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36 Cards in this Set
- Front
- Back
gold standard for quantifying the glomerular filtration rate and renal plasma flow
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radionuclide kidney clearance scanning
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when to order MRI of kidneys
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mass lesions and cysts
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test of choice for the evaluation of urologic bleeding in patients at high risk for bladder cancer with an estimated GFR above 60 mL/min/1.73 m2
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CT urography
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can identify non-uric acid–containing kidney stones
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KUB xray
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Indications for kidney biopsy
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suspected glomerular pathology such as glomerulonephritis and the nephrotic syndrome, acute kidney injury of unclear cause, and kidney transplant dysfunction
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Contraindications to kidney biopsy
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bleeding diatheses, active infection of the genitourinary system, hydronephrosis, atrophic kidneys, and uncontrolled hypertension; relative C/I: solitary kidney, severe anemia, and chronic anticoagulation
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abnormal serum osmolal gap
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>10 mosm/kg H20; reflects the presence of unmeasured solutes
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Formula: plasma Osmolality (mosm/kg H2O)
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2 × Sodium (meq/L) + Glucose (mg/dL)/18 + BUN (mg/dL)/2.8
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normal effective osmolality
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275-295 mosm/kg H204 to 6 meq/L (4-6 mmol/L) over the first 24 hours is sufficient
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goal rise in sodium in patients with symptomatic hyponatremia
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4-6 meq/L over 1st 24 hours
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conditions causing pseudohyponatremia
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yperglobulinemia or severe hyperlipidemia
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most common form of hyponatremia
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hypotonic hyponatrmeia
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causes of hypertonic hyponatremia
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marked hyperglycemia or exogenously administered solutes such as mannitol or sucrose
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first step in the evaluation of hyponatremia
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check plasma osmolality - normal in pseudohyponatremia (check chol, TG, serum total Pr)
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how is cause of hypotonic hyponatremia established
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history, vol status, urine osmolality, urine sodium level
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Uosm for primary polydipsia and hyponatremia
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<100
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mechanism of hyponatremia in beer potomania
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water excretion is in part solute dependent, chronic ETOH + low solute intake = decrease free water excretion; hyponatremia develops in setting of modest increases in fluid intake
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when does reset osmostat occur?
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quadriplegia, TB, advanced age, pregnancy, psych disorders
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how to distinguish reset osmostat from SIADH
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document excretion of dilute urine following a water load
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What is cerebral salt wasting?
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syndrome of hypotonic hyponatremia that may complicate subarachnoid hemorrhage or neurosurgery
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risk factors for acute hyponatremia
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pos-op hypotonic fluids; use of thiazides, use of ecstacy, overhydration with extreme exercise, primary polydipsia
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treatment of symptomatic hyponatremia
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hypertonic saline in symptomatic SIADH; NS for hypovolemic hyponatremia; seizure or coma - 100ml or 2ml/kg bolus infusions of 3% NS, repeated up to 2x as needed
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maximum rate of correction of hyponatremia
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not >10 meq/l within 24 hours or 18 within 48 hours
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clinical features of osmotic demyelination syndrome
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progressive quadriparesis, speech and swallowing disorders, coma, locked-in syndrome (IRREVERSIBLE)
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treatment of asymptomatic hyponatremia
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fluid restriction in SIADH or hypervolemic hyponatremia
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causes of diabetes insipidus
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decreased release of ADH (central diabetes insipidus); ADH resistance (nephrogenic diabetes insipidus); and metabolism of ADH by circulating vasopressinase (gestational diabetes insipidus)
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define polyuria
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urine volume >3L/24h
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diff Dx of polyuria
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DI, primary polydipsia, osmotic diuresis
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urine osmolality in osmotic diuresis, primary polydipsia and DI
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>300 in osmotic diuresis; <200 in Di and primary polydipsia
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effect of water deprivation testing in primary polydipsia and DI
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increases urine osmolality to ~600mosm/kg H20; <200 in DI
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effect of desmopressin in central DI / gestational DI / nephrogenic DI
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rise to 600 mosm/kg H20 except in nephrogenic DI
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treatment of hypernatremia
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in shock, NS - avoid boluses; estimate water deficit, D5 water
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rate of correction of hypernatremia
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no more than 10 meq/L to avoid cerebral edema
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estimated water deficit formula
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Total Body Water [0.6 in Men and 0.5 in Women × Body Weight (kg)] × [(Serum Sodium/140 [or target serum sodium]) – 1]
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treatment of central of gestational DI
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intranasal desmopressin
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treatment of nephrogenic DI
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thiazide diuretics (increase prox Na and water reabsorption); d/c lithium if possible or add amiloride
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