nephrology

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Author:
pszurnicki
ID:
275031
Filename:
nephrology
Updated:
2014-05-22 15:47:36
Tags:
nephrology
Folders:
nephrology
Description:
nephrology
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  1. differences between acute and chronic kidney injury
    acute--normal size, normal Hct, normal calcium
  2. what tests are done for renal cases
    • urinanalysis
    • chemistry
    • renal ultrasound
  3. bun/cr ratio is post renal azotemia
    >15:1
  4. what causes hemorrhagic cystitis
    cyclophosphamide
  5. what are the 4 causes of toxin induced renal insufficiency
    • contrast
    • amphotericin
    • aminoglycosides
    • chemotherapy
  6. most accurate test for allergic interstitial nephritis?
    • wright stain
    • hamsels stain for eosinophils
  7. most accurate test for rhabdomyolysis
    urine myoglobin
  8. on ccs cases for rhabdomyolysis
    • urine myoglobin
    • ua with microscopy
    • serum k
    • serum ca
    • chemistries
    • serum cpk
  9. what to order for a contrast induced renal failure
    magnesium levels
  10. rx for rhabdomyolysis
    • fluids
    • mannitol
    • bicarb
  11. best initial test for crystal induced renal failure
    best initial rx
    • ua
    • ethanol or fomepizole with immediate dialysis
  12. how to prevent contrast induced renal failure
    • fluids
    • bicarb
    • n-acetyl cysteine
  13. what type of damage can be done with nsaids
    • atn
    • allergic interstitial nephritis
    • nephrotic syndrome
    • afferent arteriolar vasoconstriction
  14. best initial test for good pastures
    most accurate
    • anti-basmeent membrane antibodies
    • most accurate is biopsy showing linear deposits
  15. rx for good pastures
    plasmapharesis and steroids
  16. best initial test for church strauss
    most accurate
    • cbc with eosinophilia
    • biopsy
  17. best initial rx for churg strauss
    if not responsive
    • steroids
    • cyclophosphamide
  18. best initial test for wegeners
    most accurate
    • anca antibodies
    • biopsy
  19. best initial rx for wegeners
    • cyclophosphamide
    • steroids
  20. best initial test for pan
    most accurate
    rx
    • angiography of abdominal vessels
    • biopsy
    • cyclophosphamide and steroids
  21. who gets painless recurrent hematuira aka iga nephropathy?
    best initial test-
    most accurate
    rx
    • IgA nephropathy--Berger's diseas
    • none
    • biopsy
    • steroids for acute episodes(worsening)
    • ace for proteinuria
    • fish oil may delay progression
  22. rx for all proteinurias
    ace inhibitors
  23. best initial test for hsp
    • purpura
    • abdominal pain
    • joints
    • hematuria
    • presentaiton of gi, renal, skin , join is best clue
    • biopsy
  24. rx for hsp
    nothing, self resolving
  25. best initial test for psgn
    • anti-streptolysin
    • anti-hylarunidase
    • anti-dnase
  26. rx for psgn
    • antibiotcs
    • control htn and fluid overload with acei and diuretics
  27. rx for cryoglobulinemia
    • ribavarin
    • interferon
  28. how does cryoglobulinemia present
    best initial test
    • renal involvement
    • joint pain
    • purpuric lesions

    cryoglobulin component levels--igM and low c4
  29. best initial for lupus nephritis
    most accurate
    • anti-dsdna
    • anti-smith

    biopsy here is neccessary to determine the extent of injury
  30. lupus nephritis biopsy showing
    sclerosis
    mild
    severe
    • sclerosis-nothing
    • mild--steroids
    • severe--mycophonetil and steroids
  31. how is nephrotic syndrome defined
    best initial test for nephrotic
    accurate
    • hyperproteinuria
    • hyperlipidemia
    • edema
    • thrombois due to antithrombin, protein c, 
    • urinalysis showing high protein
    • urine spot protein: creatinine ratio of 3.5:1
  32. who gets membranoproliferative
    minimal change disease
    focal segmental
    mesangial
    membranous
    • hep c
    • kids
    • hiv blacks, heroin
  33. best initial therapy for primary causes of nephrotic syndrome
    steroids
  34. if nephrotic syndrome doesnt get better after 3 months, next step
    cyclophosphamide
  35. next step in a pt with proteinuria
    repeat ua
  36. reasons for mild proteinuria transient
    chf, fever, exercise, infection,
  37. how do you work up orthostatic proteinuria
    split urine protein--collect in the am and then in the afternoon
  38. if there is no orthostatic or other reasons for proteinuria, next step
    • do spot protein:cr ratio, if >3.5:1
    • do biopsy
  39. dialyzable drugs
    • lithium
    • ethylene glycol
    • aspirin
  40. how are compications of uremia like
    high phosphate
    anemia
    high mg
    low ca handled
    • calcium acetate, calcium carbonate, sevelamer
    • epo
    • mg restriction
    • vit d supplementation
  41. 3 causes of nephrogenic insipidus
    • hypokalemia
    • high ca
    • lithium toxicity
  42. rx for hypernatremia
    bolus ns
  43. dx of central and nephrogenic di
    decrease in amount of urine and increase in osmolality of urine iwht central and administration of ddavp
  44. causes of hypervolemic hyponatremia
    euvolemic
    hypovolemic
    hypervolemic--chf, nephrotic, cirrhosis

    euvolemic---siadh--hypothyroid

    hypovolemic--diuretics, vomiting, diarrhea, burns and sweating, addisons
  45. rx for hyponatremia from adh from cancer
    demeclocycline
  46. adh blockers
    • tolvaptan
    • conivaptan for rx of euvolemic hyponatremia
  47. aldosterone
    bb
    spironolactone
    insulin
    tmp-smx
    aceI
    digoxin
  48. what is hte sequence of ekg changes from high k
    • high t wave
    • no p wave
    • wide qrs
  49. causes of high mg
    effects of high mg
    • kidney failure
    • ingestion of mg containing laxatives

    • muscular weakness
    • loss of deep tendon reflexes
  50. rx for high mg
    • saline
    • restricting of mg intake
    • dialysis
  51. causes of low mg
    low mg causes
    • loops
    • alcohol withdrawal
    • gentamycin
    • cisplatin

    low ca and cardiac arrhythmias
  52. what electrolyte is needed for pth release
    mg
  53. rx for aspirin overdose
    bicarb to alkalanize urine
  54. 2 causes of normal anion gap met acidosis
    • diarrhea
    • rtas
  55. rta 1 vs rta 2 rta 4
    • rta1- cants excrete h in distal tubule
    • rta2- cant absorb bicarb in proximal tubule
    • rta4-- aldosterone deficiency
  56. test for rta 1
    test for rta 2
    test for rta4
    • give iv acid, urine stays basic rta 1
    • give bicarb, urine turns basic rta 2
    • high urine sodium in rta 4
  57. difference between diarrhea and rta
    urinary anion gap is + in rta
  58. test for urge and stress incontinence?
    urge--urodynamic studies

    stress---observe urine leakage with coughing
  59. ccs tests for ht
    • ekg
    • eye
    • cardiac exam
    • urinalysis
  60. bp is not controlled with thiazide
    add another drug
  61. when do you investigate for causes of htn
    htn onset in yougn or old <30 or >60

    refractory to 2 medications
  62. best initial test for renal artery stenosis
    most accurate
    duplex ultrasound

    most accurate renal angiogram
  63. best initial rx for renal artery stenosis
    renal artery stenting and angioplasty

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