Term
| Cause of non-anion gap/increased chloride acidosis? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| conditions resulting in increased anion gap? |
|
Definition
|
|
Term
| Urinary indices of dehydration? |
|
Definition
Na < 20, FE Na < 1%, BUN:Cr ratio of > 20:1, increased osm (>500) and incr specific gravity (>1.025)
|
|
|
Term
| Tx for hypovolemic shock in a pt that's hypernatremic? |
|
Definition
| .9% saline until BP normal then .45% or D5W stepwise |
|
|
Term
| What if you gave a hypernatremic hypovolemia patient alot of D5W? |
|
Definition
| you'd have a cerebral edema patient |
|
|
Term
| How do you treat acute hyponatremia? |
|
Definition
| act fast, 3% saline at 1-2 mmol/kg/hr and use loop diuretics to help |
|
|
Term
| What is the tx for chronic hyponatremia? |
|
Definition
| correct 10% of sodium first then continue w 1-1.5 mmol/L/hour, remember not too fast (osmotic demyelination) |
|
|
Term
|
Definition
|
|
Term
|
Definition
tetracycline antibiotic that causes nephrogenic DI |
|
|
Term
| What is the treatment for acute and chronic SIADH? |
|
Definition
acute - water restrict, chronic - demeclocycline 300-600 bid and remember it takes 2 weeks to fix
|
|
|
Term
| what are the renal stone sx that warrant emergency care? |
|
Definition
| unrelenting pain, nausea and vomiting, fever and chills |
|
|
Term
| What is the imaging choice for renal stones? |
|
Definition
CT with stone protocol - abd and pelvis with no contrast
|
|
|
Term
| What medication is used to prevent struvite stones? |
|
Definition
| prophylactic antibiotics (remember proteus is most common cause due to urease) |
|
|
Term
| What is the general prophylaxis for all stones? |
|
Definition
| reduce oxalate, Na, animal products, high water and Ca but no CA supplements |
|
|
Term
| What is the immediate, intermediate and long-term treatment for hyperkalemia? |
|
Definition
| immediate - antagonize K with ca gluconate, intermediate - move K into cells with insulin, NA bicarb and albuterol (beta agonist), long term - remove K with dialysis or kayexalate (causes diarrhea) |
|
|
Term
| IV rate of replacement of K shouldn't exceed... |
|
Definition
|
|
Term
| what should you look at if you have abnormal Ca? |
|
Definition
| albumin - every 1 g/dl change in albumin leads to .8 to 1 mg/dl change in Ca |
|
|
Term
| What is the equation for corrected Ca? |
|
Definition
| corrected ca = measured Ca + .8 (4 - albumin) |
|
|
Term
| What is the treatment for a hypercalcemic patient? |
|
Definition
| rehydrate with .9% saline, once hydrated use a loop diuretic, bisphosphonates and calcitonin and steroids |
|
|
Term
| What is the treatment for hypophosphatemia? |
|
Definition
Severe (<1) or moderate on ventilator (2.5 - 1) should get .08 to .16 mmol IV over 2-6 hours, moderate not on ventilator or mild should get 1000 mg oral/day
|
|
|
Term
| What are the spurious causes of hyperphosphatemia that affect it at the lab level? |
|
Definition
heparin, hyperbilirubin, high lipids, and alteplase
|
|
|
Term
| What is the treatment for hypermagnesemia? |
|
Definition
calcium gluconate over 5-10 minutes then dialysis
|
|
|
Term
| What is hypomagnesemia caused by and associated with? |
|
Definition
caused by PPI's, associated wtih hypokalemia
|
|
|
Term
| What is the treatment for chloride responsive alkalosis due to NG suction? |
|
Definition
| NaCl solutions to replace, replace K stores, and PPI to prevent more HCL loss |
|
|
Term
| What is the treatment for chloride responsive alkalosis due to diuretics? |
|
Definition
KCl and K sparing diuretic
|
|
|
Term
| What is the AG dependent on? |
|
Definition
| albumin - an albumin of 2 may have a normal AG of 6 |
|
|
Term
| Normal/hyperchloremic AG may have ____ associated with it while high anion gap does not |
|
Definition
|
|
Term
| What are the causes of anion gap acidosis? |
|
Definition
MCC is metabolic acidosis, also lactic acidosis, starvation ketosis, DKA, methanol, etc
|
|
|
Term
| What is the most common cause of an anion gap greater than 30? |
|
Definition
| lactic acidosis or ketoacidosis due to DKA or starvation |
|
|
Term
| The most common causes of normal anion gap acidosis are... |
|
Definition
| diarrhea, ureteral diversion, renal tubular acidosis where you don't excrete acids |
|
|
Term
| What is type A lactic acidosis due to? |
|
Definition
| hypoxia, low perfusion (COPD and hf) |
|
|
Term
| What is type B lactic acidosis due to? |
|
Definition
| liver or renal failure, propofol use, metformin (should not be used for renal failure patients) |
|
|
Term
