesium phosphate
what 3 bacterias cause (ammonia magnesium phosphate) struvite kidney stones?proteus, enterobacter, klebsiella --> alkalinizes urine!
what type of kidney stone: Young pt with recurrent stones, examination shows HEXAGON-shaped crystalscysteine stone due cystinuria
whats the diagnostic test for kidney stones?CT scan without contrast
how do you prevent calcium kidney stones?decrease sodium and meat intake, give THIAZIDES
how do you tx struvite kidney stones?antibiotics! to kill proteus, klebsiella and enterobacter
how do you tx cystine kidney stones?alkalinize urine

Section 4

Question Answer
3+ blood on dipstick but no RBCs on microscopythink myoglobinuria --> RHABDOMYOLYSIS
WBC caststhink pyelonephritis, AIN or GN
Elevated WBCs, positive leukocyte esterase, positive nitritesUTI!
Homeless pt with AMS, serum osmolar gap and calcium oxalate crystals in urineethylene glycol intoxication
Pt with dysuria, vision changes, polyarthritisreactive arthritis (“can’t see, can’t pee, can’t climb a tree”)
What 2 drugs are a/w hematuria?cyclophosphamide and rifampin

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