Nephrology

Calcium oxalate stones: Shape? Associated condition? - Envelope (among others) Ethylene glycol poisoning (among others) Definition of microalbuminuria? Albuminuria? Nephrotic syndrome? - 30 - 300 24 hour excretion or albmin:creatinine or 3 mg/dL on dipstick 300 on 24 h or alb:cr 3.5 protein:Cr Name two benign causes of proteinuria. - Febrile illness or exercise (transient) Orthostatic (occurs in young, eval with split test) Definition of hematuria? How to manage hematuria in the young vs old? - Hematuria = 3/hpf Noncon CT if kidney stones suspected. Under 40, repeat UA for confirmation, then US) Old or at risk, requires full eval for malignancy (CT urography for preserved GFR, MR urography for GFR 30 - 60, then cystoscopy if neg) What are acanthocytes? What are they and erythrocyte casts associated with? - Spiky red blood cells. Associated with glomerulonephritis When is MRI with gadolinium contraindicated? - Stage 4 or 5 CKD or in AKI (or if s/p transplant) Name three indications and contraindications for kidney bx. - Suspected glomerulonephritis or nephrotic syndrome, AKI of unclear cause, transplant dysfxn. Bleeding diathysis, active infection, atrophic kidneys, uncontrolled htn In what two clinical scenarios is pseudohyponatremia found? What lab abnormality supports this? - Hyperglobulinemia and hyperlipidemia. Elevated plasma osmolality Hypotonic hyponatremia + Uosm 100 = (2) - Primary polydipsia Low solute (tea and toast, beer potomania) Hypotonic hyponatremia + Uosm 100 + euvolemia + Una 40 = (3) - SIADH Hypothyroidism Mineralocorticoid deficiency What are thresholds for urine osm and urine sodium in hypovolemic hyponatremia? - Uosm 100 Una 20 What are urine osm and urine Na in hypervolemic hyponatremia? - Uosm 100 Una 20 Looks the same as hypovolemic because in both cases there is decreased effective flow to the kidneys, causing renin release Treatment if acute hyponatremia with seizures: - 100 on 200 cc 3% boluses How to treat symptomatic SIADH? - 3% saline Goal improvement in sodium in symptomatic hyponatremia in 24 hours? - 4-6 (10 is maximum) What is the fastest way to lower potassium? - Insulin What complications can result from phos of 1? (3) - Rhabdomyolysis