Nephrology

Question 1

Poorly controlled DM and HTN with low Na+, high K+, low HCO3

Answer 1

RTA type 4

• hypoaldosteronism
• can be caused by DM

Question 2

1. Muddy brown granular casts
2. RBC casts
3. WBC casts
4. Fatty casts
5. Broad & waxy casts

Answer 2

1. ATN
2. glomerulonephritis
3. interstitial nephritis & pyelonephritis
4. nephrotic syndrome
5. chronic renal failure

Question 3

Within 5 days of upper respiratory tract infection, young adult men, gross hematuria, normal complement levels

Answer 3

IgA nephropathy

Question 4

Nephro risk with acyclovir

Answer 4

kidney rapidly excretes it in the urine, but the drug has low urine solubility –> obstruction

Question 5

Prevent uric acid stones

Answer 5

alkalinize urine with potassium citrate

Question 6

child with edema, hypoalbuminemia, elevated urine protein and Hepb +

Answer 6

membranous nephropathy

Question 7

Pt with HTN, DM 2, HLD, and CKD has a K+ of 6.0. Only sx are mild fatigue. Next best step

Answer 7

Review current medications

Question 8

Pt with CKD starts bleeding from blood draw site

Answer 8

Uremic coagulopathy - platelet dysfunction (platelet-vessel wall and platelet-platelet interaction) due to uremic toxins (guanidinosuccinic acid)
tx = DDAVP

Question 9

18 yo AA male with polyuria and nocturis despite fluid restriction. Normal sodium and low urine osmolality. Mom died from sickle cell disease and stroke

Answer 9

Hyposthenuria - inability of kidneys to concentrate the urine (seen in SCD and SCT)

Question 10

Fever, tinnitus, tachypnea in an overdose patient

Answer 10

ASA toxicity - mixed respiratory alkalosis and anion gap metabolic acidosis

Question 11

gross hematuria in African American male with no other sx or lab abnormalities

Answer 11

Renal papillary necrosis - associated with sickle cell dz

Question 12

Patient with recurrent sinusitis and otitis media with 2+ protein and blood on UA.

Answer 12

Granulomatosis with polyangiitis

• upper resp: sinusitis/otitis, saddle nose
• lower resp: lung nodules, cavitation
• renal: rapidly progressive GN
• skin: levido reticularis, nonhealing ulcers
• ANCA: PRS, MPO
• tx: steroids, immunomodulators

Question 13

how to calculate serum osmolal gap

Answer 13

measured serum osmolality - calculated serum osmolality

calculated = (2*Na) + (glucose/18) + (BUN/2.8)

Question 14

high anion gap metabolic acidosis with osmol gap

Answer 14

• ethylene glycol (urinary calcium oxalate crystals)
• methanol (blindness)
• propylene glycol

Question 15

Pt with hx of RA presents with 4+ proteinuria, hepatomegaly and enlarged kidneys

Answer 15

Amyloidosis

- amyloid deposits that stain with Congo Red that demonstrate an apple green birefringence under polarized light

Question 16

kidney dz most likely associated with HIV

Answer 16

FSGS

Question 17

Pt with nephrotic syndrome is at risk for developing

Answer 17

Hypercoagulability - urinary loss of antithrombin 3, altered levels of protein C and S, increased platelet aggregation, hyperfibrogenemia due to increased hepatic synthesis

• protein malnutrition
• iron-resistant microcytic hypochromic anemia
• increased susceptibility to infection
• vit D deficiency

Question 18

Pt whos on cannabinoids and cocaine with CK of 26000 is at risk for

Answer 18

acute renal failure

Question 19

What you see in the kidneys due to HTN

Answer 19

arteriosclerotic lesions of the afferent and efferent arterioles and glomerular capillary tufts

Question 20

What you see in kidneys due to DM

Answer 20

increased extracellular matrix, BM thickening, mesangial expansion, fibrosis

Question 21

Tx to aid in passage of a stone in distal ureter

Answer 21

Tamsulosin

- alpha receptors are found in distal ureter and relaxing them allows passage of stone

Question 22

Effect of fibromuscular dysplasia on the kidneys

Answer 22

Decreases perfusion to kidneys –> increased aldosterone and renin (secondary hyperaldosteronism)

