CLIPP 31- Renal

Question 1

Presentations of Conjunctivitis (allergy vs infection vs chemical)

Answer 1

Allergy: bilateral, watery, itchy, mucoid/ropey discharge
Bacterial: <6, bilateral, purulent exudate with crusting
Adenovirus: becomes bilateral, associated with pharyngitis and pre-auricular lymphadenopathy

Question 2

Perioribital swelling differential (5)

Answer 2

URI, Seasonal/Acute allergies, Sinusitis, periorbital cellulitis (pneumococci, Moraxella, haemophilus influenzae)

Question 3

Physical signs of HF

Answer 3

edema, S4 gallop (overloaded LV)

Question 4

4 major characteristics of nephrotic syndrome

Answer 4

proteinuria, hypoalbuminemia, edema, hyperlipidemia

Question 5

Underlying causes of nephrotic syndrome

Answer 5

• Primary=glomerular disease (MINIMAL CHANGE DISEASE)

- Secondary=systemic disease process

Question 6

Characteristic histologic finding of minimal change disease

Answer 6

fusion and diffuse effacement of epithelial cell foot processes on EM, normal LM

Question 7

Clinical findings of nephrotic syndrome

Answer 7

edema, dependent periorbital edema, ascites/weight gain, fatigue, decreased appetite

Question 8

Mechanisms of proteinuria in nephrotic syndrome (3)

Answer 8

loss of negative charge at glomerular filtration surface, increased capillary wall pore size, increased capillary flow

Question 9

Classifications of nephrotic syndrome

Answer 9

Steroid responsive, relapsing/steroid-dependent, steroid-resistant

Question 10

Indications for renal biopsy in nephrotic syndrome (11)

Answer 10

steroid resistance, <6 months of age, 3-18mos + hematuria, >10yo w/o drug reaction or post-infectious, DMI, hematuria+proteinuria+maternal hematuria, HSP, progressive decline in renal function, SLE/suspected lupus nephritis, low serum complement, chronic renal insufficiency

Question 11

Treatment of Primary Nephrotic Syndrome

Answer 11

corticosteroids, sodium restriction (edema), IV furosemide+albumin (symptomatic edema),

Question 12

Infectious Complications of Nephrotic Syndrome

Answer 12

spontaneous peritonitis (strep pneumo), pneumonia, cellulitis, UTI

Question 13

Evaluation of generalized edema (4)

Answer 13

• electrolytes, BUN, creatinine (renal function)
• AST, ALT, cholesterol, albumin, TG (hepatic function)
• C3/C4 (glomerulonephritis)
• Streptozyme (PSGN)

Question 14

DDx: fatigue, periorbital edema, increasing abdominal girth (4)

Answer 14

acute glomerulonephritis (HTN, hematuria), CHF (hepatomegaly, SOB), Hepatic failure (jaundice), Nephrotic syndrome