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- med school review 🔥 > Renal > Flashcards

Renal Flashcards

1
Q

Most sensitive screen for diabetic nephropathy

A

Urine Microalbumin:Creatinine ratio

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2
Q

Small bilateral kidneys

A

Chronic HTN

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3
Q

Prevention of contrast induced nephropathy (CIN)

A

Pre-CT IVF

(+ acetylcysteine)

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4
Q

Post-cardiac cath AKI

A

Cholesterol emboli vs. CIN (contrast-induced nephropathy)

  • CIN resolves within 3-7d
  • Cholesterol emboli can be immediate or delayed >30d
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5
Q

Causes of primary adrenal insufficiency

A

Autoimmune vs. TB

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6
Q

TB is a common cause of

A

Primary adrenal insufficiency

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7
Q

Na+, K+, and H+ in primary adrenal insufficiency

A

Hyponatremia, hyperkalemia, and NAGMA (decreased aldosterone)

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8
Q

Painless gross hematuria

A

Bladder cancer

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9
Q

Red urine negative for RBCs

A

Myoglobinuria vs. Beet ingestion vs. Rifampin

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10
Q

Lithium polyuria

A

Nephrogenic DI

(renal ADH resistance)

Tx: Discontinue Lithium + Salt restriction

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11
Q

Common complications of ADPKD

A

IC berry aneurysms, hepatic cysts

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12
Q

Potassium citrate

A

Alkalinization of urine

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13
Q

Uric acid stones diet

A

Low-protein diet

(low-purine diet)

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14
Q

Cause of refractory hypokalemia

A

Hypomagnesemia

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15
Q

Tamsulosin

A

α-1 blocker

(tx of ureteral kidney stone)

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16
Q

C3 dense deposits in glomerular BM due to persistent activation of the alternative complement pathway

A

MPGN

(persistently low C3)

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17
Q

Causes of Papillary Necrosis

A

NSAID:

NSAIDs, SCD, Analgesic abuse, Infection (pyelo), DM

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18
Q

Acute hypercalcemia Tx

A

Aggressive NS hydration + Calcitonin

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19
Q

Bisphosphonates in acute hypercalcemia

A

NEVER choose this. Effect is 2-4d delayed.

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20
Q

Increased bleeding in CKD

A

Uremic coagulopathy

(platelet dysfunction —> Increased BT)

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21
Q

Cocaine abuse + elevated CPK & K+

A

Renal failure

(myoglobin-induced ATN in setting of rhabdomyolysis)

Tx:

  • Aggressive hydration
  • Mannitol
  • Urine Alkalinization (potassium citrate)
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22
Q

Kidney biopsy w/ increased extracellular matrix, basement membrane thickening, mesangial expansion, and fibrosis

A

Diabetes Mellitus

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23
Q

Kidney biopsy w/ intimal thickening, luminal narrowing of renal arterioles, and e/o sclerosis

A

Hypertension

(arteriosclerosis + capillary tufts)

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24
Q

Most common cause of death in dialysis patients

A

Cardiovascular disease

(SCD then acute MI)

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25
Q

Needle-shaped crystals on CT

A

Uric acid stones

  • Rhomboid or Rosette on microscopy (uRhomboid acid)
  • Acidic pH
  • Radiolucent (transparent) on XR
  • Tx: Urine Alkalinization + Allopurinol
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26
Q

Tx of Hypercalcemia:

A
  • NS hydration (first step)
  • Calcitonin (inhibit bone resorption)
  • Bisphosphonates
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27
Q

Euvolemic hyponatremia + HIGH urine Osm + HIGH urine sodium

A

SIADH

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28
Q

Tx of post-operative urinary retention (PUR)

A

Urgent bladder scan & catheterization!

