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Renal - clin med
Clinical Medcine
| Question | Answer |
|---|---|
| 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
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