Nephro

Question 1

What are some important hematuria mimics to r/o

Answer 1

Menstrual blood, rhabdomyolysis, hemoglobinuria, porphyria, beets, fictious

Question 2

What are the immune-complex mediated glomerular causes of hematuria

Answer 2

IgA nephropathy, igA vasculitis, lupus, infectious-related

Question 3

What are the non-immune-complex mediated glomerular causes of hematuria

Answer 3

AntiGBM (goodpasture’s), ANCA asculitis, genetic disorders

Question 4

What are the non-glomerular kidney causes of hematuria

Answer 4

Pyelonephritis, RCC, PCKD, Medullary sponge kidney

Question 5

Whart are the most common causes of gross hematuria?

Answer 5

Cancer, UTI, stone, or stricture (also think trauma or recent procedure or rads) - also think about the level anatomically

Question 6

What are the important features to characterize on history?

Answer 6

Hematuria in relation to urine (e.g. if later then suggests prostate source, if beginning then urethra/bladder), onset and frequency
Accompanying urinary Sx
Associated Sx esp. fever, flank/groin pain, const / autoimmune
Triggers (trauma, exercise)
Iatrogenic tactors
Risk factors / exposures (especially dye or dye industry, analgesia, kidney stones, FH)
Pregnancy

Question 7

What workup do you send for hematuria?

Answer 7

Urinalysis + microscopy + culture + urine ACr
CBC / lytes / cr / INR/PTT, betaHCG
Viral screen (HIV, HBV, HCV)
C3/C4 + autoimmune (ANCA, antiGBM, anti-dsDNA)
+/- renal biopsy

Question 8

How do you distinguish between glomerular and non-glomerular bleeding?

Answer 8

Look for RBC casts and proteinuria (clots tends to indicate non-glomerular bleeding)

Question 9

When do you refer people to urology for hematuria?

Answer 9

Gross hematuria all patients >40 (need to r/o malignancy)

Question 10

When do you send to nephrology referral for hematuria?

Answer 10

Elevated Cr, proteinuria, casts or dysmorphic RBCs or >= 5 WBC/hpf without evidence of infection

Question 11

In a patient with a foley, where should you look to assess hematuria?

Answer 11

Look at the foley tubing; not the bag.

Question 12

What size foley do you need for CBI

Answer 12

3-way 20 French or 22 french (ideal)

Question 13

What is this cast

Answer 13

Renal tubular epithelium

Question 14

What is this cast

Answer 14

RBC cast

Question 15

What is this cast

Answer 15

Fatty cast

Question 16

What is this cast

Answer 16

Hyaline cast

Question 17

What is this cast

Answer 17

WBC cast

Question 18

If you have patients at risk of bladder Cx what is the appropriate follow-up?

Answer 18

Repeat U/A yearly, if 3x +ve for microscopic hematuria or recurrence of gross hematuria, repeat full workup.

Question 19

What is the differential for papillary necrosis

Answer 19

Pyelonephritis, obstrution, sickle cell disease / trait, NSAIDs, Tuberculosis, systemic vasculitis, (rarely DM / liver failure)

Question 20

How do you differentiate nephritic vs nephrotic

Answer 20

Nephritic = blood (rbc cast or dysmorphic) + 1-3G protein per day

Nephrotic syndrome = prot >3.5 + edema + serum albumin < 35 + hypercholestérolémia + hypercoag + inf

Question 21

What is the differential for GN

Answer 21

ANCA, GBM (also associated with DAH)
Vs immune complex (IGA, complément déposition, lupus, infection HepB/HepC/HIV (incl sepsis or endocarditis)

Question 22

I what protein is picked il on dipstick

Answer 22

Albumin (not other proteins)

Question 23

What is normal proteinuria

Answer 23

150mg day
Albumin 30

Question 24

When do you suspect glomerulonephritis?

Answer 24

Aki cr rise that is slow
Blood / protein in urine
Failed fluid challenge
Not obstructive.