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Nephrology-IM

IM

QuestionAnswer
What are the three main causes of Acute kidney injury? Pre-renal, intrinsic renal, post-renal
What are the causes of pre-renal kidney injury? Hypovolemia, CHF, peripheral vasodilation, renal artery partial obstruction, cirrhosis, hepatorenal syndrome, ACE-I, NSAIDS
What are the causes of intrinsic renal injury? ATN, Glomerular disease, vascular (TTP, HUS), intersitial disease
What are the causes of post-renal kidney injury? increase tubular pressure with intact renal blood supply. Obstruction due to BPH, stones, CA.
What are some of the signs of chronic kidney disease? CV(HTN, CHF, uremic pericarditis), GI(N/V, anorexia), neuro(lethargy, confusion, seizures), Heme(normocytic, platelet dysf), endo(hypoCa, pruritis), electrolytes(hyperK/Mg).
What is the treatment for chronic kidney disease? ACE-I to decrease proteinuria, oral Ca, EPO, pruritis(capsaicin cream, cholestyramine, UV light).
Under what circumstances would you do dialysis(acutely)? "A-E-I-O-U" -->acidosis, electrolyte abnormality(HYPERKALEMIA), Ingestion of substances (like barbiturates, salicylates, lithium, methanol), Overload fluid (unresponsive to diuretics), Uremia symptoms (pericarditis, encephalopathy)
When is hematuria considered abnormal? When 3 RBC/hpf
How can you tell if hematuria is glomerular or non-glomerular? Glomerular=dysmorphic RBCs, RBC casts, and proteinuria. Non-glomerular=isomorphic RBCs, no protein or RBC casts
Exam Q: given a pt. with hematuria that show up as dysmorphic RBCs, casts and also have proteinuria. They give you a C' value which is low. What are the possible causes? "MISCC"=Membranoproliferative GN, Infection(post strep), SLE, Cryoglobulinemia, Cholesterol emboli syndrome.
EXAM Q: Pt. is given an antibiotic medication and presents with the following triad--> rash, fever, eosinophils and blood in urine. Whats the diagnosis? Allergic interstitial nephritis-->drug rxn to PCN, NSAIDS, diuretics, anticoagulants, phenytoin, sulfa
By what age will pts with ADPKD experience end stage renal disease? 50% of pts will have it by the late 50s-60s
Pt presents with Hematuria, abd pain, HTN, and palpable kidneys. The pt tells you that his uncle had a brain aneurysm when he was 50 yrs old. DX? ADPKD
How do you diagnose ADPKD? US
What is Medullary sponge kidney? Cystic dilation of collecting ducts; +/- hematuria, UTIs, stones
How do you diagnose Medullary Sponge kidney? IVP=intravenous pyelogram
What is the mcc of secondary HTN? Renal artery stenosis
What are the 2 main causes of Renal artery stenosis? Atherosclerosis(older) or Fibromuscular dysplasia(young women-->bilat in 50%).
Exam Q: Pt. comes in with HTN, renal failure and abd bruit. Diagnosis? Renal artery stenosis
EXAM Q: pt comes in with HTN hematurian, flank pain and worsening renal function. Diagnosis? Renal vein thrombosis
How do you diagnos renal artery stenosis? renal arteriogram vs. MRA or captopril renal scintogram
How do you diagnos renal vein thrombosis? renal venography or IVP
EXAM Q: Pt. presents with flank pain radiating to the testical/labia. Diagnosis? Nephrolithiasis
Which kidney stones are radio-opaque? Calcium (bipyramidal or biconcave) and struvite(rectangular prisms)
Which kidney stones are radiolucent? Uric acid (flat squares) and Cystine (hexagon-shaped crystals)
Which kidney stones will show up on XRAY? calcium and struvite
Which kidney stones will show up on CT? Most sensitive for all stones
When do you need to consult urology in a pt who has kidney stones? If a pt has CT and is found to have stone >1cm they are unlikely to pass spontaneously and you need to consult urology
95% of prostate cancers are ________carcnioma? Adenocarcinoma
Should men have PSA screening? Controversial. PSA testing should be discussed with the patient about the pros and cons of PSA testing.
How do you diagnose Prostate cancer? DRE +/- PSA
What is the next step when you have a PSA>10 in a patient you have decided to screen? Transrectal US biopsy.
