CAQ-Nephrology flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Nephrotic syndrome features

Nephrotic syndrome features proteinuria greater than 3.5 g/day, hypoalbuminemia, edema, and hyperlipidemia; it predisposes to venous thrombosis and infection.

IgA nephropathy hallmark

IgA nephropathy shows mesangial IgA deposits and often presents with hematuria after mucosal infection; serum complement is usually normal and ACE inhibitors or ARBs are first-line antiproteinuric therapy.

Minimal change disease

Minimal change disease causes selective nephrotic proteinuria, normal light microscopy, and podocyte foot-process effacement; it is the commonest childhood nephrotic syndrome and usually responds to corticosteroids.

Membranous nephropathy antibody

Membranous nephropathy often features anti-PLA2R antibodies, subepithelial immune deposits, and nephrotic-range proteinuria; secondary causes include malignancy, hepatitis B, and drugs.

Pauci-immune crescentic GN

Pauci-immune crescentic glomerulonephritis lacks prominent immunoglobulin deposits, is associated with ANCA, and can cause pulmonary-renal syndrome; induction uses cyclophosphamide or rituximab plus glucocorticoids.

Anti-GBM disease

Anti-glomerular basement membrane disease produces linear IgG staining and crescentic glomerulonephritis; with pulmonary hemorrhage it is Goodpasture syndrome, treated by plasmapheresis, cyclophosphamide, and glucocorticoids.

Acute interstitial nephritis clues

Acute interstitial nephritis may follow NSAIDs, proton-pump inhibitors, or antibiotics and causes sterile pyuria, white-cell casts, and sometimes eosinophiluria; stopping the culprit drug is essential.

Hyponatremia first step

Measure serum osmolality first in hyponatremia; hypotonic hyponatremia is true hyponatremia, whereas normal or high osmolality suggests pseudohyponatremia or hyperglycemia-related translocational hyponatremia.

SIADH diagnostic pattern

SIADH causes euvolemic hypotonic hyponatremia with urine osmolality above 100 mOsm/kg and urine sodium usually above 30 mmol/L, after excluding thyroid and adrenal dysfunction.

Anion gap formula

The serum anion gap equals sodium minus chloride minus bicarbonate; a normal gap is about 8 to 12 mmol/L, and a high gap suggests unmeasured anions such as ketones, lactate, or toxins.

Winter formula

In metabolic acidosis, expected PaCO2 equals 1.5 times bicarbonate plus 8, with a range of plus or minus 2 mm Hg; a higher PaCO2 indicates inadequate respiratory compensation.

Distal renal tubular acidosis

Distal renal tubular acidosis causes hyperchloremic metabolic acidosis with urine pH above 5.5, hypokalemia, nephrocalcinosis, and kidney stones because distal hydrogen ion secretion is impaired.

Hyperkalemia emergency treatment

Give intravenous calcium first for hyperkalemic ECG changes, then shift potassium intracellularly with insulin plus glucose or a beta-agonist, and remove potassium with binders or dialysis.

Hypernatremia water deficit

Free-water deficit equals total body water times serum sodium divided by 140 minus 1; correct chronic hypernatremia slowly, generally no faster than 10 mmol/L per day.

KDIGO AKI definition

AKI is a serum creatinine rise of at least 0.3 mg/dL within 48 hours, at least 1.5 times baseline within 7 days, or urine output below 0.5 mL/kg/hour for 6 hours.

Prerenal azotemia indices

Prerenal azotemia typically shows a BUN-to-creatinine ratio above 20, fractional excretion of sodium below 1 percent, and urine sodium below 20 mmol/L when diuretics are not present.

Dialysis initiation indications

Urgent dialysis indications include refractory acidosis, electrolyte disturbance such as severe hyperkalemia, toxic ingestion, volume overload, and uremic complications such as encephalopathy or pericarditis.

Rhabdomyolysis urine finding

Rhabdomyolysis causes a positive urine dipstick for blood without red blood cells on microscopy; aggressive isotonic fluids and monitoring of potassium, calcium, and phosphate are central.

CRRT advantage

Continuous renal replacement therapy provides gradual solute and fluid removal and is often chosen for hemodynamically unstable critically ill patients, though trials have not shown a clear mortality benefit over intermittent dialysis.

Contrast-associated AKI prevention

For contrast-associated AKI, identify high-risk patients, use the lowest necessary contrast volume, and give isotonic intravenous fluids; there is no proven benefit from routine bicarbonate or N-acetylcysteine.

CKD definition

Chronic kidney disease is a glomerular filtration rate below 60 mL/min/1.73 m2 or kidney damage persisting more than 3 months; it is staged by GFR category and albuminuria category.

CKD anemia management

CKD anemia is usually normocytic and normochromic; correct iron deficiency first, then consider an erythropoiesis-stimulating agent, targeting hemoglobin rather than normalizing it.

Hemodialysis adequacy target

For thrice-weekly hemodialysis, a single-pool Kt/V of at least 1.2 and a urea reduction ratio above 65 percent are commonly used adequacy targets.

Fistula first principle

An arteriovenous fistula is the preferred hemodialysis access because it has lower infection and thrombosis rates than catheters, but it requires adequate vessels and time to mature.

Peritoneal dialysis peritonitis

Peritoneal dialysis peritonitis presents with cloudy effluent and abdominal pain; diagnosis requires effluent cell count and culture, and treatment usually uses intraperitoneal antibiotics.

BK virus nephropathy

BK virus nephropathy is a major cause of kidney transplant dysfunction; screening uses plasma BK viral load, and management centers on reducing immunosuppression while preserving graft function.

Scleroderma renal crisis

Scleroderma renal crisis causes malignant hypertension, acute kidney injury, and microangiopathic hemolysis in systemic sclerosis; ACE inhibitors are the cornerstone of treatment and should not be withheld.

Primary aldosteronism screening

Screen for primary aldosteronism with a plasma aldosterone-to-renin ratio in resistant hypertension, hypokalemia, or an adrenal incidentaloma; confirm with saline suppression or captopril testing.

Renal artery stenosis clue

Renal artery stenosis may cause resistant hypertension, flash pulmonary edema, an abdominal bruit, or acute kidney injury after starting an ACE inhibitor or ARB.

Thrombotic microangiopathy triad

Thrombotic microangiopathy features microangiopathic hemolytic anemia, thrombocytopenia, and organ injury such as acute kidney injury; TTP has severe ADAMTS13 deficiency and requires plasma exchange.

Lupus nephritis induction

Proliferative lupus nephritis, ISN/RPS class III or IV, is treated with glucocorticoids plus mycophenolate mofetil or cyclophosphamide; adding a biologic may be considered in selected severe cases.

Hepatorenal syndrome treatment

Hepatorenal syndrome is functional renal failure in advanced liver disease; terlipressin plus albumin is a standard treatment, and liver transplantation offers definitive cure.