| What are the most common causes of renal failure? |
|
Definition
septic shock, major surgery, and hypovolemia
|
|
|
Term
| What is pre-renal ARF due to? |
|
Definition
| hypovolemia/reduced effective circulating volume, which reduces glomerular perfusion, |
|
|
Term
| What should be seen on labs in pre-renal ARF? |
|
Definition
|
|
Term
| what is the tx for pre-renal arf? |
|
Definition
| stop NSAIDs/ARBs/ACEIs, use NaCl to replace fluid lost and tx the underlying cause |
|
|
Term
| kidney size on US in pre-renal ARF is... |
|
Definition
|
|
Term
| What is the big difference between pre-renal and renal ARF? |
|
Definition
| renal ARF you lose ALOT of salt, pre-renal you don't |
|
|
Term
| What are the causes of renal ARF? |
|
Definition
| ischemia/toxins - anything causing you to lose tubule space |
|
|
Term
| what are the labs in renal ARF? |
|
Definition
| osm down, NA up, fe na up |
|
|
Term
| Which type of renal failure has an initiation, maintenance and recovery phase? |
|
Definition
|
|
Term
| What is the imaging and treatment choice for post-renal ARF? |
|
Definition
| ultrasound and stop meds/dialysis |
|
|
Term
| What are the indications for dialysis...? |
|
Definition
| sympomatic uremia, hyperkalemia, fluid overload (things that even after treatment are unresolved and dialysis is the only way) |
|
|
Term
| Which type of hepatorenal syndrome has a worse prognosis? What should be done to tx? |
|
Definition
| type 1, get rid of triggers (NSAIDS, diuretics, diarrhea, hypovolemia, and infection) |
|
|
Term
| What are the diagnostic factors of hepatorenal syndrome? |
|
Definition
chronic/active liver disease, Cr>1.5 OR GFR<40, no shock/fluid loss, no improvement with fluids or albumin, no proteinuria, oliguria, and dilutional hyponatremia
|
|
|
Term
| what is the pharmacologic tx of hepatorenal sydrome |
|
Definition
| midodrine, octreotide and albumin |
|
|
Term
| If an IV drug user passes out and lies on the floor for several days what labs might you expect to find? (with respect to kidney probs) |
|
Definition
| incr CPK, 4+ urine dipstick, 2-5 urine RBCs |
|
|
Term
| Hypercalcemia is assoc with rhabdomyolysis - t/f? |
|
Definition
|
|
Term
| What meds can cause rhabdomyolysis |
|
Definition
| HMG coa reductase inhibitors, gemfibrozil, and fibrates |
|
|
Term
| What is the pharmacologic treatment for treatment of rhabdomyolysis? |
|
Definition
Iv bicarb and mannitol, stop both if not making urine
|
|
|
Term
| What are the factors that decrease renal perfusion? |
|
Definition
| volume depletion, NSAIDs, ACEI, ARBS, and diuretics, diabetics have increased risk |
|
|
Term
| What should be done with a diabetic? |
|
Definition
| stop all relevant meds before a procedure so their kidneys can autoregulate if needed |
|
|
Term
| What prevents contrast nephropathy? |
|
Definition
identify patient @ risk, IV saline bolus, N-acetylcysteine has antioxidant and vasodilatory effects, mixed data but he uses it
|
|
|
Term
| What IV contrast used for MRIs can cause problems? |
|
Definition
| gadolinium, usually rapidly cleared in healthy adults, reanl and liver failure becomes a prob |
|
|
Term
| What is the catastrophic complication that occurs with gadolinium? |
|
Definition
| thickening and hardening of skin starting distally and moving proximally, causing irreversible flexure contractures; gadolinium is abs contraindicated with GFR < 30 and cautioned in GFR 30-60 |
|
|
Term
| Obesity alone can cause kidney disease - T/f? |
|
Definition
|
|
Term
| A patient has normal BP/Cr, urine protein of 1+, and dysfunction of the glomerular BM... |
|
Definition
|
|
Term
| A patient has a urine protein of <1, they're stressed out from exercising so much for a marathon, so you decide to do a 24 hour urine on them after they rest for a bit... |
|
Definition
| mild isolated protienuria |
|
|
Term
| An adolescent shows up with a urine protein of 1.5, and you find in a split 24 hour urine that they're dumping protein during the day when they're up and moving |
|
Definition
|
|
Term
| What proteinuria definitely warrants a biopsy? |
|
Definition
| 3+ unless they're diabetic |
|
|
Term
| What counts as persistent fixed proteinuria? |
|
Definition
| reassess in 6-12 months, and if GFR or BP is abnormal, chekc protein again then if present renal bx... |
|
|
Term
| If a patient has only hematuria where do you send them? |
|
Definition
| urology - renal probs always have proteinuria too |
|
|
Term
| What counts as glomerular hematuria? |
|
Definition
proteinuria >2 a day and hematuria, MCC IgA nephropathy and thin bm nephropahty
