Renal

Question 1

What is the most common cause of gross hematuria in a young person with sickle cell trait?

Answer 1

Papillary Necrosis

Question 2

What diuretic can be supplemented in osteoporosis?

Answer 2

Hydrochlorothiazide – increases Ca+2 absorption in distal tubule

Question 3

What drug can be used for increasing renal blood flow at low doses?

Answer 3

Dopamine

Question 4

Why does a person with chronic renal insufficiency needing dialysis have increased bleeding time?

Answer 4

Urea inhibits platelet aggregation/adhesion

Question 5

What can cause oligouria, hempytsis, and sinusitis with positive antibodies to lysosomal enzymes of PMN?

Answer 5

Wegener’s Polyangititis

• • c-ANCA
• • Pulmonary, Upper Resp, RPGN (Crescent)

Question 6

What is primary polydipsia?

Answer 6

Drinking too much water

Question 7

What would the dehydration test show if a patient had primary polydipsia?

Answer 7

Progressive increasing OsMolarity of urine, then with ADH administration osmolarity might not increase much due to chronic deficiency of aquaporins from overhydration.

Question 8

What is most commonly associated with HIV infection and sickle cell and heroin (IV drug abuse)?

Answer 8

Focal Segmental Glomerulosclerosis (Nephrotic Syndrome)

• • glomeruli collapsed and sclerotic
• • increased matrix production with microcyst formation

Question 9

How to calculate anion gap and what causes high gap?

Answer 9

Sodium - (Cl + Bicarb) = 10-14 (Normal), if 14+ = High

Causes: DKA, ASA, Lactic Acidosis, Ethylene Glycol, Isoniazid, Uremia, Methanol

Question 10

What would be responsible for Clear Cell renal Carcinoma?

Answer 10

von Hippel-Lindau Disease
– Loss of VHL – Tumor Suppressor
Triad – Hemangioblastoma, Pheochromocytoma, Clear Cell Carcinoma

Question 11

What area of the tubule is most affected by hypotension and acute tubular necrosis?

Answer 11

Medulla – loss blood flow, first to become ischemic and more specifically proximal tubule

Question 12

What syndrome would have hematuria, elevated creatinine, and eosinophilia?

Answer 12

Churg-Strauss Syndrome

– p-ANCA

Question 13

If a kidney biospy revealed hypercellular glomeruli and “humps” on EM, what might be occuring?

Answer 13

Post-Strep Nephritis

Question 14

If a patient over produces aldosterone, which might their electrolytes look like?

Answer 14

Low K+
Elevated BP
Low Renin
Elevated pH (HCO3-) [due to loss of H+ in urine]
Low Sodium – due to ANP from Atria due to too much wall tension from plasma volume and causes sodium loss.

Question 15

What is the best way to treat primary hyperaldosteronemia and what is an adverse side effect?

Answer 15

Spirolactone
Eplerenone
**Gynecomastia

Question 16

Where is ADH synthesized?

Answer 16

Paraventricular/Supraoptic nuclei of hypothalamus, anterograde transport to posterior pituitary where Neurophysin post-translational processing

Question 17

Who is most suspectible to oxalate kidney stones?

Answer 17

Crohn’s Disease
– This is because terminal illeum is inflammed and does not absorb as much bile, thus the bile binds to Calcium in GI tract. Then since the Calcium is bound, it cannot bind Oxalate which is absorbed instead – accumulates in kidneys.

Question 18

A patient develops oligouria and elevated creatinine, who has recently develop sinusitis and asthma, what might be the cause of these symptoms?

Answer 18

Churg-Strauss Syndrome
-- vasculitis
(+) p-ANCA
Eosinophila
**Polyneuropathy
Sinus Abnormalties

Question 19

What is Probenecid used for?

Answer 19

Uricosuric Drug – excretes more uric acids from the kidney. Prevents re-absorption
– can increase risk of kidney – urate stones

Question 20

What is the most common location of renal cell carcinoma?

Answer 20

proximal tubule

• clear cytoplasm
• high lipid content
• polygonal / cuboidal cells – pushes nuclei to the side

Question 21

What kind of cell type can cause renal pelvis carcinoma?

Answer 21

Transitional Cell carcinoma

Question 22

Chronic NSAID use can lead to what?

Answer 22

Chronic Interstitial Nephritis

- modest increase in creatinine / polyuria / proteinuria

Question 23

What drug can be used to prevent gout in patients with renal impairment?

Answer 23

Febuxostat - Xanthine Oxidase Inhibitor