MKSAP Nephro VI

Question 1

Typical lactate measures L-lactate level. D-lactic acidosis is characterized by an increased anion gap metabolic acidosis in patients with ___ or ___.

Answer 1

short-bowel syndrome or other forms of malabsorption

Characteristic symptoms include intermittent confusion, slurred speech, and ataxia.

Question 2

How low is the bicarb typically in ethylene glycol or methanol intoxication?

Answer 2

<10

Question 3

In kidney transplant recipients who are planning pregnancy, mycophenolate mofetil, sirolimus, and everolimus must be discontinued 3 to 6 months prior to conception and replaced with _____, which is generally safer and well tolerated in pregnancy.

Answer 3

azathioprine

Question 4

Urine protein-creatinine ratio and level of proteinuria in light chain cast nephropathy (vague descriptors, not specific numbers)

Answer 4

Elevated; minimal

Question 5

Recurrent gross hematuria that occurs concomitantly or within days after an upper respiratory infection or physical exertion and usually follows a benign course.

Answer 5

IgA nephropathy

Question 6

Postinfectious glomerulonephritis, when associated with upper respiratory infections caused by streptococcal organisms, usually occurs __ to ___ weeks after the resolution of the streptococcal infection.

Answer 6

2 to 3 (also associated with low C3 with or without low C4)

Question 7

Interpretation of acid-base disorders requires the identification of the likely dominant acid-base disorder, followed by an assessment of the compensatory response; when measured values fall outside the range of the predicted compensatory response, a ___ acid-base disorder is considered present.

Answer 7

mixed

Question 8

The presence of significant measured proteinuria in the context of minimal proteinuria on urine dipstick suggests the presence of ____ proteinuria, which can be confirmed by a urine protein electrophoresis.

Answer 8

Bence-Jones (light chain)

Question 9

Referral for kidney transplant evaluation is indicated when the eGFR is ___ to allow for adequate time to identify suitable living donors or to be put on an early listing if no living donor is available.

Answer 9

<30

Question 10

How is HRS 1 management?

Answer 10

discontinuing diuretics, volume replacement with albumin, and use of vasoconstrictors.

Question 11

How is HRS 1 characterized?

Answer 11

It is characterized by a rise in serum creatinine of at least 0.3 mg/dL (26.5 µmol/L) and/or ≥50% from baseline within 48 hours, bland urinalysis, and normal findings on kidney ultrasound. It is also supported by a lack of improvement in kidney function after withdrawal of diuretics and 2 days of volume expansion with intravenous albumin.

And the exclusion of other causes of kidney disease.

Question 12

Hypernatremia may be caused by osmotic diuresis, (AKA loss of electrolyte-free water) in which the urine osmolality is usually between ___ and ___.

Answer 12

300 and 600 mOsm/kg H2O. This can be caused by a variety of things like mannitol, glycerin, isosorbide, urea.

Question 13

Diabetes insipidus urine osmolality (nonspecific descriptor)

Answer 13

urine osm low (Na high), excessive water/dilute urine is being excreted

Question 14

Indications for kidney biopsy include (4)

Answer 14

1. glomerular hematuria
2. severely increased albuminuria
3. acute or chronic kidney disease of unclear cause
4. kidney transplant dysfunction or monitoring.

Question 15

Patients with low comorbidity levels and a predicted survival of >___ years should be considered for all kidney disease treatment modalities, including kidney transplantation.

Answer 15

3