Quiz 2 - Nephropathies

Question 1

Diabetic nephropathy pathophy

Answer 1

1) glycosylation of proteins damage GBM (thickening)

2) Hemodynamic changes leads to glomerular hypertrophy (sclerosis)

Question 2

Diabetic nephropathy RFs

Answer 2

family hx, advanced age, concurrent HTN, poor glycemic control (>6.5%
HbA1c levels), ethnicity (blacks, Mexican-Americans, Pima Indians—often due to socioeconomic factors) obesity, smoking, oral contraceptives

Question 3

Diabetic nephro ssxs

Answer 3

albuminuria, occ hematurra

Question 4

Diabetic nephropathy monitoring

Answer 4

**Microalbumin (random am sample or 24 hr collection)

Normal: 0-30 mg/d
Microalbuminuria: 30-300mg/d
Macroalbuminuria > 300 mg/d

**HbA1c

**ophthalmic + podiatry exams

Question 5

Target values for DM pts

HbA1c
FPG
peak PPG
BP
lipids

Answer 5

A1C≤ 6.5%
FPG <110 mg/dl
peak postprandial PG <140 mg/dl
BP < 130/80mmHg
 Lipids LDL <100, <70 mg/dl

in pts with CAD, HDL: >40 mg/dl men, >50 mg/dl women, TG: <150 mg/dl

Question 6

Diabetic nephropathy natural TX

Answer 6

Ginkgo—protective against damage to glomerulus
Flax and pumpkin seed
Curcumin—antioxidant, renal protective
Guggul
Chromium 
Alpha lipoic acid, Vaccinium

Question 7

Renovascular HTN secondary to

Answer 7

atheroscleorosis (secondary to HTN)

Question 8

Renovascular HTN pathophys

Answer 8

Reduced blood flow causes affected kidney(s) to secrete renin, retain NaCl and H2O – inc BP

Question 9

Renovascular HTN ssxs

Answer 9

HTN ssxs

PE: Abdominal bruit over renal A

Question 10

Renovascular HTN complications:

Answer 10

left ventricular hypertrophy, hypertensive retinopathy

Question 11

Labs Renovascular HTN

Answer 11

Severe HTN with progressive renal insufficiency, refractory to aggressive therapy, malignant HTN, elev creatinine

Question 12

Captopril challenge test

Answer 12

administer ACE-i to watch effect on plasma renin

Question 13

Tx Renovascular HTN

Answer 13

1) Control BP with meds:
2) Percutaneous angioplasty w stent
3) Surgical reconstruction of damaged artery
4) Surgical bypass of renal arteries
5) Treat atherosclerosis: guggal, garlic, EFAs, B vits
6) Vascular protectants: bioflavonoids, vaccinium

Question 14

Benign hypertensive nephrosclerosis cause

Answer 14

chronic HTN

Question 15

Renal artery occlusion/ thromboembolism

Answer 15

Leads to flank pain, abdominal pain, fever, N&V
Hematuria. Acute renal failure may develop
Seen on CT angiography

Question 16

Renal vein thrombosis causes

Answer 16

hypercoagulability, nephrotic syndrome, amyloidosis, estrogen therapy, pregnancy, SLE
Seen on US and MR venography

Question 17

NEPHROPTOSIS RFs

Answer 17

excessive weight loss, frequent intense physical activity

Question 18

Nephroptosis Ssxs

Answer 18

severe abdominal, costovertebral, flank pain and vomiting in upright position from

1) acute hydronephrosis kinked proximal ureter
2) renal vessel lumen narrowing and resultant ischemia
3) visceral nerve stimulation from traction

Question 19

Dietl Crisis

Answer 19

severe colicky flank pain, nausea, vomiting, chills, tachycardia, oliguria, hematuria and proteinuria
Pain relieved with upward movement of kidney, supine position

