Kidney (Renal) Disease

Question 1

normal GFR rate

Answer 1

100 to 130 mL per min

less than 100 ml/min is abnormal kidney dysfunction

Question 2

inulin

Answer 2

gold standard in renal function tests (100% accurate about GFR rate)

plant starch IV infusion

Question 3

Creatinine

Answer 3

byproduct of metabolism and compare blood and urine(renal clearance) levels

overestimates GFR

Question 4

abnormal creatinine blood levels for kidney dysfunction

Answer 4

more than 1.3 mg/dL

Question 5

abnormal creatinine urine levels for kidney dysfunction

Answer 5

less than 500 mg/day

Question 6

BUN

Answer 6

blood urea nitrogen

byproduct of DNA and protein metabolism

Question 7

abnormal BUN levels for kidney dysfunction

Answer 7

more than 18 mg/dL

Question 8

azotemia

Answer 8

abnormal lab results with no clinical signs

Question 9

uremia

Answer 9

azotemia + clinical symptoms of kidney dysfunction (renal failure) like HTN, anemia, edema, oliguria (less urine production)

Question 10

Nephritic diseases

Answer 10

hematuria and mild/none proteinuria

glomerulonephritis

Question 11

nephrotic diseases

Answer 11

no hematuria but significant proteinuria (foamy urine from albuminuria)

hyperlipidemia, edema, and HTN

resolve completely or ESRD / kidney failure

Question 12

diabetic nephropathy

Answer 12

50% of all nephrotic diseases

leading cause of ESRD
leading cause of death in T1DM

endothelial glycation leading to thickened basement membrane and scars the kidney

RF: T1DM > T2DM, HTN, smoking + race (AA)

Tx: control BP, BG, lipids and smoking cessation or if ESRD (dialysis or transplant)

Question 13

Minimal Change Disease

Answer 13

most common nephrotic syndrome in children (1 - 7 years old)

idiopathic (70-90%) + NSAIDS, vaccines, viral infection

Face edema is noticed as first sign and pathology under EM (loss of foot processes, appearance of microvilli, and vacuolation)

Tx: steroids! (95% total recovery)

Question 14

Acute Tubular Necrosis

Answer 14

necrosis of tubular epithelial cells
most common cause of acute renal failure

recovery is possible with timely treatment

Question 15

types of acute tubular necrosis

Answer 15

ischemic: 50% due to vascular collapse (shock or hypotension) or pre-renal vessel occlusion (HTN, DM, thrombosis)

Toxic due to contrast media in x-ray (25%) or antibiotics, NSAIDs, other substances

Question 16

hypertensive nephropathy

Answer 16

sclerosis of renal arteries + glomeruli secondary to chronic HTN

2nd most common cause of ESRD

Question 17

types of HTN nephropathy

Answer 17

benign nephrosclerosis (55%) and only 1-5% lead to ESRD

malignant nephrosclerosis (diastolic is more than 130) 45% and 33% lead to ESRD

Question 18

renal failure / ESRD

Answer 18

less than 15 ml/min GFR OR dialysis or less than 10% renal function

primarily caused by DM, HTN, and GN (glomerulonephritis) ~ 78%

Tx: dialysis, transplant, acceptance of death from uremia

Question 19

types of renal failure

Answer 19

Acute Renal Failure: less than 3 mos and caused by vascular collapse (shock)
- reversible effects
- acute oliguria, azotemia/uremia, fatigue, decreased appetite, N/V/HA
Tx: diuretics, transplant, dialysis

Chronic Renal Failure: more than 3 mos and irreversible damage
RF: DM, HTN, GN, CVD, Idiopathic
Oliguria, Azotemia/uremia, fatigue

Transplant indicated for ESRD (95% 1 year survival rate)
- rejection is main concern

Question 20

ocular manifestations of renal disease

Answer 20

band keratopathy (calcium in cornea), posterior subcapsular cataract (prednisone), or renal retinopathy

Question 21

renal cell carcinoma

Answer 21

80-90% of all renal cancers usually 50-70 year old

Hematuria, lose weight, dull flank pain, palpable mass

RF: smoking, family history of VHL, preexisting renal disorder

Question 22

nephroblastoma / Wilm’s Tumor

Answer 22

most common kidney cancer in children

palpable mass, pain, HTN, hematuria, ANIRIDIA (25%)

95% unilateral but 90% of bilateral end up ESRD
RF: AA
90% 5 year survival rate

Question 23

transitional cell carcinoma

Answer 23

98% of bladder cancer usually over 65 year old

RF: smoking!! + occupational exposures and chronic bladder infections

Hematuria, Dysuria, Polyuria

Question 24

UTI

Answer 24

urethritis - cystitis (bladder) - ureteritis - pyelonephritis(kidney) - septic body

ascending order

caused by e coli (70-90%) + stasis urine flow

Fever, Dysuria, bacteriuria, pyuria (pus)

Question 25

Nephrolithiasis

Answer 25

kidney stones caused by solute supersaturation, low urine volume, abnormal urine pH, infection

Hematuria + renal colic (super painful)

Calcium is most common type

Tx: hydration/pain meds or ultrasound or sx