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Nephrology
| Question | Answer |
|---|---|
| When do we dialyze the pt ? | AEIOU, Acidemia, Electrolyte abnormalities w/ EKG changes (hyperkalemia), Intoxication and infection related to uremia, Overload fluid not responsive to diuretics, Uremia complications (pericarditis,encephalitis, GI bleed) |
| Causes of increas BUN | Renal failure, proteins, tissues catabolism (fever, burns,steroids), shock, CHF, dehydration, UT obstruction |
| Acute tubular necrosis ATN cause | Ischemic hypoperfusion of kidneys, toxins |
| Acute tubular necrosis ATN sx | Azotemia, uremia (mental status change, edema, fatigue, nausea/vomiting) |
| Acute tubular necrosis ATN dx | Urinalysis, muddy brown casts, CMP to asses potassium, ekg if K high |
| Acute tubular necrosis ATN tx | No acute therapy as kidneys dont work, admit to observation, monitor electrolyte, dialysis (if necessary) |
| Allergic interstitial nephritis AIN cause | Drugs : allpurinol , penicillin, cephalosporin, quinolones, rifampin, sulfas. Infection. Autoimmune disorder |
| Allergic interstitial nephritis AIN sx | Fever, rash shortly after first dose |
| Allergic interstitial nephritis AIN dx | Urinalysis (drug +fever/rash), WBC+, esinophilia, hensel stain detect urine eosinophils |
| Allergic interstitial nephritis AIN tx | Stop drug admit for observation and get serial CMP, if renal failure persists after 3 days may start IV prednison |
| Toxin-mediated renal insufficiency causes | Drugs, unlike AIN, will not occur after 1st dose. |
| Toxin-mediated renal insufficiency sx | Uremic sx, no fever, no rash |
| Toxin-mediated renal insufficiency dx | Sx by exclusion, may find specific toxin by hx |
| Toxin-mediated renal insufficiency tx | Dependent on drug |
| Atheroembolic disease of the kidneys cause | Multiple small infarction of renal parenchyma, genarally secondary to recent vascular prosedure |
| Atheroembolic disease of the kidneys sx | Uremix sx, signs of vascular congestion(bluish discoloration, livedo reticularis) blue/purplish skin lesions |
| Atheroembolic disease of the kidneys dx | Hx, clinical |
| Atheroembolic disease of the kidneys tx | No tx |
| Rhabdomyolysis causes | Trauma, snake bites, seizures, crash injuries |
| Rhabdomyolysis dx | Always first EKG and CMP to check K, then UA to check myoglobin, RBC+, cinfirm w/ CPK level |
| Rhabdomyolysis tx | Icu admission, if elevated k w/ EKG changes (peaked T waves) admininstier calcium glucanate, hydrate saline pt, along w/ osmotic diuretic( mannitol) and alkalinization w/ sodium bicarbonate |
| Renal insufficiency secondary to multiple myeloma causes | Patholgic B cell clonal population in MM results in excessive production of bence jones protien wich cause tubular damage |
| Renal insufficiency secondary to multiple myeloma dx | 24 hr urine protein |
| Crystal mediated renal insufficiency cause | Oxalate and urate crystales (stones) |
| Crystal mediated renal insufficiency sx | Uremic sx, poising, elevatef anion gap metabolic acidosis |
| Crystal mediated renal insufficiency dx | Hx (sweet odor on breath, found unrespnosive, suicidal, pt undergoing chemotherapy) must get UA and see stones |
| Crystal mediated renal insufficiency tx | Hydration and for oxalate IV ethanol or fompezole and dialysis. For urate alkalinization w/ soudim bicarbonate |
| Renal insufficiency secondary to hypercalcemia cause | Calcium stones, usually in pt w/ hyperparathyroidism |
| Renal insufficiency secondary to hypercalcemia sx | Bone pain, osteoporosis, abdominal pain, constipation, polyuria, polydipsia |
| Renal insufficiency secondary to hypercalcemia dx | Uremic sx in pt w/ hyperparathyroidism |
| Renal insufficiency secondary to hypercalcemia tx | All pt w/ hyperparathyroidism and decreased renal function should be surgical treatment ( parathyroidectomy) |
| Papillary necrosis cause | Pt w/ DM cirrhosis or SCD following ingestion of acetaminophen or NSAID |
| Papillary necrosis sx | Fever and flank pain |
| Papillary necrosis dx | 1st get UA red , white cell and may necrotic kidneys tissue, most accurate test is CT |
| Papillary necrosis tx | Stop offending agent |
| Wegener granulomatosis def | Multisystemic vascular disease characteristics by prominent renal, respiratory and skin involvement |
