Day 9 - GU1

Question 1

Diuretic(s) most useful: acute pulmonary edema

Answer 1

Loop diuretic (recall: LMNOP)

Question 2

Diuretic(s) most useful: Hypercalciuria causing kidney stone

Answer 2

Thiazides

Question 3

Diuretic(s) most useful: Glaucoma

Answer 3

Acetazolamide or Mannitol

Question 4

Diuretic(s) most useful: Mild to moderate CHF & expanded extracellular volume

Answer 4

Loop diuretic (~double dose to get fluid off, then assess for UOP for adjustments); Note: All CHF pts should be on low-dose, potassium-sparing diuretic (e.g., spironolactone or eplerenone), which reduces long-term mortality

Question 5

Metolazone: drug class & use

Answer 5

Thiazide diuretic used in cases of cirrhosis (mixed w/ loop diuretic)

Question 6

Diuretic(s) most useful: in conjunction w/ loop diuretics to retain potassium

Answer 6

Potassium-sparing diuretics

Question 7

Diuretic(s) most useful: Edema assoc. w/ nephrotic syndrome

Answer 7

Loop diuretic, Metolazone (one of strongest thiazides)

Question 8

Diuretic(s) most useful: Increased ICP

Answer 8

Mannitol

Question 9

Diuretic(s) most useful: Mild to moderate HTN

Answer 9

Thiazides

Question 10

Diuretic(s) most useful: Hypercalcemia

Answer 10

Loop diuretic

Question 11

Diuretic(s) most useful: Altitude sickness

Answer 11

Acetazolamide

Question 12

Diuretic(s) most useful: Hyperaldosteronism

Answer 12

Potassium sparing diuretics

Question 13

Nephrolithiasis Expectant mgt

Answer 13

Strain urine w/ strainer - analyze stone after passing; Most pass spontaneously in 1-2 wk, especially if

Question 14

Surgical tx for kidney stones: indications & options

Answer 14

Surgical tx - 10-20% required in cases; Indications: unable to pass after 1 mo, complete urinary obstrx, impariment renal infx, peristent infx; Surgical options: Extracorporeal shock wave lithotripsy for stones in renal pelvis or ureter; Ureterorenalscopy for ureteral stones for possible lithotripsy and stent placment; Percutaneous nephrostolithotomy Staghorn calculi need possible

Question 15

Hematuria w/u

Answer 15

H & P, UA w/ cell ct, CBC, Chemistry w/ electrolytes, PSA (men > 40, elevated w/ any prostate pathology); Note: tampon placement to prevent menstrual bleeding into UA OR do straight cath; Imaging - (1) CT scan ab/pelvis stone protocol (2) If no stones, CT ab/pelvis w/ contrast to eval kidney/ureters (3) Co-CT KUB x-ray (since already giving contrast), equivalent to IVP to view radiopaque stones; If low suspicion of disease, consider tx for UTI and f/u UA in 3-5 days

Question 16

Indications for cystoscopy in case of hematuria

Answer 16

If no clear etiology and… Age > 50, Smoker, FH urinary tract cancer, PMH cyclophosphamide, suspicion for cancer => Send urine for cytology & get cystoscopy

Question 17

Considerations/Next steps if basic hematuria w/u negative

Answer 17

IgA nephropathy, Thin basement membrane disease; Repeat U/A and urine cytology routinely, f/u w/ renal sonogram & cystoscopy in 1 yr

Question 18

Glomerular diseases: Most common nephrotic syndrome in children

Answer 18

Minimal change disease

Question 19

Glomerular diseases: Granular IF pattern on LM, hypercellularity glomeruli

Answer 19

Post streptococcal glomerulonephritis

Question 20

Glomerular diseases: Linear pattern w/ immune complex deposition

Answer 20

Goodpasture’s

Question 21

Glomerular diseases: Kimmelstiel-Wilson nodular glomerulosclerosis

Answer 21

Diabetic nephropathy

Question 22

Glomerular diseases: Most common nephrotic syndrome in adults

Answer 22

Membranous glomerulonephritis

Question 23

Glomerular diseases: EM loss of epithelial foot processes

Answer 23

MCD

Question 24

Glomerular diseases: nephrotic syndrome assoc w/ hepatitis B

Answer 24

Membranoproliferative glomerulonephritis

Question 25

Glomerular diseases: HIV

Answer 25

FSGS

Question 26

Glomerular diseases: Anti-GBM antibodies, hematuria, hemoptysis

Answer 26

Goodpasture’s

Question 27

Glomerular diseases: Subendothelial tram tracks and immune complex humbs

Answer 27

Membranoproliferative glomerulonephritis

Question 28

Glomerular diseases: nephritic syndrome, cataracts, high frequency hearing loss

Answer 28

Alport syndrome

Question 29

Glomerular diseases: Crescent formation in glomeruli

Answer 29

RPGN or crescentic glomerulonephritis

Question 30

Glomerular diseases: Segmental sclerosis and hyalinosis

Answer 30

FSGS

Question 31

Glomerular diseases: Purpura on arms & legs, Ab pain, IGA nephropathy

Answer 31

HSP

Question 32

Glomerular diseases: Apple green birefringence w/ Congo red stain under polarized light

Answer 32

Renal amyloidosis

Question 33

Glomerular diseases: Positive ANCA

Answer 33

Crescentic glomerulonephritis (aka RPGN)

Question 34

Glomerular diseases: dsDNA antibodies

Answer 34

Lupus nephropathy

Question 35

Glomerular diseases: spike and dome of basement membrane

Answer 35

Membranous glomerulonephropathy