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29
Q

Nodular glomerulosclerosis

A

Pathognomonic change in diabetic nephropathy

(Diabetic GN)

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30
Q

Cervical motion tenderness

A

PID

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31
Q

Metformin should be discontinued in pts w/ renal failure, liver failure, or sepsis as it can cause ____

A

Lactic acidosis

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32
Q

IBD predisposes to this type of nephrotic syndrome

A

Amyloidosis (AA)

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33
Q

RA predisposes to

A

Amyloidosis (AA)—abnormal proteins

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34
Q

Hyalinosis of afferent and efferent glomerular arterioles on LM

A

Diabetic nephropathy

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35
Q

Incontinence in uncontrolled diabetes

A

Diabetic autonomic neuropathy

(DAN)

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36
Q

Congo Red staining and Apple Green birefringence in polarized light

A

Amyloidosis

(staining of glomerular deposits)

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37
Q

Earliest renal abnormality in diabetic nephropathy

A

Glomerular hyperfiltration, followed by:

  • Glomerular basement thickening
  • Mesangial expansion (creating broad casts)
  • Nodular glomerulosclerosis (pathognomonic for DM [Kimmelsteil-Wilson nodules])
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38
Q

Associated with HBV

A

PAN

(Polyarteritis Nodosa: small- to medium-sized vasculitis)

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39
Q

Associated with HCV

A

Cryoglobulinemia

(HSP-like adult syndrome w/o GI)

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40
Q

Associated with Cryoglobulinemia

A

HCV

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41
Q

Test all pts with mixed cryoglobulinemia for ____

A

HCV

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42
Q

HSP-like renal disease in adults w/ HCV

A

Mixed cryoglobulinemia

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43
Q

GFR when uremic symptoms may occur

A

GFR <60

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44
Q

Tx for symptomatic uremia

A

Dialysis!

(encephalopathy, pericarditis, or bleeding)

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45
Q

Indications for urgent dialysis

A

AEIOU

  • Acidosis <7.1 refractory to medical therapy
  • Electrolyte abnormalities (severe hyperkalemia, >6.5 refractory to medical therapy)
  • Intoxication (ASA, methanol/ethylene glycol, lithium, valproic acid/carbamazepine)
  • Overload (e.g. CKD; refractory to diuretics)
  • Uremia (Symptomatic [encephalopathy, pericarditis, bleeding; usually will have GFR <60)
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46
Q

Chlorthalidone is a _____

A

thiazide diuretic

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47
Q

Thiazide diuretic effects →

A
  • Decreased K+ (hypokalemia)
  • Decreased Mg2+ (hypomagnesemia)
  • Decreased Na+ (hyponatremia)
  • Increased Ca2+ reabsorption (hypercalcemia)
  • Increased glucose (hyperglycemia)
  • Increased uric acid (hyperuricemia; predisposed to gout)
  • Increased LDL & TGs
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48
Q

Contrast is required/not required to visualize ureteral stones (abd CT)

A

Not required

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49
Q

Lower abd pain that radiates to groin

A

Obstructive ureterolithiasis

(kidney stone)

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50
Q

Winter’s Formula is used to

A

calculate respiratory compensation for metabolic acidosis

(pCO2 = 1.5(HCO3) + 8 ± 2)

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51
Q

ASA causes mixed respiratory alkalosis & metabolic acidosis by directly stimulating the ____ and decreasing ____ respectively

A
  • medullary respiratory center (tachypnea)
  • renal elimination of lactic acid & ketoacids (& increased production)
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52
Q

Low C3, Normal C4

A

PSGN

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53
Q

Persistently Low C3, Normal C4

A

​MPGN

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54
Q

Low C3 & C4

A

SLE

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55
Q

Higher Ca2+ concentrations required to suppress PTH release due to AD mutation of Ca2+-sensing receptor (CaSR)

A

FHH

(Familial Hypocalciuric Hypercalcemia)

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56
Q

Drug that causes red to orange discoloration of body fluids (urine, saliva, sweat, tears)

A

Rifampin

(also causes AIN)

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57
Q

High-dose TMP-SMX requires serial monitoring of ____

A

K+ levels

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58
Q

MOA of ADH stimulation from hypovolemia

A

Stretch receptors in LA

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59
Q

MOA of ADH stimulation from decreased renal perfusion

A

Angiotensin II

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60
Q

MOA of ADH stimulation from hypotension

A

Baroreceptor stimulation in carotid arteries

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61
Q

____ stimulates thirst

A

Angiotensin II

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62
Q

Decreased skin turgor

A

Hypovolemia

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63
Q

“Red Urine”

A

Rifampin

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64
Q

Elevated urinary sodium AND potassium

A

Diuretic use/abuse

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65
Q

Pre-renal causes:

