MKSAP - Nephrology

Question 1

Orthostatic proteinuria?

Answer 1

Proteinuria only when upright (children)

Question 2

Persistent hematuria? Interpretation of urine? Tests

Answer 2

3+ RBCs in urine on 2 more samples

If casts/dysmorphic RBCs - glomerular origin
If normal RBCs - from lower in the urinary tract

Kidney US and cytoscopy

Question 3

Risk factors for genitourinary malignancy?

Answer 3

1. Male
2. age>50
3. tobacco use
4. cyclophosphamide/benzene/radiation exposure

Question 4

Pt with azotemia - must do this before dialyzing?

Answer 4

Fluid resuscitation (and see if pt improves)

Question 5

Drugs to help with hepatorenal syndrome?

Answer 5

Octreotide and midodrine

Question 6

Drug to treat malignancy-related hyperuricemia?

Answer 6

Rasburicase

Question 7

In acute interstital nephritis - expect to see what UA findings?

Answer 7

pyuria, WBC casts, eosinophils on UA

Question 8

On ACE/ARB - acceptable increase in Cr?

Answer 8

30%

Question 9

Gap-metabolic acidosis - next steps?

Answer 9

1) Winters

2) Delta-Delta (AG - 12 + bicarb)

Question 10

Ammonium excretion in types of metabolic acidosis?

Answer 10

extra-renal - high acid secretion and high urine ammonium

renal acidosis - low acid secretion and low urine ammonium

Question 11

Urine anion gap? Normal range? Interpretation?

Answer 11

Urine Na + Urine K - Urine Cl
Normally 30-50
Neg UAG - non-renal (NH4 excreted)
Positive UAG - renal cause

Question 12

HyperK in pt with CKD - how to tell if its due to the CKD or other factor?

Answer 12

If GFR>15, due something else

Question 13

Pt with CKD - when is a thiazide not effective?

Answer 13

When GFR<30

Question 14

Way to estimate osmolarity?

Answer 14

2*Na

Question 15

hyperosmolar Pt without hyperglycemia who presents with polyuria and polydipsia with dilute urine? Test and interpretation?

Answer 15

Diabetes Insipidus

Give AVP - if urine concentrates, then central, if not nephrogenic

Question 16

Cinacalet?

Answer 16

Binds to parathyroid Ca-sensing receptor decreasing PTH release

Question 17

Pt with hyperCa and sarcoidosis - tx for hyperCa (and mech)?

Answer 17

Steroids (Ca from macrophages, steroids deactivate macrophages)

Question 18

Hypophosphatemia seen in what types of pt? Precipitated by? Symptoms?

Answer 18

Alcoholics, glucose administration (pushes phosphate into cells)

Confusion, rhabdomyolysis, hemolytic anemia, severe muscle weakness

Question 19

Indications for dialysis?

Answer 19

AEIOU

1. Acidosis
2. Electrolyte abnormalities-hyperkalemia
3. Ingestion of substances like barbiturates, salicylates, lithium, methanol, etc
4. Overload fluid (unresponsive to diuretics)
5. Uremia symptoms (pericarditis, encephalopathy)