Renal
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Renal - Details
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69 questions
| 🇬🇧 | 🇬🇧 |
| Normal: < 120/80, Stage 1: < 120-140/ 80-90 Stage 2: > 140/90 Rx: > 130/80. HTN Urgency: > 180/110 Asymptomatic HTN Emergency > 180/110 Symptomatic | Stages of HTN, threshold for treatment |
| BP > 20/10 above goal, > 160/100 Usually ACE/CCB combo | When do you start with two medications? |
| Poor control despite 3 meds ( can try spironolactone 25 m/d) Suspect secondary causes. | When do you refer out for HTN? |
| Resistant HTN Young Spontaneous low K | Secondary HTN , when to work up? |
| Metabolic Syndrome, renovascular ( FMD and AS), polycystic kidney, renal disease, OSA, Pheo, Cushing, hyperthyroid, hyperaldosterone, Scleroderma, | What are the secondary causes of HTN? |
| Renal MRA or angiography- String of beads Presents in young pt, with HTN urgency or Resistant HTN May have unilateral abdominal bruit. | How do you dx Fibromuscular dysplasia? |
| NSAIDS, OCP, Etoh, sympathomimetics, steroids, cocaine, MJ, SSRI, erythopoietin. | Which drugs can elevate BP? |
| Check for end organ damage: Eyes, Heart and kidney Chem 7, Ca, Lipid, UA and EKG | What is the evaluation for HTN? |
| Don't work with Crcl < 20, Use loop dosed bid Supplement K when < 3.5 or if on Dig or DM, CAD Avoid: Gout, hyperlipidemia, orthostatic, Lithium, Sulfa allergy Lytes: Increase Ca, glucose, uric acid, lower Mg and K. | Thiazide Diuretics in renal disease, what to look for ? |
| Asthma or RAD, Severe PVD, Cocaine: may precipitate MI | BB for HTN: When to use caution? |
| Goal DBP < 105 in 2-6 hours. or < 25% of original BP Can use oral if asymptomatic. Rx: Loop diuretics, BB, CAB or alpha 2 antagonist Avoid Nifedipine. | How do you treat a HTN crisis? |
| Renal US, PRA ( stimulated Plasma renin Acitvity) and plasma aldosterone. See low renin, low K in Hyperaldosteronism. 5% of all resistant HTN. | How do you screen for secondary HTN? |
| Adrenal adenoma Dx with CT | Cause of hyperaldosterone? |
| 24 urine for metanephrine, VMA and catecholamine. If positive do a CT of adrenals. | How do you screen for Pheo? |
| W/U if present 3x UA and cx. and renal function Repeat UA 6 wk, if positive referral | Microscopic hematuria W/U |
| Age > 35, analgesic abuse, exposure to chemicals, smoking, chronic UTI or irritating voiding sx, irradiation. W/U will need CT urography and cystoscopy. | Risk factors for urologic malignancy |
| High BUN/ Cr ratio FENA: < 1% | Prerenal w/u: |
| Renal us | Post renal w/u |
| FENA > 1% UA ; Large muddy granular cast Referral out | Intrarenal ATN w/u |
| AMG, NSAIDS, ACE/ARB, Amphotericin, Cisplatin, Contrast, PPI, Tenofovir (Prep) | Which meds are associated with ATN? |
| GFR < 60 / 3 mo | Definition of CKD |
| Stage 1: GFR >90 Stage 2: GFR 60-80 Stage 3a GFR 45-60 Stage 3b GFR 30-45 Stage 4 GFR 15-30 Stage 5 GFT < 15 Dialysis | What are the stages of CKD? |
| Phosphate binders to keep Ca x P < 55 Use Ca carbonate, Sevelaamer ( Renagel) | How do you treat hyperparathyroid in CKD? |
| Cr< 15, pericarditis, progressive uremic encephalopathy, | When do you start dialysis? |
| UA with C&S Spiral CT, Ca level to r/o hyperparathyroid. | Kidney stone w/u |
| Stone < 4 mm, may take up to 4 wks. | Which stone pass on own? |
