Diseases

Question 1

Defined as a sudden decline in kidney function causing disturbances in fluid, electrolytes and acid-base balance due to a loss of small solute clearance and
decreased GFR

Answer 1

acute kidney injury

Increased mortality even if renal function returns to normal**

Question 2

AKI is defined as

Answer 2

Reduction of renal function within 48 hrs as defined by:
Absolute increase in serum creatinine > or equal to 0.3 mg/dl
Percentage increase in serum creatinine > or equal to 50%
Reduction in urinary output, with documented oliguria of less than 0.5 ml/kg per hour for more than 6 hours

Question 3

stages of AKI

Answer 3

Stage 1-Inc. in Serum Cr >.3 or 150-200% from baseline, along with oliguria for
>6 hrs

Stage 2-Inc. in Serum Cr 200-300% from baseline, along with oliguria for >12 hrs

Stage 3-Inc. in Serum Cr >300% from baseline, need for RRT, and/or oliguria for 24 hrs/anuria > 12 hrs

Question 4

An adaptive response to severe volume depletion and hypotension, with structurally intact nephrons
**Most common form of AKI, accounts for 55% AKI

Answer 4

pre-renal

Question 5

what can cause prerenal failure

Answer 5

• volume depletion
• decreased CO
• arteriole vasoconstriction
• systemic vasodilation

Question 6

M/C caused by acute tubular injury (ATN), either ischemic or cytotoxic

Answer 6

intrinsic

Question 7

what can cause intrinsic renal failure

Answer 7

• drugs
• vascular
• AI
• tubular

Question 8

Mechanical obstruction of urinary collecting system resulting in obstructive uropathy

Answer 8

postrenal

Question 9

S/S chronic renal failure

Answer 9

fatigue, weight loss, anorexia, nocturia, and pruritis

Question 10

acute tubular necrosis casts

Answer 10

granular, muddy brown

epitheleal

Question 11

glomerulonephritis casts

Answer 11

RBC, tea colored

Question 12

prerenal failure will have a FENa of

Answer 12

< 1%

Question 13

how to tx AKI

Answer 13

volume expansion

decrease potassium intake, insulin & glucose, albuterol, kayexelate, lasix, IV calcium (cardiac instability)

Question 14

when is dialysis indicated

Answer 14

volume expansion that cannot be controlled by diuretics Hyperkalemia refractory to medication
Severe acid-base imbalances refractory to medication Severe azotemia (BUN > 80-100), uremia,

Seizure/coma

CC <10 and serum Cr >9

Question 15

how long after AKI is a pt dx with chronic renal failure

Answer 15

no improvement after 6-8 weeks

Question 16

Accounts for 85% of Intrinsic AKI

Death of tubular cells that form the tubule that
transports urine to the ureters while reabsorbing 99% of the water (and highly concentrating the salts and
metabolic byproducts)

Answer 16

ATN

Question 17

ischemic ATN shows

Answer 17

skip lesions through tubules

Question 18

toxic ATN

Answer 18

Characterized by proximal tubular epithelium necrosis due to a toxic substance, necrotic cells fall into the tubule lumen, obliterating it
BM intact, so regen is possible

Question 19

MC drug causing toxicity

Answer 19

aminogylcosides

Question 20

acute interstitial nephritis usually caused by

Answer 20

acute allergic reaction to a medication, including antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs)

Also linked to infections, diseases, and transplant rejection

Question 21

Clinical presentation hallmark:

Fever, Rash, Eosinophilia **
Also arthralgias, proteinuria, hematuria, and Sterile pyuria

Answer 21

AIN

Question 22

AGN

Answer 22

Acute glomerular Nephritis always have some urinary
protein, hematuria with RBC casts, and sometimes pyuria with WBC casts….this is known as nephritic or active urine. Dark tea colored urine

Question 23

CGN

Answer 23

Chronic Glomerular Nephritis is noted for heavy

proteinuria and urine fat (oval fat bodies)….this is known as nephrotic urine.

Question 24

low vs normal complement for AGN

Answer 24

low-Post infectious, SLE, MPGN

normal-Iga nephropathy, Good pastures,

Question 25

Young men > women (6 X )
Hemoptysis , SOB, anemia, reddish urine
High bun/creat. , high anti serum anti GMB
Often have pulmonary & renal symptoms

Answer 25

Goodpasture’s Syndrome

tx w/plasmapharesis and steorids

Question 26

Patients tend to be s/p pharyngitis, impetigo, sub acute
endocarditis…. Group A beta hemolytic streptococcal infections
1-3 weeks after infection
Patient becomes lethargic slight edema,oligiuric, HTN, red urine “cola colored”.

Answer 26

post infectious GN

Question 27

Most common form of Acute GN
Children and young adults, M>W

Occurs 1-3 days af ter throat infection with reddish
“cola” urine.

Answer 27

IgA Nephropathy (Berger’s dx)

Question 28

MCC Cryoglobulin Associated GN (Necrotizing skin lesions, Arthralgias, Fever, Hepatosplenomegaly, Low complement levels)

Answer 28

Hep B/C

Question 29

Effects the basement membrane becomes thickened due to immune deposition and mesangial proliferation.
BM “double layer” appearance

Answer 29

membranoproliferative GN
type one is more nephrotic
type two is more nephritic

Question 30

Heavy proteinuria (>3.5gr./24hr)
Hypoalbuminemia (<3gr./dl)

Fat bodies in urine (“maltase cross”)

Answer 30

nephrotic syndrome

Question 31

MC cause of N.S. in kids (<10 y/o) and can follow a viral URI

Loss / fusion of epithelial cell foot processes

In adults its MC associated NSAIDS, and less commonly associated with Hodgkin’s Dx.

Proteinuria with no hematuria

Answer 31

minimal change disease (nil’s)

Question 32

M.C. primary Cause of N.S. in adults, 5-6th decade of life

Answer 32

membranous nephropathy

Question 33

Characterized by scaring of mesangial cells on microscopy and is diagnostic

May see decreased renal function at time of diagnosis in 30-50% of patients

Answer 33

Focal Segmented Glomerulur Sclerosis

Question 34

MCC end stage renal disease

Answer 34

Diabetic nephropathy

Question 35

chronic renal failure

Answer 35

GFR will increase to nl as a result of hyper filtration of remaining nephrons… this eventually leads to scaring and progressive rapid loss of GFR

broad waxy casts

Question 36

when should diabetics start dialysis

Answer 36

GFR is 15 or serum Cr. Is