MTB 1

Question 1

Ethylene Glycol Toxicity effect on kidney

Answer 1

Acute kidney injury
Oxalic acid and oxalate precipitate in tubule to cause ATN
Envelope shaped crystals
LOW Calcium (calcium oxalate)

Question 2

NSAIDs and Ibuprofen cause what kidney damage

Answer 2

Acute interstitial nephritis

Papillary necrosis

Question 3

Presentation of Papillary necrosis

Answer 3

Sudden flank pain

Fever

Question 4

Opiates ass’d with what kidney damage

Answer 4

Focal Segmental Glomerulonephritis

Question 5

What electrolyte disturbance increases risk of aminoglycoside or cisplatin toxicity

Answer 5

Low Magnesium

Question 6

Bence Jones protein effect on kidney

Answer 6

Directly toxic to renal tubules

Death by RF and Infxn in Myeloma

Question 7

What kind of crystals do we see in Crohn’s?

Why?

Answer 7

Oxalate

Fat malabsorption - fat stays in gut, binds to calcium, so oxalate can’t bind to calcium and we get oxalate crystals

Question 8

Best initial test for rhabdomyolysis

Answer 8

UA

Positive on dipstick for large amts of blood, but no cells seen on microscope

Question 9

Causes of rhabdomyolysis

Answer 9

Crush Injury
Immobilization 
Snake bite
Trauma
SEizures

Question 10

Labs in rhabdomyolysis

Answer 10

Markedly elevated CPK
Hyperkalemia
Hyperuricemia
Hypocalcemia

Question 11

Most specific test for rhabdomyolysis

Answer 11

Urine test for myoglobin

Question 12

TX for rhabdomyolysis

Answer 12

Saline hydration
Mannitol
Bicarbonate = drives K+ back into cells

Question 13

Wrong answers for TX for ATN

Answer 13

Low dose dopamine
Diuretics
Mannitol
Steroids

Question 14

Dialysis is answer when

Answer 14

Fluid Overload
Encephalopathy 
Pericarditis
Metabolic Acidosis
Hyperkalemia

Question 15

TX for hypocalcemia

Answer 15

Vitamin D + Calcium

Question 16

Drugs that cause ototoxicity

Pathophys of ototoxicity

Answer 16

Furesomide, Gentamicin
Damages hair cells of cochlea - sensorineural hearing loss, burns inner ear
Aminoglycosides decrease trough for free period to prevent damage

Question 17

Signs of hepatorenal syndrome

Answer 17

Cirrhosis
New onset renal failure w no explanation 
Very LOW Urine Sodium < 10-15
FeNa < 1%
Elevated BUN/Cr > 20:1

Question 18

TX for hepatorenal syndrome

Answer 18

Albumin
Midodrine - increase mean arterial pressure
Octreotide

Question 19

What is Midodrine
MOA
Use

Answer 19

Pressor/Inotrope
Stimulates alpha 1 receptors
Constricts arterioles and veins = Increases peripheral resistance
Significant improvement of Supine BP

Question 20

Atheroemboli - Cholesterol emboli in kidney presentation

Answer 20

Blue/purplish skin lesions in fingers and toes
Livedo reticularis
Ocular lesions

Question 21

What is Livedo reticularis

Answer 21

Venule swelling caused by capillary obstruction by thrombi

“Blue fish net stocking”

Question 22

What are peripheral pulses in Atheroemboli

Answer 22

Normal

Too small to occlude vessels

Question 23

Labs in Atheroemboli

Answer 23

Eosinophilia
Low complement
Eosinophiluria
High ESR

Question 24

Most accurate diagnostic test for atheroemboli

Answer 24

BX of purplish skin lesions

Question 25

Acute/Allergic Interstitial Nephritis Definition

Answer 25

ARF damaging tubules | Abs and eosinophils attack cells lining tubules as rxn to drugs, infxn, AI dz

