Awesome Review

Question 1

Which type of AGMA causes nephrolithiasis?

Answer 1

Ethylene Gycol making glycolic acid; calcium phosphate kidney stones
Tx- Fomepizole

Question 2

Which type of AGMA can cause blindness and papilledema?

Answer 2

Methanol from too much formic acid

Question 3

If osmolol gap is greater than 20?

What if osmolol gap is greater than 50?

Answer 3

Give Fomepizole

Hemodialysis

Question 4

Tx Type 2 RTA

Answer 4

Thiazides and alkali depletion
Problem with proximal CT, can’t reabsorb bicarbonate or NaCl

Looks like Fanconi Syndrome

Question 5

Tx Type 1 RTA

Answer 5

Give potassium citrate

Distal CT can’t acidfy urine, urine pH > 6 and hypocitaturia

Question 6

Features of type 4 RTA

Answer 6

Aldosterone deficiency or resistance causing hyperkalemia

Tx- try fludrocortisone

Question 7

Features of Barter’s syndrome

Answer 7

Like loop diuretic
Hypokalemia, low BP, urine Cl > 15

Tx- inhibit prostaglandin production with indomethacin and ibuprofen

Question 8

Features of Gitelman syndrome

Answer 8

Like thiazides
Problem with DCT sodium receptor
Hypokalemia, low BP, urine Cl > 15
Uric acid

Question 9

Salicylate overdose causes…?

Answer 9

Respiratory alkalosis followed by metabolic acidosis

Question 10

Features of Liddles Syndrome

Answer 10

Increased transport defect in distal tubule causing hyperaldosteronism
High BP

Question 11

If you see hyponatremia and urine sodium

Answer 11

Hepatorenal syndrome

Question 12

Lab findings in SIADH

Answer 12

Low serum sodium
High urine sodium
High urine osmolarity

Tx: demeclocycline or tolvaptan
(Demeclocycline in CI in liver cirrhosis)

Question 13

How to fix it when you overcorrect hyponatremia?

Answer 13

Desmopressin with Dextrose 5%

Question 14

When to give calcium gluconate in hyperkalemia?

Answer 14

Flattened P waves or wide QRS

Question 15

Best test to measure microalbuminuria

Answer 15

spot urine protein/urine creatinine ratio, if >0.3

Question 16

List 5 causes of papillary necrosis

Answer 16

Analgesics
Sickle cell trait 
Sickle cell disease
DM
Pyelonephritis 
Obstruction
TB
Chronic EtOH
RV thrombosis

Question 17

Treat ADPKD-

Autosomal Dominant Polycystic Kidney Disease

Answer 17

Tolvaptan (also used to treat SIADH)

Associated with Hepatic Cysts and Berry Aneurysms and mitral Valve Prolapse and elevated hematocrit

Question 18

Fatty Oval Bodies associated with

Answer 18

Nephrotic Syndrome

Question 19

Light Microscopy Finding of

Focal Segmental

Answer 19

Sclerosis in some parts of some glomeruli

Focal/segmental

Question 20

Etiology of

Focal Segmental

Answer 20

Obese Black patient with HIV and Sickle Disease using Heroin

Question 21

Electron Microscopy Finding of

Membranous

Answer 21

Subepithelial deposits

LM- thickened capillary loops

Question 22

Etiology of Membranous

Answer 22

Hep B, Hep C, Syphillis, Solid Tumor, Lymphoma, malaria, NSAIDs, SLE, ACE-I, Gold, Pencillamine

Question 23

Etiology of Minimal Change Disease

Answer 23

Hodgkin’s lymphoma, thymoma, leukemia, NSAIDs, Lithium

Question 24

Electron Microscopy of Minimal Change

Answer 24

Effacement of Epithelial Foot Processes

Question 25

Etiology of MembranoProliferative

Answer 25

Hep B, Hep C, SLE, Cryoglubinemia, SBE, monoclonal gammopathy

Question 26

Which nephrotic syndrome has low Complement levels?

