Misc

Question 1

What condition do you calculate urine anion gap?

Answer 1

renal tubular acidosis

Question 2

what is the equation for urine anion gap?

Answer 2

UAG = (UNa + Uk) - Ucl

Question 3

RTA is characterized by what type of metabolic acidosis?

Answer 3

NORMAL anion gap metabolic acidosis

Question 4

what are the metabolic findings of distal (classic or type 1) RTA?

Answer 4

hypOkalemia, + UAG, urine pH > 5.5

Question 5

what are the metabolic findings of proximal (type 2) RTA

Answer 5

NEGATIVE UAG, hypOkalemia, urine pH < 5.5

Question 6

what are the metabolic findings of type 4 RTA (aka)?

Answer 6

(aka hyporeninemic hypoaldosteronism)
hypERkalemia, + UAG, urine pH < 5.5
–> these patients often have CKD and diabetes; may develop severe hyperkalemia after treatment with ACEI or ARBs.

Question 7

what is the plasma osmolal gap equation? and what is it used for?

Answer 7

Plasma Osmolality (mOsm/kg H2O) = 2 × Serum Sodium (mEq/L) + Plasma Glucose (mg/dL)/18 + Blood Urea Nitrogen (mg/dL)/2.8
used for ALCOHOL POISONING and to determine tonicity

When the measured osmolality exceeds the calculated osmolality by greater than 10 mOsm/kg H2O, the osmolal gap is considered elevated

Question 8

Urine osmolality <100 mOsm/kg H2O indicates?

Answer 8

excessive water intake, as seen with psychogenic polydipsia or poor solute intake

Question 9

Hypernatremia may be caused by *** diuresis, in which the urine osmolality is usually between 300 and 600 mOsm/kg H2O.

Answer 9

osmotic (such as glucose or uremia)

Question 10

How are patients with newly diagnosed primary membranous glomerulopathy usually treated?

Answer 10

observed for 6 to 12 months while on conservative therapy (renin-angiotensin blockade, cholesterol-lowering medication, and edema management) to allow time for possible spontaneous remission before initiating immunosuppression

Question 11

Patients with symptomatic anemia of chronic kidney disease may be treated with ? to reduce transfusion requirements with a target hemoglobin level of 11 to 12 g/dL (110-120 g/L) to avoid increased risk of adverse cardiovascular events.

Answer 11

erythropoiesis-stimulating agents; use only when the patient has adequate iron stores
- Iron repletion is recommended if the transferrin saturation is ≤30% and the ferritin is ≤500 ng/mL (500 µg/L).

Question 12

Patients receiving daptomycin therapy should undergo baseline measurement?

Answer 12

of kidney function and creatine kinase level followed by weekly monitoring

Question 13

Balkan endemic nephropathy is strongly associated with the development of?

Answer 13

upper tract transitional cell (urothelial) cancers, and urologic evaluation is necessary

Question 14

Electron microscopy of a kidney biopsy with primary FSGS will typically show what?

Answer 14

extensive effacement of the podocyte’s foot process

Question 15

Contrast-induced nephropathy (CIN) results in ATN with an increase in serum creatinine within how many hours of exposure?

Answer 15

48

Question 16

What antibiotics are the preferred antimicrobial agents for the treatment of recurrent cystis when trimethoprim-sulfamethoxazole local resistance rates are high or the patient has been treated with an antibiotic for a urinary tract infection within the previous 3 months?

Answer 16

Ciprofloxacin and levofloxacin

Question 17

Screening for intracranial cerebral aneurysms using CT or MR angiography is recommended for patients with?

Answer 17

autosomal dominant polycystic kidney disease

Question 18

What is the most appropriate venous access strategy before hemodialysis initiation?

Answer 18

tunneled IJ CVC

- NOT PERIPHERALLY INSERTED CATHETER

Question 19

What are the clinical clues to the diagnosis of light chain cast nephropathy from multiple myeloma?

Answer 19

An elevated urine protein-creatinine ratio with minimal proteinuria by urine dipstick, anemia, and hypercalcemia.

Question 20

Topiramate, a carbonic anhydrase inhibitor, causes a decrease in urinary citrate excretion and formation of alkaline urine that favor the creation of what type of stones?

Answer 20

calcium phosphate stones

Question 21

What is the preferred opioid to treat cancer-related pain in patients with CKD?

Answer 21

Hydromorphone

Question 22

Initial antihypertensive treatment in black patients without chronic kidney disease should include?

Answer 22

a thiazide diuretic or calcium channel blocker, or combination of the two. However, if chronic kidney disease (CKD) is present, initial or add-on therapy should include an ACE inhibitor or angiotensin receptor blocker, especially in those with proteinuria

Question 23

Saline-responsive metabolic alkalosis typically presents with?

Answer 23

hypovolemia and a low urine chloride of <15 mEq/L (15 mmol/L); the most common causes are vomiting, nasogastric suction, and diuretic use.

Question 24

a high urine chloride (>15 mEq/L [15 mmol/L]) with elevated blood pressure and hypokalemia and do not appear to be overtly volume overloaded, what disorder must be considered?

Answer 24

a mineralocorticoid excess disorder must be considered (saline-resistant metabolic alkalosis). Examples include Cushing syndrome and primary aldosteronism

Question 25

Hypoaldosteronism caused by?

Answer 25

heparin, inhibitors of the renin-angiotensin system, type 4 renal tubular acidosis, or primary adrenal disease can cause hyperkalemia, especially in patients with chronic kidney disease or diabetes mellitus, or in those taking an ACE inhibitor or angiotensin receptor blocker.

Question 26

At estimated glomerular filtration rates <30 mL/min/1.73 m2, what tend to be more effective at controlling extracellular volume expansion and should be used instead of (or added to) thiazide diuretics?

Answer 26

loop diuretics