Extras

Question 1

Aldosterone acts WHERE

Answer 1

cortical collecting duct

principal cell

Question 2

most sodium resorbed where

Answer 2

65% PCT
25% LOH
10% DCT and CD

Question 3

PLA2 actually expressed where

Answer 3

podocytes

Question 4

reduced podocyte levels in diabetes correlates with

Answer 4

risk prog diabetic nephropathy

Question 5

Klotho expression in CKD

Answer 5

reduced- less responsive to FGF23

Question 6

factors in membranous nephropathy that predict progression CKD

Answer 6

renal function off at baseline
male 
over age 50
increase degree and duration proteinuria
hypertension
biopsy showing tubuloint fibrosis, stage 3 or 4, 
non asian

Question 7

podocyte foot effacement seen in

Answer 7

minimal change

Question 8

ANP acts on which bit of nephron

Answer 8

medullary collecting duct to inhibit sodium reabsorption

Question 9

BK nephropathy RF

Answer 9

female donor
use ATG
older recipient
DR mismatch

Question 10

treatment BK nephropathy
(urine and blood PCR positive, biopsy show tubulitis, interstitial infiltrate lymphocytes, intranuclear inclusion bodies)

Answer 10

reduce overall immunosupression
leflunomide (antiviral as well as pyrimidine synth inhibitor)
IV cedofovir maybe

Question 11

when would you consider bicarb for contrast induced neph prevention

Answer 11

when urgent CT and do not have the 12 hours pre-scan, bicarb is probably non inferior

Question 12

heart failure AND proteinuria, think

Answer 12

AL amyloidosis

Question 13

Most common presentation of dialysis related amylodiosis

Answer 13

carpal tunnel
shoulder pain
Thy cystic lesions at the end of long bones contain amyloid

Question 14

Why do you hold metformin before and after contrast?

Answer 14

If there is deterioration in renal function, then will be at higher risk of lactic acidosis, NOT because there is increased risk lactic acidosis

on the other hand,
ACEi and ARB, diuretics, NSAIDS DO increase risk

Question 15

what type of transplant is most likely to give you PTLD?

Answer 15

bowel
heart lung

10-20% each

liver next
then lung
kidney only 1%

Question 16

PTLD treatment

Answer 16

reduce immunosupresssion
next line ritux
no antivirals work

Question 17

Uveitis and interstitial nephritis, think

Answer 17

acute tubuloint nephritis with uveitis syndrome

HLADQA1 DQB1 and DRB1

Question 18

FSGS after renal transplant- what does it look like?

Answer 18

hours to days- massive proteinuria
or
late- insidiously years to months

give high dose ARB, ACE, statins
immunosupression increase
most commonly try plasmapheresis or immunoadsorption with protein A
can try ritux if no response to plasmapheresis

Question 19

COX2 inhib use assoc with which GN

Answer 19

minimal change

Question 20

MPGN on

• light
• immuno
• EM

Answer 20

Light: diffuse thickening capillary walls, mesangial hypercellularity
IF: coarse granular pattern along capillaries
EM: large discreet electron dense supendothelial deposits

Question 21

For every 100 patients given tac instead of CycA…

Answer 21

2 fewer graft loss
12fewer rejectons
5 extra cases DM

Question 22

Benefits of mTOR over CNI

Answer 22

not nephrotoxic alone
malignancy- def reduced skin cancers
reduced CMV - definite
early on there is more rejection- only swap after a few months
increased graft survival 
better renal function 
but MORE proteinuria 

When conversion from a CNI to an mTOR inhibitor is performed late, the patient has GFR

Question 23

When picking a kidney, is matching or Ab level most important?

Answer 23

levels ab

Question 24

Tac does what to your hair

Answer 24

alopecia

Question 25

What cells in urine suggest BK nephropathy?

Answer 25

Decoy cells

also look for EM- bug
and IHC- SV70 antigen

Question 26

Which GN cause does not really reccur

Answer 26

post strep GN

Question 27

which is highest risk of recurrence
which is highest risk failure

GN

Answer 27

recurrence MPGN

failure IgA

Question 28

Which transplant med does NOT increase risk DM

Answer 28

MMF