Answer 26

MembranoProliferative

Question 27

Treatment for Nephrotic Syndrome

Answer 27

Steroids | Then consider cyclophosphamide, calcineurin inhibitors, mycophenolate,rituximab

Question 28

IM finding of Rapidly Progressive Glomerulonephritis

Answer 28

Linear IgG deposition along glomerular basement membrane

Question 29

Treatment of Rapidly Progressive Glomerulonephritis | Hint- Goodpastures

Answer 29

Plasmapheresis to remove the antibody | Cyclophosamide and steroids

Question 30

Biopsy finding of IgA nephropathy

Answer 30

Mesangial Proliferation

Question 31

Treatment of IgA Nephropathy

Answer 31

Fish Oil with omega 3 Fatty Acid

Question 32

Lab findings with Infection Related GN (Hint- complement)

Answer 32

Low C3 Low CH50 Normal C4

Question 33

Lab Findings in pre-renal Azotemia

Answer 33

BUN:Cr >20:1 Urine Osm >500 Urine Na

Question 34

Anemia goal in CKD | Hgb, ferritin, transferrin sat

Answer 34

Hgb -10 Transferrin sat >30% Ferritin >500

Question 35

Compensation for Metabolic Acidosis

Answer 35

1.5 (HCO3) + 8

Question 36

Compensation for Metabolic Alkalosis

Answer 36

40 + 0.7(change in HCO3)

Question 37

Compensation for Respiratory Acidosis

Answer 37

Acute- increase by 1 for 10 mmHg in PCO2 | Chronic- increase by 3.5 for 10 mmHg in PCO2

Question 38

Compensation for Respiratory Alkalosis

Answer 38

Acute: decrease in 2 for 10 mmHg decrease in PCO2 Chronic: decrease in 5 for 10 mmHg decrease in PCO2

Question 39

Serum Complement levels decreased in which nephritic syndrome?

Answer 39

Post Streptococcal GN MembranoProliferative (SLE, SBE, Cryoglobulinemia) Atheroembolism (livedo reticularis/blue toe syndrome, eosinophilia, eosinophiluria)

Question 40

Name 5 causes of Acute Tubular Necrosis

Answer 40

``` Aminoglycosides Amphotericin B Cyclosporine Tumor Lysis Rhabdo Atheroembolism Ethylene glycol Calcium oxalate crystals Contrast ```

Question 41

5 cause (Meds) of Acute Tubulointersitial Nephritis

Answer 41

``` Beta Lactam PCN Sulfa Phenytoin Quinolone Mesalamine NSAIDs PPI ```

Question 42

Which macrolide causes AKI?

Answer 42

Clarithomycin

Question 43

Difference btwn Rhabdo and Tumor Lysis Syndrome

Answer 43

Heme dipstick is positive in Rhabdo ``` Both have increased CPK Increased Uric acid Increased Potassium Low calcium Increased phosphate ```

Question 44

Treatment of Uric Acid Stones

Answer 44

Adequate urine output of 2 liters in 24 hours Alkalinize urine (potassium citrate or potassium bicarbonate) Allopurinol only if hyperuricososuria

Question 45

Acquired Cystic Kidney Disease have high risk of ... What?

Answer 45

Renal Cell Carcinoma

Question 46

Which VEGF causes Thrombotic Microangiography?

Answer 46

Bevacizumab and Sunitinib

Question 47

Orliastat causes which type of nephrolithiasis?

Answer 47

Calcium Oxalate due to hyperoxaluria | Bonds intestinal calcium so more oxalate is absorbed intestinally and more peed out (enteric hyperoxaluria)

Question 48

Post transplant kidney patients have higher risk of which cancer?

Answer 48

Squamous cell cancer (skin)

Question 49

Pneumococcal vaccine administration in CKD

Answer 49

``` 23 valent 1 year 13 valent 5 years 23 valent ```

Question 50

Treatment for calcium Oxalate stones

Answer 50

Avoid oral oxalate Calcium carbonate/calcium citrate to bind intestinal oxalate Cholestyramine to bind oxalate as bile salts (Pyridoxine only for rare primary hyperoxaluria)