R2

Question 1

Hematuria defination?

Answer 1

Having more than 3 RBC/HPF

Question 2

Bladder Ca fetcher?

Answer 2

Old person
Painless hematuria
Smoking or industrial exposure

Question 3

Diet recommendation in Ca-oxalate stone?

Answer 3

1-increase fluid intake
2-Decrease sodium intake(Na will increase urine ca excretion)
3-Normal Ca intake(High ca intake will increase urine Ca level and low ca intake will increase oxalate absorption and secretion in the kidney).
4-High K intake(Increase urine citrate secretion(make ca more soluble)
5-Avoid animal protein(metabolites make the urine acidic–Hypocitreturia–precipitation)
6)-avoid diet with high oxalate(Vit c.chocolate,
peanut, and tea)
7)Thiazides–lower urine Ca level

Question 4

Calcium stone feaucher?

Answer 4

Radiopaque and Shaped like envelope or dumbbell
Calcium stones most common (80%);
calcium oxalate more common than calcium
phosphate stones.
Can result from ethylene glycol (antifreeze)
ingestion, vitamin C overuse, hypocitraturia
(associated with  urine pH), malabsorption(increase free oxalate absorption) (eg, Crohn’s disease).

Question 5

Cause of nephrotic syndrome?

Answer 5

1-primary

2 secondary

Question 6

1-primary?

Answer 6

1-FSGS(most common cause in adult especially BA)
2-MCD(common in children)
3-MN(2nd MCC)

Question 7

2 secondary

Answer 7

1-amyloidosis

2-DM

Question 8

Risk for FSGS?

Answer 8

1- 1° (idiopathic) 
2° to other conditions 
 HIV  
 Obesity
 Heroin use,
 Sickle cell disease
 Interferon treatment,
 congenital malformations).
1° disease has an inconsistent response to steroids. May progress to CKD.

Question 9

Sign of Nephrotic syndrome?

Answer 9

Proteinuria > 3.5 mg/dl
Hypoalbuminemia
Hyperlipidemia
Lipiduria

Question 10

Precipitating factor for HRS?

Answer 10

The factor that led to decrease renal perfusion
GI bleeding
Vomiting
Sepsis
Excessive diuretic use
SBP

Question 11

Urinary finding?

Answer 11

FeNA <1 %(urine Na <10 Meq)

no blood,protien or granular cast

Question 12

What is the initiating factor?

Answer 12

Cirrhosis–Portal HTN–high NO–pheripherial and splanchnic vasodilation–Low renal perfusion–Low GFR–RAAS activation.–further decrease GFR

Question 13

myoglobin/hemoglobinuria?

Answer 13

Will have positive urine for blood(B/C of Heme) but no RBC.

Question 14

cause for rhabdomyolysis?

Answer 14

Crush injury
prolonged immobilization
Intense muscle activity(seizure/exertion)
Drug or medication toxicity(statin)

Question 15

Clinical manifestation?

Answer 15

Muscle pain and weakness
Dark urine(myoglobinuria/pigmenturia)
\+blood urinalysis/no RBC on microscopy
Increase serum K and PO4, decrease serum Ca, increase AST/ALT 
AKI
serum CK > 1000 U/L

Question 16

Medication that causes Hyperkalemia?

Answer 16

NSBAB (B2 receptor blokage)
ACE and ARB(inhibit aldosterone production)
KSD(amilioride) and trimetoprime–inhibit Na reabsorbtion in CD
Digitalis(inhibit Na/k ATPase)
Cyclosporine-Block aldosterone activity
Heparin–Block aldosterone production
NSAID: Decrease K delivery to the kidney
succinylcholine: promote extracellular K movement by activating AC receptors.

Question 17

Trimetoprim effect in Rf?

Answer 17

Raise creatinin(inhibit secretion of Cr)
Hyperkalemia(inhibit ENAK chanel)

Question 18

What to do patient with an asymptomatic UTI with a negative deepstick?

