1

Question 1

Acute interstitial nephritis

• c/f
• causes
• laboratory
• mx

Answer 1

Maculopapular rash, fever, renal failure, -/+ arthralgia
-drugs- penicillin, cotri, NSAIDs,cephalosporins,
-lab- AKI, pyuria, hematuria, wBC casts, eosinophilia
Renal biopsy- inflammatory infiltrate, edema
Mx- discontinue drug +/- systemic glucocorticoid

Question 2

The most common form of drug induced chronic renal failure in the US is? - the two most common pathologies seen are?
C/F include?
Imaging eg CT-

Answer 2

Analgesic nephropathy
1. Chronic tubulointerstitial nephritis( polyuria, sterile pyuria, proteinuria, wbc casts may b seen) 2. Papillary necrosis( microscopic hematuria, renal colic)
They can also stay asymptomatic with an incidental finding of elivated creatinine
CT- can show small kidneys with bilateral renal papillary calcification

Question 3

Crystal induced AKI by drugs like acyclovir, methotrexate, ethylene glycol…is due to?

Answer 3

Renal tubular obstruction

Question 4

A pt with hypovolemic shock developed AKI. The most likely pathologic finding will b? Indicated on urinalysis by?

Answer 4

Acute tubular necrosis

Muddy brown cast

Question 5

TB is a common cause of chronic primary adrenal insufficiency (Addison). The expected acid base imbalance is?

Answer 5

Non-anion gap metabolic acidosis

(Aldosterone normally acts on the distal tubules to increase Na reabsorption n secretion of k+ and H+

Question 6

A 65 yr old woman with known htn, Rheumatoid arthritis came with fatigue. She has generalized edema, hepatomegaly, 4+proteinuria, bilaterally enlarged kidneys

• the most likely dx ( clues include)
• renal biopsy would show

Answer 6

Nephrotic syndrome secondary to amyloidosis
Clues- rheumatoid arthritis, enlarged kidneys n liver
Biopsy- amyloid deposits that stain with Congo red n demonstrate a cxc apple green birefringence under polarized light

Question 7

A 45yr old came with nausea, fever, severe tinnitus, vertigo after overdosing on one of her meds. Respiration’s are 24/min, PR- 115/min, T-38.1, BP-130/76
Arterial blood gas analysis would show

Answer 7

Aspirin(salicylate) intoxication
Acutely leads to resp alkalosis then causes anion gap metabolic acidosis. Therefore, ABG- low PaCO2, low bicarbonate, => near normal PH with mixed resp alkalosis n metabolic acidosis
- a normal PH in the setting of abnormal co2 n bicarb levels is suggestive of a mixed process

Question 8

ABG in the following situations

1. A pt with stridor after an allergic reaction
2. Acute asthma exacerbation
3. Persistent vomiting
4. Excessive diuresis

Answer 8

1. Resp acidosis
2. Resp alkalosis
   3&4. Met alkalosis( volume contraction with an increased bicarb) because the RAAS will b stimulated in response to low volume state

Question 9

The most feared complication of an untreated asymptomatic becteruria during pregnancy is?

Answer 9

Acute pyelonephritis

Also associated with preterm labor n low birth weight

Question 10

Screening for bladder ca?

Answer 10

Nope! Not recommended

Question 11

A man came with diffuse abdominal pain, tenderness with guarding after suffering a direct blow to his abdomen n pelvis. What injury do u expect to see on abdominal CT?

Answer 11

Bladder dome rupture(intraperitonial bladder injury)- diffuse abd tenderness n guarding r indicative,, which would b absent in cases of extraperitoneal bladder injury

Question 12

Abnormal hemostasis in pts with CRF is due to?
PT, PTT, bleeding time will look like?
Rx if needed?

Answer 12

Uremic coagulopathy secondary to platelet dysfunction.
PT, PTT r normal, increased bleeding time
Desmopressin is the Rx of choice,, increases factor Vlll:von Willebrand multimers

Question 13

The most common cause of death in dialysis pts is?

Answer 13

Cardiovascular disease

Question 14

A 60 yr old male a known CKD pt came with hypertensive emergency n is given sodium nitroprusside( arterial n venodilator). His BP dropped to normal range but after 36hrs he developed diffuse hyperreflexia, confusion, creatinine is raised , bicarbonate is low(WHY?)The problem is?
Rx?

Answer 14

Cyanide toxicity
Oxidative phosphorylation is inhibited—> lactic acidosis
Cyanide is excreted thru the kidneys so in a pt with ckd, there’s an increased risk of toxicity
Rx- sodium thiosulphate

Question 15

The 1st step in managing hypovolemic hypernatremia is?

Answer 15

IV NS(0.9%) is preferred then, once the patient is euvolemic, the fluid is switched to 5%dextrose in water

Question 16

1st line pharmacotherapy for enuresis is—, 2nd line?

Answer 16

1st desmopressin
2nd TCAs(because of side effects)

Question 17

Hypercalcemia with an elivated or high normal PTH suggests either— or —?
How can u differentiate between the two?

Answer 17

• primary hyperparathyroidism- increased urinary calcium levels
• primary hypocalciuric hypercalcemia- low urinary Ca since Ca sensing receptors r defective there’s increased Ca reabsorption at the renal tubules

Question 18

The most common form of HIV related nephropathy is?

Typical presentation

Answer 18

Collapsing focal segmental glomerulosclerosis

- nephrotic range proteinuria, azotemia and normal sized kidneys.

Question 19

A 45 yr old came with 6months of fatigue. Knee n elbow pain of 4months, itchy rash on his leg of 2months . BP- 140/90, Cr- 1.9, albumin-3.1, AST-78, ALT- 99, low C3 n C4, elivated rheumatoid factor, U/A- blood3+, protein3+, few RBC casts
What Ix should b done to establish the dx?
The clinical manifestations r due to?
Dx is?
Rx?

Answer 19

Viral hepatitis serology
Dx- mixed cryoglobulinemia associated with hepC
Vasculitis involving the skin, kidneys, nerves, joints
The immune complexes r IgM abs(similar to rheumatoid factor) with IgG anti hepC, hepC RNA and complement
Rx - treating hepC, plasmapheresis to remove cryoglobulins, immunosuppressants( steroids, cyclophosphamide)

Question 20

Features of hepatorenal syndrome ( urine sodium, creatinine )

Answer 20

Similar to pre-renal azotemia
Elevated creatinine, very low urine Na level typically <10mEq/L. However, pts do not respond to iv fluids n renal function keeps on deteriorating