Approach to Kidney Disease

Question 1

Will a patient with nephritic or nephrotic syndrome outwardly appear to be more unwell?

Answer 1

Nephritic syndrome

Question 2

Dark brown urine can represent increased levels of these three things

Answer 2

Bilirubin (liver disease)

Hemoglobin

Myoglobin (rhabdomyolysis)

Question 3

Method to differentiate if heme in urine is from hemoglobin or myoglobin

Answer 3

Microscopic analysis

Question 4

Three hallmark signs of nephrotic syndrome

Answer 4

More than 3.5 grams of protein in the urine per day

Edema

Hypoalbuminemia

Question 5

A parent with congenital polycystic kidney disease where their progressively growing renal cysts replace normal kidney tissue has this % chance of passing it on to their child

Answer 5

50%

ADPKD - autosomal dominant polycystic kidney disease

Question 6

This condition is associated with a characteristic thickening of basement membranes of the glomerulus

Answer 6

Membranous nephropathy

Question 7

Most common cause of nephrotic syndrome in whites and the elderly

Answer 7

Membranous nephropathy

Question 8

Dysmorphic red blood cells seen on microscopic analysis of urine suggest this condition

Answer 8

Damage at the level of the kidney

RBCs misshapen from passing through glomerular basement membrane

Question 9

Between which ages does anti-GBM disease most commonly occur?

Answer 9

Men - 20 to 40
Women - 60 to 80

Question 10

This IgA nephropathy variant generally occurs in children, and has a clinical tetrad of purpuric rash on thighs, arthralgias, abdominal pain, and gross hematuria (from renal failure)

Answer 10

HSP (Henoch-Schonlein Purpura)

Question 11

This renal condition has a classic “tram tracking” appearance on biopsy, can cause nephrotic OR nephritic syndrome, low complement levels, and a strong relationship with Hep C

Answer 11

MPGN (Membranoproliferative Glomerulonephritis)

(tram tracking = double inner and outer membrane)

Question 12

These two signs/symptoms nearly always co-present with diabetic caused nephrotic syndrome

Answer 12

Peripheral nephropathy

Diabetic retinopathy

Question 13

Leading cause of nephrotic syndrome in adults, especially blacks

Answer 13

FSGS (focal segmental glomerular syndrome)

Question 14

Two causal associations for minimal change disease

Answer 14

NSAIDs

Hodgkin’s lymphoma

Question 15

Most common glomerulonephritis worldwide

Answer 15

IgA nephropathy

Question 16

Your patient has rapidly progressing renal failure with gross hematuria and oliguria, hemoptysis, dyspnea, and pulmonary infiltrates. What do you think they have, and how would you confirm this diagnosis?

Answer 16

Anti-glomerular basement membrane disease

Confirm with serology that shows Anti-GBM antibodies

Question 17

Does a patient who presents with hematuria, flank pain, dysuria, or urinary frequency, but no proteinuria more likely have a renal or non-renal issue?

Answer 17

Non-renal source

Question 18

Area where edema is first seen in cases of significant pediatric proteinuria

Answer 18

Periorbital edema (especially in children)

Question 19

Does a patient who presents with hematuria, increased BUN and creatinine in the blood, and dysmorphic RBC casts in the urine more likely have a renal or non-renal issue?

Answer 19

Renal source

Question 20

Gold standard for analysis of proteinuria

Answer 20

24 hour urine sample

Question 21

Most common cause of obstructive uropathy in adults

Answer 21

BPH

Question 22

Patients with severe and generally acute inflammatory injury to glomerulus where patients are frequently oliguric with tea colored hematuria, and hypertension have this syndrome

Answer 22

Nephritic syndrome

Question 23

Podocyte effacement is a hallmark sign of this condition

Answer 23

Nephrotic syndrome

Question 24

This condition causes multiple abnormalities including proteinuria which will show on 24 hour urine collection, but not on dipstick

Answer 24

Multiple myeloma

Question 25

Patients with a first degree relative who died of a cerebral aneurysm should be screened for this renal condition

Answer 25

ADPKD (autosomal dominant polycystic kidney disease)

Question 26

Diagnosis method for orthostatic proteinuria

Answer 26

Split day/night urine collection

Question 27

Urine that looks foamy and bubbly suggests this ...

Answer 27

Proteinuria

Question 28

Four associated conditions with ADPKD (autosomal dominant polycystic kidney disease)

Answer 28

Mitral valve prolapse Cerebral aneurysms Diverticulitis Ovarian cysts

Question 29

Orthostatic proteinuria occurs when the patient is upright/active. Which type of patient is this condition most common in?

Answer 29

Adolescents (gets better with time)

Question 30

This condition is associated with massive proteinuria (>10 grams/day), rapid onset of swelling, but kidney structure looks normal on light microscopy

Answer 30

Minimal change disease (need electron microscopy to see squashed podocytes)

Question 31

Number one cause of end stage renal disease in the US

Answer 31

Diabetes

Question 32

Three treatments for nephrotic syndrome

Answer 32

Statins ACE/ARBs to decrease protein push through glomerulus Treat edema with salt restriction and loop diuretic

Question 33

Secondary causes (3) of membranous nephropathy

Answer 33

Hepatitis B/C Lupus Occult malignancy

Question 34

Microcystic disease, renal scarring, and nephrogenic diabetes insipidus is induced by use of this medication

Answer 34

Lithium (lithium induced renal disease)

Question 35

In nephrotic syndrome, overcompensation as a response to albumin loss can lead to these two conditions

Answer 35

Hyperlipidemia Hypercoagulable state

Question 36

A child develops hypertension, swelling, and has tea-colored/red urine 10-14 days after a strep infection. Diagnose this child.

Answer 36

Post-streptococcal GN (glomerulonephritis)

Question 37

Most common secondary cause of FSGS (focal segmental glomerular syndrome)

Answer 37

Obesity/OSA

Question 38

Number one cause of proteinuria

Answer 38

Type 2 diabetes

Question 39

Your patient has developed blood in their urine within 24 hours of having an upper respiratory infection/sore throat/ear infection. What condition might they have developed and how would you slow its progression?

Answer 39

IgA nephropathy "syn-pharyngitic nephritis" Slow progression with ACE inhibitors

Question 40

Name the classic triad associated with cholesterol emboli

Answer 40

Eosinophilia and eosinophiluria Low complements Livido reticularis

Question 41

Which of these, minimal change disease or focal segmental glomerular syndrome is the most common cause of nephrotic syndrome in children?

Answer 41

Minimal change syndrome

Question 42

Acute interstitial nephritis is usually caused by (blank) and begins (time) after exposure

Answer 42

Caused by medications Occurs 7-10 days after exposure

Question 43

This renal condition is more common after invasive procedures around the heart and can cause acute or chronic renal failure

Answer 43

Cholesterol embolitis

Question 44

Which of these, minimal change disease or FSGS (focal segmental glomerular syndrome) is the more treatment resistant?

Answer 44

FSGS tends to be treatment resistant Minimal change disease is very responsive to steroids, especially in children

Question 45

This nephritis is associated with long term NSAID use

Answer 45

Chronic interstitial nephritis