9/25- Renal III: AKI, CKD, and Everything Else Flashcards
An infant is found to have glucosuria, bicarbonaturia, and aminoaciduria. Serum bicarbonate is stable at 14.
What is the renal defect?
A. Abnormality of sodium coupled transport in the proximal nephron
B. Abnormality of sodium coupled transport in the cortical collecting duct
C. Abnormality of sodium coupled “tri-transport” in the loop of Henle.
D. Abnormality of electrogenic sodium channel in medullary collecting duct
What is the renal defect?
A. Abnormality of sodium coupled transport in the proximal nephron
B. Abnormality of sodium coupled transport in the cortical collecting duct
C. Abnormality of sodium coupled “tri-transport” in the loop of Henle.
D. Abnormality of electrogenic sodium channel in medullary collecting duct
- Proximal tubular RTA
A patient with altered mental status is being seen in ER, and has the following electrolytes:
Na=140, K=2.4, Cl=125, HCO3=4 .
Which disease is compatible with these electrolytes?
A. Diabetic keto-acidosis
B. Methanol poisoning
C. Septic shock
D. Distal renal tubular acidosis
Which disease is compatible with these electrolytes?
A. Diabetic keto-acidosis
B. Methanol poisoning
C. Septic shock
D. Distal renal tubular acidosis
- AG = 140 - 125 - 4 = 11
- NAGMA
A hypertensive patient on no medications has edema, hypokalemia, and a high serum bicarbonate.
You find that the aldosterone is elevated and renin is low.
Which single medication will most likely cure his hypertension
A. The angiotensin converting enzyme inhibitor lisinopril.
B. The aldosterone receptor blocker spironolactone.
C. The beta blocker atenolol.
D. The calcium antagonist amlodipine.
Which single medication will most likely cure his hypertension
A. The angiotensin converting enzyme inhibitor lisinopril.
B. The aldosterone receptor blocker spironolactone?
C. The beta blocker atenolol.
D. The calcium antagonist amlodipine.
- If you have low K (hypokalemia) and HTN, need to look at renin/aldosterone levels
High renin:
- Renal artery stenosis
- Renin-secreting tumor
High aldosterone (hyperaldosteronism)
- Renal hyperplasia
Nl aldosterone and low renin
- Liddle’s syndrome
- Licorice
A patient presents to the emergency room with a serum potassium of 8 mEq/L and EKG changes.
Why did the senior resident in the ER give calcium gluconate first?
A. Calcium reestablishes cardiac repolarization, even though serum potassium remains high.
B. Calcium decreases proximal tubule potassium absorption.
C. Calcium depolarizes thick ascending limb of Henle, inhibiting the Na-K-2Cl transporter.
D. Calcium competes with sodium for the principal cell sodium channel, stimulating K secretion by the collecting duct.
Why did the senior resident in the ER give calcium gluconate first?
A. Calcium reestablishes cardiac repolarization, even though serum potassium remains high.
B. Calcium decreases proximal tubule potassium absorption.
C. Calcium depolarizes thick ascending limb of Henle, inhibiting the Na-K-2Cl transporter.
D. Calcium competes with sodium for the principal cell sodium channel, stimulating K secretion by the collecting duct.
Other treatments:
- Lasix/loop diuretics
- Insulin (+ glucose)
- Bicarb (if acidotic)
- Diuretics
What can be seen on EKG in hyperkalemia?
- Sine wave
- PT wave
Which of the following statements about the hormone PTH is correct?
A. PTH decreases urinary phosphorus excretion
B. PTH increases calcium release from osteoclasts
C. PTH decreases 1-alpha hydroxylase at the kidney, reducing levels of 1,25OH vitamin D
D. PTH and calcitonin work together to raise calcium levels
Which of the following statements about the hormone PTH is correct?
A. PTH decreases urinary phosphorus excretion
B. PTH increases calcium release from osteoclasts
C. PTH decreases 1-alpha hydroxylase at the kidney, reducing levels of 1,25OH vitamin D
D. PTH and calcitonin work together to raise calcium levels
A patient has the following lab tests:
[Na+] = 140 mEq/L, [K+] = 3.2 mEq/L, [Cl-] = 96 mEq/L, [HCO3] = 32 mEq/L, arterial pH = 7.48, pCO2=46.
What is the correct diagnosis?