| Wegener granulomatosis sx | Anemia, sinusitis, otitis media, mastoiditis |
| Wegener granulomatosis dx | Best initial test is C-ANCA |
| Wegener granulomatosis tx | Prednisone and cyclophosphamide |
| Churg- straus syndrome def | Asthma, eosinophelia > 10% |
| Churg- straus syndrome dx | P-ANCA |
| Churg- straus syndrome tx | Prednisone and cyclophosphamide |
| Goodpasture syndrome def | Present with lung and kidney but there is no skin or GI issues |
| Goodpasture syndrome dx | First step AntiGBM levels, accurate biposy renal or lung |
| Goodpasture syndrome tx | plasmapheresis and steroids |
| Polyarteritis nodosa px | Can involve any organ |
| Uremia px | Metabolic acidosis, fliud overload, encephalopathy, hyperklaemia, pericarditis |
| Most common cause of ESRD | Diabetes and hypertension |
| Classifyng CKD | Stage 1 - GFR = 90-120. Stage 2= 60-89.Stage 3 = 30-59. Stage 4 = 15-29. stage 5 <15 (ESRD) |
| Manifestation of renal failure | Anemia, hypocalcemia, osteodystrophy, bleeding , infection, pruritus, hyperphophatemia, hypermagnesemia |
| Tx hyperphosphatemia | Sevelamer , lanthanum |
| Syndrome of anappropriate ADH (SIADH) def | To much ADH secretion, over-reabsorption of h2o resulting in decreased plasma concentration of sodium |
| Syndrome of anappropriate ADH (SIADH) causes | Infection, tumors, antidepressants, haloperidol, carbamazpeine, chemotherapeutics |
| Syndrome of anappropriate ADH (SIADH) tx | Demeclocycline or lithium |
| Mangment of hyponatremia | Mild - no symptoms- restrict fluids. Moderate- minimal confusion- saline and loop diuretic. Sever- lethargy, seizure, coma- hypertonic saline 3% |
| Complications of tx hyponatremia | Central pontine myelinolysis, osmotic demyelinization |
| Diabetes insipidus tx | Administrator ADH |
| Hypokalemia causes | Vomiting, diuretics, insulin, high aldosterone, hypomagnesemia, any kind of alkalosis |
| Hyperkalemia causes | Salt-replacement, acidotic state, any kind of renal failure, low aldesterone ( addison), rhabdomyolysis, pt on KCL drip |
| Hypokalemia px | Weakness , paralysis, loss of reflexes |
| Hypokalemia ECG | Flattend t wave and st depression |
| Hypokalemia mangment | If asymptomatic- oral potassium replacement. Otherwise maintenance fluids w/ kcl . Replacment magnisum if low, monitoring k. |
| Hyperkalemia EKG | Peaked t wave, wide qrs, pr prolngation |
| Hyperkalemia mangment | Abnormalities EKG- IV calcium chloride,fluids and add glucose and insulin. Bicarbonate. Diuretics-kayexalate. Dialysis |
| Nephrolithiasis sx | Flank pain radiating to groin |
| Nephrolithiasis tx | 1st step paind medication ( ketorolac) |
| Nephrolithiasis labs | Spiral ct, ua , check calcium, HTN |
| Nephrolithiasis <5 mm | Can pass on own, strain urine . > 7 mm surgery |
| Nephrolithiasis 5-7 mm | Nifedipine + tamsulosin |
| ↓Ca | numbness, Chvostek or Troussaeu, prolonged QT interval. |
| ↑Ca | bones, stones, groans, psycho. Shortened QT interval. |
| ↓K | paralysis, ileus, ST depression, U waves. |
| ↑K | peaked T waves, prolonged PR and QRS, sine waves. |
| Acute Renal Failure def | >25% or 0.5 rise in creatinine over baseline |
| prerenal Acute Renal Failure def | BUN/Cr ratio >20/1. FENA < 1% . diuretic measure FENurea?is <35% |
| prerenal Acute Renal Failure tx | tx Prerenal causes, tx w/ fluids |
| “terminal hematuria” + tiny clots? | Bladder cancer or hemorrhagic cystitis (cyclophosphamide!) |
| Painless hematuria? | Bladder/Kidney cancer until proven otherwise |
| Best 1st test? | Urinanalysis |
| Dysmorphic RBCs or RBC casts? | Glomerular source |
| Definition of nephritic syndrome? | Proteinuria (but <2g/24hrs), hematuria, edema and azotemia |
| 1-2 days after runny nose, sore throat & cough? | Berger’s Dz (IgA nephropathy). MC cause. |
| 1-2 weeks after sore throat or skin infxn? | Post-strep GN- smoky/cola urine, best 1st test is ASO titer. Subepithelial IgG humps |
| Hematuria + Hemoptysis? | Goodpasture’s Syndrome. Abs to collagen IV |
| Hematuria + Deafness? | Alport Syndrome. XLR mutation in collagen IV |
| Henoch-Schonlein Purpura. IgA. Supportive tx +/- steroids | Kiddo s/p viral URI w/ Renal failure + abd pain, arthralgia and purpura. |
Created by:
Drsakhnini