disorders of the kidney

Question 1

When could a patient with pyelonephritis have a negative urine culture?

Answer 1

usually have >10^5 bacteria/mL, but can be negative if pyelonephritis is the result of hematogenous spread

Question 2

What are complications of pyelonephritis in pregnant women?

Answer 2

increased risk of preterm labor and low birth weight

Question 3

What drugs can cause kidney stones?

Answer 3

acetazolamide and loop diuretics

Question 4

What is the most common site of renal stone impaction?

Answer 4

-urterovesicular junction

Question 5

Struvite kidney stones. precipitate at high or low pH?

Answer 5

aka ammonium magnesium phosphate. caused by infection with urease positive bugs like proteus, staph, klebsiella
precipitate at high pH

Question 6

What causes calcium phosphate stones?

Answer 6

hyperparathyroidism, RTA (precipitate at high pH like struvite)

Question 7

What kinds of stones are associated with ethylene glycol ingestion?

Answer 7

oxalate crystals

Question 8

What can be used to alkalinize urine and when would you want to?

Answer 8

• potassium citrate

- treats uric acid stones or calcium phosphate

Question 9

What kinds of stones form staghorn caliculi?

Answer 9

cystine and struvite/ammonium magnesium phosphate

Question 10

When is shock wave lithotripsy useful?

Answer 10

breaks up stones

Question 11

What are some causes of temporary hematuria?

Answer 11

-idiopathic, UTI, exercise/trauma, endometrisis, nephrolithiais

Question 12

What are some causes of persistent hematuria?

Answer 12

in kids, think glomerular disease

in adults, think adult polycystic disease, neoplasm, glomerular disease, possible BPH

Question 13

What is the next step in a patient who presents with anuria?

Answer 13

attempt bladder catheterization to rule out bladder or ureteral obstruction

Question 14

How is hydronephrosis treated?

Answer 14

drainage with nephrostomy tube, treat underlying obstruction (balloon dilation of ureter and placement of a double-J stent in ureter to allow urine flow)

Question 15

What is a key complication that patients with polycystic kidney disease may experience?

Answer 15

15% develop SUBARACHNOID HEMORRHAGE and intracranial aneurysms; some also have mitral valve prolapse

Question 16

What does the UA of a pt with polycystic kidney disease show?

Answer 16

hematuria and proteinuria

Question 17

What are treatments of polycystic kidney disease?

Answer 17

vasopressin receptor antagonists, amiloride (blocks the sodium channel in the DCT and collecting tube/duct) to prevent fluid collection in the kidneys, treat UTI and HTN. may need dialysis and transplant

Question 18

What malignancies cause increased erythropoeitin?

Answer 18

renal cell cancer, hepatocellular cancer, pheochromocytoma, hemangioblastoma

Question 19

What are common causes of interstitial nephropathy (acute interstitial nephritis)

Answer 19

• see fever, rash, hematuria, and CVA tenderness, or is asymptomatic. may also have eos
• usually 1-2 wks after beta-lactam abx, sulfonamides, aminoglycosides, PPIs, diuretics, allopurinol. NSAIDs (though may present later following NSAID exposure)
• Also lead and cadmium
• infections, sarcoid, amyloidosiscan also do this

Question 20

tWhat are toxins that can cause ATN?

Answer 20

aminoglycosides, radiocontrast dyes, ethylene glycol, myoglobinuria, cisplatin.