Renal

Question 1

Definition of AKI

Answer 1

Cr increase .3
or by 50%
or .5ml/kg/h over 6 hours decrease in urine

Question 2

Labs to be ordered in AKI

Answer 2

BMP, CBC wdif, urinalysis (osmolality, sediment, output, electrolytes), ABG (expect metabolic acidosis),

Question 3

In AKI when do we order serologies? ultrasound? biopsy?

Answer 3

suspecting glomerular disease
PKD, hydronephrosis, post renal cause
suspecting glomerular disease

Question 4

What are the dialysis indications.

Answer 4

When refractory to treatment
A- Acidemia
E- electrolyte disturbances (hyperK, phos, tumor lysis)
I- Intoxication (methanol, glycols, lithium, salicylates)
O- Overload
U- uremia (encephalopathy, pericarditis, bleeding from platelet dysfunction)

Question 5

All forms of acute renal failure cause an increase in what?

Answer 5

BUN and Cr

Question 6

How do we diagnose post-renal azotemia?

Answer 6

catheterization, renal ultrasound (pre and post urination)

>100 mmL remaining in bladder = voiding obstruction

Question 7

AKI testing algorithm?

Answer 7

Rule out post renal
rule out pre-renal
determine intrarenal

Question 8

What is the post renal urine osmol? FeNA? BUN:Cr?

Answer 8

urine osmol 2%, BUN:Cr>15.

Question 9

Besides volume depletion and low Cardiac output, what are causes of pre renal azotemia?

Answer 9

cirrhosis, sepsis, NSAIDS, cyclosporine, ACEI, ARBs

Question 10

What is orthostatic hypotension?

Answer 10

S-BP decrease >20 HR increase >20

Question 11

In pre-renal azotemia what is the FENa?

Question 12

What is the BUN:Cr? FENa? FEurea? Urine osmol? Ua dipstick SG in pre-renal?

Answer 12

> 20, 500, >1.020

Question 13

What is the BUN:Cr? FENa? FEurea? Urine osmol? Ua dipstick SG in intra-renal?

Answer 13

2%, >55%,

Question 14

What toxin is pre-renal by vasoconstriction and ATN?

Answer 14

contrast

Question 15

what drugs cause ATN? 4

Answer 15

aminoglycosides
vanco
amphotericin
cisplatin
and contrast!

Question 16

What endogenous substances cause ATN?

Answer 16

hemoglobin, myoglobin

Question 17

Why does myeloma cause ATN?

Answer 17

light chains

Question 18

What crystals cause ATN>

Answer 18

uric acid, acyclovir, MTX, indinavir

Question 19

What are the allergic causes of AIN? 5 drugs

Answer 19

• B-lactams (penicillins, cephalosporins, monobactams and carbapenems)
• sulfa drugs
• NSAIDS
• PPIs
• allopurinol

Question 20

What infections cause AIN?

Answer 20

pyelonephritis, legionella, TB, Leptospira

Question 21

What infiltrative malignancies cause AIN?

Answer 21

sarcoid, lymphoma, leukemia

Question 22

What autoimmune diseases cause AIN?

Answer 22

Sjogren’s, SLE, cryoglobulins

Question 23

nephrotoxic ATN causes necrosis where? what about ischemic ATN?

Answer 23

PCT

PCT and TAL

Question 24

what is the pathogenesis of ATN?

Answer 24

necrosis–> necrotic debries plugs tubules–> decrease GFR–> tubular dilation and flattening of cells with cast formation

Question 25

In ATN, Heme 4+ with no RBC would signify what?

Answer 25

hemoglobin or myoglobin

Question 26

What is the clinical triad of AIN?

Answer 26

oliguria, fever, rash

Question 27

What are the diagnostic hallmarks of AIN?

Answer 27

eosinophilia, inflammatory infiltrate in interstitium, WBC casts, rare eosinophils in urine

Question 28

How do we prevent contrast- induced AKI? Cr inc by .5 or 25% in 48 hrs

Answer 28

1. isotonic IV fluids 2. Hold ACEI, ARB, diuretics, NSAIDS 3. N-acetylcysteine

Question 29

What are the pauci immune diseases?

Answer 29

wegeners, churg strauss, microscopic polyangiitis

Question 30

What are the 3 causes of cresentric GN?

Answer 30

goodpasteurs pauci immune Immune complex GN (sle, PSGN, membranoprolipherative GN)

Question 31

If the serum complement is low in nephritic syndrome, what labs do we need to differentiate the diseases?

Answer 31

ASO tite, ANA/dsDNA, HepB/C serology, blood cultures

Question 32

If the serum complement is normal in nephritic syndrome, what labs do we need to differentiate the diseases?

Answer 32

Anca, anti-GBM

Question 33

What disease has subepithelial humps? subendothelial humps?

Answer 33

PSGN | SLE

Question 34

Membranoproliferative GN is associated highly with what?

Answer 34

Hep B/C

Question 35

What is the treatment for good pasteurs

Answer 35

steroids, cytotoxic agents, plasmapheresis

Question 36

Is wegener's c-anca? what differentiates it from goodpasteurs?

Answer 36

yes, involvement of the naso pharynx

Question 37

p anca microscopic polyangiitis has what clinical uniqueness?

Answer 37

mononeuritis multiplex (wrist drop, foot drop)

Question 38

what are the 3 major features of the p-anca churg strauss syndrome?

Answer 38

granulomatous inflammation + eosinophilia + asthma

Question 39

What are 2 key differences of IgA nephropathy from PSGN?

Answer 39

follows mucosal infection 2-4 days and serum complement is normal. (also IgA deposits in mesangium are different, but this is with biopsy)

Question 40

What is minimal change associated with? drug + cancer

Answer 40

NSAIDS, Hodgkins | selective hypoalbuminemia

Question 41

What is focal segmental glomerulosclerosis associated with?

Answer 41

HIV, heroin, sickle cell disease, obesity

Question 42

What is the EM appearance of membranous nephropathy?

Answer 42

spike + dome appearance

Question 43

What is the treatment for diabetic nephropathy?

Answer 43

ACEIs and ARBs