Renal USMLE
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| show | prerenal (MC), renal, postrenal (least common)
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| biggest risk ARF | show 🗑
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| show | F, can be oliguric, anuric, nonoliguric
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| key lab values use to difft pre-renal v ATN (renal) causes of ARF | show 🗑
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| how urine sediment is difft bw pre-renal and renal ARF | show 🗑
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| show | renal ARF (specifically glomerular)
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| Causes ATN: MC, other causes | show 🗑
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| show | 1) ATN, 2) glomerular
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| causes of postrenal ARF | show 🗑
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| RBC casts suggests what ARF etiology | show 🗑
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| WBC casts suggests what ARF etiology | show 🗑
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| show | nephrotic syndome (glomerular cause ARF)
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| key causes of prerenal ARF | show 🗑
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| show | NSAIDs, ACEI, cyclosporin
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| show | metabolic acidosis w incrsd anion gap, hi K and P, low Ca and Na + uremia
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| at what level correct acidosis w bicarb | show 🗑
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| when start dialysis for ARF | show 🗑
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| causes of CRF | show 🗑
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| cut offs for severity of CRF | show 🗑
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| at what pt does uremia usu become symptomatic | show 🗑
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| show | 1.5-3 [kidneys are irrev compromised, but not failed]
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| clinical features of CRF by organ system (HTN, GI, CNS, Heme, Lytes, hormone, ID) | show 🗑
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| show | hi K, Mg, P and metabolic acidosis
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| show | bone pain, fractures from incrsd P leading to low Ca++ and 2ry hyperparathyroidism
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| Tx CRF: diet, Rx | show 🗑
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| show | Lytes: hyperP: Ca++ citrate which binds P, prevent 2ry hyperparathyroid by Ca++ and vitD, for acidosis give bicarb; heme: give EPO
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| in ARF which diuretic give | show 🗑
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| show | AEIOU, A=acidosis, E=electrolytes (hi K), I=intoxications, O=overload (hypervol), U=uremia
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| which intoxications use dialysis for | show 🗑
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| show | N/V, CNS: changes in mental status, seizures, **absolute indication=uremic pericarditis
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| show | 1) central catheter to subclavian, 2) A-V fistula, best for permanent access, needs time to mature, listen for bruits to make sure open, 3) implantable graft **Note: blood must be heparinized
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| show | renal synthesis of EPO and vit D
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| show | hypotension; CNS: hyposmol of ECF wrt brain causes N/V, headache; heparin complications; vascular access infxn; amyloidosis b2 microglobulin in bones and joints
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| complications/limitations of peritoneal dialysis | show 🗑
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| what dialysis membrane is used in peritoneal dialysis | show 🗑
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| show | proteinuria= >150mg/d; nephrotic level= >3.5g/d
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| show | proteinuria >3.5g/d, hypoalbumin, hyperlipid, edema, hypecoag (losing anti-coag), infxn (losing Ig)
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| show | 1) glomerular (more protein loss than other categories), 2) tubular, 3) other (UTI, fever, heavy exertion/stress, CHF, preg, orthostatic)
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| tx nephrotic syndrome (general, not etiology specific) | show 🗑
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| key features of nephritic syn | show 🗑
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| show | Post Strep
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| show | min change=steroids, FSGS ? Combo--not clear effective, HIV nephropathy=prednisone, ACEI, HAART
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| MC causes of nephrotic in kids, adults | show 🗑
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| FSGS nephrotic or nephritic? | show 🗑
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| show | membranous
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| what dz: asx mild hematuria/proteinuria that becomes gross hematuria after URI or exercise | show 🗑
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| hematuria w hi freq hearing loss | show 🗑
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| which glomerular dz assoc w HepC and cryoglobulinemia | show 🗑
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| show | 10-14d after infxn, nephritic but also see proteinuria, edema and low complement; usu children, usu self-limited [tx anti-HTN, loop diuretics]