Question 20

Nephroptosis work-up

Answer 20

US, IV urography

Question 21

Nephroptosis Tx

Answer 21

surgical nephropexy, wear truss

Question 22

Simple cysts ssxs

Answer 22

Flank or back pain, intermittent and dull; Fever and malaise if infected
Abdominal mass, may be palpable or percussed, tender if infected

Question 23

Simple cysts Tx

Answer 23

Leave alone
If infected: antimicrobial tx, may need percutaneous drainage
Surgical excision if obstructing ureter

Question 24

ADPKD SSx:

Answer 24

Pain over both kidneys due to infection, obstruction, hemorrhage, “drag” from heaviness
Gross or microscopic hematuria; nocturia
HTN (retinopathy can develop)
Palpable, nodular kidney(s)
Developing renal insufficiency: HA, N&V, weight loss
If infected: fever, chills, tender kidney(s)

Question 25

ADPKD Imaging

Answer 25

1. US Most cost effective`` 2. CT 3. MRI can differentiate RCC from cysts

Question 26

ADPKD complications

Answer 26

``` Gross hematuria Nephrolithiasis (20%) Hypertension ESRF Increasing, intractable pain Other possible findings in this population ```

Question 27

ADPKD Tx

Answer 27

Low protein diet – 0.5-0.75 g/kg/d Force fluids to 3000 ml or more per day (to suppress plasma vasopressin) Restrict caffeine Flax oil Reasonable physical activity – avoid strenuous activity or contact sports reat uremia, stones, infection when present Screen for and treat HTN. Poss tx: dialysis, renal transplantation cystic decompression (for pain) Constitutional HP: tumors, cystic—Baryta carb, Calc carb, Phos Constitutional hydro Conventional drug trials: somatostatin, everolimus (mTOR inhibitor)

Question 28

ADPKD prognosis kids

Answer 28

poor.

Question 29

ARPKD assoc with

Answer 29

biliary dysgenesis. Leads to hepatomegaly and portal hypertension in most cases

Question 30

ARPKD severity

Answer 30

may lead to death in newborn | may lead to ESRD and the need for Ki transplant by age 10 or 15.

Question 31

Von-Hippel Lindau syndrome

Answer 31

Autosomal Dominant | retinal angiomas, hemangioblastomas, pheochromocytoma, islet cell tumors, renal cysts, epididymal cysts

Question 32

Tuberous sclerosis

Answer 32

CNS + heart, skin, lung lesions | seizures, mental retardation, adenoma sebacum

Question 33

Renal Cell Carcinoms RFs

Answer 33

Cigarette smoking Hypertension Chronic analgesic use Obesity: Toxin exposure (Cd, asbestos, Pb, gasoline and petroleum products, PAHs) Cytotoxic chemotherapy use in children (for malignancy, autoimmune dz) HCV Sickle cell disease itrites in diet, prior radiation therapy, use of oral contraceptives High coffee intake, animal fat diet, dialysis, hysterectomy, contrast IV

Question 34

RCC mets to...

Answer 34

lung | also, bones, LNs, adrenals, kidney

Question 35

RCC ssxs "classic triad"

Answer 35

gross hematuria, flank pain, palpable abd mass ssxs of paraneoplastic syndrome

Question 36

RCC Tx

Answer 36

1) Partial or Radical nephrectomy for localized stage I & II (<4cm tumor size) 2) Chemo and radiation ---not proven effective 3) Biologic response modulators, eg interleukin-2 therapy, interferon alpha 4) Molecularly Targeted Therapies: 5) Pre- and post-surgical support tissue healing nutrients, modified citrus pectin 6) Adjuvant naturopathic care—health, nutrition optimization 8) Note: Clinical trials underway for RCC vaccination: TroVax

Question 37

Nephroblastoma

Answer 37

"Wilm's Tumor" | mixed malignant. Seen in children 3-4 yrs

Question 38

Neohroblastoma ssxs

Answer 38

Presents as abdominal swelling, abd pain, hypertension, N&V, constipation, Loss of appetite, SOB

Question 39

mets to kidney from...

Answer 39

lung, breast, stomach, renal