|
|
|
Term
| What are the nephrotic syndrome characteristics? |
|
Definition
| protein 3.5 gm/day, edema, hyperlipidemia, hypoproteinemia, |
|
|
Term
| what are the most common causes of nephrotic syndrome? |
|
Definition
| membranous nephropathy, focal segmental GS |
|
|
Term
| what are the causes of hyperlipidemia in nephrotic syndorme pts? |
|
Definition
| increased chol due to overproduction of liver due to decreased oncotic pressure, increased LDL due to decr receptor synth, and increased trig due to decr catabolism |
|
|
Term
| What is different about nephritic syndrome compared to nephrotic syndrome? |
|
Definition
| RBC casts, increased BP/JVD, decreased serum albumin, abrupt onset, increased creatinine, more edema, |
|
|
Term
| What are the MCC of nephritic syndrome? |
|
Definition
| crescenteric/rapidly progressive glomerulonephritis, and IgA |
|
|
Term
| What is the most common HIV assoc nephropathy presentation? |
|
Definition
| african american male with nephritic range protein, renal dxn, normal bp, and large kidney on US |
|
|
Term
| what are the treatment goals in diabetic nephropathy? |
|
Definition
| BP 120/70, LDL <70 and HBA1C of <7 |
|
|
Term
| What is the treatment for proteinuria found in diabetic nephropathy? |
|
Definition
| ACEI or ARB and watch for hyperkalemia, rhabdomyolysis |
|
|
Term
| What are the common clinical findings in TIN? |
|
Definition
| sterile pyuria with WBC casts, triad of fever, rash and eosinophilia, polyuria and nocturia |
|
|
Term
| What is considered classical tin? |
|
Definition
| shows up 10-20 days after drug tx, assoc wtih NSAIDS |
|
|
Term
| What is the treatment for classic TIN? |
|
Definition
| remove offending drug, then do renal bx and tx with corticosteroids/cyclophosphamide |
|
|
Term
| How does minimal change disease appear? |
|
Definition
| effacement of foot processes |
|
|
Term
| What people have a worse prognosis in FSGN? |
|
Definition
| high Cr at dx, increased proteinuria and males |
|
|
Term
| What is the most common cause of nephritic syndrome in adults and how do they present? |
|
Definition
| membranous glomerulopathy, MC is male in his 40s-50s with edema, nephrotic syndrome, possible association with carcinoma, hypercaog state, and proteinuria |
|
|
Term
| What is the presentation of type I membranoproliferative GN? |
|
Definition
| assoc with hep c, children 8-16, hypocomplementemia, tx underlying disease |
|
|
Term
| What is the presentation of type 2 membranoproliferative GN? |
|
Definition
| dense deposit disease, poor prognosis, hypocomplementemia, there's not really a good tx for this one |
|
|
Term
| What are the clinical findings of rapidly progressive glomerulonephritis? |
|
Definition
| nephritic syndrome, hematuria/RBC casts, rapid loss of renal fxn |
|
|
Term
| If a pt presents with microhematuria, no edema and no HTN, 24 hr urine collection shows 1.4 gm protein, what's your dx? |
|
Definition
| IgA nephropathy aka berger's disease, MCC GN worldwide |
|
|
Term
| What is the clinical course of berger's syndrome? |
|
Definition
| asymp hematuria progresses to hematuria then crescenteric GN, Tx with ACE/ARB |
|
|
Term
| What are the prominent ACNAs in wegener's and pauci immune? |
|
Definition
| cANCA and pANCA respectively |
|
|
Term
|
Definition
| IgG abs to GBM, assoc with crescenteric GMN (linear IgA deposits), alveolar hemorrhage, 30-60s, white male, present with lung hemorrhage |
|
|
Term
| What other things come along with uremia? |
|
Definition
| renal osteodystrophy, VitD deficiency, and secondary hyperPTH |
|
|
Term
| What is the tx for uremia? |
|
Definition
| dietary phosphate restriction, phosphate binders/phoslo, vit D supplement, restrict Na/K/water, watch ACE/ARB |
|
|
Term
| What should people with uremia avoid? |
|
Definition
| salt substitutes, NSAIDS, aldo inhibitors, and oral hypoglycemics |
|
|
Term
| How do you dx and tx a coagulopathy? |
|
Definition
| prolonged bleeding time, normal PT, PTT and PT count; EPO takes 7 days to work, cryoprecipitate for acute bleeds, desmopressin, estrogens and dialysis |
|
|
Term
Which of the following doesn't contribute to increased BUN?
a. hypercatabolic state
b. glucocorticoids
c GI bleed
d. severe liver disease |
|
Definition
| d. - severe liver disease will actually cause decreased BUN? |
|
|
Term
| If a patient comes in with a serum calcium of 14 (normal is 8.5 - 10) what should you treat them with after aggressive IV hydration? |
|
Definition
|
|
Term
If a patient comes in with grossly bloody urine after a UTI the most likely diagnosis is...