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| show | Wegeners, Goodpasteurs, PAN (+ Scleroderma): Goodpasteurs usu see hemoptysis first; Wegeners has nasal involvement/bldg; PAN has no pul component
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| show | both steroids and cyclophosphamide
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| show | MC=Rx, but can be after infxn esp in children (ie Strep, Legionella), + sarcoid
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| show | ARF, rash, fever, eosinophilia (so seeing eosinophils in urine suggests dx)--note can't always difft from ATN w/o bx but usu don't need bx
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| how are acute and chronic interstitial nephritis difft | show 🗑
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| show | MC=overuse OTC painkillers, (also DM, sickle cell, EtOH, UTI/UTO); dx=excretory urogram
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| how can analgesic nephropathy present | show 🗑
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| show | sloughed pap can obstruct ureter
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| show | 1) acute/chronic interstitial nephritis, 2) renal pap necrosis, 3) renal tub acidosis, 4) hatnup syndrome, 5) fanconis
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| show | RTA1&2=low K, hi Cl, non AG metab acid w alk urine; RTA4=hi K, non AG met acidosis w acidic urine
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| cxns of ea RTA | show 🗑
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| show | RTA1=can't secrete H+ in distal tub; RTA2=can't reabsorb HCO3 in prox tub; RTA4=hypoaldost, distal tb decrsd Na absorb and Na, K sxn
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| show | RTA1=bicarb to prevent stones, P to help acid sxn; RTA2=no bicarb (would just be excreted), Na restriction
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| show | defect: AR aa transporter can't transport Tryp, causing nicotinamide defic; clinical like pellagra dermatitis, diarrhea, + ataxia, psych dz [dementia in pellagra]
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| show | suppl nicotinamide if symptomatic
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| describe defect, clinical pic of Fanconis | show 🗑
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| show | low P leads to rickets, impaired growth, osteomalacia, and path fx bones
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| show | P, K, alkali, salt, hydration
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| what lab value suggests myoglobulinuria or rhabdomyolysis | show 🗑
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| show | hematuria, abd pain, abd mass, HTN, berry aneurysms, cysts in other organs, MVP, colon diverticuli, abd/inguinal hernias
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| dx, tx adult polycystic kid dz | show 🗑
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| show | cystic dilation of collecting ducts, thgt assoc w hyperparathyroid and parathyroid carcinoma
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| show | dx: IVP; presentation: hematuria, UTI, stones; tx:none [stone prevention, tx UTIs]
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| define, tx of simple renal cyst | show 🗑
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| name 4 renal vascular dzs | show 🗑
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| show | 1) atheroscl, 2/3, see in older men w hi chol and smoking; 2) fibromuscular dyspl
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| show | 1) sudden onset of HTN w/o fam hx, 2) refractory HTN, 3) abd bruit
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| show | 1) renal arteriogram w contrast if no RF, 2) MRA if RF, 3) captopril renal scintigram scan if nml renal fxn
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| tx renal arter stenosis | show 🗑
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| show | nephrotic syn, preg, OCP
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| show | 1) benign, thickening of arterioles in long-standing HTN; 2) malignant: rapid decrs renal fxn and incrs HTN in AA men; grtly incrsd BP (papilloedema, cardiac decomp, CNS); rapid incrs Cr, proteinuria, RBC/WBC +/- nephrotic +/- microangiopathic hemo anemia
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| show | nephrotic, often pap necrosis incrsd UTI, if tubules damaged can't concentrate urine leading to dehydration and more sickle events; ACEI can help
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| risk factors for stones, incl MC, dzs, Rx, ID | show 🗑
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| show | 1) Ca++ (MC)=can see, 2) uric=can't see, 3) struvite (ammonium Mg PO4)=can see; 4) cystine=can't see
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| bipyramidal or biconcave oval stone on radiograph=what type? | show 🗑
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| flat sq plate kidney stone=what type? See on radiograph? | show 🗑
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| show | struvite, can see
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| show | cystine, can't see on plain radiograph
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| show | gout, chemo of leuk and lymph
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| what incrses risk of Ca++ kidney stones | show 🗑
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| show | alk urine, UTI w urease bug PESK=proteus, enterobac, serratia, klebsiella
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| show | limit Ca++ intake, thiazide diuretic [for all stones: hydration, pain manage]
