Nephrology

Question 1

Urnie Na and FENa consistent with pre-renal causes

Answer 1

Urine Na <20

FENa <1%

Question 2

Urnie Na and FENa consistent with intrinsic renal dysfunction

Answer 2

Urine Na >20 (inability to concentrate)

FENa >1%

Question 3

How is contrast induced nephropathy different than other forms of ATN?

Answer 3

Mechanism of action

Contrast induced causes spasm of the afferent arteriole leading to concentrated urine and very low urine Na

Question 4

What is the timing for ATN caused by medications?

Answer 4

5-10d

Question 5

Shape of oxalate crystals

Answer 5

Envelope shaped

Question 6

Drugs implicated in ATN

Answer 6

Aminoglycosides

amphoterocin

Cisplatin

Vancomycin

acyclovir

Cyclosporin

Question 7

Is medication induced ATN dose dependant?

Answer 7

YES

Question 8

Aminoglycosides and furosemide share this adverse effect

Answer 8

Ototoxicity

Question 9

Kidney dysfunction and rash in a patient who recently underwent cardiac or renal artery cath

Answer 9

Livedo reticularis

cholesterol atheroemboli

Question 10

Hansel or wright stain

Answer 10

stain for eosinophils

most accurate test for AIN

Question 11

Most accurate test in papillary necrosis

Answer 11

CT showing anatomic changes to papilla

Question 12

Classic presentation for IgA nephropathy

Answer 12

Gross hematuria in asian american 1-2d after URI

Question 13

Therapy for polyarteritis nodosa

Answer 13

Predisone and cyclophosphamide

Question 14

What screening test to perform in a patient with polyarteritis nodosa

Answer 14

HBV surface antigen

Question 15

In amyloidosis, HIV nephropathy, polycystic kidney disease and diabetes, the kidneys are….(small or enlarged)

Answer 15

enlarged

unlike HTN where they are smaller

Question 16

Treatment for amyloidosis nephropathy

Answer 16

prednisone and melphalan

Question 17

Nephrotic range proteinuria =

Answer 17

>3.5g/24hrs in urine

Question 18

Nephrotic syndrome leads to this coagulopathy…why

Answer 18

Thrombosis

loss of protein C, protein S and antithrombin

Question 19

Cancer patients more likely have this type of nephrotic syndrome

Answer 19

Membranous

Question 20

Children commonly develop this type of nephropathy

Answer 20

minimal change disease

Question 21

AIDS and IV drug abusers typically have this type of nephropathy

Answer 21

Focal segmental glomerulonephritis

Question 22

NSAID users will typically develop this type of nephropathy

Answer 22

minimal change disease and membranous

Question 23

By definition nephrotic syndrome is…

Answer 23

Hyperproteinuria (>3.5g/24hrs)

Hypoproteinemia

Hyperlipidemia

Periorbital edema

Question 24

Used to reduce protein loss in nephrotic syndrome

Answer 24

ACEi and ARBs

Question 25

Used to manage edema in nephrotic syndrome

Answer 25

Salt restriction and diuretics

Question 26

Initial therapy for Nephrotic syndrome includes....second line includes...

Answer 26

Glucocorticoids 2nd line-- further immune suppression with cyclophosphamide

Question 27

Uremia is defined as

Answer 27

Metabolic acidosis Fluid overload Encephalopathy Hyperkalemia Pericarditis

Question 28

Type of RTA associated with hyperkalemia

Answer 28

type IV RTA

Question 29

Type of RTA associated with hypokalemia

Answer 29

Type I and II

Question 30

Location of type I, II and IV RTA

Answer 30

I- distal II- Proximal IV- Hyporeninemia, hypoaldosteronemia-- throughout

Question 31

Defect in Type I RTA

Answer 31

Distal tubule unable to genernate new HCO3 which means H+ cannot be excreted Leads to high urine pH

Question 32

People with Type I RTA will commonly suffer from recurrent...

Answer 32

Calcium oxylate kidney stones

Question 33

Type I RTA is associated with

Answer 33

SLE and Sjogrens Use of Amphoterocin

Question 34

Test for type I RTA

Answer 34

Give Acid and watch urine pH Inability for urine to decrease pH indicates a Type I RTA

Question 35

Cause of type II RTA

Answer 35

Proximal Inability of tubule to resorb filtered bicarb (fanconi, amyloidosis, myeloma, acetazolamide, heavy metals)

Question 36

Urine findings in type II RTA

Answer 36

At first, persistently high urine pH due to increase HCO3 excretion. When Bicarb is depleted HCO3 will be low

Question 37

Test for Type II RTA

Answer 37

Give HCO3 If Urine pH increases= type II RTA

Question 38

Type II RTA has this effect on bones

Answer 38

Chronic metabolic acidosis causes leaching of Ca from bones and osteomalacia

Question 39

Treatment for Type II RTA

Answer 39

Difficault Thiazides will help volume deplete and cause distal retention of HCO3

Question 40

Cause of Type IV RTA

Answer 40

Hyporeninemia/hyopaldosteronemia --most often occurs in diabetes --Loss of aldosterone effect leads to loss of Na+ and retention of potassium and H+

Question 41

Persistently high Na+ despite low Na+ diet is consistent with this type of RTA

Answer 41

Type IV

Question 42

Treatment for type IV RTA

Answer 42

administer fludrocortisone | (high mineralocorticoid effect)

Question 43

Measurement of urine anion gap...why?

Answer 43

UAG= Na - Cl Acid is buffered in urine as ClNH4 Therefore Cl is a measure of acid in the urine

Question 44

Stones \<5mm-- let pass Stones 5-7mm get this tx...

Answer 44

Nifedipine and tamulosin to help

Question 45

Best initial therapy for hypertensive crisis

Answer 45

Lebetolol or nitroprusside