a. membranous glomerulonephritis
b. focal sclerosis
c. rapidly progressive glomerulonephritis
d. IgA nephropathy |
|
Definition
|
|
Term
| A patient comes into the ER with fever, chills, and purulent urine. He is hypotensive and lethargic, his serum bicarb is 14 (low) and his anion gap is 18 (high), what is the most likely cause of his condition? |
|
Definition
| type A lactic acidosis - his low volume and purulent urine show that this could be shock --> lower circulating volume can lead to ischemia/hypoperfusion |
|
|
Term
The most common cause of acute renal failure in an HIV infected patient is...
a. pre-renal azotemia
b. obstruction
c. acute interstitial nephritis
d. acute tubular necrosis
|
|
Definition
|
|
Term
Which of the following agents will improve the morbidity and mortality associated with acute renal failure?
a. ANP
b. dopamine
c. N-acetylcysteine
d. none of the above |
|
Definition
|
|
Term
| Lasix is beneficial as a prophylactic therapy to prevent dye toxicity... |
|
Definition
|
|
Term
| Treatment of hyperphosphatemia in chronic renal failure involves the use of which of the following? |
|
Definition
|
|
Term
| Which diuretic has the highest potential to cause hypokalemia? |
|
Definition
|
|
Term
the hypertriglyceridemia in nephrotic syndrome is due to which of the following mechanisms?
a. overproduction and decreased catabolism
b. overproduction
c. decreased catabolism |
|
Definition
overproduction and decreased catabolism
|
|
|
Term
Which one of the following drugs doesn't vasoconstrict the afferent arteriole?
a. NSAIDS
b. cyclosporin
c. tacrolimus
d. ace inhibitors |
|
Definition
|
|
Term
| A patient has a kidney biopsy and flattened epithelium, bare BM and intraluminal cell debris are seen, mostly in the proximal tubule and thick ascending limb of henle, what do they have? |
|
Definition
|
|
Term
| What things might decrease the ability of the kidneys to compensate and therefore should be discontinued before any diabetic undergoes a kidney involving procedure... |
|
Definition
|
|
Term
| causes of increased intrarenal vasoconstriction? |
|
Definition
| sepsis, tacrolimus, radiocontrast, hepatorenal syndrome, hyperCa |
|
|
Term
| What are the indications for dialysis? |
|
Definition
| Uremia, hyperkalemia, fluid overload, metabolic acidosis |
|
|
Term
| What is the mortality of ARF? |
|
Definition
| 10-30% in the community, 70-90% in the ICU |
|
|
Term
| What is the defining feature of hepatorenal syndrome? |
|
Definition
| lack of improvement with volume expansion, therefore u need to use drugs |
|
|
Term
| What are the two stages of hepatorenal syndrome? |
|
Definition
| Stage 1 - portal hypertension leads to vasodilation but it's compensated, Stage 2 - portal hypertension so bad it can't be compensated --> RAAS, ADH, SNS activated |
|
|
Term
| What will happen to the urine in hepatorenal syndrome? |
|
Definition
| pee less often/oliguria, bland sediment, Na < 10 |
|
|
Term
| What are the causes of metabolic acidosis associated with a high URINE anion gap? |
|
Definition
|
|
Term
| What are the causes of metabolic acidosis associated with a negative URINE anion gap? |
|
Definition
| diarrhea, external loss of pancreatic/biliary secretions |
|
|
Term
| What are the causes of a low or negative anion gap? |
|
Definition
| hypercalcemia, hypermagnesmia, low Na w SIADH, hypoalbuminemia, other stuff |
|
|
Term
| What is the equation for urinary anion gap? What are the usual values? |
|
Definition
|
|
Term
| A patient comes in breathing heavily, their O2 sat is 92, they have a blood pressure of 70/40, and they can't remember their name. Their sister tells you that they were referred to a nephrologist a while ago for peeing problems and have since started seeing a new doctor who diagnosed them with diabetes and prescribed metformin, what's the problem? |
|
Definition
They were already probably in kidney failure then started taking metformin --> type B lactic acidosis.
