Renal Dysfunction

Question 1

What is the general approach to a patient with a new finding of kidney dysfunction?

Answer 1

Consider pre-renal, intrinsically renal, post-renal

Question 2

What are common causes of pre-renal azotemia

Answer 2

Dehydration, anemia (hypovolemia)

Question 3

What are common causes of intrinsic renal disease?

Answer 3

Acute interstitial nephritis (allergy)
Acute tubular necrosis (late stage of pre-renal azotemia)
Chronic kidney disease

Question 4

What is are common causes of post-renal disease?

Answer 4

Ureteral obstruction (stricture or tumor), bladder outlet obstruction (BPH, prostate cancer, tumor)

Question 5

A healthy female patient presents with new acute renal dysfunction after being treated for a simple uncomplicated urinary tract infection. She is afebrile with negative CVA tenderness. What is the likely cause of her renal dysfunction?

Answer 5

Medication (bactrim)

Question 6

An elderly male presents with new acute renal failure after suffering for 5 days with a viral gastroenteritis. He has had diarrhea, vomiting and unable to eat or drink. What is the most likely cause of his acute renal failure?

Answer 6

Pre-renal azotemia

Question 7

A patient with new renal failure is found to have heavy proteinuria on urine studies. What is the most likely diagnosis?

Answer 7

Nephrotic Syndrome

Question 8

What type of renal dysfunction has pigmented granular casts?

Answer 8

Acute Tubular Necrosis

Question 9

What type of renal dysfunction has white blood cell casts?

Answer 9

Acute interstitial nephritis

Question 10

What are hyaline casts a sign of?

Answer 10

Dehydration

Question 11

A 65 year old female presents with new discovery of renal dysfunction. Urinanalysis is negative for white blood cells. There is microscopic hematuria. She denies pain. What is the best diagnostic test to order?

Answer 11

Renal ultrasound

Question 12

A 67 year old male presents with back pain located in the spine and new discovery of renal failure. What test should you order?

Answer 12

Serum protein electrophoresis, urine protein electrophoresis (SPEP/UPEP) to look for multiple myeloma

Question 13

What are the two most common cause of chronic renal dysfunction?

Answer 13

1. Diabetic nephropathy

2. Hypertensive nephropathy

Question 14

What are complications of patients with chronic renal dysfunction? (name 3)

Answer 14

1. Anemia - need EpoGen (Epoetin alpha) injections
2. Vitamin D deficiency - decreased production
3. Hyperkalemia
4. Metabolic Acidosis - decreased bicarbonate reabsorption
5. Volume overload
6. Uremia - toxins accumulate, systemic inflammation

Question 15

What is the first sign of diabetic nephropathy?

Answer 15

Microalbuminemia

Question 16

A patient with CKD secondary to diabetes, develops hypertension. What medication should be started?

Answer 16

ACE-I

Question 17

What is the FeNa value that suggests pre-renal azotemia?

Answer 17

Less than 1%

Question 18

A patient with chronic musculoskeletal back pain presents with new renal failure. The pain is the result of a skiing injury. The PCP refuses to prescribe narcotics. What is the likely culprit?

Answer 18

NSAIDS

Question 19

A 17 year old female presents a week after having had a pharyngitis with cola colored urine and oliguria. She has malaise and flank pain. What is the likely diagnosis?

Answer 19

Post-streptocococcal glomerulonephritis (urine will have protein, blood, white blood cells and might have red blood cell casts)