GO WITH THE FLOW
Central and nephrogenic diabetes insipidus can look very similar, but only in the case of central DI will administration of this drug lead to a significant increase in urine osmolarity.
What is:
DDAVP?
This initial manifestation of diabetic kidney disease is why the ADA recommends yearly assessment of this laboratory value yearly for all patients with type 2 DM and patients with type 1 DM after 5 years of disease.
What is:
Mildly increased albuminuria?
Genetic testing for this gene mutation is recommended for all men with high-risk prostate cancer, including patients with positive lymph nodes or metastatic disease.
What is:
BRCA gene mutation?
CAD and CKD share risk factors/comorbidities like HTN/DM. However, this is not the only reason that prevalence of CAD is higher in the CKD population - CKD's independent association with CAD strengthens with decline in eGFR and rise of this second laboratory parameter.
What is:
Albuminuria?
There are a lot of conflicting recommendations out there from various institutions. Consensus of both KDIGO and ACC/AHA, however, states that the blood pressure target for patients with HTN and CKD should be less than these systolic and diastolic measurements.
What are:
<130 systolic &
<80 diastolic?
Oh no, your MDCalc app is down! No worries - you know that to estimate corrected serum sodium in a patient with hyperglycemia, you just subtract this amount from the measured Na, for every increase of 100 in BG >100.
What is:
2?
This class of medication is cornerstone to treatment in diabetic kidney disease, because it reduces both blood pressure and proteinuria in patients.
What is:
ACE-inhibitor
or
Angiotensin receptor blocker?
Previously referred to as "watchful waiting," the management strategy is now referred to as "active surveillance." For men with very-low-risk or low-risk prostate cancer with a life expectancy of at least 10 years, it involves these 3 components.
What are:
DRE (not more than q12mo),
Serial measurement of serum PSA (assessing changes and calculating doubling time), &
Repeat biopsy (typically at 1 year)?
For patients with non-dialysis dependent CKD, KDIGO guidelines recommend treatment with a statin for all patients >50 years old, as well as patients 18-49 years old with any of these additional cardiovascular risk factors (name at least 2).
What are:
Coronary artery disease,
Diabetes mellitus,
Prior ischemic stroke,
>10% estimated risk for coronary death or nonfatal myocardial infarction?
(AHA/ACC say separately that it is "reasonable" to initiate a moderate-intensity statin if 40-75 Yo w/ CKD + LDL of 70-189 + 10-yr atherosclerotic cardiovascular disease risk of 7.5% or higher)
Of all the lifestyle modifications we recommend to patients for treatment of hypertension, the one with the potential to decrease systolic pressures the most is adherence to the DASH diet. This plan involves eating less saturated fat and sodium and more of these categories/nutrients (list at least 3).
What are:
Fruits,
Vegetables,
Whole grains,
Legumes,
Potassium,
Magnesium, &
Calcium?
(can expect 8-14 mm Hg reduction in SBP if followed)
What are:
Remote diuretic use?
Volume depletion?
Vomiting (bulimia)?
NGT aspiration?
Exogenous alkali?
In patients with CKD who have additional cardiovascular risk factors, it is recommended to prescribe this class of medication to reduce the risk for CKD progression, cardiovascular events, or both - regardless of eGFR or urine albumin-creatinine ratio.
What is:
Glucagon-like peptide 1 receptor agonist (GLP 1)?
Testicular cancer is the most common solid tumor diagnosed in men 15-35 years old. Therefore, if a patient in this demographic presents with unilateral testicular swelling or mass, you know to order these 3 tests STAT.
What are:
Scrotal US,
Baseline alpha-fetoprotein, &
Baseline Beta-human chorionic gonadotropin?
Increased prevalence of arterial calcification, including in the coronary arteries, has been noted in patients with CKD. A subsequent reduction in vascular compliance makes it no surprise that this common abnormality is often found on echocardiogram of patients with CKD.
What is:
Left ventricular hypertrophy?
(In ESKD patients, rapid shifts of serum electrolytes during dialysis and chronic volume overload contribute to this, too, in addition to cardiac fibrosis. Recall - sudden cardiac death is the leading cause of death in ESKD.)
A 45-year-old patient is being evaluated in your office for suspected secondary hypertension. When discussing some laboratory results with them, you mention that these 2 tests were ordered to screen for the most common cause of secondary hypertension.
What are:
Plasma aldosterone concentration &
Plasma renin activity?
(most common cause of secondary HTN in middle-aged adults = primary hyperaldosteronism)
In classic distal (type I) RTA, the defect is in excretion of H+, causing decreased serum K+ and elevated urine pH >5.5. Name 1 of the conditions or medications that is commonly associated with type I RTA.
What is:
Sjogren's?
SLE?
Stones?
Obstruction?
Amphotericin B?
The ADA recommends to consider prescribing SGLT-2 inhibitors to patients with diabetic kidney disease if their eGFR and their urine albumin-creatine ratio are both greater than this value.
What is:
30?
(Recommend SGLT-2 inh. when eGFR is >30 mL/min/1.73m2 & urine albumin-creatinine ratio is >30 mg/g.)
Any patient with gross hematuria should be referred to urology, but the good news for our patients is that if found to be a result of bladder cancer, most patients are found to have non-muscle invasive disease. Treatment of superficial bladder cancer includes these 2 components.
What are:
TURBT (transurethral resection of the bladder tumor) &
Intravesical chemotherapy / bacillus Calmette-Guerin
The perfect storm, these 3 issues occurring together comprise the triad of cardiorenal syndrome.
What are:
Decreased kidney function,
Diuretic-resistant heart failure with congestion, &
Worsening kidney function during heart failure therapy?
Your patient who presented with a BP 200/120, is now found to have an acute coronary syndrome. That doesn't cause you any chest pain, though, because you know that first-line IV drugs to lower their BP are one of these 2 agents.
What are:
Esmolol &
Nitroglycerin?
In proximal (type II) RTA, the defect is in reabsorption of bicarb, causing decreased serum K+ but variable urine pH. Name 1 of the conditions or medications that is commonly associated with type II RTA.
What is:
Fanconi syndrome?
Multiple myeloma?
Osteomalacia?
Acetazolamide?
Zonisamide?
Topiramate?
Why the hype? The ADA most strongly advises prescribing SGLT-2 inhibitors to patients with diabetic kidney disease when their urine albumin-creatinine level is greater than this number; only in these patients have studies consistently shown reduced progression of kidney disease and/or cardiovascular events.
What is:
300?
(More STRONGLY advised with higher grade albuminuria >300 mg/g)
Diagnosis of renal cell carcinoma is minimal; if CT findings are pathognomonic for it, no biopsy is needed to confirm. What isn't so minimal? The paraneoplastic syndromes/conditions that can be seen in patients with RCC. List 3 of the most common.
What are:
Anemia,
Hepatic dysfunction in the absence of liver metastases,
Fever,
Hypercalcemia,
Erythrocytosis,
AA amyloidosis,
Thrombocytosis, &
Polymyalgia rheumatica?
Vascular calcification is accelerated in patients with ESKD due to the presence of 3 main factors - list at least 2 of them.
What are:
Uremic toxins,
Chronic inflammation, &
Calcium-based medications/vitamin D analogues
(This is why limiting medications that raise serum calcium and achieving adequate clearance during dialysis may help delay the progression of atherosclerosis)
You're helping to create a new PowerPlan for Cerner with Natalia for hypertensive emergencies! She asks which options you should list as first-line choices when the only comorbidity is acute kidney injury, to which you reply with these 3 agents.
What are:
Clevidipine,
Fenoldopam, &
Nicardipine?