Hematuria, abd/flank pain, abd mass, fever, wt. loss, polycythemia, anemia. DIAGNOSIS? Renal cell cancer
What are the major risk factors for renal cell cancer? Smoking, Phenacetin, ADPKD, ESRD
How does Renal cell cancer metz? hematogenously
90% of bladder cancers are __________cell Transitional cell
Hematuria +/- dysuria/frequency. Diagnosis? Bladder cancer
When should you investigate hematuria? ALWAYS
Pt. is found to be hyponatremic-->next step? Look at BP-->if its low then get a urine Na.
Pt. is found to be hyponatremic-->you find that they are hypovolemic-->so you get a Una-->it's found to be high. What does that mean? It means that the kidney is not working properly. If a pt. is hyponatremic and volume down the kidney should be saving Na+. Another problem could be that the patient is taking too many diuretics.
Pt. is found to be hyponatremic-->you find that they are hypovolemic-->so you get a Una-->it's found to be low. What does that mean? This means that the kidney is doing its job and saving Na+ since the body is low in Na+. It means the the Na+ is being lost by other means-->N/V/D.
What will the Una be in a patient that has hyponatremia-hypovolemia which is due to extrarenal losses? Una<10
What will the Una be in a patient that has hyponatremia-hypovolemia which is due to ATN, diuretics? Una>20
What is the mcc of a pt with Hyponatremia-Euvolemia? SIADH-->Una >40
What are the causes of Hyponatremia-Hypervolemia? CHF, nephrotic syndrome, cirrhosis
What is the cause of Hypernatremia (in general)? Loss of water (extrarenal loss such as Skin, lungs, GI) or retention of Na+ (high Na intake, mineralocorticoid excess)
What is the treatment for hypercalcemia? NS(causes calciuresis), Bisphosphinates, Calcitonin, Steroids if Vit D excess,
What are the 2 general causes of hypocalcemia? Absence of PTH effect or Absence of Vit D effect
What are the main causes of hypokalemia? GI losses low Uk <20, renal losses high Uk >20, decreased intake, intracelluar shift (insuline, B2 agonists etc).
What will the EKG look like in a patient with hypokalemia? T waves flattened or inverted-->U waves
What physical exam findings might you find in a pt with hypokalemia? decreased DTR's, weakness
Treatment of hypokalemia? Oral KCL, if K< 2.5 or arrhythmia, IV KCL slowly
What are the general causes of hyperkalemia? High total body K(renal failure, addison's, spironoloactone), Redistribution (acidosis), pseudohyperkalemia
What wil lthe EKG look like in hyperkalemia? Diffuse peaked T waves-->long QT-->long PR-->P loss--> sign wave
How do you treat a pt with severe hyperkalemia (>7) or pt who has EKG changes? give calcium first b/c at cellular level that will counteract K+ effect on depolarization. Then after you save their heart acutely-->do dialysis for K+
Pt. comes in with weakness and their EKG shows flattened T wave. What is the next step in managment? order serum K+
Pt with DKA has hyperkalemia. How do you correct this? You need to give K+ when you correct their pH b/c if you don't the K+ will drop dramatically
Causes of High Anion gap? MUDPILES=Methanol, uremia, DKA, Paraldehyde, Iron/INH, Lactic acid, Ethanol/Ethylene glycol, Salicyclates
High anion gap and optic neuritis/retinal edema. Whats the cause? Methanol
High anion gap and high Cr. What's the cause? Uremia
High anion gap and Ketones in urine and blood. What's the cause? DKA
High anion gap and TB prophylaxis treatment. What is the cause? Iron/INH
High anion gap and lactic acid increase. What is the cause? Ischemia some where
Homeless patient with high anion gap and oxalate crystals in urine. What is the cause? Ethanol/Ethylene glycol
High anion gap and initial acute resp alkalosis followed by acute metabolic acidosis. What is the cause? Salicyclates
Diagnosis: Pt with high HCO3, high pH, hypokalemia Metabolic alkalosis
What is the next step in management in a patient who you suspect has metabolic alkalosis? check urine chloride to determine where cl- is being lost. Salt-sensitive (Ucl<10)-->due to V/D
Created by: shelybel
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