nephrology

Question 0

Prevention of kidney injury due to tumor lysis syndrome following chemotherapy

Answer 0

Allopurinol, Hydration, Rasburicase

Question 1

When is dialysis required for patients with ATN

Answer 1

Fluid overload
Metabolic acidosis
Encephalopathy
percarditis 
hyperkalemia

Question 2

treatment of Rhabdomyolysis

Answer 2

Hydration
mannitol
Bicarbonate

Question 3

Drug(s) that causes ototoxicity

Answer 3

Loop diuretics such as furosmide

Also caused by aminoglycoside antibiotics

Question 4

Hepatorenal syndrome lab work shows

Answer 4

Very low urine sodium (20:1)

Question 5

Treatment of hepatorenal syndrome

Answer 5

Midodrine
Octreotide
Albumin

Question 6

Presentation of atheroembolic acute kidney injury

Answer 6

Blue/purplish skin lesions in the fingers and toes
livedo reticularis
ocular lesions

-occurs in a patient who undergoes coronary angioplasty and several days later develops renal failure

Question 7

Lab tests for Atheroembolic disease

Answer 7

Eosinophilia
Low complement levels
Eosinophiluria
elevated ESR

Question 8

Most accurate diagnostic test for atheroemboli

Answer 8

biopsy of on of the skin lesions

• usually shows cholesterol crystals

Question 9

treatment of atheroemboli

Answer 9

No specific therapy

Question 10

Presentation of AIN

Answer 10

Fever
Rash
Eosinophilia
arthralgia

Question 11

What is different about urinalysis on NSAIDs causing AKI

Answer 11

NO EOSINOPHILS are seen in the urine

Question 12

AIN: labs

Answer 12

Eosinophilia
Eosinophiluria
BUN:Cr <20:1
Una and FeNa: increased

Question 13

AIN: best initial test and most accurate test

Answer 13

Best initial: UA - shows WBCs

Most accurate: Hansel and Wright stain - determines the type of WBC- eosinophils

Question 14

AIN treatment

Answer 14

Resolves spontaneously with stopping the offending agent or controlling infection and autoimmune diseases

• if still no response: STEROIDS
• Sever disease: dialysis

Question 15

Presentation of Papillary necrosis

Answer 15

Sudden onset of flank pain, fever and hematria in a patient taking NSAIDs with underlying diseases that affect kidney function:

Sickle cell disease
diabetes
urinary obstruction
Chronic pyelonephritis

Question 16

How do NSAIDs cause Papillary necrosis

Answer 16

by analgesic mediated vasoconstriction of medullary blood vessels which causes death of the cells in the papillae

Question 17

Papillary necrosis: best initial test

Answer 17

UA which shows RBC, WBC, and necrotic kidney tissues

Question 18

Papillary necrosis: most accurate test

Answer 18

CT scan - shows abnormal internal structures of the kidney from the loss of the papillae

Question 19

Papillary necrosis teatment

Answer 19

None

Question 20

Dital RTA (type I)

Answer 20

Distal tubules cannot generate HCO3 therefore acid cannot be excreted in the tubules from the serum.

No acid in the tubules= increase urine PH

decrease serum K+

Question 21

most accurate test for RTA type 1

Answer 21

Acid load test:
-acid is infused into the patients blood with ammonium chloride. A healthy person will pill it out into the tubules making the urine acidic. In RTA type 1, patient is unable to excrete acid into tubules therefore urine stays basic

Question 22

Treatment of RTA type 1

Answer 22

Replace bicarbonate along with K+ supplements

Question 23

What causes RTA type 1

Answer 23

Autoimmune disease (RA, SLE, sjogren syndrome)
Drugs (amphotericin B and Lithium)

Question 24

Complications of RTA type 1

Answer 24

Nephrocalcinosis (Calcium Oxalate stones)

Question 25

What causes RTA type 2

Answer 25

``` Amyloidosis Meyloma Fanconi syndrome acetazolamide heavy metals ```

Question 26

Labs seen in RTA type 2

Answer 26

urine PH- is initially high (>5.5), once all the HCO3 is lost in the urine, PH decreases (<5.5) urine HCO3- due to inability to reabsorb HCO3, it is lost in the urine therefore urine HCO3 is low Serum K+ is low due to increased exchange at the distal tubules

Question 27

most accurate test for RTA type 2

Answer 27

HCO3 load test: give patients HCO3 and test urine PH | -Urine PH will rise due to inability to reabsorb in the PCT

Question 28

Treatment of RTA type 2

Answer 28

Thiazides Thaizides cause volume depletion which enhances HCO3 reabsoprtion

Question 29

Type IV RTA pathophysiology

Answer 29

Decrease in the amount of Aldosterone which leads to Na loss and K and H retention

Question 30

What causes RTA type IV

Answer 30

Diabetes Addisons disease Sickle cell disease Renal insufficiency

Question 31

Diagnosis of RTA type IV

Answer 31

High urine Na despite a Na depleted diet

Question 32

RTA type II complications

Answer 32

Osteomalacia and Rickets

Question 33

Treatment of RTA type IV

Answer 33

Fludrocortisone (mineralocorticoid)

Question 34

RTA: urine anion gap

Answer 34

Positive RTA- defect in acid excretion into the urine so the amount of Cl (acid buffer) in the urine is diminished. This gives a + number when calculating Na-Cl.

Question 35

Diarrhea: Urine anion gap

Answer 35

Negative -Diarrhea is associated with metabolic acidosis therefore the kidney tries to compensate be increasing acid excretion. There is more acid in the urine. More acid in the urine means more Cl (buffer) in the urine. Na-Cl becomes negative!

Question 36

Normal anion gap (6-12) is seen in :

Answer 36

RTA, TPN, and Diarrhea

Question 37

Elevated anion gap is seen in:

Answer 37

MUD PILES

Question 38

What is emphysematous pyelonephritis

Answer 38

- a complications of pyelonephritis seen in diabetic women | - there is air in the renal parenchyma--usually due to gram negative organism such as E.coli

Question 39

Treatment for emphysematous pyelonephritis

Answer 39

Antibiotics and surgery

Question 40

Perinephric abscess: radiologic finding

Answer 40

- focal, hypodense, mass like lesion - followed by liquefaction, which walls off the center of the pyelonephritic area leaving a hyperdense rim of contrast surrounding the walled-off abscess cavity.