A. Type IV Renal Tubular Acidosis
B. Primary hyperaldosteronism
C. Proximal (Type 2) renal tubular acidosis
D. Ethylene glycol intoxication
E. Distal (Type 1) renal tubular acidosis
What is the correct diagnosis?
A. Type IV Renal Tubular Acidosis
B. Primary hyperaldosteronism
C. Proximal (Type 2) renal tubular acidosis
D. Ethylene glycol intoxication
E. Distal (Type 1) renal tubular acidosis
- Metabolic alkalosis?
- Know principal cell working
Which of the following mechanisms is responsible for hypokalemia seen after vomiting?
A. GI loss of potassium
B. High aldosterone state due to volume depletion
C. Increased delivery of H+ to the kidney
Which of the following mechanisms is responsible for hypokalemia seen after vomiting?
A. GI loss of potassium
B. High aldosterone state due to volume depletion
C. Increased delivery of H+ to the kidney
- Principal cell reabsorbs Na with sacrifice of K
Syphilis can cause what renal dz?
Membranous nephropathy
Your patient needs a loading dose of 1000 mg of Penicillin to treat his tertiary syphilis. You realize he has CKD and a GFR of 20 ml/min.
Syphilis also causes membranous nephropathy and his albumin is 2.0 g/L. The drug is 50% protein bound.
How many mg of Penicillin should you load with?
A. 1000 mg
B. 500 mg
C. 250 mg
D. 50 mg
?
A patient presents with severe left flank pain and hematuria. Her urine pH is 8.5. She has a history of several urinary tract infections in the past. You look at the urine and the picture below is seen.
What is the most likely composition of the kidney stone?
A. Calcium Oxalate
B. Struvite
C. Drug induced (crystalline)
D. Cysteine
What is the most likely composition of the kidney stone?
A. Calcium Oxalate
B. Struvite
C. Drug induced (crystalline)
D. Cysteine
- Associated with certain bacteria (commonly urease-producing)
- Result from chronic urinary infection
- Urea splitting organisms (e.g., Proteus)
- Alkaline pH
- Urinary debris and crystal niduses
- Stones composed of magnesium, calcium, ammonium, phosphate, carbonate (Struvite)
- Radiopaque
- Difficult or impossible to eliminate stones
- Staghorn calculi (cast of pelvicocalyceal system)
If you give a normal patient without CKD one liter of Normal Saline (0.9%), what will happen to his serum sodium level?
A. Increase
B. Decrease
C. Stay the same
If you give a normal patient without CKD one liter of Normal Saline (0.9%), what will happen to his serum sodium level?
A. Increase
B. Decrease
C. Stay the same
You are sitting in the renal review session and develop an acute RIGHT sided flank pain. By the end of class, the pain seems to be migrating towards the front. You have a history of kidney stones and this feels like another stone.Your serum creatinine is normal.
What test will the ER likely order to confirm this diagnosis?
A. Non contrast CT scan
B. IV Pyelogram (IVP)
C. Ultrasound
D. Typically, ER will wait until stone passes to do stone analysis
What test will the ER likely order to confirm this diagnosis?
A. Non contrast CT scan
B. IV Pyelogram (IVP)
C. Ultrasound
D. Typically, ER will wait until stone passes to do stone analysis
- US is good if stone in kidney, but non-contrast CT scan is good if you need to find exactly where the stone is (if it’s moving/where exactly)
You are consulted for a currently 50 kg female patient with a serum sodium of 150. You wish to normalize his serum sodium to 140. His blood pressure is 140/80 and he is euvolemic. Which fluid do you give; what is his water deficit?
A. Normal Saline; 1.8 Liters
B. Normal Saline; 4 Liters
C. Dextrose-Water; 1.8 Liters
D. Dextrose-Water; 4 Liters
Water deficit = TBW x (NApt/NAnl - 1)
(pt’s sodium level - normal sodium level)
- Dehydrated people need water!
- Hypovolemic people need salt! (low BP)
Tachycardia could indicate what in regard to volume status?
Hypovolemia (decreased BP -> reflex tachycardia)
You admit a patient from the ER with hypovolemic hyponatremia, Na is 106 meq/L. The overzealous intern agressively treats the patient with normal saline and 12 hours later, his serum sodium is 130 meq/L.
What is this patient at risk for?
A. Central Pontine Myelinolysis
B. Myocardial Infarction
C. Diabetes Insipidus
D. Hypertension
Treatment?
What is this patient at risk for?