|
|
|
Term
| What defines metabolic alkalosis? |
|
Definition
| increase in serum bicarb > 28 mmol/L |
|
|
Term
| What states can lead to chloride depletion alkalosis? |
|
Definition
| gastric losses, diarrhea, Cl deprivation, CF |
|
|
Term
| What are the causes of bicarb excretion that allow metabolic alkalosis to persist? |
|
Definition
| decreased GFR, increased tub reab, cl depl and hypokalemia |
|
|
Term
| What is the equation used to predict PCO2 in metabolic alkalosis? |
|
Definition
| PCO2 = 40 + .7(HCO3 - 24) |
|
|
Term
| A patient comes in with a serum potassium of 2.5, O2 sat of 92, weak voluntary muscle movement and can't remember where they are. They've been vomiting a lot the past couple of weeks, and have been trying to drink water to make up for it but aren't sure if they've been drinking enough (about 2 extra glasses a day). What is they're problem? |
|
Definition
| metabolic alkalosis - losing acid through GI |
|
|
Term
| What is the treatment for chloride responsive alkalosis? |
|
Definition
| depends - could use HCl and PPI for gi loss of acid, could use KCl for diuretics in kidney |
|
|
Term
| what does bartter's syndrome present as? |
|
Definition
| hypokalemia, hypochloremia, due to defective Na/K/2Cl channel |
|
|
Term
| what is gitelman's syndrome? |
|
Definition
| defective channels cause hypocalcemia and hypomagnesemia |
|
|
Term
| What is Liddle's syndrome? |
|
Definition
| increased activity of the collecting duct Na channel, presents as Htn due to volume expansion, hypoK w norm ald |
|
|
Term
| What are the treatments for Liddle's, Bartter's and Gitelman's syndromes? |
|
Definition
| Liddle's - amiloride, Bartter's and Gitelmans' - NAIDS which minimize Cl losses |
|
|
Term
| What is the main mechanism in hepatorenal syndrome? |
|
Definition
| reduction in systemic vascular resistance leads to primary arteriolar vasodilation |
|
|
Term
| What happens in type I HRS? |
|
Definition
incr Cr to 2.5, reduce clearance by half, low survival, 90% mortality by 3 mo
|
|
|
Term
| what happens in type II HRS? |
|
Definition
| slow or insidious onset of reduction in GFR with refractory ascites |
|
|
Term
|
Definition
| Cr >1.5 w GFR < 40, no shock/fluid loss, no improvement with fluids, no proteinuria |
|
|
Term
| how can HRS be prevented in patients with spontaneous bacterial peritonitis? |
|
Definition
| Iv albulim and norfloxacin 400 mg/day |
|
|
Term
| In which patients is stressful exercise more likely to cause rhabdomyolysis? |
|
Definition
|
|
Term
| What form of hyperthermia is found in patients treated with phenothiazides or haloperidol? |
|
Definition
| neuroleptic malignant hyperthermia |
|
|
Term
| What drugs can cause rhabdomyolysis? |
|
Definition
| HMG-CoA reductase inhibitors, gemfibrozil, alcohol, etc |
|
|
Term
| What are the mechanisms of renal failure in rhabdomyolysis? |
|
Definition
| vasoconstriction/dehydration, intraluminal cast formation (tx with NaHCO3), direct heme protein induced cytotox |
|
|
Term
| How can dx of rhabdomyolysis be done? |
|
Definition
| urine myoglobin, CPK, aldolase |
|
|
Term
| What should be given IV to help with rhabdomyolysis? |
|
Definition
| .45% with 2 amps NaBicarb, 15% solution of mannitol at 10 ml/hr |
|
|
Term
| What drugs can be given to prevent and treat the ARF from rhabdomyolysis? |
|
Definition
| allopurinol, pentoxyfilline, control hyperK, hypocalcemia and hemodialysis |
|
|
Term
| what's the change in creatinine needed for contrast nephropathy to be established as a dx? |
|
Definition
|
|
Term
| What things will increase risk for contrast nephropathy? |
|
Definition
|
|
Term
| What's the timeline for contrast nephropathy? |
|
Definition
decline over 3-5 days then return to normal in 10
|
|
|
Term
| What is the tx for contrast nephrotoxicity? |
|
Definition
| .9% saline at 1 ml/kg/hr for 12 hours before and after surgery, acetylcysteine 600 mg 2x daily |
|
|
Term
| What is the disease that gadolinium can cause called? |
|
Definition
| nephrogenic systemic fibrosis |
|
|
Term
| When should gadolinium NOT be used? |
|
Definition
| GFR < 30, GFR 30-60 probably still no, hemodilaysis daily for 3 days in pts with ESRD |
|
|
Term
| what factors are independently associated with proteinuria? |
|
Definition
| high A1C, systolic BP, income |
|
|
Term
| What characteristics regarding lipids are assoc with more rapid CKD progression? |
|
Definition
| low HDL, increased apolipoprotein B and increased Chol |
|
|
Term
| Potentially treatable causes of CRF? |
|
Definition
| analgesic nephropathy, obstruction, lupus, myeloma |
|
|
Term
| If advanced renal failure isn't following the predicted values (1/Cr chart) then what should you do? |
|
Definition
| eval exacerbating factors and probably dialysis |
|
|
Term
| Uremic symptoms associated with advanced renal failure? |
|
Definition
