NEPHROLOGY

created w/ the use of step 3 dorian ANKI flashcards as well as answers to questions. This list is not exhaustive for step 3 studying, but simply the terms/information that was commonly missed in questions or information that was pertinent enough to warrant review numerous times. More obviously known things were not included

what electrolyte disturbance is possible in a patient that comes to the emergency department w/ respiratory distress 2/2 asthma exacerbation

hypokalemia secondary albuterol usage

for management of HTN and initiation of ACEi or ARB, reassessment of labs in 2-4 weeks is needed and up to ___ % increase in Cr is acceptable since it is expected that there will be a slight bump in Cr

30% (but will need to decrease dose or discontinue the med if there is more significant increase in Cr seen and if there is hyperkalemia seen, may also need to add a loop diuretic temporarily)

in patients w/ acquired b/l kidney cysts, what is the best management?

annual kidney ultrasounds to evaluate for possible end stage kidney dx since these patients are at increased risk for renal cell carcinoma

patients with nephrotic syndrome and hypoalbuminemia are at increased risk for:

venous thromboembolism within the next 12 months

what is the likely diagnosis in a euvolemic patient w/ low serum osmolality, high urine osmolality (>100), and high urine sodium (>40)?

SIADH

management of SIADH

fluid restriction and salt tabs (ONLY hypertonic saline for severe hyponatremia)

management/definitive diagnosis for renal cell carcinoma

abdominal CT and partial/complete nephrectomy for histology

definition of nephrotic syndrome level of proteinuria

>3.5 g of protein over a 24 hr period

renal transplant can increase the risk of new onset ___ within the first few months post-transplant

diabetes (due to immunosuppressive regimen)

management of observed exercised-induced hematuria

follow up urinalysis in 1 week (due to repetitive trauma to the bladder during exercise)

management of complete urinary tract obstruction due to a stone + systemic signs

percutaneous nephrostomy (IR call) + retrograde ureteral stent (probably calling urology → will decompress the system and then collect the stone)

what is the size of stone cutoff for conservative management vs urology consultation?

10 mm (less than can use oral fluids/analgesia/alpha blockers to facilitate passage)

hepatorenal syndrome occurs due to..

splanchnic arterial dilation, which results in decreased vascular resistance and activation of the RAAS system

what is the primary management of severe preeclampsia with features of HELLP?

patient will have features of end organ damage as well as severe elevated blood pressure, and low platelets, so initial management is rapid delivery of the fetus via C-section, blood pressure control, IV Mg for seizure prophylaxis

what medication can be used for peptic ulcer dx treatment safely in a patient with stage 4 CKD?

famotidine

PPI’s can cause hypokalemia via:

drug induce hypomagnesemia over a long period of time

immediate treatment for symptomatic hypermagnesemia (such as muscle strength changes, bradycardia, etc…), is

IV calcium gluconate (rapidly antagonizes the cardiovascular and neuromuscular effects of the hypermagnesemia, and this allows time for set up and initiation of dialysis most likely)

what are some of the etiology for hypervolemic hypotonic hyponatremia?

CHF, cirrhosis, and nephrosis

what are some of the etiology for euvolemic hypotonic hyponatremia?

SIADH, glucocorticoid deficiency, and hypothyroid

what are some of the etiology for hypovolemic hypotonic hyponatremia?

GI losses, sweating, diuretics, and decreased aldo

what is the cutoff for serum osm for hypotonicity in evaluating hyponatremia?

<280

potter sequence may be caused by

obstructive uropathy (such as posterior urethral valves: leading to oligohydramnios since cannot urinate out amniotic fluid → pulmonary hypoplasia and other deformities)

what are some absolute contraindications to living kidney donation?

<18 years old, intellectual disability, DM, HTN w/ end organ damage, BMI >35, malignancy

what electrolyte disturbance causes decreased DTRs, cardiac arrest, bradycardia, hypotension, and hypocalcemia?

hyperMg

what low serum concentration causes tetany, seizures, and spasm?

calcium (hypocalcemia causes Chvostek sign or twitching, and spasm, or Trousseau sign)

what is the formula for corrected Ca2+ w/ low albumin

serum Ca2+ + 0.8 (4 - serum albumin)

what is the likely diagnosis in a patient w/ hematuria, progressive renal insufficiency, proteinuria, hypertension, hearing loss, lens protrusion, and renal biopsy shows splitting of GBM?

Alport syndrome (X-linked, mutation of type IV collagen)

what is the likely diagnosis in a patient w/ family hx of isolated hematuria without renal failure or hearing/visual loss?

thin basement membrane nephropathy (aka benign recurrent hematuria)

what test can usually be used to diagnose ADPKD?

ultrasound (this is usually sufficient and obviously less expensive. only use genetic testing if ultrasound testing is unclear)

before CKD patients start receiving EPO therapy, check ___ levels

iron levels (since there may be concomitant iron deficiency anemia and EPO agents can cause rapid depletion of iron stores)

ifosfamide can cause what type of dysfunction to the kidney and resulting electrolyte dysfunction?

proximal renal tubular dysfunction leading to hypophosphatemia (Fanconi syndrome)

after the initiation of chlorthalidone, what would be the next additional treatment add on if that was not sufficient?

ACEi/ARB

in patients with severe CKD, and hyperphosphatemia, the initial step in management is

low phosphate diet (the next step would then be a phosphate binder)

what is the first line therapy for management of IgA nephropathy?

if there are no other complications present and Cr is reasonable, first line is management w/ ACEi/ARB (blockade of renin-angiotensin system)

what is the second-line therapy for patients with IgA nephropathy despite immunosuppression?

mycophenolate mofetil

most appropriate IV treatment for ascending aortic dissection after referral for emergency surgical consultation is placed

IV esmolol or labetalol

___ tubular acidosis is characterized by a NAGMA, hypokalemia, glycosuria, low-molecular-weight proteinuria, and renal phosphate wasting

type 2 (proximal), patients may present w/ weakness and fatigue

management of type 2 proximal renal tubular acidosis

oral potassium citrate (or thiazide diuretics if this is not tolerated or effective)

___ tubular acidosis is characterized by NAGMA, hypokalemia, urine pH >6, and calcium phosphate kidney stones

type 1 (distal) RTA

management of type 1 (distal) RTA

oral sodium bicarb

what organism can lead to a UTI that can precipitate magnesium ammonium phosphate crystals due to increased urine pH seen as coffin-lid shaped appearance under microscope?

urea-secreting organisms such as proteus, klebsiella, and pseudomonas

management of lithium induced arginine vasopressin resistance (nephrogenic diabetes insipidus)

amiloride (blocks the epithelial sodium channel in the collecting tubule and prevents the uptake of lithium in these cells)

what is the SBP criteria for patients on peritoneal dialysis?

>100 cells with at least 50% neutrophils (instead of the typical 250 PMN cutoff). this is because of the cells being constantly washed out → source from IDSA

what is the most common cause of glomerulonephritis in the elderly population?

Wegner’s glomerulonephritis

severe hyponatremia is defined as:

Na <125

acute hyponatremia is defined as:

<48 hr onset