Nephrology

Question 1

What stain is used to detect eosinophils in urine?

Answer 1

Wright and Hansel stains

Question 2

Muddy brown casts

Hyaline Csts

Waxy Casts

Answer 2

Muddy brown - ATN (dead tubular cells)

Hyaline - pre-renal, dehydration, normal protein concentrates into cast when dehydrated

Waxy - chronic renal disease

Question 3

Where do NSAIDs affect kidney?

Answer 3

Constrict AFFERENT

Question 4

Where do ACE inhibitors affect kidney?

Answer 4

Dilation of EFFERENT

Question 5

Renal Effects of Sickle Cell Trait

Answer 5

Isothenuria - inability to concentrate urine

Continue to make dilute urine even when dehydrated

Question 6

Timing of Various Causes ATN

Answer 6

Contrast - induced = 24 to 36 hrs later

Meds (vancomycin, gentamicin, amphotercin) = after at least 5-10 days of use

Question 7

Labs in Contrast-Induced AKI

Answer 7

Look like pre-renal

Low urine Na, FeNa < 1%, able to concentrate urine

Question 8

PPX to Prevent Tumor Lysis Syndrome

Answer 8

Allopurinol

Rasburicase

Hydration

Question 9

Tx of Rhabdomyolysis

Answer 9

IV normal saline + mannitol (osmotic diuretic)

DEC CONTACT TIME BETWEEN MYOGLOBIN AND TUBULES

EKG stat - hyperkalemia

Question 10

What do you do when Cr continues to rise in AIN after stopping offending drug?

Answer 10

Give steroids

Question 11

Good pasture v. Alport

Answer 11

Both glomerular diseases

GP - anti BM antibodies, hematuria and lung/hemoptysis

Alport - sensorineural hearing loss, loss of fibers that hold eye lenses

Question 12

IgA Nephopathy

Answer 12

Asian women

Give ACE inhibitors

Hematuria 1-2 days after URI (as opposed to post-strep GN which is 1-2 weeks later)

Question 13

Tx of TTP-HUS

Answer 13

1- may need urgent plasmaphoresis

2 - FFP (not platelet transfusion)

3- Eculizumab if atypical HUS (aka not from infection)

4 - steroids in TTP but not HUS

Question 14

Causes of Nephrogenic DI

Answer 14

Lithium, demeclocycline, CKD, hypokalemia, hypercalcemia

Question 15

Correction of Na for high glucose

Answer 15

Add 1.6 x however many 100’s glucose is increased by above 100

Question 16

Tx of Hyponatremia

Answer 16

Fluid restriction

Saline + loop diuretics

If severe, hypertonic saline + ADH antagonists (tolvaptan, conivaptan)

Question 17

What is the relationship between K and Mg?

Answer 17

If Mg is low then potassium channels open and spill K into urine

Low Mg –> low K

Question 18

Barter

Gitelman

Liddle

Answer 18

Barter - acts like loop diuretic, no Na absorption, more K excretion

Gitelman - act like HCTZ, no Na absorption, more K excretion, less Ca excretion

Liddle - act like aldosterone, inc ENaC, more Na absorption, more K excretion

Question 19

RTA I, II and IV

Answer 19

I - problem w/ distal tubule H+ secretion (alkalotic urine - STONES), caused by amphotercin, topirimate and autoimmune diseases, treat w/ bicarb

II - problem w/ proximal tubule bicarb absorption, caused by acetazolamide, Fanconi, treat with HCTZ

IV - problem with distal aldosterone resistance so dec ENaC, HYPERKALEMIA, fludocortisone

Question 20

Urine Anion Gap

Answer 20

Tells you diarrhea v. RTA in normal anion gap metabolic acidosis

UAG = urine Na - urine Cl

Pos … less Cl because defective acid secretion (RTA)

Neg … more Cl because body comps for metabolic acidosis by excreting acid in urine (DIARRHEA)

Question 21

Pain Mgt in Kidney Stones

Answer 21

Ketorolac

Question 22

Associations w/ ethylene glycol OD and methanol OD

Answer 22

Ethylene - oxalate stones

Methanol - inflamed retina

Question 23

First Presentation of HTN Work-Up

Answer 23

EKG

UA

Blood glucose

Lipids

Question 24

General Kidney Stone Mgt

Answer 24

Analgesia + hydration

CT best imaging, can do US to look for hydronephrosis

If < 5 mm pass on own
If 5-7 mm use nifedipine and tamsulosin to help pass
If .5 - 2 cm use lithotripsy
If > 2 cm require surgery

Question 25

Prevention of Ca Stones

Answer 25

HCTZ - less Ca in urine

Question 26

Meds that Inc K+ (8)

Answer 26

Beta blockers

ACE/ARBs

NSAIDs

Digitalis

Cyclosporine

Heparin

Succinylcholine

Bactrim (blocks Na channels in collecting ducts)

Question 27

What meds can cause SIADH? (3)

Answer 27

Carbamazepine

SSRIs

NSAIDs