Renal

Question 1

Nephrotic

First 2
associations?

Answer 1

Minimal changes - Hodgkin (Cytokine) - steroids, clinical dx in kids

FSGS - HIV, heroin, IFN - no steroid

Question 2

Nephrotic - Last 4

Associations?

Answer 2

Membranous, HBV, HCV, NSAIDS. spike and dome
subEpi. Renal vein thrombosis

MP T1 - HBV, HCV, Tram tracking - subendo

MP T2 - DEC C3. NF+ convertase. Intramembranous

DM - hyaline, KW nodule. Eff>aff. Hyperfiltration

Amyloidosis - Apple green congo, Chronic SAA.

Question 3

Nephritic - First 2- Associations?

Answer 3

PSGN - DEC C3, hypercellular Glom - Subepi

DPGN - SLE, Wire looping. Subendo

Question 4

Nephritis - Last 3 - associations.

Tx for the last one?

Answer 4

IgA nephropathy - Occurs after viral. blood in UA. Mesangial. NORMAL C3!!! dont confuse w/ PSGN.

Alport - Xr - T4 genetic - Ears, eyes, hematuria

Goodpastures - Anti-T4 ab, lung and kidney - Emergent plasmapx.

Question 5

Tx to help stone pass?

Answer 5

Hydration, analgesia, A1 blocker (tamsulosin)

Question 6

4 types of stones - APPEARANCE - assocations, tx

Answer 6

Ca Oxalate - Dumbell/envelop. Vit C, Chrons, Normocalcemic. First one - observe. 2nd - tx HCTZ

Ammonium MG P - Struvite - Staghorn. Urease+. Tx - acidify

Uric Acid - Risk: dry, arid, leukemia, GOUT. Radiolucent

Cysteine - Test for sample w/ Cyanide, Nitroprusside

Question 7

Causes, association, presentation, lab

AIN

vs

ATN

Answer 7

AIN - Diuretics, PCN, NSAIDS, Sufla. EOS! White casts

ATN - Ischemic or Nephrotoxic (AmigoG, Pb, myoglobin) - Muddy brown casts

Question 8

R. Papillary necrosis - when do you see this?

vs

Diffuse Cortical Necrosis

Answer 8

Frank hematuria - DM, Acute pyelo, HbSS, NSAIDS.

Vasospasm, DIC.

Question 9

Chronic renal failure - coag and platelet findings?

Answer 9

Normal INR, Normal PT/pTT

Normal plt count but INC BT. Tx DDAVP (INc F8)

Question 10

Rental tubular acidosis acid base status and lab finding?

Who is at risk?

Answer 10

Metabolic acidosis w/ normal anion gap .

Preserved kidney function - May see HyperK (especially in poorly controlled DM)

Question 11

In void cycle

intiial hematuria

vs

terminal hematuria

Vs

TOTAL hematuria

Answer 11

Initial - urethral damage

Terminal - bladder/prostate - may see clots as well

Total - kidney, ureter damage

Question 12

Best way to prevent UTI when cathing?

Answer 12

Intermittent cath > antibacterial wash

Question 13

Single renal cyst found - ax - what now?

How to know it is a simple cyst?

Answer 13

Simple cyst - thin wall, no solid parts, not loculated.

asx - reassurance and observe

Question 14

Interstitial cystitis presentation, UA findings, tx?

Answer 14

INC frequency, dyspareunia, RELIEF WITH VOIDING (aka the irritable bowel of pee), NORMAL UA!!

Tx amitriptaline, analgeics. Found in women, psych comorbid

Question 15

RCC - originates from? histo findings? Gross findings>?

presentation (3 factors)

Answer 15

RCC - proximal

Histo - Clear cell

Grossly - Yellow Mass

Findings: Hematuria> Mass> Flank pain

Question 16

AGE AND PRESENTATIOn

Neuroblastoma

Wilms?

Answer 16

NB - 1 - poorly circumsribed, crosses midline, HVA INC

WIlms - 2-5y.o - midlinem, smooth, WAGR, Beckwith Wiederman

Question 17

Renal oncocytoma - gross and histo?

Answer 17

Central scar. Large Eos cell.

Question 18

Transitional CA -

Answer 18

Lower tract, field defect. Smoking, Rubber.

Question 19

Squamous CCA - - origins, etiology

Answer 19

Chronic irritation, smoking, schistosoma

Question 20

Angiomyolipoma - seen in whom? risk?

Answer 20

Tuberous sclerosis kids, hamartoma (benign )

Question 21

Adeno CA in UG tract?