| pericarditis, fluid overload, hyperkalemia, resistent hypertension, uncompensated met acid, declining intellectual fxn |
|
|
Term
| what do you treat renal osteodystrophy with? |
|
Definition
| restrict phosphate, phosphate binders, vit d supplements |
|
|
Term
| When does potassium become a problem in chronic renal failure? |
|
Definition
| when gfr is <10 you should restrict to 60 meq/d |
|
|
Term
| What are some endocrine abnormalities seen with CRF? |
|
Definition
| decreased T4, increased GH, increased insulin |
|
|
Term
| what is the most common manifestation of coag problems with crf? |
|
Definition
| occult GI blood loss --> tx with DDAVP, cryoprecipitate and conj E |
|
|
Term
| what are the 3 products used for uremic anemia tx? |
|
Definition
| epogen, procrit and anaresp |
|
|
Term
| What is the pathophysiology of uremic coagulopathy? |
|
Definition
| dysfunctional vWF, cAMP, uremic toxins, anemia, cGMP |
|
|
Term
| What is cryoprecipitate rich in? |
|
Definition
| vWF, factor VIII and fibrinogen - beneficial in 8-12 hours |
|
|
Term
| What does desmopressin do to help with uremic coagulation? |
|
Definition
|
|
Term
| What do estrogens do to help with uremic coag? |
|
Definition
| decrease L-arg production which decreases NO |
|
|
Term
| What drug was shown to be beneficial for reducing the incidence of doubling creatinine/ESRD in the renaal study? |
|
Definition
|
|
Term
| When the body senses low sodium, what systems return it to normal? |
|
Definition
|
|
Term
| where are the osmotic receptors located? |
|
Definition
| in the anterior hypothalamus |
|
|
Term
| What causes higher ADH levels, hypovolemia or hyperosmolality? |
|
Definition
| hypovolemia, sensed in the carotid sinus |
|
|
Term
| What is the eqn for water excess... water defecit? |
|
Definition
excess = .6w x (1-Na/140)
defecit = .6w x (Na/140 - 1) |
|
|
Term
| How does hypovolemic hyponatremia occur? |
|
Definition
| lose body water then ADH replaces water more than sodium |
|
|
Term
| What are the symptoms of hyponatremia? |
|
Definition
greater than 130 there's none, 125-130 NV, below 125 headache, lethargy, psychosis, seizures, etc
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|
|
Term
| in chronic hyponatremia, you don't want to increase sodium faster than this... |
|
Definition
|
|
Term
| what is the method of action of lithium and demeclocycline (chronic SIADH tx) |
|
Definition
| inhibit kidney's response to ADH |
|
|
Term
| What two things can be used to increase solute in hyponatremia? |
|
Definition
|
|
Term
In hypovolemic hyponatremia the goal is to...
while in hypervolemic hyponatremia the goal is to... |
|
Definition
treat the volume depletion with crystalloids
treat the underlying cause: CHF/cirrhosis/nephrotic syndrome
|
|
|
Term
| What is the primary difference between CSW and SIADH? |
|
Definition
|
|
Term
| What is the treatment for CSW? |
|
Definition
|
|
Term
| What happens in osmotic demyelination syndrome? |
|
Definition
| encephalopathic followed by improvement then deterioration, w dysphagia, flaccid quadriperesis then spasticity, oculomotor abnormalities |
|
|
Term
| How can you dx osmotic demylination? |
|
Definition
| MRI - but it lags 2 weeks behind clinical findings |
|
|
Term
| What things can help prevent contrast nephropathy? |
|
Definition
| saline, low-osmol media, stop lasix/mannitol, and N-acetylcysteine |
|
|
Term
| What treatment would you use to help with contrast nephropathy? |
|
Definition
| normal saline 1 ml/kg/hr for 12 hours before nad 12 hours after procedure, N-acetylcysteine day before and day after procedure |
|
|
Term
| What condition does gadolinium cause? |
|
Definition
| nephrogenic systemic fibrosis - catostrophic complication that has the highest risk fo happening in stage 5 CKD/ESRD, don't give in stages 3+ |
|
|
Term
| Who gets neuroleptic malignant syndrome? |
|
Definition
phenothiazides, haloperidol
|
|
|
Term
| What creatinine increase would be associated with a GFR decrease of 50%? |
|
Definition
| creatinine increase of 3 to 6 |
|
|
Term
| What electrolyte abnormality will most likely be found in renal artery stenosis? |
|
Definition
|
|
Term
| What is the normal respiratory compensation for an uncomplicated metabolic acidosis? |
|
Definition
| 1.2 mmol decrease in CO2 for every 1 meq/L decrease in HCO3 |
|
|
Term
| What is the normal respiratory compensation for an uncomplicated metabolic alkalosis? |
|
Definition
.6 mmol increase in pCO2 for every 1 mEq increase of HCO3
|
|
|
Term
| Which diuretic would correct the metabolic alkalosis caused by a loop diuretic? |
|
Definition
| carbonic anhydrase inhibitor |
|
|
Term
| what electrolyte abnormality to loop diuretics cause? |
|
Definition
|
|
Term
| What is the best treatment for uremic coagulopathy? |
|
Definition
|
|
Term
How does a T3 resin uptake work?