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| show | limit protein, allopurinol [for all stones: hydration, pain manage]
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| if urine acidic w stones, what type? Alk? | show 🗑
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| show | struvite (UTI w urease bug)
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| show | if cant control pain w oral meds, renal colic + UTI +/- F, stone >1cm which isn't likely to pass spontaneously
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| 2 procedures for stones won't pass | show 🗑
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| show | upper UTO=renal colic; lower UTO=urination
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| show | intrinsic renal=kidney stones, sloughed papillae, blood clots, tumor; extrinsic=preg, tumors, AAA
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| show | BPH, prostate cancer, bladder cancer
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| show | renal US, IVP (but not in preg, CRF), voiding cystourethrography can be used for lower UTO
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| show | 95% adeno; risk: ***age, AA, high fat diet, fam Hx, herbicides/pesticides
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| show | starts periphery, moves centrally, then obstructive but by this time often mets (can present bone pain, ie lower back)
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| show | 1) DRE (dig rectal exam): abnml -> TRUS (transrectal US) w bx regardless of PSA; 2) PSA>10 or velocity>0.75/yr -> TRUS w bx
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| what can incrs PSA other than cancer | show 🗑
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| stages of prostate cancer | show 🗑
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| show | 1) localized to prostate (A, B)=radical prostatectomy (but older asx men <10yr survival might leave), 2) local invasive=radiation therapy&androgen deprivation; 3) mets=decrs testost (anti-androgen, remove testes, LHRH agonist (Leuprolide))
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| classic triad of renal cell carcinoma presentation | show 🗑
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| what dz has autosomal dominant transmission at risk renal cell carcinoma | show 🗑
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| show | smoking, phenacetin analgesics, adult polycystic kidney dz, VHL, Hg&cadmium exposure
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| show | renal US, f/u CT for staging
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| tx renal cell carcinoma | show 🗑
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| MC genitourinary cancer | show 🗑
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| MC type of bladder cancer | show 🗑
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| tx bladder cancer | show 🗑
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| risks for bladder cancer | show 🗑
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| how does bladder cancer nmlly present | show 🗑
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| show | cytoscopy+bx; CXR and CT for staging
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| show | 0=mucosa (intravesicular chemo), A=lamina propria (transurethral resxn, but recur so rept cytoscopy), B=mscl invasion (radical cystectomy+LN disxn, urinary diversion), C=perivascular fat (same tx as B), D=mets to LN, other sites (cystectomy and chemo)
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| types of germ cell testicular cancers | show 🗑
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| show | germ cell nonseminoma; hemorr/necrosis, mets abd lymph&lungs early, incrsd AFP
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| show | germ cell nonseminoma; most aggressive, usu met by time dx, but rare; incrsd bHCG (but also seen in other testic cancers)
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| qualties of seminoma? Germ cell? | show 🗑
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| qualities of teratoma? Germ cell? Seminoma? | show 🗑
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| show | germ cell, nonseminoma; usu in young boys
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| show | Leydig (sxn hormones causing precocious puberty or gynecomastia, if met poor px), Sertoli (usu benign)
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| show | germ cell (95%) and of those MC is seminoma
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| show | A=testicle/cord, B=retroperitoneal LN spread below diaphragm, C=distant mets
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| difftl for testicular cancer | show 🗑
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| incrsd risk testic cancer | show 🗑
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| incrsd AFP in testicular cancer indicates | show 🗑
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| show | risk: circumcision may protect, HSV, HPV18; peak age 60
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| MC etiologies for epidimytis | show 🗑
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| show | testicular torsion is sudden, testicle elevated in scrotum, no F, usu appears in adolescent
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| effects of Angio II | show 🗑
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| show | JGA rel renin, which cleaves angiotensin (from liver) making AngioI, ACE in lung capillaries cleaves Angio I to make Angio II
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| what's Conn's dz | show 🗑
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| cause, signs/symptoms of primary hyperaldosteron | show 🗑
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| tx primary hyperaldosteron | show 🗑
