Nephrology 2
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- What is the differential for non-anion gap metabolic acidosis? (DURHAM mnemonic)
- Diarrhea, Ureteral diversion, RTA, Hyperalimentation, Acetazolamide, Misc (Ampho B)
- What is Winter's formula and when should it NOT be used?
- [1.5(HCO3) + 8] +/- 2. Should not be used if primary disorder is not metabolic acidosis.
- Why does a metabolic alkalosis ensure from volume contraction?
- Chloride is depleted in volume contraction and since the kidenys become sodium avid, HCO3- is reabsorbed with sodium.
- What should be the next test to order after a renal panel and ABG in metabolic alkalosis?
- Urinary chloride.
- What are the causes of saline-responsive metabolic alkalosis?
- NG suction, Vomiting, diuretics, post-hypercapnea
- What are the causes of saline-RESISTANT metabolic alkalosis with a normal BP?
- Hypomagnesemia, severe hypokalemia, Bartter's, NaHCO3 administration, licorice
- What are the causes of saline-RESISTANT metabolic alkalosis with a ELEVATED BP?
- Conn's, Cushing's, RAS,
- How much should the PC02 rise for every 1 increase in HCO3 above 24?
- 0.5 - 1
- For every 10 increase in PCO2 what is expected changes in pH and HCO3? Acutely? Chronically?
- ACUTE: pH falls 0.08 and HCO3 increases by 1. CHRONIC: pH falls by 0.03 and HCO3 increases by 3-4.
- Which RTA shows an inability to acidify the urine below 5.5 despite an acid (NH4Cl) challenge?
- RTA I
- What is the most common cause of type I RTA?
- congenital autosomal dominant disorder
- What genetic disorders are associated with type I RTA?
- Ehrlers-Danlos; Marfan's
- What autoimmune diseases are classically associated with type I RTA?
- SLE, RA, Sjogrens
- What medications are associated with a type I RTA?
- Amphotericin, lithium, high dose salicylates.
- What are the essential defects in RTA types I, II and IV?
- Type I: inability to excrete H+ in the distal tubule; Type II: inability to resorb HCO3 in the prox tubule; Type IV hyporeninemic hypoaldosteronism
- What hemoglobinopathy and anatomic urinary pathology lead to RTA, type I?
- sickle cell anemia and obstructive uropathy.
- What disorders of calcium homeostasis occur in RTA, type I?
- hypercalciuria and calcium oxalate stones. Hyperparathyroidism and vit D deficiency may develop leading to rickets or osteomalacia.
- What confirmatory test is used to diagnose RTA, type I?
- Acid infusion (NH4Cl). Fails to acidify urine.
- What are causes of RTA, type II?
- Fanconi's, carbonic anhydrase inhibitors, outdated tetracycline, lead and mercury toxicity.
- What are some other causes of type I RTA?
- hepatitis (cirrhosis), nephrocalcinosis, and multiple myeloma
- What type of RTA does multiple myeloma cause?
- Types I & II
- What are some causes of RTA type II?
- Fanconi's, amyloidosis, multiple myeloma, acetazolamide
- What are some causes of RTA type IV?
- Diabetic nephropathy (most common), NSAIDs, ACEIs, ARBs, heparin, TMP-SMX, K+ sparing diuretics, pentamadine, cyclosporine A, tacrolimus, Addisons
- Which drugs are associated with RTA?
- Type II: outdated tetracycline, acetazolamide; Type I: amphotericin B, lithium, high dose salicylates; Type IV: NSAIDS, heparin, TMP-SMX, pentamadine, cyclosporine A, tacrolimus, ACEI/ARB, K+ sparing diuretics
- What is the calculation for serum osmolarity?
- [(2xNa)+(BUN/2.8)+(glc/18)+(EtOH/4.6)]
- What percentage of weight is TBW and what percentage is typically intracellular vs. extracellar?
- TBW is 60% of weight and 2/3 is intracellular
- What is the average "insensible" water loss/day?
- 1L
- What are the main branch points in assessing hyponatremia?
- 1) rule out pseudohyponatremia, 2) measure serum osmolarity to confirm hypotonic hyponatremia, 3) assess volume status, 4) Check urine sodium
- How do you calculate free water deficit?
- pt wt x 0.4-0.6 x (ptNa/140 -1)