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Renal - clin med

Clinical Medcine

Oliguria definition less than 400 mL of urine output in 24 hours
Postrenal AKI/acute failure is usually diagnosed by finding _____ on ultrasound. hydronephrosis
muddy brown granular casts found on urine microscopy could indicate what? ischemic and nephrotoxic ATN
You suspect your patient has an AKI. Their FENa is found to be.8%, and their BUN:Cr ratio is 25:1. What type of AKI do they likely have? Prerenal
You suspect your patient has an AKI. Their FENa is found to be 2.2%, and their BUN:Cr ratio is 12:1. What type of AKI do they likely have? Intrinsic
Indications for acute dialysis (AEIOU) Acid-base disturbances (Severe) Electrolyte disturbances (ie hyperkalemia) Intoxications (ie salicylates) Overload of fluid Uremic syndrome
The descending limb of the LOH is permeable to ___. Water ONLY
The ascending lim of the LOH is permeable to___. ions only--not water
CG equation for eGFR is best used on patients who ____. have a rapidly changing serum creatinine
The MDRD equation for eGFR is best used for patients with ____. stable serum creatinine levels
Restriction of dietary protein will cause an (increase or decrease) in SCr? Decrease
Does obesity affect the SCr level? No--excess mass is fat and does not contribute to SCr levels.
What is the effect of an ACEi on the nephron? Dec the ability of the e-arteriole to constrict in response to inc resistance...meaning that the e-arteriole stays more relaxed and keeps GFR lower...why ACEis are renoprotective. However, if you start one and their SCr increases more than 20%, dc it.
The overall purpose of the RAAS is to increase or decrease blood pressure? Increase!
Site of action of thiazides block reabsorption of sodium and chloride in the distal convuluted tubule
Loop diuretics MOA block the reabsorption of sodium, k, and cl in the ascending LOH-->prevents the medulla of the kidneys from getting as "salty" so less water leaves the tubule in the descending limbs and you pee like crazy!
In renal failure, phosphorus excretion is ___ and calcium reabsorption is ___. This causes PTH levels to ___. reduced, reduced, rise.
What are additional conditions that tend to develop in a person with AD polycystic kidney disease? HTN, berry aneurysms, diverticulosis, mitral valve prolapse
Somatostatin can be used as a treatment for what disease? AD Polycystic Kidney Disease
How do you diagnose RPGN? Decrease GFR 50% in 3 months or less Crescent formations on renal biopsy Proteinuria <3 g/24hr, hematuria, HTN, UA (NEPHRITIC)
PE findings in testicular torsion Testicle is high riding and lying in horizontal orientation, swelling, cremaster reflex on affected side is ABSENT, Prehn's sign is negative (NO relief of pain)
Insulin causes potassium to shift __ cells. into
Beta activation causes K to shift ___cells into
Symptoms of rhabdomyolisis muscle pain, weakness, dark red-brown urine, elevated CK (usually 5x normal)
Test of choice in pregnancy if you suspect nephrolithiasis? Renal ultrasound
You suspect your patient is suffering a ureteral kidney stone based on the location of their pain. However, on x ray, you see nothing. Why can you not absolutely rule out nephrolithiasis? Uric acid stones are not visible on x ray...must get spiral cut CT (w/o contrast) to diagnose
What is the gold standard for diagnosis of nephrolithiasis? thin cut spiral CT w/o contrast
What will urinalysis and CBC show in a patient with acute pyelonephritis? UA: pyuria and baturia, white blood cell casts, + culture CBC: leukocytosis and left shift
When do you order a US or CT in a patient with acute pyelonephritis? if patient has persistent fever or clinical symptoms after 48-72 hours of appropriate antimicrobial therapy
Symptoms of hypernatremia lethargy, spontaneous cerebral bleeds, coma
signs/symptoms of hyponatremia confusion, convulsions, fatigue, HA, muscle weakness, N/V
symptoms of hyperkalemia weakness, paralysis, respiratory failure
What medication can be used to treat chronic hyperkalemia? Fludrocortisone--> acts like aldosterone and increases the number of sodium/potassium pumps in the kidney--> secrete more potassium
Diagnosis of SIADH urine osm >100 (concentrated) No ECFV depletion--euvolemic Normal thyroid, adrenal, cardiac, hepatic, renal fx *dx of exclusion
What is central diabetes insipidus? Impaired renal water conservation due to inadequate vasopressin secretion from the neurohypophysis (dilute urine, administer desmopressin and urine concentrates)
What is nephrogenic diabetes insipidus? Insufficient renal vasopressin response (administer desmopressin and there is little to no effect on urine osmolality)
Anion gap equation and normal value Na - (Cl+HCO3) 10-14
HTN, proteinuria, urinary RBC casts Glomerulonephritis!