|
|
Definition
| it is inversely proportional to the TBG, estrogen makes TBG go up |
|
|
Term
| Are T3 and T4 proportional or inversely proportional to tbg? |
|
Definition
proportional - more TBG means more T3/T4
|
|
|
Term
| What symptoms are seen in a myxedema coma? |
|
Definition
| hypothermia, hypoventilation, hyponatremia, hypoglycemia, seizures |
|
|
Term
| What should be done with patients in a myxedema coma? |
|
Definition
eval for AI, treat with thyroxine, hydrocortisone and fluids
|
|
|
Term
| What are the labs seen in hyperthyroidism? |
|
Definition
high free T4, low TSH, high T3, high antibodies (TPO, TG, etc)
|
|
|
Term
| What abs will be high in hyperthyroidism? |
|
Definition
|
|
Term
What is the treatment for hyperthyroid
|
|
Definition
| antithyroid meds, 131 iodine, beta blockers, and surgery |
|
|
Term
| What anti-thyroid drug can be used in the first trimester of pregnancy? |
|
Definition
|
|
Term
| What is the aim when you use 131-iodine? |
|
Definition
| to achieve hypothyroid, higher dose with large/nodular gland |
|
|
Term
| When should you biopsy a thyroid nodule? |
|
Definition
|
|
Term
| What does the zona glomerulosa release? |
|
Definition
| mineralocorticoids - aldosterone, which causes Na/H2O retention |
|
|
Term
| What regulates aldosterone secretion from the zona glomerulosa? |
|
Definition
|
|
Term
| What does angiotensin ii lead to? |
|
Definition
aldosterone release and vasoconstriction
|
|
|
Term
| What do the zona fasciculata and reticularis release? |
|
Definition
| cortisol and androgens respectively |
|
|
Term
| What happens in congenital adrenal hyperplasia? |
|
Definition
| CAH - enzymatic defects in steroid production yield androgen over cortisol (21-hydroxylase usually) |
|
|
Term
what happens in early onset CAH? late onset?
|
|
Definition
| baby girls with ambiguous genitalia; older women with hirsutism |
|
|
Term
| A patient shows up with a previous neoplasm that was non-compressive in their brain, that has recently hemorrhaged compromising vision and pituitary function... |
|
Definition
|
|
Term
| What should a patient with potential pituitary apoplexy be told? |
|
Definition
| they're at a high risk, call 911 if sudden vision change |
|
|
Term
| What is the formula for corrected calcium/ |
|
Definition
corrected calcium = serum calcium + .8 (4-albumin)
|
|
|
Term
| What would the calcium and phosphate be in a hypoparathyroid patient? |
|
Definition
| calcium low phosphate high |
|
|
Term
| What does secondary hyperparathyroidism involve? |
|
Definition
| high PTH even with normal to low serum Ca |
|
|
Term
| what is the emergent treatment for hypercalcemia? |
|
Definition
| Iv saline followed by loop diuretcis to help, calcitonin, bisphosphonates |
|
|
Term
| When should one consider a secondary etiology for hypocalcemia/osteoporosis? |
|
Definition
when a patient has a z-score less tahn 2
|
|
|
Term
| What does the frax model predict? |
|
Definition
| fracture risk in the next decade for untreated osteoporosis patients |
|
|
Term
|
Definition
| SERM good for bone loss secondary to osteoporosis |
|
|
Term
| What can parathyroid hormone be used for? |
|
Definition
| subq injection for severe osteoporosis and fracture |
|
|
Term
| What is RANKL important for? |
|
Definition
| activation of osteoclasts |
|
|
Term
|
Definition
| released by osteocytes, negatively regulates bone formation |
|
|
Term
| Agents that inhibit bone resorption include... |
|
Definition
| bisphosphonates, SERMS, calcitonin and estrogen, |
|
|
Term
| What is the agent that increases bone formation? |
|
Definition
| teriperatide - also the most expensive |
|
|
Term
| What are the hormones from the anterior pituitary? |
|
Definition
| LH, FSH, TSH, GH, ACTH, prolactin |
|
|
Term
| you suspect a patient has a pituitary tumor, what should you order? |
|
Definition
an MRI of the head ATTN sella
|
|
|
Term
| a patient has normal lab values with the exception of low albumin, what should you treat them for? |
|
Definition
| hypercalcemia, more free ca will be available |
|
|
Term
What can a prolactinoma cause?
|
|
Definition
decreased libido, galactorrhea, infertility, amenorrhea
|
|
|
Term
| Waht is the treatment for a prolactinoma? |
|
Definition
| bromocriptine, cabergoline, rarely surg |
|
|
Term
Whatis the go to test for acromegaly?
|
|
Definition
| serial GH values for OGTT, glucose should suppress |
|
|
Term
| What is the treatment for acromegaly? |
|
Definition
| octreotide/pegvisomant, trans-sphenoidal surg, radiation tx |
|
|
Term
| What are the symptoms seen with a TSH secreting tumor? |
|
Definition
| thyrotoxicosis, not hypothyroid (not high TSH/low T3/T4!), high TSH with high T3/T4 |
|
|
Term
|
Definition
| too much ACTH leading to obesity, striae, ecchymoses, hyperglycemia, atherosclerosis, etc |
|
|
Term
| How can one dx cushing's? |
|
Definition
| 24 hour urine free cortisol and dexamethasone suppression |
|
|
Term
| Your 24 hour urine cortisol detects ___________ while your dexamethasone suppression test identifies ___________ |
|
Definition
| cortisol excess, the source |
|
|
Term
| What is lactotroph hyperplasia usually due to? |
|
Definition
|
|
Term
| What is thyrotroph or gonadotroph hyperplasia usually due to? |
|
Definition
|
|
Term
| What are somatotroph or corticotroph hyperplasias due to? |
|
Definition
|
|
Term
| pituitary hyperplasia's mass effect can cause problems with... |
|
Definition
|
|
Term
| What does diabetes insipidus result from? |
|
Definition
| loss of ADH secretion from posterior pituitary |
|
|
Term
| What does desmopressin help us figure out in DI? |
|
Definition
| if it concentrates the urine then its' a hypothalamus/pituitary problem, if it doesn't then it's a kidney problem |
|
|
Term
What karyotype would you expect with a patient that has male gonads but female body habitus?