A. Central Pontine Myelinolysis
B. Myocardial Infarction
C. Diabetes Insipidus
D. Hypertension
(aka Osmotic Demyelination; doesn’t just happen in pons)
- Don’t correct more than 10 in 24 hours
Treatment:
- Hypertonic saline (3 x 154 = 462); pulls out water and prevents some symptoms
The urine anion gap tests answers which of the following questions?
A. Is there an ingestion of an alcohol?
B. Is the kidney able to acidify urine?
C. Is the body producing too much acid?
The urine anion gap tests answers which of the following questions?
A. Is there an ingestion of an alcohol?
B. Is the kidney able to acidify urine?
C. Is the body producing too much acid?
- Osmolar gap tests for alcohol ingestion
A patient presents with potassium of 1.7 meq/L (LOW) and sodium of 115 meq/L (LOW).
What is the effect of giving this patient potassium
A. Raise the serum sodium
B. Lower the serum sodium
C. No change to serum sodium
What is the effect of giving this patient potassium
A. Raise the serum sodium
B. Lower the serum sodium
C. No change to serum sodium
- Because of Na/K/ATPase, if you give K, Na will move out
- Raise serum sodium
Which statement regarding change in renal function with increasing age is true.
A. The estimated GFR progressively falls
B. The renal vascular resistance progressively decreases
C. The normal range for serum creatinine increases
D. The kidney size slowly increases.
Which statement regarding change in renal function with increasing age is true.
A. The estimated GFR progressively falls
B. The renal vascular resistance progressively decreases
C. The normal range for serum creatinine increases
D. The kidney size slowly increases.
Which statement about diabetic nephropathy is true?
A. The majority of diabetics will develop nephropathy at some time in their lives.
B. Any finding of microalbuminuria indicates structural renal damage (such as cysts)
C. Patients with large kidneys do not have diabetic nephropathy
D. Persistent micro albuminuria indicates nephropathy
Which statement about diabetic nephropathy is true?
A. The majority of diabetics will develop nephropathy at some time in their lives.
B. Any finding of microalbuminuria indicates structural renal damage (such as cysts)
C. Patients with large kidneys do not have diabetic nephropathy
D. Persistent micro albuminuria indicates nephropathy
- This is the test for diabetic kidney disease
A patient with diabetes for 15 years has hypertension and nephrotic range proteinuria.
Which combination of medications below has the greatest probability of slowing diabetic nephropathy.
A. ACE-inhibitors [angiotensin converting enzyme, such as captopril] and statins [lipid lowering agents]
B. Thiazide diuretics and statins [lipid lowering agents]
C. Beta Blockers (Metoprolol) and aspirin
D. Direct vasodilators (Minoxidil) and statins [lipid lowering agents]
Which combination of medications below has the greatest probability of slowing diabetic nephropathy.
A. ACE-inhibitors [angiotensin converting enzyme, such as captopril] and statins [lipid lowering agents]
B. Thiazide diuretics and statins [lipid lowering agents]
C. Beta Blockers (Metoprolol) and aspirin
D. Direct vasodilators (Minoxidil) and statins [lipid lowering agents]
- ACEIs are mainstay of treatment (lower BP in glomerulus, lowering hydrostatic pressure, and decreasing protein filtration)
Effects of ACEI/ARB?
- Lower systemic BP
- Lower PGC
- Lower proteinuria
- Inhibit non-hemodynamic effects of A-II
- Less proliferation, hypertrophy, matrix expansion, growth factor synthesis.
- Inhibits macrophage activation, proliferation and migration
- Natriuretic
A ten-year old child with palpable purpura, proteinuria, hematuria, and abdominal pain most likely has…
A. Minimal Change Disease
B. Henoch-Schonlein Purpura (HSP)
C. Lupus Nephritis
D. IgA Nephropathy
A ten-year old child with palpable purpura, proteinuria, hematuria, and abdominal pain most likely has…
A. Minimal Change Disease
B. Henoch-Schonlein Purpura (HSP)
C. Lupus Nephritis
D. IgA Nephropathy
What would you expect the fractional excretion of sodium (FeNa) to be in a patient who is profoundly volume depleted?
A. < 1%
B. 1-3%
C. > 3%
What would you expect the fractional excretion of sodium (FeNa) to be in a patient who is profoundly volume depleted?
A. < 1%??
B. 1-3%
C. > 3%
FeNA > 1% (esp > 2%) is indicative of tubular injury (not absorbing Na)
