1. Oliguria - Proteinuria

Question 1

chronic kidney disease (CKD) is defined as one or more markers of kidney damage, and a decreased GFR (less than 60ml/min) for how many months?

Answer 1

after three months (less than 3 months is acute kidney injury)

Question 2

The vast majority (64%) of CKD is caused by diabetes or?

Answer 2

HTN

Question 3

Symptoms of CKD include edema, HTN, decreased urine output (UOP) foamy urine, uremia, pericardial friction rub, asterixis and uremic?

Answer 3

frosh (seen on feet/face white dust)

Question 4

3 tests to identify most CKD patients include eGFR (estimated via mathematics- not accurate in rapid creatinine change- AKI), urine albumin to creatinine ratio or urin protein to creatinine ratio and?

Answer 4

urinalysis

Question 5

Renal US (MC) may be performed and can see atrophic/small kidneys, cortical thinning, increased echogenecity and elevated?

Answer 5

resistive indices

NOTE: Abd CT best for masses, Abd MRI for stenosis

Question 6

CKD treatment includes Renal Replacement Therapy (RRT) including hemodialysis, peritoneal dialysis, and renal transplantation. Indication for dialysis can be remembered by AEIOU...
A: severe acidosis
E: electrolyte disturbances
I: Ingestion (ethylene glycol/methanol)
O: Volume Overload
U:

Answer 6

UREMIA

Question 7

Acute kidney injury AKI is diagnosed/staged based on serum creatinine and or on urine output being less than?

Answer 7

0.5ml/kg/h

Question 8

AKI presents with edema, HTN, decreased urine output, foamy urine (proteinuria), hematuria, SOB, uremia, pericardial friction rub, asterixis and?

Answer 8

Uremic frost

NOTE: mild AKI usually asymptomatic

Question 9

Common diagnostic tests for AKI include UA with microscopy, urine albumin/cr ratio or protein/cr ratio, and a?

Answer 9

renal US

Question 10

What is characterized by proteinuria (>3.5g/day), hypoalbuminemia, peripheral edema, hyperlipidemia, and lipiuria?

Answer 10

Nephrotic Syndrome

NOTE: if serum albumin is normal, pt does not have nephrotic syndrome, rather nephrotic range proteinuria

Question 11

Along with the obvious outcomes of nephrotic syndrome, there is also increased chance for infection due to urinary loss of IgG and increased thrombosis due to?

Answer 11

loss of antithrombotic factors

also VIT D deficiency and Anemia

Question 12

Multiple myeloma, amyloidosis, and monoclonal immunoglobulin deposition disease MIDD, are all possible DDX for?

Answer 12

nephrotic syndrome

Note: has bland urinary sediment compared to nephritic

Question 13

Nephrotic syndrome is diagnosed by serum creatinine with eGFR, urinalysis, urine albumin to cr ratio, 24 hour protein collection, glomerulonephritis serologic evaluation and most importantly?

Answer 13

RENAL BIOPSY

Question 14

What is characterized by proteinuria of less than 3.5gm per day, hematuria, HTN and commonly with renal failure?

Answer 14

Nephritic Syndrome

***Active urinary sediment (RBC/WBC/granular casts)

Question 15

Low complement levels (C3/4) are helpful in DDx of nephritic syndrome- only a few cause them to drop. Low C3/4 indicated activation of classical while low C3 only indicates activation of?

Answer 15

alternative pathway

Question 16

Kidney Disease:

Urinary Pattern: renal tubular epithelial cells, transitional epithelial cells, granular casts/waxy casts

Answer 16

Acute tubular necrosis ATN

Question 17

Kidney Disease:

Urinary Pattern: WBC, WBC casts, Urine eosinophils

Answer 17

Acute interstitial nephritis/pyelonephritis

Question 18

Kidney Disease:

Urinary Pattern: Dysmorphic RBCs, RBC casts

Answer 18

Vasculitis/GN

Question 19

Kidney Disease:

Urinary Pattern: Hyaline casts

Answer 19

Non-specific, prerenal azotemia

Question 20

Kidney Disease:

Urinary Pattern: WBCs, RBCs, bacteria

Answer 20

urinary tract infection

Question 21

With hyperkalemia, you can see peaked T waves on EKG, the high concetration of K+ makes membrane potential?

Answer 21

less negative = more excitable initially then impairs excitation later
**treat hyperK first

Question 22

All of the following are signs of what?

hemoconcentration, hypovolemic hyponatremia, contraction metabolic acidosis, BUN/Cr ratio >20:1 and hyaline casts

Answer 22

Hypovolemia or Prerenal azotemia

Question 23

All of the following are signs of what?

proteinuria, renal tubular epi cells, transitional epi cells, granular casts and FENA >2%

Answer 23

Acute tubular necrosis