Question 26

Drugs that cause AIN

Answer 26

``` PCNs Cephalosporins Sulfas Phenytoin Rifampin Quinolones Allopurinol PPIs ```

Question 27

Presentation of AIN

Answer 27

Fever Rash Arthralgias Eosinophilia + Eosinophiluria

Question 28

Most accurate test for AIN

Answer 28

Hansel or Wright stain - detects eosinophils

Question 29

TX for AIN

Answer 29

Resolves spontaneously - treat underlying cause | If Creatinine keeps rising after, admin glucocorticoids

Question 30

Best initial test for AIN

Answer 30

UA for eosinophils

Question 31

Pathophys of analgesic nephropathy

Answer 31

PG Inhibition (constriction at afferent arteriole) causes vascular insufficiency = decreased renal perfusion ATN - directly toxic to tubules Papillary necrosis

Question 32

Papillary Necrosis seen in

Answer 32

Underlying renal disease + NSAIDs - Sickle Cell - Diabetes - Urinary obstruction - Chronic Pyelonephritis

Question 33

Papillary Necrosis Presentation

Answer 33

Sudden onset flank pain Fever Hematuria

Question 34

Best diagnostic test for Papillary Necrosis

Answer 34

UA shows red and white cells

Question 35

Most accurate test for Papillary Necrosis

Answer 35

CT scan shows abnormal internal structures

Question 36

Chronic Pyelonephritis on IVP

Answer 36

Blunting of calices | Calyceal clubbing focal, parenchymal scarring

Question 37

CT scan of Papillary Necrosis

Answer 37

Bumpy contour (lost papillae)

Question 38

TX for Pyelonephritis

Answer 38

Abx - Amp/Gent - FQ's

Question 39

Tests for Glomerular DZ

Answer 39

``` UA w hematuria UNa and FeNa= Low Red cell casts Proteinuria Dysmorphic red cells ```

Question 40

Goodpasture Dz Presentation

Answer 40

Lungs and kidney No = URT, skin, joint, GI, eye, or neuro Anemia often present

Question 41

Goodpasture v Wegener

Answer 41

Goodpasture = No Upper respiratory tract involvement | Wegener =URT involvement

Question 42

Best initial test for Goodpasture

Answer 42

Antiglomerular BM Abs

Question 43

Most accurate test for Goodpasture

Answer 43

Lung or Kidney BX | - Kidney Bx = linear deposits

Question 44

TX for Goodpasture

Answer 44

Plasmapheresis + Steroids

Question 45

IgA Nephropathy Aka? Presentation? Complement levels

Answer 45

``` Berger Dz Young, adult men Asians Recurrent gross hematuria 1-2 days post URI Normal Complement levels ```

Question 46

MCC of acute glomerulonephritis

Answer 46

IgA Nephropathy

Question 47

Post URI glomerulonephritis

Answer 47

1. IgA Nephropathy = 1-2 days | 2. Poststrep GN = post pharyngitis by 1-2 weeks

Question 48

Post strep GN Presentation Test results Labs

Answer 48

MC in children High ASO +/-DNAase Abs for GAS Subepithelial humps of C3 Low complement C3 levels

Question 49

Most accurate test for IgA Nephropathy

Answer 49

Kidney BX | IgA only elevated in 50%

Question 50

TX for IgA Nephropathy

Answer 50

No Tx to reverse | Severe proteinuria w ACE-I + Steroids

Question 51

Postinfectious GN Presentation

Answer 51

Dark urine (cola-colored) Edema = periorbital HTN Oliguria

Question 52

Management of Postinfectious GN

Answer 52

Supportive - Abx - Diuretics

Question 53

Pathophys of Hepatorenal syndrome

Answer 53

Arterial Vasodilation of splanchnic circulation | Results in under filling of arterial circulation

Question 54

Pathophys of Atheroemboli

Answer 54

Cholesterol plaques near aorta/coronary arteries broken off during manipulation of vessels with catheterization Lodge in kidney Cause AKI

Question 55

Infxn that cause AIN

Answer 55

``` Leptospira Legionella CMV Rickettsia Streptococcus Hantavirus ```