A
  • Decreased EABV (HF, Cirrhosis)
  • Displaced intravascular fluid (sepsis, pancreatitis)
  • Decreased afferent flow (RAS, NSAIDs)
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66
Q

Small bowel disease malabsorption of fatty acids and bile salts can predispose to ____ kidney stones

A

calcium oxalate

(Unabsorbed fatty acids chelate with calcium, freeing up oxalic acid for absorption)

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67
Q

Coffin-lid

(stud-shaped) kidney stone

A

Struvite

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68
Q

Kidney stone caused by infection w/ urease+ bugs

(Proteus mirabilis, Klebsiella, Staph saprophyticus)

A

Staghorn calculi

(struvite—ammonium magnesium phosphate stone)

caused by bacterial conversion of urea to ammonia

Tx: Abx + Surgery

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69
Q

Tx of calcium oxalate kidney stones

A
  • IVF
  • Low sodium diet
  • Thiazides (prevent hypercalciuria)
  • Citrate (lowers insoluble calcium oxalate formation)
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70
Q

Dumbell-shaped crystals

A

Calcium oxalate

(alternatively “envelope-shaped”)

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71
Q

Rhomboid or rosette-shaped stones

A

Uric acid stones

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72
Q

Radiolucent (transparent) on XR and CT

A
  • Uric acid stones (visible on US)
  • Cystine stones
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73
Q

Hexagonal kidney stones

A

Cystine stones

(AR cystinuria; +sodium cyanide nitroprusside test)

74
Q

Acidic urine predisposes to ____ kidney stones

A
  • Uric acid stones
  • Cystine stones (AR cystinuria—sodium cyanide nitroprusside test+)
  • Tx for both: Alkalinization of urine ​​​
    • +allopurinol for UA stones and low Na+ diet for cystine stones
75
Q

Kidney stones are radioopaque on CT and XR

A
  • Calcium oxalate
  • Calcium phosphate
  • Struvite (ammonium magnesium phosphate)
76
Q

___ kidney stones occur in dehydration and acidic urine

A

Uric acid stones

77
Q

____ kidney stones are common in primary hyperparathyroidism

A

Calcium phosphate

78
Q

75-90% of kidney stones are composed of ____

A

Calcium oxalate

79
Q

Renal stones measuring less than ___ in diameter typically pass spontaneously w/ conservative management (IVF >2L/day & analgesia)

A

5mm

80
Q

Acyclovir can cause ____ if adequate hydration/IVF is not also provided

A

Crystalline nephropathy w/ renal tubular damage

81
Q

Chronic diarrhea leads to metabolic ____

A

alkalosis

(due to loss of bicarbonate)

82
Q

Contraction alkalosis

A

when aldosterone increases to restore intravascular volume, which leads to urinary H+ loss in the process

  • Aldosterone functions to retain water by pulling in bicarb at the expense of excreting both potassium and acid in the urine.
83
Q

Respiratory alkalosis induced by mechanical hyperventilation is compensated by _____

A

the kidney preferentially excreting bicarbonate in the urine

(high urine pH)

84
Q

Decreased renal perfusion in hepatorenal syndrome is due to ____

A

afferent vasoconstriction 2/2 splanchnic vasodilation

85
Q

· Tx for prevention of recurrent calcium oxalate kidney stones

A
  • Diet recs: Increased fluid intake, decreased sodium intake, and normal calcium intake
  • Sodium-restricted diet (low sodium promotes sodium & calcium reabsorption thru effect on medullary concentration gradient)
  • HCTZ (reduces Ca2+ excretion; use in pts w/ hypercalciuria)
86
Q

Anticholinergic treatment for detrusor instability in uninhibited detrusor contractions (urge incontinence)

A

Oxybutynin

87
Q

Stress incontinence Tx

A

Kegels, Duloxetine, Pseudoephedrine

88
Q

Neurogenic bladder Tx

A

Bethanechol

(cholinergic agonist)

or Intermittent urethral catheterization

89
Q

Normal PVR (Post-Void Residual)

A

<150mL in women, <50mL in men

(rules out urinary retention)

90
Q

Crystal-induced AKI w/ renal tubular injury/obstruction

A
  • Acyclovir
  • Sulfonamides
  • MTX
  • Ethylene glycol (rectangular envelope-shaped)
  • Protease inhibitors
91
Q

Acyclovir renal complication

A

Crystal-induced AKI w/ intratubular obstruction (Always give w/ IVF!)