Nephrotic syndrome Neprhitic+ edema, hypoalbuminemia, hyperlipidemia
Oval fat bodies== Nephrotic syndrome....if in child think Minimal change disease!
Renin release is stimulated by: Decreased BP, decreased flow or decreased NaCL sensed by macula densa, sympathetic stimulation, angiotensin II
Thiazide diuretics cause more ___ to be excreted than ___, so they can cause __natremia. sodium, water, hypo
Gold standard for diagnosis of lower UTI urine culture
Nitrate in the urine can indicate infection with gram __ bacteria negative
Alkaline urine promotes ____ crystallization Calcium-phostphate
Acidic urine promotes ___ crystallization uric acid
uric acid + ___urine = uric acid stone acidic
"envelope" urine crystals on pathology Calcium stones
Coffin lid urine crystals on pathology struvite stones
Rosebud/rhomboid/needles on pathology uric acid stones
benzene rings/stop sign crystals on pathology cystine stones
What are some exongenous substances that cause a high anion gap metabolic acidosis with an osmolar gap? Methanol, ethanol, DKA, isopropyl alcohol, ethylene glycol
What is the first clinical sign of chronic kidney disease? proteinuria
A patient with metabolic acidosis is more likely to be ___ kalemic. hyper
NAGMA from GI loss (diarrhea)--> what would the K+ level be? hypOkalemia--> interesting bc normally metabolic acidosis causes hyperkalemia
In type 4 RTA, the patient will be __kalemic. hyper
In type 1 or 2 RTA, the patient will be ___kalemic. hypo
Type 1 RTA pathophys failure of H+ secretion in the distal tubules
Type II RTA pathophys Failed bicarb reabsorption in the proximal tubules
What is the IPSS profile? Used to assess severity of BPH symptoms
Treatment of acute bacterial prostatitis FQ or bactrim for 30 days
What is the next step if during a DRE on a 65 year old male patient, you palpate a hard nodule in his prostate? Biopsy! Regardless of what his PSA level is.
In your patient with epididymitis, would you expect the cremaster reflex to be present or absent? present!
Which side is more commonly affected by varicocele? the left side because the testicular vein feeds into the left renal vein. On the right, the testicular vein feeds into the IVC, which is a lower pressure to work against
When a hydrogen ion is secreted, a ___ is reabsorbed. bicarbonate
Metabolic alkalosis is chloride ____ if the urine chloride is less than 10 responsive
You see a patient with a respiratory rate of 9. What acid base disorder could they be compensating for? metabolic alkalosis
20-40% of calcium stone formers are deficient in ___. citrate--> an inhibitor of stone formation
What is the only type of stone not visible on x ray? uric acid stones
Treatment of hypercalciuria HCTZ to reclaim Ca, low sodium diet
Treatment of hypocitraturia increase dietary citrate, potassium citrate supplement
How to treat hyperuricosuria in a patient with frequent uric acid stones allopurinol, low purine diet, alkalinize the urine
Indications for UTI prophylaxis 2 or more symptomatic UTIs within 6 months, or 3 or more in a year
2/3 of total body water is in the ____ intracellular compartment
etiology of hypertonic hypOnatremia consider hyperglycemia
Isotonic hyponatremia pseudohyponatremia due to high lipids or protein (facticious low sodium level)
Hypotonic hyponatremia where the patient is hypovolemic vomiting is a possible cause
Hypotonic hyponatremia where the patient is eurvolemic SIADH--rule out all other possibilities first
Hypotonic hyponatremia where the patient is hypervolemic Cirrhosis, renal failure
Treatment for CRITICAL hyponatremia 3% NaCL in the ICU SLOWLY to avoid cerebral demyelination
Name some causes of hypernatremia osmotic diuresis from glucose, diabetes insipidis (urine osm<150)--central or nephrogenic
If you have primary adrenal insufficiency, are you at risk for hyper or hypokalemia? hyperkalemia
If you have hyperaldosteronism, are you at risk for hyper or hypo kalemia? hypokalemia
How does the cation exchange resin kayexalate work? exchanges Na for K in the colon, helps you get rid of extra potassium. given with sorbitol to prevent constipation
In metabolic alkalosis, what will your potassium level do? May become hypokalemic, because cells will put out hydrogen ions in exchange for taking in a potassium
Hypokalemia with urine K less than 20 means: k loss is extra renal-->diarrhea, laxative abuse, decreased intake, GI fistula
Hypokalemia with urine K more than 20 means: renal loss of K-->look into acid base status for cause. If metabolic alkalosis, must get urine chloride.
Created by: duanea00