Answer 18

urine culture

Question 19

Does nitrate positivity indicate?

Answer 19

Gram-negative organism mainly enterobacteria (eg. ECOLI) infection–metabolize nitrate to nitrite

Question 20

Differentiation of IgA nephropathy and PSGN?

Answer 20

Clinically
IgA-More common in adults(20-30), occurs within 5 days URI and will have a recurrence hematuria history.

PSGN: More in children(10-20),occur 10-15 day URI.gross hematuria.

Question 21

Laboratory?

Answer 21

IgA:normal complement,mesangial IgA deposit
PSGN: Low C3 with subepithelial bump/antiSO and DNAs

Question 22

Prognosis?

Answer 22

IgA: good, sometimes progress to RPGN and NS
PSGN: Good in children, CKD in adult

Question 23

complement level in lupus nephritis?

Answer 23

low C3 and C4

Question 24

Renal vein thrombosis sign and symptom?

Answer 24

Flank pain
Hematuria
Left varicose vein dilation

Question 25

Risk factor?

Answer 25

Renal Ca Nephrotic syndrome Trauma

Question 26

Why NS have hypercoagulability risk?

Answer 26

Loss of protein S & C, plasminogen & antithrombin III | Platelet activation and high serum fibrinogen level

Question 27

Membranoproliferative glomerulonephritis fetcher?

Answer 27

Is a nephritic syndrome that often co-presents with nephrotic syndrome. I.e patient will have nephrotic range proteinuria with haematuria. Classified as type I and II Both types: mesangial ingrowth Ž GBM splitting Ž “tram-track” on H&E and PAS E stains.

Question 28

Type I?

Answer 28

May be 2° to hepatitis B or C infection. May also be idiopathic. Subendothelial IC deposits with granular IF

Question 29

Type II?

Answer 29

Is associated with the C3 nephritic factor (IgG autoantibody that stabilizes C3 convertase Ž persistent complement activation Ž  C3 levels). Intramembranous deposits also called dense deposit disease

Question 30

CKD-specific factor related to CV complication?

Answer 30

Anemia Vascular calcificaion Uremia and dialysis--oxidative stress--atherosclerosis and impaired vascular NO synthesis CV cases account for 50% of death among CKD

Question 31

Drug-induced interstitial nephritis fetcher?

Answer 31

common in cephalosporins, penicillin, and sulphonamide fever, arthralgia, and rash are a major symptom eosinophilia,eosinophiluria,WBC cast,haematuria and sterile pyuria discontinuation of the drug is the major Tx.

Question 32

what is normal post-void urinary volume?

Answer 32

<50 ml

Question 33

clinical feucher of analgesic nephropaty?

Answer 33

associated with long term analgesic (e.g aspirin)usage usually asymptomatic chronic tubulointerstitial nephritis haematuria due to papillary necrosis

Question 34

Diagnosis?

Answer 34

Elevated creatinine with urinalysis showing hematuria or sterile pyuria. Can have mild proteinuria(,1.5 mg/day) Trace proteinuria Bilateral small kidney with papillary calcification on CT

Question 35

painless hematuria, sterile pyuria, trace protein, and WBC cast indicate?

Answer 35

Non-glomerular disorder | like tubulointerstitial and urinary tract lining.

Question 36

Hypomagnesemia?

Answer 36

common electrolyte abnormality in alcoholics | present as refractory hypokalemia(b/G magnesium helps in K absorption in the kidney)

Question 37

How hypophosphatemia patient present?

Answer 37

``` common in alcoholics weakness rhabdomyolysis paraesthesia respiratory failure ```

Question 38

calciurine inhibitors(cyclosporine and tacrolimus) adverse effect?

Answer 38

have vasoconstrictive effect HTN AKI CKD

Question 39

CIN AKI?

Answer 39

reversible | due to efferent and afferent arteriole constriction

Question 40

CIN CKD?

Answer 40

Irriversible Due to progresive RFT decline Ischemia and drug related parenchymal injury can be the cause