Answer 21

Urachal remnant -Associated w/ extrophy

Question 22

Thiazide - complications x 4

Answer 22

Hyper

Glycemia
Lipidemia
Uricemia
Calcium

Question 23

Uncomplicated cystitis - workup and tx?

Answer 23

Tx W/O CULTURE.

Culture if tx fails once.

bactri, Nitrofurantoine, Quinolone

Question 24

Rhabdomyolysis renal workup findings?

Answer 24

Blood on UA, NONE on sed microscopy

Question 25

Pedi UTI - What to do?

Answer 25

2mo-2y. Bladder, renal US. recurrent UTI -> voidiing cystourethrogram

Question 26

AD PKD - presentation? associations?

Answer 26

Mass, hematuria, HTN hepatic cyst, divertulosis, berry aneurysm, abd, inguinal hernia

Question 27

Renal osteodystrophy findign

Answer 27

After ESRD, DEC GFR leads to phosphate retention. See INC P, with DEC Ca, with INC PTH. Similar to Pseudohypoparathyroidism.

Question 28

Overflow incontinence – presentatio

Answer 28

full bladder w/ frequent low volume leaks in DM

Question 29

Overflow incontince pharm tx vs Urge incontinence?

Answer 29

Overflow - Cholinergic agonists (Bethanechol) vs Urge – Anticholinergic (oxybutynin)

Question 30

Urge Incontinence– Initial tx

Answer 30

– conservative – “bladder training” with frequent scheduled voiding.

Question 31

Multiple myeloma kidney damage due to which spot on nephron?

Answer 31

– Renal tubular > Glomerular (amyloidoisisi )

Question 32

MOST EFFECTIVE means of DEC DM nephropathy

Answer 32

blood pressure control. Not glucose control.

Question 33

SIADH urine findings - osm and Urine Na?

Answer 33

has HIGH URINE SODIUM with High Urin osmolality!

Question 34

Tx of Myoglobinuria

Answer 34

Salien Mannitol Bicarb Myoglobin is a toixin - mannitol allows INC urine flow rates taht DEC contact time between tubular cells and myoglobin.

Question 35

Lab values of hepatorenal are consitent w?

Answer 35

Prerenal azotemia

Question 36

Most accurate test for AIN?

Answer 36

Hansel /Wright Stain - detects Eos! UA cannot detect Eos

Question 37

WHich stones get Lithotripsy?

Answer 37

0.5 to 2~cm. Later than 2cm may need surgery.

Question 38

Anticoagulation in pt w/ renal insufficiency (GFR less than 30)

Answer 38

MUST GIVE UNFRACTIONATED HEPARIN – Cannot give LMWH, fondaparainux, and rivaroxaban to pt w/ renal problems. Bridge to Warfarin.

Question 39

Posterior urethral injury

Answer 39

high riding prostate, inability to urinate. Scrotal hematoma

Question 40

Fatty cats? Broad/waxy casts?

Answer 40

Fatty – Neprhotic. Broad/waxy = Chronic renal failure

Question 41

Immedaite and long term treatemetn of uric stones?

Answer 41

Potassium Citrate (alka) helps prevent recurrent stones.

Question 42

Imaging modality for uric acid stone –

Answer 42

radiolucent – cant be seen on Xray, but CT noncom can see them

Question 43

Varicocele think?

Answer 43

RCC

Question 44

Renal artery stenosis in fibromuscular dysplasia tx

Answer 44

– Angioplasty with stent> ACE/medical therapy

Question 45

Crystalline nephropathy (acyclovir) dmg via?

Answer 45

Rental tubular obstruction

Question 46

Hyposthenuria –

Answer 46

found I pt with sickle cell disease – inability to concentrate urine. Frequent nocturia. Sickle cells sickle in vasa rectae and impair countercurrent exchange.

Question 47

Vesicoureteral reflux vs posterior urethral valves?

Answer 47

Vesicoureteral reflux -> scarring. Posterior urethral valves – most common cause of chronic renal failure in children.

Question 48

Pyelo meds

Answer 48

Cipro, Amp+Gent. Bactrim and Nitrofurantoin are for UNCOMPLICATED CYSTITIS. Complicated -> Cipro as well.

Question 49

Massive hematuria that resolves, with UA sig only for blood

Answer 49

- Renal papillary necrosis – extraglomerular, often resolves spontaneously. Other problems in Ss patients – inability to concentrate urine in tubes.

Question 50

Infective endocarditis in IVDU w/ DIASTOLIC MUMUR with 2:1 AV block

Answer 50

– Aortiv valve endocarditis w/ with perivalvular abscess. Tricuspid regurg would be SYSTOLIC!

Question 51

Urethral stone ith onset of high fever and INC pain

Answer 51

immediate abx and percutaneous stent