Question 23

How to prevent uric acid kidney injury with initiation of chemotheraphy

Answer 23

pretreatment with iv fluids and allopurinol

Question 24

Male with recurrent UTIs treated multiple times with abx and has minor improvement. Prostate is smooth and nontender. He has pain with ejaculation. External genitalia are normal. UA shows pyuria with bacteria

Answer 24

Chronic bacterial prostatitis

- tx with fluoroquinolones for 6 weeks

Question 25

Effect of trimethoprim on kidneys

Answer 25

blocks epithelial sodium channel in collecting tubule - leads to hyperkalemia

Question 26

Fluctuating fatigable extraocular and bulbar (dysarthria, dysphagia) muscle weakness as well as symmetrical proximal weakness of the neck and extremities

Answer 26

Myasthenia gravis | - problem with motor end plate/NM junction

Question 27

When urgent dialysis is required

Answer 27

AEIOU Acidosis (metabolic) pH<7.1 Electrolytes (hyperkalemia - sx or >6.5) Ingestion (toxic alcohols, salicylate, lithium, sodium valproate, carbamazepime) Overload by fluids Uremia (pericarditis, encephalitis, bleeding)

Question 28

Homeless man with hypocalcemia and calcium oxalate deposition in kidneys

Answer 28

Ethylene glycol ingestion - give fomepizole or ethanol to inhibit alcohol dehydrogenase - sodium bicarb to correct acidosis - dialysis

Question 29

management of kidney stones

Answer 29

< or = 5: will pass on own 6-10: can give alpha blocker >10, refractory pain, anuria, AKI, urosepsis: urology consult

Question 30

4 month old with macrocytic anemia, reticulocytopenia, normal platelets and WBCs. Has triphalangeal thumbs and craniofacial abnormalities (cleft palate, webbed neck).

Answer 30

Diamond-Blackfan anemia - congenital erythroid aplasia - tx: corticosteroids and transfusions RBCs

Question 31

deposits on C3 in GBM with fatigue, LE edema and dark urine

Answer 31

Membranoproliferative glomerulonephritis | - activation of alternate complement pathway

Question 32

Well defined hypoechoic testicular mass with elevated bhcg and negative afp

Answer 32

seminoma

Question 33

Drugs that cause hyperkalemia

Answer 33

NSAIDs, TMP/SMX, ACEi, ARBs sx: muscle weakness, cardiac arrhythmia, decreased DTRs

Question 34

Renal vein thrombosis is most common seen with

Answer 34

membranous glomerulopathy - loss of antithrombin III in the urine increases the risk - sudden abdominal pain, hematuria and fever

Question 35

Electron micro of alport syndrome

Answer 35

splitting of basement syndrome

Question 36

Acute interstitial nephritis

Answer 36

- hypersensitivity to meds like NSAIDs and PPIs (also rifampin, penicillins, cephalosporins) or AI - rapid decline in renal function - Rash, fever and eosinophilia are the classic triad of symptoms - inflammatory infiltrate on biopsy - tx: steroids

Question 37

cause of HTN in ADPKD

Answer 37

renal ischemia --> increased renin release --> secondary hyperaldosteronism -tx: ACEi

Question 38

hepatorenal syndrome

Answer 38

decrease in GFR without any other cause of renal dysfunction, mild hematuria, and lack of improvement with volume resuscitation - due to splanchnic arterial dilation, decreased vascular resistance, and local renal vasoconstriction due to RAAD

Question 39

pancytopenia, intravascular hemolysis, and acute thrombosis. Flow cytometry demonstrates absence of CD55 and CD59.

Answer 39

paroxysmal nocturnal hemoglobinuria

Question 40

hypospadias is associated with

Answer 40

chordee, cryptorchidism, and inguinal hernias.

Question 41

patients with nephrotic syndrome are at increased risk of infection with

Answer 41

``` encapsulated organisms (strep pneumo) - vaccinate with PPV23 ```

Question 42

He has right- and left-sided costovertebral angle tenderness. He gives a urine sample, which has a strong odor, like rotten eggs. When sodium cyanide-nitroprusside is added to his urine, the sample turns purple.

Answer 42

Cysteine stones - caused by renal defect in transport of certain amino acids (cystine, ornithine, lysine and arginine) *COLA