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| signs, symptoms hypoaldoster | show 🗑
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| definition Addisons | show 🗑
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| when is aldosterone rel? | show 🗑
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| show | incrsd Na reabsorb and incrsd K sxn
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| show | incrs K, decr BP
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| show | thiazide, loop, K+ sparing, carbonic anhydrase
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| show | inhibit Na reabsorb in distal (decrs Na, decrs K); SE: GLUC (incrs glu, lipid, uric, Ca++), sulfa allergy
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| describe loop diuretic mech of action, SE | show 🗑
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| show | works on cortical collecting; SE: incrs K, decrs aldosterone, gynecomastia, hirsutism, sexual dysfxn **don't use in RF
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| describe carbonic anhydrase diuretic mech of action, SE | show 🗑
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| show | inhibits ADH
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| what diuretic use if hi uric? | show 🗑
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| what diuretic use if sulfa allergy? | show 🗑
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| show | acetazolamide
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| show | acetazolamide (carbonic anhydrase inhib), loop, HCTZ
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| which diuretic works on PCT? Distal tubule? TAL? | show 🗑
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| show | K+ sparing (where aldosterone acts)
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| what's the order of the portions of the tubules that diuretics act? | show 🗑
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| show | HCTZ (and loop)
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| don't use loop diuretic with what antibiotic? | show 🗑
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| what's the name of a K= sparing diuretic | show 🗑
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| what's the name of a loop diuretic | show 🗑
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| what diuretic use in nephrogenic diabetes | show 🗑
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| if pt on digoxin, which diuretic? | show 🗑
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| in CHF use what diuretics | show 🗑
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| show | hypoCa (not making 1,25 vitD), Hyper K, Mg, and P, Hypovol Hypotonic HyperNa
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| how treat electrolyte abnmlties in CRF | show 🗑
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| show | post infxn, IgA, Wegeners, Goodpasture, Alports
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| What's Berger's | show 🗑
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| show | s/p URI and GI infxn in young men
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| renal bx: lumpy bumpy | show 🗑
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| C3 is decrsd in which nephropathy? Nml in which? | show 🗑
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| show | Wegeners: hi dose corticosteroids, Goodpastures: plasmaphoresis, pulse steroids
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| what Alports? (ie age, other assoc anomalies) | show 🗑
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| Alports bx findings? | show 🗑
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| tx IgA nephritic syndrome | show 🗑
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| MC cause nephrotic in kids? | show 🗑
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| bx min change dz | show 🗑
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| tx min change dz (nephrotic)? Post infxs nephritic? | show 🗑
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| demographics assoc focal segmental nephrotic | show 🗑
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| bx findings: sclerosis of capillary tufts | show 🗑
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| membranous nephropathy: nephritic? | show 🗑
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| MC cause nephrotic in caucasian adults? | show 🗑
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| bx membranous | show 🗑
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| bx DM nephropathy | show 🗑
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| show | both
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| bx Lupus nephropathy | show 🗑
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| what dz has Congo red stain on renal bx | show 🗑
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| show | mltpl myeloma or chronic inflamm (I.e., RA, TB)
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| what 2 dzs can cause nephrotic and nephritic? | show 🗑
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| show | tram track BM
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| show | Hep C, Lupus, cryoglobulin, SBE
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| show | proteinuria >3.5g/d, decrsd albumin, edema (classically periorbital in the am), incrsd lipid
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| lab findings of nephritic | show 🗑
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| difft patterns of deposits on bx | show 🗑
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| show | GBM splitting=Alports; tram track=membranoprolifer
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