Nephrology

Question 1

In a young muscular man, can measure ____ instead of Cr to get accurate kidney function

Answer 1

Cystatin C

Question 2

ART, H2 blockers, Bactrim can increase Cr by default, so simply repeat later in time

Question 3

Urine reddening drugs_____

Answer 3

Phenytoin, Pyrazinamide (Pyridium), Rifampin

Question 4

Rhomboid crystals with low urine pH______

Answer 4

Uric acid, gout

Question 5

Coffin crystals with high urine pH

Answer 5

struvite, proteus

Question 6

Hexagonal crystals______

Answer 6

Homocysteinuria

Question 7

Envelope shaped crystals______

Answer 7

Calcium oxalate, ethylene glycol, high calcium/oxalate in serum

Question 8

If there is a proteinuria but dipstick with trace protein indication of____

Answer 8

bend jones light chain from MM, unmeasured from the urinalysis assay

Question 9

Nephrolithiasis best seen with _____

Answer 9

NON contrast CT Scan, might do US renal first

CT Urography used for malignancy

Question 10

Hypernatremia: If the losses are nonrenal, urine osmolality will be _____

Answer 10

elevated to >600 mOsm/kg H2O

Body is trying to retain as much water as possible, ADH activity

Question 11

Hypokalemia urine studies : A value ____ mEq/g identifies hypokalemia secondary to lack of intake, transcellular shifts, or gastrointestinal losses.

Answer 11

<13 (Potassium/Cr ratio)

Question 12

_____, increased sodium reabsorption in the distal nephron causes hypertension, metabolic alkalosis, and potassium wasting

Answer 12

In Liddle syndrome

HypoK syndromes: Liddle, Gittleman, Barter

*Mag potentiates Ca2+ and K+

Question 13

EKG changes with hypokalemia_____

Answer 13

U wave, ST depression, low T amplitude

Question 14

____ is a medication that can cause hypokalemia through hypoaldosteronism

Answer 14

Heparin

Question 15

EKG changes with hyperkalemia______

Answer 15

Peaked T wave, short QT, Wide QRS and PR, almost invisible P wave

Question 16

Symptoms of ____ ion deficiency: nclude tremors, fasciculations, muscle weakness, carpopedal spasm, Chvostek and Trousseau signs, seizures, and cardiac arrhythmogenicity.

Answer 16

Mg2+ and Ca2+

Question 17

Acetaminophen in strict vegetarians can causes metabolic acidosis (T/F)

Answer 17

True

Question 18

Ethylene glycol has gap acidosis and _____

Answer 18

Osmolar gap

Question 19

_______ RTA is associated with falcon syndrome, which has glucose/phosphate/amino acids in the urine

Answer 19

Type II, hypokalemia

*Type 1 associated with Sjogrens, drugs (amphoterecin), hallmark of type 1 is normal urine pH because urine can’t be acidified (H+ failure)

Question 20

_____ drug associated with RTA, and formation of calcium phosphate stones, low urine citrate

Answer 20

Topiramate

Question 21

The most common causes of ______ are associated with chloride depletion: vomiting, nasogastric suction, and diuretic use.

Answer 21

metabolic alkalosis

*Low urine chloride<15, implies chloride wasting and supplement with NaCl

Question 22

____ poisoning associated with respiratory alkalosis, metabolic acidosis

Answer 22

ASA (salicyclate)

Question 23

Baseline electrocardiography is appropriate for all patients with newly diagnosed hypertension.

Question 24

Special populations: African American

Answer 24

In general, ACE inhibitors are less efficacious in lowering BP in Black patients than are CCBs. Additionally, a landmark trial (ALLHAT) revealed that in Black patients, a thiazide diuretic was more effective in improving cardiovascular outcomes compared with an ACE inhibitor,

Question 25

Common medications causing interstitial nephritis

Answer 25

Lithium, NSAIDS, H2 blocker/PPI, HIV meds, Abx, anti-cancer medications

Question 26

Kidney involvement in______ is common and can manifest as nephrocalcinosis from hypercalcemia and hypercalciuria, obstructive uropathy, and TIN due to granulomatous interstitial nephritis.

Answer 26

sarcoid

Question 27

Heavy metal causing nephrotic syndrome_________

Answer 27

Lead

Question 28

In immunosuppressed patients with transplanted organs, _______ can cause interstitial nephritis. Diagnosis of BK virus nephropathy can be difficult to distinguish from acute cellular rejection. The most important treatment intervention is to decrease immunosuppressive therapy.

Answer 28

BK virus

Question 29

Fanconi syndrome characterized by____

Answer 29

Phosphate amino acids glucose in the urine, acidosis, associated with cisplatin use, Wilsons disease

Question 30

____ causes multiple types of renal injury: nephrogenic DI, TIN, Type 1 RTA

Answer 30

Lithium

Question 31

definition of nephrotic range proteinuria ______

Answer 31

3500mg over 24 hrs

Question 32

___________is a leading cause of the nephrotic syndrome in White adults.

Answer 32

Membranous glomerulopathy (membranous nephropathy) Can be associated with PLA2R Patients with newly diagnosed primary forms of membranous glomerulopathy are usually observed for 6 to 12 months on conservative therapy (renin-angiotensin system blockade, cholesterol-lowering medication, and edema management) before initiating a course of immunosuppression for patients with persistent nephrotic-range proteinuria: Tacro/Pred

Question 33

The biopsy finding of nodular mesangial sclerosis with glomerular and tubular basement thickening, in the absence of immune deposits, is the classic description of ______

Answer 33

diabetic nephropathy

Question 34

most common etiologies seen in RPGN cases are ANCA-associated glomerulonephritis, lupus nephritis, and anti–glomerular basement membrane glomerulonephritis.

Answer 34

RPGN is a G.nephritis

Question 35

Anti GBM disease is a type of RPGN, linear staining of type 4 collagen antibody

Answer 35

Types of G Nephritis: Lupus, post strepp, IgA, MPGN, cryoglobinemia Treatment for anti-GBM disease consists of plasmapheresis, pulse glucocorticoids (high doses of intravenous glucocorticoids over a short period of time) followed by oral prednisone, and cyclophosphamide. More than half of patients with anti–glomerular basement membrane antibody disease have lung involvement manifesting as hemoptysis, shortness of breath, or cough.

Question 36

____________ is typically characterized by a vasculitic prodrome of malaise, arthralgia, myalgia, and skin findings; hematuria, proteinuria, and acute kidney injury are present, and kidney biopsy will confirm diagnosis

Answer 36

ANCA-associated glomerulonephritis Typical induction therapy consists of glucocorticoids combined with either cyclophosphamide or rituximab. Plasmapheresis is reserved for patients with evidence of alveolar hemorrhage or severe kidney failure. Other induction options include cyclophosphamide or rituximab-based therapies.

Question 37

Hint to immune complex mediated G.nephritis__________

Answer 37

Low C3/C4

Question 38

IgA nephropathy is actually a G.nephritis, associated among asian patients,

Question 39

Preferred treatment of lupus nephritis_______

Answer 39

Mycophenylate Treatment of classes I and II lupus nephritis (LN) includes conservative therapy with an ACE inhibitor or angiotensin receptor blocker; classes III, IV, and V LN may require aggressive immunosuppressive therapy; and class VI LN may be treated with conservative therapy.

Question 40

Common viral cause of MPGN______

Answer 40

Hepatitis C, MPGN is a type of G.nephritis

Question 41

≥60 years old if blood pressure is >150/90 mm Hg, with a goal of reducing systolic blood pressure to <150 mm Hg

Answer 41

Varies by organization