92
Q

Drug-reaction AKI

A

AIN

(Pee, Pain-free, PCN, PPI, rifamPin)

  • +Cephalosporins
  • +TMP-SMX
  • +Pyuria, +Azotemia
93
Q

Benign recurrent hematuria

A

Thin basement membrane nephropathy

(familial isolated microscopic hematuria, aka Benign Familial Hematuria)

94
Q

Anti-GBM antibodies

A

Pulmonary renal syndrome

(Goodpasture’s)

95
Q

XL defect in collagen IV formation w/ ocular abnormalities & hematuria

A

Alport syndrome

(+hearing loss, +progressive renal insufficiency)

96
Q

Post-infectious hematuria 10-21d post-pharyngitis

A

PSGN

(low C3, elevated ASO ± anti-DNAse B)

97
Q

Post-URI hematuria (within 5 days)

A

IgA Nephropathy

(normal complement levels)

98
Q

Rectangular envelope-shaped crystals w/ AGMA

A

Calcium oxalate crystals

(ethylene glycol poisoning [antifreeze] in setting of AGMA)

99
Q

Diarrhea effect on serum potassium

A

Hypokalemia

100
Q

Decreased mineralocorticoid activity effect on serum potassium

A

Hyperkalemia

(Hyperaldosteronism excretes K)

101
Q

Acidosis effect on serum potassium

A

Hyperkalemia

102
Q

Insulin effect on serum potassium

A

Hypokalemia

(C BIG K)

103
Q

Albuterol effect on serum potassium

A

Hypokalemia

(part of C BIG K DD tx for hyperK+)

104
Q

BBs effect on serum potassium

A

Hyperkalemia

105
Q

Very nephrotoxic antibiotics

A

Aminoglycosides

(STANKG)

106
Q

Tx for cyanide toxicity

A

Sodium thiosulfate

107
Q

Prolonged hypovolemic shock renal injury

A

ATN

(muddy brown casts)

108
Q

Muddy brown granular cast

A

ATN

pathognomonic)

109
Q

RBC casts

A

Glomerulonephritis, Malignant HTN

110
Q

WBC casts

A

Interstitial nephritis, Pyelonephritis, Transplant rejection

111
Q

Fatty casts

(“oval fat bodies”)

A

Nephrotic syndrome

(assoc. w/ “Maltese cross” sign)

112
Q

Broad & waxy casts

A

Chronic renal failure

113
Q

Hyaline casts

A

Normal or ASx prerenal azotemia

114
Q

Renal vein thrombosis presentation

A

Abd pain + hematuria

115
Q

MPGN

A

HCV infection

116
Q

Bland urine sediment

A

no red cells, casts, or protein

(no intrinsic renal pathology)

117
Q

Very low urine sodium level

A

Prerenal: FENa <1% or <10mEq/L —> Hepatorenal syndrome renal failure

(renal hypoperfusion), dehydration, etc.

118
Q

Eosinophils in urine

A

Interstitial nephritis (AIN)

  • Think drug reaction (hapten-like drugs; 5 P’s)
  • +pyuria, +azotemia
  • Pee (diuretics)
  • Pain-free (NSAIDs)
  • PCN or cephalosporins
  • PPI
  • rifamPin
119
Q

Metabolic alkalosis w/ low urine chloride (<20 mEq/L)

A

Saline-responsive metabolic alkalosis:

  • Surreptitious vomiting
  • NG aspiration
  • Prior diuretic use
120
Q

Metabolic Alkalosis w/ high urine chloride (>20mEq/L)

A

Saline-unresponsive metabolic alkalosis:

Hypovolemic:

  • Current diuretic use (this one is saline-responsive)
  • Bartter syndrome
  • Gitelman syndrome

Hypervolemic = excess mineralocorticoid activity

  • Primary hyperaldosteronism
  • Cushing disease
  • Ectopic ACTH production
121
Q

Black licorice ingestion

A

“hyperaldosteronism” presentation

122
Q

Hyperkalemia-causing drugs:

A

ACE-I/ARBs, BBs

(nonselective), K-sparing Diuretics, NSAIDs

123
Q

AGMA

A

MUDPILES

  • Methanol (formic acid)
  • Uremia
  • DKA
  • Propylene glycol
  • INH or Iron tablets
  • Lactic acidosis
  • Ethylene glycol (—> —> oxalic acid)
  • Salicylates (late)
124
Q

NAGMA

A

HARDASS

Hyperalimentation

Addison disease

RTA

Diarrhea

Acetazolamide

Spironolactone

Saline infusion

125
Q

Metabolic Alkalosis:

A

LVAH

Loop diuretics

Vomiting (Tx: NS infusion)

Antacid use

Hyperaldosteronism (Tx: aldosterone antagonists)

126
Q

Respiratory Alkalosis:

A

Hyperventilation

  • Hysteria
  • Hypoxemia (high-altitude)
  • Salicylates (early)
  • Tumor
  • PE
127
Q

Respiratory Acidosis:

A

Hypoventilation

  • Airway obstruction
  • Acute or chronic lung disease
  • Opioids, sedatives
  • Weakening of respiratory muscles
128
Q

Urinary protein excretion >3.5g/day

A

Nephrotic proteinuria

129
Q

High water channels

A

SIADH

(too much ADH)

130
Q

SIADH vs. Diabetes Insipidus

A

SIADH:

Too much ADH, excessive water retention; DI: Not enough ADH; excessive water loss

131
Q

Urine osmolality <100

A

Dilute urine

  1. Primary polydipsia, or
  2. Beer potomania (malnutrition–poor dietary solute intake mixed w/ excessive intake of alcohol)
132
Q

Urine osmolality in increased ADH

A

Increased

(concentrated)

133
Q

Urine osmolality > Serum osmolality

A

Concentrated urine

2/2 dehydration and increased ADH; or hyponatremia

134
Q

Recurrent stones

A
  • Cystinuria (cystine)
  • Klebsiella UTI (Struvite stone formation)
  • Parathyroid adenoma
135
Q

Dipstick+ for leukocyte esterase

A

Pyuria in urine

136
Q

Dipstick+ for nitrites

A

E. Coli

137
Q

Hexagonal crystals on UA

A

Cystinuria

(inherited recurrent kidney stones)

  • Acidic pH
  • Radiolucent (transparent on XR)
  • Begins in childhood (usually)
  • Dx: Sodium cyanide nitroprusside test
    • Purple urine within 2-10 min: Positive test (aminoaciduria)
    • Cyanide converts cystine to cysteine; nitroprusside binds w/ cysteine, producing purple color
  • Tx: Urine Alkalinization + Low sodium diet
138
Q

Cyanide nitroprusside test

A

Cystinuria

(recurrent kidney stones)

  • Purple urine = Positive test = Aminoaciduria
139
Q

Nephrotic syndrome (adults)

A

Focal Segmental Glomerulosclerosis

(FSGS)

140
Q

Nephrotic syndrome (kids)

A

Minimal change disease

141
Q

Nephrotic syndrome (Hodgkins)

A

Minimal change disease

142
Q

Nephrotic syndrome

(lung/breast/prostate/colon malignancy)

A

Membranous Glomerulonephropathy

143
Q

Nephrotic syndrome (Multiple Myeloma)

A

Amyloidosis

144
Q

Renal disease in HBV or HCV

A

MPGN

145
Q

Hyperkalemia Tx

A

C BIG K DD

  • Calcium gluconate (IV)
  • Bicarbonate/Beta-agonists (albuterol)
  • Insulin
  • Glucose
  • Kayexalate
  • Diuretics
  • Dialysis
  • Cation Exchange Resins (Polystyrene)
146
Q

Fever, tinnitus, tachypnea

A

Salicylate toxicity (ASA)

Tx: Sodium bicarbonate

147
Q

Kussmaul breathing (deep, rapid)

A

DKA

(T1DM)

148
Q

Metabolic acidosis after seizure is due to:

A

Postictal lactic acidosis

(MUDPILES)

  • Transient & self-ltd AGMA, resolves within 90 minutes
149
Q

Pt w/ nephrotic syndrome is at most risk for:

