Kidneys

Question 1

Appearance of Simple Cysts

Answer 1

small, no loculations, no septations, asymptomatic & incidential findings on U/S or CT

*do nothing

Question 2

Appearance of Complex Cysts

Answer 2

large, septations, loculatoins, symptomatic +/- flank pain, hematuria = needle guided biopsy

Question 3

Renal Cell Carcinoma

rf? dx? tx?

Answer 3

RF: VHL, smoking, ESRD
DX: U/A, CT, U/S –> biopsy
TX: Resect

*watch out for Renal Vein Thrombosis, anemia & EPO paraneoplastic syn

Question 4

AR PKD

Answer 4

children w/oligohydramous, bilateral flank pain, U/S

-kid usually dies

Question 5

AD PKD

*where else u get cysts

Answer 5

adults, cause ESRD, hematuria, flak pain, stones, HTN
DX: U/S & CT
tx: managment + transplant
**cysts on liver, pancreas + brain

Question 6

Hyperkalemia tx

Answer 6

1. IV Ca-gluconate to stablize membranes
2. Insulin + glucose
3. decrease K w/diuretics or Kayexalate

Question 7

Hypokalemia tx

Answer 7

give K <10mEg/hr IV

*also check Mg

Question 8

Familial Hypocalcemic Hypercalcemia

Answer 8

mut CaSR = does detect elevated serum Ca causing cont. elevation in PTH.
*asymptomatic = no tx just watch for aortic stenosis

Question 9

Hypercalcemia tx

Answer 9

IVF + calcitonin

Long term: bisphophanates + IVF & sometimes furosemide

Question 10

Tx of Kidney stone <5mm

Answer 10

pass spontaneously, give fluid and pain managment

Question 11

Tx of Kidney stone <7mm

Answer 11

medical explusive therapy = CCB + A-blocker

Question 12

Tx of Kidney stone <1.5cm

Answer 12

Uteroscopy(distal) or Lithotripsy(proximal)

Question 13

Tx of Kidney stone >1.5cm

Answer 13

Resect!

Question 14

How fast do you correct sodium?

Answer 14

0.25 mmol/hr

Question 15

Characteristics of NephrOtic Syn. Name the nephrotic syndromes

Answer 15

>3.5g/protein/d, HTN, Edema, Anti-thrombin 3
"MMM FSD"
-Minimal Change Dz
-Membranous Nephropathy
-Membranoproliferative glom
-Focal Segmental Glomerulosclerosis
-Systemic Amyloidosis
-Diabetic Nephropathy

Question 16

Minimal Change Dz

assoc? tx?

Answer 16

Nephroic syn, effacemnt of podocytes via cytokines. associaed w/hodgkin lymphoma, tx w/steroids

Question 17

Focal Segmental glomerulosclerosis

assoc? sx?

Answer 17

nephrotic syn, collagen depo, HTN, dec GFR, pink sclerosis

-assoc: HIV, Heroin, SS, Idiopathic

Question 18

Membranous Nephropathy

causes? assoc?

Answer 18

nephrotic syn, sub-epi IC depo causing “string of pearls”.

• cause: DISC = drugs, infection, SLE, cancer/hepC
• assoc: assoc w/ renal vein thrombosis which is often seen with RCC

Question 19

membranoproliferative glomerulonephritis

Answer 19

nephrotic syn, BM thickens due to IC depo causing MESANGIAL CELL PROLIF = HYPERCELLULARITY

• T1: tram track: assoc w/ a1at def, HBV/C
• T2: ribbin w/C3 nephritic factor

Question 20

NephrItic Syn sx? dz’s?

Answer 20

RBC casts, <3.5g/d, HTN

=> PSGN, Rapidly Progressive GN, Alport, IgA Nephrop, Henoch Schonlein Purpura

Question 21

Post-Streptococcal Glomerulonephritis(PSGN)

Answer 21

Nephritic Syndrome, IC depo = decrease C3&C4 in serum, look for child whose post-strep

Question 22

Rapidly Progressive GN

3 types? dz’s?

Answer 22

Nephritic Syndrome w/cresents of Fibrin + macrophages.

1. Linear IF = GOODPASTURES = Ab to A3 of T4collagen = lungs and kidney
2. Granular: PSGN, SLE GN
3. Paui-Immune: Wegners, MPAN, Churg Strauss

Question 23

Alport Syndrome

Answer 23

Nephritic Syndrome, XL def in T4 collagen, ocular, hearing loss, basket weave BM

Question 24

IgA Nephropathy(Berger dz)

Answer 24

Nephritic Syndrome, IgA depo, episodic, usually follows URTI

Question 25

henoch Schonlein Purpura

Answer 25

Nephritic Syndrome, systemic IgA depo, w/rash, purpura, etc

Question 26

When would you see OXALATE CRYSTALS? how do you treat this?

Answer 26

seen in suicidal ppl who ingest antifreeze(ethylene glycol) tx: FOMEPIZOLE + dialysis + NaHCO2(correct acidosis)

Question 27

Hepatorenal syndrome | dx? tx?

Answer 27

RF due to Liver failure = vasoconstriction of affarent arteriol causing decrease in perfusion. dx: 1.5L colloid = no change tx: octreotide, Midodrine, tx cause

Question 28

RTA T1 | ph? assoc?

Answer 28

pH>5.5 , Stones, impaired H+ excretion in distal tubules, bicarb <10

Question 29

RTA T2 | ph? assoc?

Answer 29

Impaired HCO3 resorb in prox tubule, pH<5.5, Bone probs/pains, bicarb 12-20

Question 30

RTA T4 | ph? assoc?

Answer 30

decrease aldo or aldo resistance, pH <5.5, no bones, no stones, elevated K, >17 bicarb

Question 31

Acute Tubular Necrosis(ATN) | tx? sx?

Answer 31

tubular dmg due to decrease perfusion causing inflammation = PGI2 causes ischemia = cell apop = no NaK pump! sx: muddy casts, increased K, decreased Na, eleved U-Na, Low osm tx: hydration + support

Question 32

Acute/Allergic Interstitial Nephritis(AIN) | sx? tx?

Answer 32

allergy/irritation to somthing = wks of drug exposure, or infection sx: 80% ppl have rash + fever, eosinophilia, WBC casts, Proteinuria, elevated IgE tx: hydration + stop drug