MTB

Question 1

Methods to assess total amount of protein in a day

Answer 1

1. Single protein to creatinine ratio

2. 24 hour urine collection

Question 2

WU for proteinuria

Answer 2

1. UA

2. Protein to Creatinine (P/Cr)

Question 3

What determines cause of proteinuria

Answer 3

Kidney BX

Question 4

Diabetic pt with microalbuminuria - next step in management

Answer 4

Start ACE

Question 5

Is Bence jones protein detectable on dipstick?

Answer 5

No

Must do immunoelectrophoresis

Question 6

What stain is important in allergic interstitial nephritis

Answer 6

Wright and Hansel

Detect eosinophils in urine

Question 7

DDX for Hematuria

Answer 7

Stones in KUB
Heme disorders
Infxn
Cancer - KUB
Cyclophosphamide
Trauma
Glomerulonephritis

Question 8

Dysmorphic RBCs indicates

Answer 8

Glomerulonephritis

Question 9

When is cytoscopy the answer

Answer 9

Hematuria w/out infxn
Prior trauma
AND
Renal US or CT inconclusive
Bladder sonography shows mass for possible BX

Question 10

What is cytoscopy the most accurate test for

Answer 10

Bladder

visualizes bladder and urethra = areas that do not show up well on X ray

Question 11

Red cell cast?

Answer 11

Glomerulonephritis

Question 12

White cell cast?

Answer 12

Pyelonephritis

Question 13

Eosinophil cast?

Answer 13

Allergic Interstitial Nephritis

Question 14

Hyaline cast?

Answer 14

Dehydration

Question 15

Broad, waxy cast?

Answer 15

Chronic Renal DZ

Question 16

Granular muddy brown cast?

Answer 16

Acute Tubular Necrosis

Question 17

Fatty Casts?

Answer 17

Nephrotic syndrome

Question 18

Prerenal azotemia causes

Answer 18

Decreased perfusion

• Hypovolemia
• HypoTN
• Renal Artery stenosis
• Hypoalbuminemia
• Cirrhosis
• NSAIDs = constrict afferent arteriole
• ACE I = efferent arteriole VD

Question 19

NSAIDs effect on kidney

Answer 19

Constrict afferent arteriole = decrease GFR

PGs dilate afferent to increase GFR

Question 20

ACE-I impact on GFR

Answer 20

Worsen GFR - but prevent progression of renal insufficiency - long term protect glomerulus

Question 21

Postrenal Azotemia causes

Answer 21

Obstruction = blocks filtration at glomerulus

• Prostate Hypertrophy
• Stone in ureter
• Cervical Cancer
• Urethral stricture
• Neurogenic bladder = MCC in DM and MS
• Retroperitoneal fibrosis

Question 22

MCC of death in cervical cancer

Answer 22

postrenal azotemia - renal insufficiency b/c both ureters blocked

Question 23

What is the major force favoring filtration in kidney

Answer 23

Hydrostatic pressure in glomerular capillary

Question 24

Drugs that cause retroperitoneal fibrosis kidney

Answer 24

Bleomycin
Busulfan
Methylsergide
Radiation

Question 25

MCC of intrinsic renal dz

Answer 25

ATN - ischemia and toxins

Question 26

Presentation of AIN

Answer 26

Fever Rash Eosinophils

Question 27

Causes of Intrinsic renal dz

Answer 27

``` AIN Rhabdomyolysis Hemoglobinuria Contrast agents Crystals Proteins Post strep infxn ```

Question 28

Presentation of AKI

Answer 28

Asymptomatic rise in BUN and Creatinine Sx's - N/V, malaise, weakkness, SOB Severe - Confusion, arrhythmia from hyperkalemia, acidosis. Pericarditis

Question 29

Presentation of Postrenal Azotemia

Answer 29

Enlargement of bladder | Massive diuresis after Foley placement

Question 30

Diagnostic test for Acute Kidney Injury

Answer 30

BUN | Creatinine

Question 31

BUN/Cr ratio > 20:1

Answer 31

Prerenal Azotemia | Postrenal Azotemia

Question 32

BUN/Cr intrinsic renal dz

Answer 32

Around 10:1

Question 33

Best imaging test for acute kidney injury

Answer 33

Renal sonogram

Question 34

Postrenal Azotemia

Answer 34

BUN/Cr > 20:1 Distended bladder, urine release w foley BL or UL hydronephrosis on sonogram

Question 35

When do we do kidney BX

Answer 35

Rarely correct answer | Most accurate for Allergic interstitial nephritis or poststrep GN

Question 36

What is UNa and FeNa in Prerenal azotemia

Answer 36

Low UNa = < 20 | Low FeNa = <1%

Question 37

What is urine Osmolality in ATN

Answer 37

Inappropriately LOW Isosthenuria - same as blood, about 300 mOsm/L Tubule cells damaged = urine cannot be concentrated

Question 38

Dehydration does what to osmolality (urine concentration)

Answer 38

Normally increases

Question 39

In ATN, what happens to sodium

Answer 39

Body inappropriately loses sodium and water into urine UNa > 20 UOsm < 300

Question 40

Healthy person w fluid overload | Osmolality?

Answer 40

LOW urine Osmolality | Dilute urine

Question 41

Healthy person w dehydration | Osmolality?

Answer 41

HIGH urine osmolality | Concentrated Urine

Question 42

Sickle cell trait pts management

Answer 42

Advise avoid dehydration | Do not need other TX

Question 43

What is Uremia

Answer 43

Renal insufficiency to the degree that dialysis is needed

Question 44

What does urine specific gravity correlate to

Answer 44

Urine osmolality

Question 45

Causes of ATN

Answer 45

Ischemia | Toxins

Question 46

Renal Insufficiency with rapid onset

Answer 46

Contrast

Question 47

Renal insufficiency drugs | How long to be nephrotoxic

Answer 47

``` Vanco Gentamicin Amphotericin Cisplatin Acyclovir Cyclosporine 5 to 10 days ```

Question 48

Most proven benefit at preventing contrast-induced nephrotoxicity

Answer 48

Saline Hydration

Question 49

Pathophys of contrast on kidney

Answer 49

Contrast causes spasm of afferent arteriole causing renal tubule dysfunction. High reabsorption of Na and water, causing high specific gravity of urine = VERY low urine Na

Question 50

Tumor Lysis Syndrome

Answer 50

Hyperuricemia | Hyperkalemia

Question 51

Renal failure prevention in chemo pts

Answer 51

Prior to chemo to prevent tumor lysis syndrome: Allopurinol Hydration Rasburicase

Question 52

Management of Hyperkalemia in tumor lysis syndrome

Answer 52

1. Normalize cellular electrical activity with Calcium 2. Drive K+ Intracellulary 3. Decrease total body K+ content - insulin and glucose = rapidly act to drive K+ intracellular within 15-30 mins