A

HypercOagulability 2/2 renal loss of ATIII

(PrOteinuria, HypOalbuminemia, Edema, HLD)

  • Renal vein thrombosis (most common complication)
  • Pulmonary embolism
  • Other thromboses
  • Protein malnutrition (hypoalbuminemia 2/2 renal loss)
  • Iron-resistant hypochromic microcytic anemia
  • Increased susceptibility to infection
  • Vitamin D deficiecny (loss of cholecalciferol-binding protein)
  • Decreased thyroxin (loss of thyroxin-binding globulin)
150
Q

Sodium nitroprusside infusion

A

Cyanide toxicity

  • AGMA (MUDPILES) from lactic acidosis 2/2 cellular shift to anaerobic metabolism due to cyanide binding to cytochrome oxidase (inhibiting oxidative phosphorylation in mitochondria)
  • Can occur from combustion of carbon-containing compounds (house fires, wool, silk), industrial exposure (metal extraction in mining), or IV infusion of sodium nitroprusside
  • p/w:
  • Tx: Sodium thiosulfate
151
Q

WBC casts, pyuria, eosinophiluria

A

AIN (drug-induced interstitial nephritis)

  • 5 P’s
  • TMP-SMX (sulfas)
  • AlloPurinol
  • Loops & thiazides (sulfas, except the loop, ethacrynic acid)
  • Tx: Discontinue agent
152
Q

Only non-sulfa loop diuretic

A

Ethacrynic Acid

153
Q

Scrotal varicoceles are almost always left-sided because

A
  • L gonadal vein drains into the L renal vein, which then drains into the IVC
  • In contast, R gonadal vein drains directly into the IVC
  • Thus, any renal pathology on left side can p/w L varicocele if obstruction is involved (e.g. RCC)
154
Q

Left-sided varicocele that does not reduce (empty) when pt is recumbent (lying down)

A

RCC

  • Obstruction of venous flow due to L gonadal vein draining into renal vein before IVC
  • CT abd
155
Q

Quickest way to lower potassium levels in hyperkalemia

A

Insulin + Glucose drip

(creates rapid intracellular shift)

  • +beta agonist if no CVD
156
Q

Diabetic w/ urinary retention & high post-void residual volume (>50 mL)

A

Neurogenic bladder

(from DAN [Diabetic Autonomic Neuropathy]; Overflow incontinence)

  • Pt has decreased ablity to sense full bladder
  • Can p/w continuous dribbling (day or night), incomplete emptying, distended bladder, overflow incontinence
157
Q

Most common cause of AL amyloidosis (Primary)

A

Multiple Myeloma

  • Also seen in Waldenström macroglobulinemia
  • Light chain accumulation (Lambda)
158
Q

Most common cause of AA amyloidosis (2o)

A

Rheumatoid Arthritis

159
Q

RA + nephrotic syndrome

A

AA Amyloidosis (2o)

  • Congo Red Apple Amyloid
  • Amyloid Apple Green Birefringence under Polarized Light
160
Q

Pelvic pain exacerbated by a full bladder and relieved by voiding

A

Interstitial Cystitis

(Painful bladder syndrome)

  • Bladder pain w/ no other cause for >6 weeksChronic pelvic pain
  • Urinary urgency & frequency
  • Dyspareunia
  • Normal UA
  • Tx = Palliative: Trigger avoidance, amitryptiline, & analgesics for pain flares
161
Q

Bleeding + very high BUN

A

Uremic coagulopathy

(Platelet dysfunction 2/2 uremic toxins)

  • PT, PTT & platelet count normal
  • BT prolonged
  • Tx: DDAVP (desmopressin)
    • Increases release of Factor VIII:vWF multimers from endothelial storage sites
  • Platelet transfusion not indicated b/c transfused platelets become inactive
162
Q

Facilitates kidney stone passage

A

Alpha blockers

(tamsulosin)

  • Alpha receptors found on distal ureter, base of the detrusor, bladder neck, & urethra
163
Q

The magnesium gate protects ____ from being excreted by the kidneys

A

Potassium

  • ROMK channels (Renal Outer Medullary Potassium) in collecting tubules inhibit K+ secretion.
  • Hypomagnesemia leads to excessive renal potassium wasting & refractory hypokalemia
  • Common in chronic alcoholics
164
Q

Hypomagnesemia’s effect on potassium & effect on reflexes?

