Last kidney lecture + review

Question 1

acute tubular nephrosis can be caused by?

Answer 1

sepsis, hypotension, ischemia, or drugs

Question 2

what ion should be monitored when treating acute tubular nephrosis and why?

Answer 2

potassium to prevent hyperkalemia… when you increase volume of fluids, potassium levels within the blood will increase because potassium is an intracellular ion. increasing fluids will increase potassium flow out of cells

Question 3

what is a quick way to lower potassium levels if they become too high?

Answer 3

give pt sodium bicarb

Question 4

what is continuous renal replacement therapy and what can it be used to treat?

Answer 4

very slow dialysis for pts with hypotension to treat acute tubular nephrosis

Question 5

if pt has CKD with protein in the urine, what is the best drug therapy?

Answer 5

ACE-Is or ARBs to decrease glomerular pressure and decrease BP

Question 6

A 55-year-old male presents to the outpatient clinic for a health check-up
advised as a pre-employment requirement at his office. The patient has a past
medical history for diabetes and hypertension for 15 years that were previously
well controlled with pharmacological intervention and lifestyle modifications
until last year when he lost his insurance due to unemployment. The patient has
no active complaints. The patient is a former computer programmer who
currently leads a sedentary lifestyle. The vital signs are heart rate of 86 beats per
minute, 14 breaths per minute, and blood pressure of 152/94 mmHg. On
examination, he has a soft abdomen with normal breath sounds on auscultation
in both lungs. Laboratory work shows hemoglobin 14g/dl, platelets
295,000/mm3, sodium 139 mEq/L, potassium 4.3 mEq/L, and HbA1c 6.9.
Urine analysis shows no cells, casts, and urine albumin-creatine ratio 325mg/g.
Which of the following medication should be prescribed and why? what drug class would also work which is not listed as an option?
A. Metoprolol
B. Losartan
C. Spironolactone
D. Nifedipine
E. Hydralazine
*Why is nifedipine not a good choice?

Answer 6

B. pt has protein in urine and he has CKI. best treatment is ACE-I or ARB such as losartan.
SGLT-2 inhibitor will help as well and slightly lower BP and reduce A1C.
*nifedipine is a calcium channel blocker which will increase glomerular pressure and will not help with proteinuria

Question 7

what is the best treatment for renal arterial stenosis? how do we diagnose?

Answer 7

beta blockers
listening to kidneys w/ stethoscope

Question 8

what is the only drug that is not contraindicated with pregnancy within classes of diuretics, SGLT-2 inhibitors, beta-blockers, ACE-Is, and ARBs?

Answer 8

labetalol

Question 9

which potassium-sparing diuretic has the least effect on sexual function?

Answer 9

eplerenone

Question 10

after a few days of ending treatment of severe peripheral edema, the patient is found to have cerebral edema. what class of drug would have caused this to occur?

Answer 10

aquaretic

Question 11

we should not use angiotensin II blockers for _____, but we should use them for ___

Answer 11

AKI, CKI

Question 12

to compensate for heart failure, the sympathetic nervous system releases more epi and norepi. what does this cause?

Answer 12

vasoconstriction and:
increased RAAS activity
increased vasopressin
increased HR
increased contractility

Question 13

to compensate for heart failure, the RAAS is activated. what is the issue with what this does?

Answer 13

causes vasoconstriction and:
increased BP
increased aldosterone
increased hypertrophy
increased fibrosis

Question 14

to be completely specific, what portion of the loop of henle do loop diuretics target?

Answer 14

the tick portion of the ascending loop of henle

Question 15

when do we use carbonic anhydrase inhibitors such as acetazolamide and what side effect do they cause that we need to watch for?

Answer 15

when other treatments have failed. it causes acidosis

Question 16

which two diuretic classes exacerbate gout?