| Strain urine Indomethacin 100mg did, Tamsulosin 4 mg/d x 4 wk. | Treatment of kidney stone |
| Persistent pain > 4 wks Stone > 10 mm Need stereoscopy first then lithotripsy. Monitor: renal function, periodic image for stone location and hydronephrosis. | When do you refer for kidney stone? |
| Primary hyperparathyroid ( Ca < 11), Malignancy (Ca>13), Vit D box, Renal failure, Meds: Thiazide, Lithium, Theophylline | Hypercalcemia causes |
| Repeat test with ionized Ca level Corrected Ca= Serum Ca + .8 ( nl albumin x 4 - pt's albumin) Causes: Increase protein or dehydration | Cause and w/u of pseudohypercalcemia |
| Ca < 12 Asymptomatic Constipation, fatigue, depression, polyuria, polydypsia, kidney stone | Hypercalcemia Sx |
| Ca < 12 : Find and remove underlying cause and hydrate 8 glasses water/d Ca 12-14: Usually symptomatic. IVF and biophosphante Ca > 14 : Usually comatose Hemodyalysis | Hypercalcemia Treatment |
| Repeat ionized Ca, PTH,Vit D, BMP Second line: Alk Phos, SPEP,CXR ( look for granuloma) | W/U of hypercalcemia |
| Ca level < 8.5 | Define Hypocalcemia |
| Low PTH ( surgery, autoimmune, radiation) Low Vit D/Ca ( malnutrition, ETOH) Low albumin Low Mg Loop diuretics Pancreatitis | Causes of hypocalcemia |
| Mild: Perioral numbness, paresthesia in hand and feet, cramps fatigue Severe: Neuromuscular irritability/ Tetany/Seizure | What are the sx of hypocalcemia |
| First correct low Mg and low Vit D Ca > 7.5: Oral replacement Ca < 7.5 IV replacement | Treatment of hypocalcemia? |
| K > 5.5 | Definition of Hyperkalemia |
| K > 7 : Progressive muscle weakness to paralysis | What are the sx of hyperkalemia? |
| Peaked T wave, Short QT initially then prolonged QT Leads to arrhythmias | What is the EKG sign of hyperkalemia? |
| K < 3.5 | Definition of Hypokalemia |
| Vomiting, Diarrhea, Diuretics | What are some of the causes of hypokalemia? |
| Progressive muscle weakness to paralysis N/V/Anorexia/ Ileus | What are the symptoms of hypokalemia? |
| Uwaves, St depression and QT prolongation. | What is the EKG sign of hypokalemia? |
| Repeat and check Mg level Check for Sx EKG | Hypokalemia evaluation |
| Remove cause if known K 3-4: Oral KCL 10-20 bid K < 3 : IV KCL or oral 40 mEq tid-qid Treat until level > 3.5 | Treatment of hypokalemia |
| Hyperglycemia, diuretics, High TG and protein, Volume overload or depletion, SIADH ( CNS and malignancy) | Hyponatremia causes |
| Osmo > 300 Cause: Glucose | Hypertonic hyponatremia |
| UNa < 10 Cause: diuretics, GI loses Treat with IV NS | Cause and treat low volume hyponatremia |
| CHF, Cirrhosis Treat with water restriction and liberal Na intake | Cause and treat high volume hyponatremia |
| Always represents a water deficit. Always hyperosmolar Dementia, no access to water, ADH abnormality or CNS disease ( Diabetes Insipidus. | What is the cause of hypernatremia? |
| Drugs: Laxative/antacids containing Mg Renal failure | What is the cause of hypermagnasemia? |
| Muscle weakness progressive to paralysis, sedation, loss of reflex and nausea. | Syptoms of hypermagnesemia |
| Remove underlying cause Hydrate Calcium | Treatment of hypermagnasemia |
| Diuretics, ETOH , Insulin, Gentamycin and Cisplatin | What causes hypomangasemia? |
| Low Ca and Low K | What other electrolyte abnormalities do you see with hypo Mg? |
| Cramps and arrythmias | What are sx of low Mg? |