MKSAP Nephro III

Question 1

Increased muscle mass can result in an increase in serum creatinine level in the absence of change in kidney function. So a young, otherwise healthy bodybuilding patient may have a falsely elevated creatinine. A more accurate measure of kidney function would be ____.

Answer 1

Cystatin C

Question 2

In patients with hypercalciuria and kidney stones, calcium excretion and stone formation can be decreased by the use of ______ diuretics.

Answer 2

thiazide

Question 3

What is anti–phospholipase A2 receptor (PLA2R) antibodies associated with?

Answer 3

primary membranous glomerulopathy

Patients with newly diagnosed primary membranous glomerulopathy are usually observed for 6 to 12 months while on conservative therapy (renin-angiotensin blockade, cholesterol-lowering medication, and edema management) to allow time for possible spontaneous remission before initiating immunosuppression. Alternating months of glucocorticoids and alkylating agents is first-line immunosuppressive therapy of choice for primary membranous glomerulopathy, and substituting with a calcineurin inhibitor such as cyclosporine is now considered a viable alternative for patients with contraindications to alkylating agents.

Question 4

Most patients with renovascular disease have atherosclerosis ( >90% ). Treatment is medical optimization of risk factors such as starting an ACEI/ARB if hypertensive. Kidney function should be checked 2 weeks. ACEI/ARB can be continued if there is not a > ____% rise in the serum creatinine from baseline.

Answer 4

25%

Question 5

What is the difference between Type 1 and 2 RTA?

Answer 5

Type 1 (hypokalemic distal): NAGMA, positive urine AG, pH >6.0, K wasiting

TYpe 2 (hypokalemic proximal AKA Fanconi syndrome): defect in reclaiming bicarb, NAGMA, glycosuria (without hyperglycemia), renal phosphate wasting, hypokalemia, pH <5.5 (distal urine acidification remains intact), urine AG wnl

Question 6

What are the features of Type 4 RTA?

Answer 6

Hyperkalemic distal, due to aldosterone deficiency or resistance, assoc with hyperkalemia and urine pH <5.5

Question 7

For patients with alcoholic ketoacidosis, ___ is appropriate treatment/fluid.

Answer 7

5% dextrose in 0.9% saline

Question 8

What kind of diuretic is metolazone?

Answer 8

Thiazide

Question 9

Diabetic nephropathy is the sequelae of chronic glycemic-induced damage to the glomerulus. On average, it occurs __ years after the diagnosis of overt diabetes mellitus and is typically associated with other microvascular or macrovascular complications of diabetes.

Answer 9

8

Question 10

Nephrotic syndrome is defined by (4)

Answer 10

1. proteinuria >3500 mg/24 h
2. serum albumin usually <3.0
3. hypercholesterolemia
4. edema

Question 11

Risk factors for secondary FSGS (3)

Answer 11

1. obesity
2. history of premature birth
3. solitary kidney

Secondary focal segmental glomerulosclerosis is due to hyperfiltration injury in the setting of relatively reduced renal mass.

Question 12

What is the difference between pre-eclampsia and HELLP?

Answer 12

HELLP is associated with microangiopathic hemolytic anemia where as pre-eclampsia is:

1. new-onset HTN
2. proteinuria
3. after 20 weeks of pregnancy
4. If severe can show end-organ damage like elevated LFTs, AKI, thrombocytopenia, BP >160/110

Question 13

What is the difference between eclampsia and preeclampsia?

Answer 13

Eclampsia is the presence of generalized tonic-clonic seizures

Question 14

Findings found in men with Fabry’s (it’s X-linked mutation of alpha-galactosidase).

Answer 14

1. burning in hands and feet triggered by stressors like exercise
2. angiokeratomas
3. decreased perspiration
4. eye problems
5. kidney/heart/neuro involvement starts occurring 30-45 years old (AKA early ESRD or CV death)

Question 15

What kind of a stone makes a staghorn calculous?

Answer 15

Struvite (created by urea-splitting bacteria like Proteus, Klebiella, rarely pseudomonas) which increases urin pH. These stones MUST be removed.

Question 16

What is adynamic bone disease?

Answer 16

A variety of renal osteodystrophy characterized by reduced osteblasts and osteoclasts, no accumulation of osteoid and markedly low bone turnover.

It is associated in patients with CKD/ESRD. PTH and alk phos are typically normal. Often associated with significant vascular calcifications.

Question 17

What is osteitis fibrosa cystica?

Answer 17

The classic pathology associated with kidney disease.

This disorder is associated with increased bone turnover and elevated PTH and alkaline phosphatase levels.

Question 18

What is osteomalacia?

Answer 18

Defect with both low turnover and abnormal mineralization of bone caused by vitamin D deficiency.

Question 19

What is β2-Microglobulin–associated amyloidosis?

Answer 19

A disease usually seen in patients who have been on dialysis for at least 5 years. This disorder involves osteoarticular sites, and patients may present with carpal tunnel syndrome or shoulder pain. Bone cysts may be visible on radiograph.