A
  • Potassium loss by kidneys (ROMK channels [potassium gate] are held closed by Mg2+) → Refractory hypokalemia (common in chronic alcoholics)
  • Hyperactive reflexes
165
Q

Infraumbilical fullness

A

Urinary retention

  • Urinary catheterization & d/c amitriptylene
  • >50mL
  • Usually from Anticholinergics (amitriptylene [TCAs]), BPH, post-anesthesia, etc.
166
Q

Intermittent episodes of high-volume urination

A

Post-obstructive diuresis

(2/2 obstructive uropathy due to nephrolithiasis)

  • Occurs when urinary obstruction (from renal calculi) is overcome by a large volume of retained urine
  • Excessive diuresis may lead to potassium wasting (mild hypokalemia) & dehydration
  • Pt p/w flank pain, low-volume voids (w/ or w/o occasional high-volume voids), & renal dysfunction if BL
167
Q

Psych patient w/ hyponatremia & low uOsm (<100 mOsm)

A
  • Primary Polydipsia (increased thirst 2/2 central defect in thirst regulation)
  • Malnutrition (beer potomania–low solute intake 2/2 excessive beer intake)
168
Q

Nephrotic proteinuria, hematuria, dense deposits stained for C3

A

MPGN, Type 2

(aka “Dense deposit disease”)

  • Caused by IgG Abs against C3 convertase, leading to persistent activation of the alternative complement pathway & kidney damage
169
Q

Horseshoe kidney

A

Turner Syndrome (XO)

170
Q

25M w/ weak urine stream and incomplete emptying of bladder. MCC?

A

Urethral stricture

(a fibrotic narrowing of the urethra 2/2 trauma, infection, or radiotherapy)

  • Dx: Urethrography or cystourethroscopy
  • ↑ Postvoid residual volume
  • Tx: Urethral dilation or Surgical urethroplasty
171
Q

Severe LLQ abd pain radiating to the groin, vomiting, and soft nontender abdomen on exam

A

Ureterolithiasis

  • Severe flank pain that radiates to the perineum, penis, scrotum, or inner thigh
  • Colicky in nature & poorly localized
  • Pts often writhing in pain and unable to sit still, but benign abd exam
  • Dx: Abdominal U/S
172
Q

Presents similarly to nephrolithiasis but w/ enlarged kidney and ↑LDH

A

Acute Renal Vein Thrombosis

  • Dx: CT Angiography (or MR Angiography), Renal venography
  • Usually occurs in setting of nephrotic syndrome due to urinary loss of anticoagulant proteins & alteration of hemostatic balance, but can also occur w/ acquired hypercoagulability a/w malignancy or trauma.

(RVT)

173
Q

When giving pt acyclovir, always give

A

IVF

due to risk of crystalluria w/ renal tubular obstruction (crystal-induced AKI) due to the drug’s low urine solubility and how it easily precipitates in renal tubules causing intratubular obstruction and direct renal tubular toxicity.

  • Note: This is more common specifically w/ High-Dose IV Acyclovir, and occurs only rarely with oral acyclovir.
174
Q

Muddy brown granular cast

A

Acute Tubular Necrosis

(ATN)

175
Q

Red blood cell casts

A

Glomerulonephritis

176
Q

White blood cell casts

A

Interstitial nephritis and pyelonephritis

177
Q

Fatty Casts

A

Nephrotic Syndrome

178
Q

Broad & Waxy Casts

A

Chronic Renal Failure

179
Q

When to medically manage ureteral stones (instead of urology consult / lithotripsy)

A
  • <10mm
  • No urosepsis (e.g. fever, AMS)
  • No acute renal failure
  • No complete obstruction

Medical Management:

  • Hydration
  • Pain control
  • Alpha blockers (e.g. tamsulosin)
  • Strain urine
180
Q

Scars/calluses on the dorsum of the hands

Dental erosions

A

Surreptitious vomiting

  • Low urine chloride 2/2 hypochloremia from ↑ vomiting
  • In diuretic abuse, Bartter syndrome, & Gitelman’s syndrome, urine chloride will be high
181
Q

Hematuria following a URI

A

IgA Nephropathy

(or PSGN)

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