CMS 3: Nephro

Pt is on HCTZ for HTN, what part of the nephron is it working on

Distal covolulted tubule

What GFR calculation can be used if serum Creat is normal

Cystatin C

Best overall index of kidney function

GFR

When would you order a non contrast CT?

Kidney stones or a hemorrhage

How to calculate osmolarity

2 x (Na + glucose/18 + BUN/2.8)

Normal osmolarity gap

<10

Measured vs calculated osmoles

At what lab value do patients become symptomatic with hyponatremia

<120

Causes of euvolemic hyponatremia

SIADH

Causes of pseudohyponatremia

Hypertriglyceridemia and multiple myeloma

Causes of hypovolemic hyponatremia

Loss of fluid (burns/hemorrhage/diuretics)

Causes of hypervolemic hyponatremia

CHF, nephrotic syndrome, cirrhosis

What drug can cause DI

Lithium

Causes normovolemic hypernatremia

DI / insensible losses

MCC of hypernatremia

hypovolemic hypernatremia

Diarrhea / vomitting

MCC of HAGMA

DKA

Lactic acidosis

MCC of NAGMA

Rental tubular acidosis

Diarrhea

What are isotonic fluids you can use to expand the ECVF

NS and LRs

What can correction of hyponatremia with 3% NS lead to if done too quickly

CPM

Know acid base im sure there's gonna be one

:)

What acid base disorder is the result of an aspirin overdose

Respiratory alkalosis + metabolic acidosis

What is seen on UA in nephrItic syndrome

-hematuria +/- casts

-Dec GFR

-mild proteinuria

Low pH, low CO2, and low bicarb would be what acid base disorder

Metabolic acidosis

Low pH, high CO2 and low bicarb would be what acid base disorder

Respiratory acidosis

How do you know if a acid base disorder is compensated

Winters formula (just look to see of CO2 and pH are close)

Close = compensated

Pt presents with a puffy face, and dark, brown ish urine 2 weeks after strep throat. What do you expect to see on UA?

Post infectious GN >>>

-RBC casts

-Proteinuria

MCC of acute GN

IgA nephropathy

Presents with URI (24-48 hrs)

GS diagnosis of IgA nephropathy

Renal Bx

Pt presents with painless hematuria, runny nose, and a cough. What’s the Dx?

IgA nephropathy

HTN, edema, and hematuria are associated with what type renal dz

NephrItic

What presents with GN and hemoptysis

Goodpastures:

- GN & pulm hemorrhage

Confirmation dx for goodpastures

Anti-GBM ab

Hallmark of nephrotic syndrome

peripheral edema

What will you see on UA and labs for nephrotic syndrome

-proteinuria

-Maltese cross (lipiduria)

-hypoalbuminemia

How do you treat proteinuria

Ace or ARBs

MCC of nephrotic syndrome in kids

Minimal change disease

Tx with prednisone

What is membranous nephropathy associated with

-occult neoplasms

-renal vein thrombosis

What are triggers of focal glomerular sclerosis

-heroine abuse

-HIV

MCC of ESRD in US

diabetic nephropathy

GS Dx of renal artery stenosis

Renal angiogram

What microscopic findings will you see in chronic tubulointerstital disease

PMN (eosinophil) infiltration

MCC of chronic tubulointerstial dz

Obstructive uropathy

MCC of renal failure

prerenal azotemia

>> caused by volume depletion

Know the urine na values for surgery too

:)

Low urine Na

Pre renal

High urine Na

Intrinsic (FeNa >1%)

Post renal (FeNa >4%)

MCC of post renal azotemia in men

BPH

Causes of intrinsic AKI

-ATN

-acute intestinal nephritis

-acute GN

Muddy brown granular casts

acute tubular necrosis (ATN)

At what stage of renal failure should you initiate dialysis

Stage 5

Cr >8 or >6 in DM

ESRD causes what acid base disorder

Metabolic acidosis

Broad waxy casts

CKD

What type of stone will not be seen on KUB

Uric acid

What should you screen for in a person with polycystic kidney disease

Berry aneurysms via CT/MRI/Angiogram

What protein is seen in healthy pts bc of its defense properties

Tamm-horsfall glycoprotein

MCC of UTI

E. coli

MCC of UTI in sexually active female

Staph sapro

WBC casts in urine

Acute pyelonephritis

TX with FQ

MC type of kidney cancer

renal cell carcinoma

Horseshoe kidney increases ones risk for what

Wilms tumor

MC childhood abdominal malignancy

Wilms tumor