Answer 16

loops and thiazides

Question 17

A 50-year-old woman comes to the emergency department for evaluation of right-sided flank pain and dark urine for the past few hours. The patient states, “I thought my back was acting up again so I took two extra naproxen today. I decided to come get checked out once my urine appeared dark.” The patient denies dysuria, urinary frequency, urgency, fever or chills. Past medical history includes type 2 diabetes mellitus, chronic lumbosacral back
pain and migraine headaches. Current medications include phenacetin, acetaminophen, ibuprofen, naproxen and insulin. Temperature is 37.1°C (98.8°
F), pulse is 85/min, respirations are 21/min, and blood pressure is 130/70 mm Hg. Serum creatinine is 1.9 mg/dL (reference range: 0.6-1.2 mg/dL).
Urinalysis is shown.
Which of the following is the most likely etiology of this patient’s hematuria?
A. Renal papillary necrosis
B. Hemolytic uremic syndrome
C. Renal artery stenosis
D. Urinary tract infection

Answer 17

A

Question 18

A 64-year-old man comes to the emergency department because of generalized fatigue, nausea, vomiting, and muscle
aches. He has a history of hypertension and was recently diagnosed with hyperlipidemia for which he takes verapamil,
metoprolol, and simvastatin. He denies the use of any over-the-counter medications. Current blood pressure is 145/95
mm Hg. Medical history shows the patient’s blood urea nitrogen and creatinine levels were normal 1 month ago.
Current laboratory studies show:
Blood urea nitrogen: 32 mg/dL
Creatinine: 3.0 mg/dL
Urine sodium: 45 mEq/L
Urine dipstick positive for heme
Urinalysis shows numerous brown granular casts, but no cells.
Which of the following is the most likely cause of this patient’s worsening kidney function? What can you check to confirm which drug it is and why?
A. Adverse effect of aspirin
B. Adverse effect of metoprolol
C. Adverse effect of simvastatin
D. Adverse effect of verapamil
E. Cholesterol emboli syndrome
F. Hypertension

Answer 18

C
his statin caused rhabdomyolysis. this can be confirmed by checking the pts creatinine kinase since it will be elevated due to excess creatinine from muscle tissue breakdown

Question 19

A 72-year-old woman hospitalized for osteomyelitis is evaluated on day 4 in the hospital for worsening renal function
and low urine output. On day 1, she received vancomycin and ceftriaxone. On day 2, she underwent operative bone
debridement, during which her blood pressure dropped to 85/60 mm Hg, and then recovered with administration of
normal saline and vasopressors to normalize. Although her operative site appears normal today, her blood pressure is
currently 126/82 mm Hg, and she is afebrile. Serum studies show a blood urea nitrogen level of 34 mEq/L and
creatinine of 2.6 mg/dL. Urinalysis shows a sodium level of 46 mEq/L, fractional excretion of sodium of 2.1%, and tubular epithelial cells.
Which of the following is the most likely cause of this patient’s acute kidney injury?
A. Adverse effect of ceftriaxone
B. Adverse effect of vancomycin
C. Autoimmune glomerular injury
D. Postinfectious glomerulonephritis
E. Renal ischemia
F. Seeding of infection to kidneys

Answer 19

E

Question 20

A 72-year-old man recovering from hip surgery in the hospital is found to have a urinary output of 400 mL/24 hours.
Examination shows 3+ peripheral edema, and bilateral basal crepitations. The rest of the examination revealed no gross
abnormalities. His blood urea nitrogen is 76 mg/dL, and serum creatinine is 3 mg/dL; both were normal on admission. His
urine sodium is 14 mEq/L, and fractional excretion of sodium is 0.54%. The urinalysis is normal.
Which of the following is most likely to cause this patient’s condition?
A. Acute interstitial nephritis
B. Acute tubular necrosis
C. Heart failure
D. Prostatic hyperplasia
E. Right renal artery stenosis

Answer 20

D

Question 21

A 50-year-old man is hospitalized with osteomyelitis and bacterial endocarditis. He is found to have an infected hip
prosthesis placed 3 weeks earlier. He also has a history of arthritis and hypertension, each treated with multiple
medications. One week after his admission, he develops reduced urine output and rising serum creatinine. The urinalysis is
shown.
Which of the following medications is the most likely cause of this patient’s disorder?
A. Acyclovir
B. Ampicillin
C. Benazepril
D. Gentamicin
E. Ibuprofen
F. Trimethoprim-sulfamethoxazole

Answer 21

E