Clinical Medcine
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| Oliguria definition | less than 400 mL of urine output in 24 hours
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| Postrenal AKI/acute failure is usually diagnosed by finding _____ on ultrasound. | hydronephrosis
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| muddy brown granular casts found on urine microscopy could indicate what? | ischemic and nephrotoxic ATN
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| 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
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| 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
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| Indications for acute dialysis (AEIOU) | Acid-base disturbances (Severe)
Electrolyte disturbances (ie hyperkalemia)
Intoxications (ie salicylates)
Overload of fluid
Uremic syndrome
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| The descending limb of the LOH is permeable to ___. | Water ONLY
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| The ascending lim of the LOH is permeable to___. | ions only--not water
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| CG equation for eGFR is best used on patients who ____. | have a rapidly changing serum creatinine
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| The MDRD equation for eGFR is best used for patients with ____. | stable serum creatinine levels
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| Restriction of dietary protein will cause an (increase or decrease) in SCr? | Decrease
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| Does obesity affect the SCr level? | No--excess mass is fat and does not contribute to SCr levels.
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| 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.
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| The overall purpose of the RAAS is to increase or decrease blood pressure? | Increase!
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| Site of action of thiazides | block reabsorption of sodium and chloride in the distal convuluted tubule
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| 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!
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| In renal failure, phosphorus excretion is ___ and calcium reabsorption is ___. This causes PTH levels to ___. | reduced, reduced, rise.
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| What are additional conditions that tend to develop in a person with AD polycystic kidney disease? | HTN, berry aneurysms, diverticulosis, mitral valve prolapse
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| Somatostatin can be used as a treatment for what disease? | AD Polycystic Kidney Disease
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| 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)
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| 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)
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| Insulin causes potassium to shift __ cells. | into
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| Beta activation causes K to shift ___cells | into
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| Symptoms of rhabdomyolisis | muscle pain, weakness, dark red-brown urine, elevated CK (usually 5x normal)
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| Test of choice in pregnancy if you suspect nephrolithiasis? | Renal ultrasound
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| 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
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| What is the gold standard for diagnosis of nephrolithiasis? | thin cut spiral CT w/o contrast
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| 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
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| 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
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| Symptoms of hypernatremia | lethargy, spontaneous cerebral bleeds, coma
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| signs/symptoms of hyponatremia | confusion, convulsions, fatigue, HA, muscle weakness, N/V
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| symptoms of hyperkalemia | weakness, paralysis, respiratory failure
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| 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
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| Diagnosis of SIADH | urine osm >100 (concentrated)
No ECFV depletion--euvolemic
Normal thyroid, adrenal, cardiac, hepatic, renal fx
*dx of exclusion
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| What is central diabetes insipidus? | Impaired renal water conservation due to inadequate vasopressin secretion from the neurohypophysis (dilute urine, administer desmopressin and urine concentrates)
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| What is nephrogenic diabetes insipidus? | Insufficient renal vasopressin response (administer desmopressin and there is little to no effect on urine osmolality)
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| Anion gap equation and normal value | Na - (Cl+HCO3) 10-14
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| HTN, proteinuria, urinary RBC casts | Glomerulonephritis!
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| Nephrotic syndrome | Neprhitic+ edema, hypoalbuminemia, hyperlipidemia
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| Oval fat bodies== | Nephrotic syndrome....if in child think Minimal change disease!
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| Renin release is stimulated by: | Decreased BP, decreased flow or decreased NaCL sensed by macula densa, sympathetic stimulation, angiotensin II
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| Thiazide diuretics cause more ___ to be excreted than ___, so they can cause __natremia. | sodium, water, hypo
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| Gold standard for diagnosis of lower UTI | urine culture
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| Nitrate in the urine can indicate infection with gram __ bacteria | negative
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| Alkaline urine promotes ____ crystallization | Calcium-phostphate
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| Acidic urine promotes ___ crystallization | uric acid
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| uric acid + ___urine = uric acid stone | acidic
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| "envelope" urine crystals on pathology | Calcium stones
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| Coffin lid urine crystals on pathology | struvite stones
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| Rosebud/rhomboid/needles on pathology | uric acid stones
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| benzene rings/stop sign crystals on pathology | cystine stones
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| What are some exongenous substances that cause a high anion gap metabolic acidosis with an osmolar gap? | Methanol, ethanol, DKA, isopropyl alcohol, ethylene glycol
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| What is the first clinical sign of chronic kidney disease? | proteinuria
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| A patient with metabolic acidosis is more likely to be ___ kalemic. | hyper
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| NAGMA from GI loss (diarrhea)--> what would the K+ level be? | hypOkalemia--> interesting bc normally metabolic acidosis causes hyperkalemia
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| In type 4 RTA, the patient will be __kalemic. | hyper
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| In type 1 or 2 RTA, the patient will be ___kalemic. | hypo
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| Type 1 RTA pathophys | failure of H+ secretion in the distal tubules
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| Type II RTA pathophys | Failed bicarb reabsorption in the proximal tubules
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| What is the IPSS profile? | Used to assess severity of BPH symptoms
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| Treatment of acute bacterial prostatitis | FQ or bactrim for 30 days
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| 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.
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| In your patient with epididymitis, would you expect the cremaster reflex to be present or absent? | present!
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| 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
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| When a hydrogen ion is secreted, a ___ is reabsorbed. | bicarbonate
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| Metabolic alkalosis is chloride ____ if the urine chloride is less than 10 | responsive
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| You see a patient with a respiratory rate of 9. What acid base disorder could they be compensating for? | metabolic alkalosis
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| 20-40% of calcium stone formers are deficient in ___. | citrate--> an inhibitor of stone formation
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| What is the only type of stone not visible on x ray? | uric acid stones
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| Treatment of hypercalciuria | HCTZ to reclaim Ca, low sodium diet
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| Treatment of hypocitraturia | increase dietary citrate, potassium citrate supplement
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| How to treat hyperuricosuria in a patient with frequent uric acid stones | allopurinol, low purine diet, alkalinize the urine
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| Indications for UTI prophylaxis | 2 or more symptomatic UTIs within 6 months, or 3 or more in a year
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| 2/3 of total body water is in the ____ | intracellular compartment
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| etiology of hypertonic hypOnatremia | consider hyperglycemia
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| Isotonic hyponatremia | pseudohyponatremia due to high lipids or protein (facticious low sodium level)
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| Hypotonic hyponatremia where the patient is hypovolemic | vomiting is a possible cause
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| Hypotonic hyponatremia where the patient is eurvolemic | SIADH--rule out all other possibilities first
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| Hypotonic hyponatremia where the patient is hypervolemic | Cirrhosis, renal failure
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| Treatment for CRITICAL hyponatremia | 3% NaCL in the ICU SLOWLY to avoid cerebral demyelination
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| Name some causes of hypernatremia | osmotic diuresis from glucose, diabetes insipidis (urine osm<150)--central or nephrogenic
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| If you have primary adrenal insufficiency, are you at risk for hyper or hypokalemia? | hyperkalemia
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| If you have hyperaldosteronism, are you at risk for hyper or hypo kalemia? | hypokalemia
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| 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
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| 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
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| Hypokalemia with urine K less than 20 means: | k loss is extra renal-->diarrhea, laxative abuse, decreased intake, GI fistula
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| 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.
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