Deja - Internal - Nephrology

Question 1

ARF - Signs and symptoms NOT 2o to uremia:

Answer 1

1. Metabolic acidosis.
2. Hyperkalemia –> Arrhythmias.
3. Fluid overload –> Pulm. edema, CHF, HTN.
4. Hyperphosphatemia.
5. HTN 2o to excess renin secretion.

Question 2

Oliguria - Definition:

Answer 2

Less than 400cc/24h.

Question 3

What tests would you initially order to evaluate for ARF?

Answer 3

1. Urine/serum electrolytes.
2. Urine/serum BUN/Cr.
3. Urinalysis including urine osmolarity.

Question 4

What is FENa?

Answer 4

Stands for fractionals sodium excretion and is the best diagnostic test to help discriminate between the different types of ARF.

Question 5

FENa in Prerenal, renal, and post renal?

Answer 5

Pre –> >2%.

Postrenal –> >4%.

Question 6

Name the type of ARF associated with the following urinary sediment findings: Red cell casts, urine eosinophils, WBCs, granular casts.

Answer 6

Red cell casts –> GN.
Urine eosinophils –> AIN.
WBC casts –> AIN.
Granular casts –> ATN.

Question 7

What medications classically cause ATN?

Answer 7

CLAAP

Contrast
Lithium
Aminoglycosides
Amphotericin
Pentamine

Question 8

What are the causes of AIN?

Answer 8

Inflammation of the renal parenchyma caused by:

1. Medications: diuretics, NSAIDs, penicillin.
2. Infection: CMV, EBV, Toxo, Syphilis.
3. Systemic diseases: Sarco, Sjögren.

Question 9

Uremic syndrome - Cardiovascular:

Answer 9

1. HTN

2. Pericarditis

Question 10

Uremic syndrome - Pulmonary:

Answer 10

1. Pleural effusions

2. Pulm. edema.

Question 11

Uremic syndrome - CNS:

Answer 11

1. Asterixis

2. Clonus

Question 12

Uremic syndrome - Hematology:

Answer 12

1. Anemia due to low erythropoietin.

2. Incr. bleeding time due to platelet dysfunction.

Question 13

Uremic syndrome - GI:

Answer 13

1. Nausea

2. Vomiting

Question 14

Uremic syndrome - Metabolic:

Answer 14

1. Acidosis.
2. Electrolyte imbalances (especially hyperkalemia).
3. Hypocalcemia (lack of vitD).
4. Azotemia.

Question 15

What can be used to measure the severity of CRF?

Answer 15

GFR.

Question 16

In CRF, there is decreased synthesis of what 2 entities?

Answer 16

1. VitD

2. EPO

Question 17

Electrolyte abnormalities seen in CRF:

Answer 17

1. Hyperkalemia
2. Hypocalcemia
3. Hyperphosphatemia

Question 18

Indications for dialysis:

Answer 18

AEIOU

Acidosis
Electrolyte abnormalities
Ingestion of toxins
Overload of fluid
Uremic symptoms

Question 19

How can urinary cholesterol be identified?

Answer 19

If urine is seen under polarized light, there will be “MALTESE CROSSES”.

Question 20

Other names for minimal change disease?

Answer 20

Nil disease or lipoid nephrosis.

Question 21

Nephrotic syndrome - MC primary cause in adults:

Answer 21

FSGS or membranous glomerulonephritis.

Question 22

Nephrotic syndrome - 2 forms, type I is slowly progressive and type II has autoantibodies against C3 and is more rapidly progressive.

Answer 22

Membranoproliferative glomerulonephritis.

Question 23

Nephrotic syndrome - Associated with refractory HTN:

Answer 23

FSGS

Question 24

Nephrotic syndrome - Frequently recurs:

Answer 24

Minimal change disease

Question 25

Nephrotic syndrome - Granular deposits of IgG and C3:

Answer 25

Membranous glomerulonephritis.

Question 26

Nephrotic syndrome - Present in young, black men with refractory HTN:

Answer 26

FSGS

Question 27

Nephrotic syndrome - Associated with HIV, IVDA, SCA:

Answer 27

FSGS.

Question 28

Nephrotic syndrome - "Spike and dome" on histology due to excess basement membrane:

Answer 28

Membranous glomerulonephritis.

Question 29

Nephrotic syndrome - Slowly progressive with minimal response to steroids:

Answer 29

Membranous GN

Question 30

Nephrotic syndrome - Associated with hep, SLE, syphilis, malaria, penicillamine, gold, CA:

Answer 30

Membranous GN.

Question 31

Main treatment for FSGS:

Answer 31

Steroids with cyclophosphamide - Poor prognosis.

Question 32

Main treatment for membranous GN:

Answer 32

Steroids, can add cyclophosphamide in refractory cases.

Question 33

Main treatment for membranoproliferative GN:

Answer 33

Steroids. Plasmapheresis can be added.

Question 34

Name the systemic diseases that can lead to nephritic syndrome.

Answer 34

1. SLE 2. SCA 3. HIV 4. Diabetes 5. Myeloma

Question 35

ARF - Signs and symptoms 2o to uremia:

Answer 35

1. Asterixis 2. Nausea 3. Vomiting 4. Anemia 5. Pericarditis 6. Pruritus 7. Urea crystals on the skin ("uremic frost"). 8. Fatigue 9. Oliguria