|
|
Definition
| klinefelter's XXY - male form of hypergonadotrophic hypergonadism |
|
|
Term
| What are the forms of hypogonadotrophic hypogonadism? |
|
Definition
| kallman's, anorexia, delayed puberty, neoplasm, etc |
|
|
Term
| what should be administered to restore fertility in hypogonadotropic hypogonadism? |
|
Definition
|
|
Term
| What is a hyperprolactinoma associated wtih? |
|
Definition
| hypothyroidism and pituitary neoplasms |
|
|
Term
What does hypothyroidism promote?
|
|
Definition
| icnreased prolactin, suppressed gonadotrophins, low male hormone, infertility, etc |
|
|
Term
| What are the findings associated with Turner's syndrome? |
|
Definition
| hypogonadism, short stature, broad webbed shoulders, primary amenorrhea, etc |
|
|
Term
| what conditions are associated with hypergonadotrophic hypogonadism/ |
|
Definition
| menopause, surg removal of ovaries, turner's |
|
|
Term
| What should you look at if you see a patient who's tired, weak, fatigued with ED... |
|
Definition
| look at hair growth pattern, free testosterone and total testosterone |
|
|
Term
| what is the NIH criteria for PCOS? |
|
Definition
| androgen excess, oligomenorrhea (american and euro crit add ultrasound) |
|
|
Term
| What can be done to assess insulin resistance? |
|
Definition
| scale and eyeball, HOMA (insulin x glucose x .055)/22.5, and insulin clamp |
|
|
Term
| What are the standards set by WHO for diabetes mellitus... |
|
Definition
hdl < 35, BP 140/90, waist to hip ratio of .9, body mass index of 30 or greater
|
|
|
Term
| What are the inflammatory markers associated with diabetes mellitus? |
|
Definition
| crp, IL-6 and PAI-1, fat cells may be a cytokine source |
|
|
Term
| What is the most common cause of hypokalemia? |
|
Definition
|
|
Term
What is metformin not safe in?
|
|
Definition
| renal insufficiency, active liver disease, pulmonary disease |
|
|
Term
What are TZD's not safe in?
|
|
Definition
|
|
Term
| What are the effects of hyperglycemia on tissues? |
|
Definition
| glycates proteins, accumulation of sorbitol and fructose, activation of protein kinase c |
|
|
Term
| What does fructosamine/glycated protein reflect? |
|
Definition
| mean glucose over 1-2 weeks |
|
|
Term
|
Definition
| mean glucose over 2 months |
|
|
Term
| Once you get above these values for fasting, post-proandial and hbA1c, retinopathy shoots up... |
|
Definition
|
|
Term
What can late onset type I diabetes be identified by?
|
|
Definition
|
|
Term
| what are the criteria for a very high risk pregnant patient for GDM? |
|
Definition
severe obesity, prior hx of GDM, presence of glycosuria, dx of PCOS, strong hx of DM II
|
|
|
Term
| How should GDM screening be carried out for women 24-28 weeks pregnant not known already to have dm? |
|
Definition
| 75 g OGTT with fasting > 92, 1 hr > 180, and 2 hr > 156 |
|
|
Term
| What are the risk factors for diabetes mellitus/metabolic syndrom |
|
Definition
| abdominal obesity, triglycerides, HDLc, bp and fasting glucose |
|
|
Term
| what are the fasting/preprandial and HBA1C reduced by? |
|
Definition
| sulfonylurea repaglinide, metformin and glitazones (TZDs) |
|
|
Term
| What does metformin do in the body? |
|
Definition
| decreases gluconeogenesis, increases glycolysis, and increases peripheral glucose uptake |
|
|
Term
What is metformin contraindicated in?
|
|
Definition
| renal failure because it can cause metabolic acidosis |
|
|
Term
| What do sulfonylureas result in? |
|
Definition
| close k channel in beta-cell membrane, causes depolarization and insulin release due to ca influx; causes u to release your own insulin |
|
|
Term
| What is the method of action of glitazones? |
|
Definition
| increase insulin sens in peripheral tisues through binding PPARgamma nuclear txn receptors |
|
|
Term
| What are the side effects of glitazones? |
|
Definition
| weight gain, hepatic tox, CV tox, edema |
|
|
Term
| What are the alpha glucosidase inhibitors? |
|
Definition
|
|
Term
| What's the method of action of alpha-glucosidase inhibitors? |
|
Definition
| delay sugar hydrolysis and glucose absorption leading to decr postprandial glucose |
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