Nephro Flashcards
Eosinophils in urine suggests what 5 diagnoses?
AIN, postinfectious GM, atheroembolic disease, septic emboli, small vessel vasculitis
Erythrocyte casts and Acanthocytes indicate what diagnosis?
Glomerular disease
Leukocyte casts indicate what 2 diagnoses?
Infection or inflammation of renal parenchyma
Muddy Brown casts indicate what diagnosis?
ATN
Broad casts indicate what diagnosis?
CKD
The patient’s anion gap is <4, what 2 Dx does this suggest?
Multiple myeloma or hypoalbuminemia
150-200 mg/g Proteinuria on urine sample suggests what 2 dx?
Tubulointerstitial or glomerular dx
> 3500 mg/g Proteinuria on urine sample suggests what dx?
Glomerular dz
What are the five causes of tubulointerstitial kidney disease?
Medications, infections, Immunologic, oncologic, obstructive.
What type of RTA is associated with multiple myeloma?
RTA Type 2
Sterile pyuria (leukocytes on UA & negative culture) Suggest what 4 diagnoses?
Genitourinary tuberculosis, interstitial cystitis, interstitial nephritis, STIs
How is urine anion gap calculated?
Urine na+ urine K - urine chloride.
What type of kidney stones are often implicated in recurrent UTIs?
Struvite (Magnesium Ammonium phosphate) stones
What would you expect the C3 complement levels to be (increased/decreased/same) in a patient with post-infectious glomerulonephritis?
Decreased
What kidney stones are most commonly missed on plain xrays?
Uric acid stones
Which form of nephrotic syndrome is often associated with lithium use?
Minimal change disease
Which form of nephrotic syndrome is most associated with heroin use, obesity, sickle cell dz, AA?
Focal segmental glomerulosclerosis
What is the most likely diagnosis in a patient on hemodialysis with skin ulcerations and an elevated calcium-phosphate product?
Calciphylaxis
What is the gold standard imaging modality for diagnosing kidney stones?
Noncontrast spiral CT
What is the goal hemoglobin level in patients with end stage renal disease?
11-12 g/dl (higher than this can increase risk of embolism or strokes)
What is the most common type of glomerulonephritis throughout the world?
IgA Nephropathy
Which type of renal tubular acidosis is associated with defect in proximal bicarbonate absorption?
RTA type 2
Which renal disorder can present both as nephritic and nephrotic syndrome?
Membranoproliferative glomerulonephritis (MPGN)
Which two CD markers are often deficient in individuals with paroxysmal nocturnal hemoglobinuria? (PNH)
CD55 and CD59
Which subtype of nephrotic syndrome is most commonly associated with hepatitis B Infections?
Membranous nephropathy
Rapid fire assoc:RBC casts in urine
Glomerulonephritis
Rapid fire assoc: Podocyte fusion or “effacement” on electron microscopy
Minimal change disease (child with nephrotic syndrome)
Rapid fire assoc: Linear appearance of IgG deposition on glomerular and alveolar basement membranes
Goodpasture syndrome
Rapid fire assoc: Cellular crescents in Bowman capsule
Rapidly progressive crescentic glomerulonephritis
Rapid fire assoc:Anti-glomerular basement membrane antibodies
Goodpasture syndrome (glomerulonephritis and hemoptysis)
Polyuria, renal tubular acidosis type II, growth failure, electrolyte imbalances, hypophosphatemic rickets
Fanconi syndrome (multiple combined dysfunction of the proximal convoluted tubule)
Periorbital and/or peripheral edema, proteinuria (>3.5g/day), hypoalbuminemia, hypercholesterolemia
Nephrotic syndrome
Rapid fire assoc: “Lumpy bumpy” appearance of glomeruli on immunofluorescence
Poststreptococcal glomerulonephritis (due to deposition of IgG, IgM, and C3)
Rapid fire txt: Pheochromocytoma
α-antagonists (eg, phenoxybenzamine) or alpha blockers (prazosin). Can use beta blockers (typically labetalol) only after adequate alpha blockade
2º hyperparathyroidism is classically caused by what?
Hypocalcemia of chronic kidney disease
Rapid fire txt: Cyclophosphamide-induced hemorrhagic cystitis
Mesna
Rapid fire assoc:”Wire loop” glomerular capillary appearance on light microscopy
Diffuse proliferative glomerulonephritis (usually seen with lupus)
Rapid fire assoc:WBC casts in urine
Acute pyelonephritis or AIN
Rapid fire assoc:”Waxy” casts with very low urine flow
Chronic end-stage renal disease
Which nephrotic syndrome is typically associated with hepatitis C and cryoglobulinemia?
Membranoproliferative glomerulonephritis
Rapid fire assoc:”Tram-track” appearance of capillary loops of glomerular basement membranes on light microscopy
Membranoproliferative glomerulonephritis
Rapid fire assoc:Thyroid-like appearance of kidney
Chronic pyelonephritis (usually due to recurrent infections)
Rapid fire assoc:”Spikes” on basement membrane, “dome-like” subepithelial deposits
Membranous nephropathy (nephrotic syndrome)
Proximal bicarbonate reabsorption is seen in which renal tubular acidosis type?
Renal tubular acidosis type 2
NSAIDS are known to cause allergic interstitial nephritis without eosinophils. What other class of medication is known to cause allergic interstitial nephritis without eosinophils about 33% of the time?
Proton pump inhibitors (PPI)
Muddy brown casts in a urinalysis is a clue towards which renal process?
Acute tubular necrosis (ATN)
In males, a creatinine level of this or higher is a contraindication to giving metformin? Or gfr less than what?
1.5 mg/dl or higher. 45
How many days after aminoglycoside use can acute tubular necrosis arise?
4-5 days
What is the cause of unexplained hypoK and Met ALk? How do you differentiate?
surreptitious vomiting or diuretic use. Elevated urinary cl >20 assoc with diuretics
What are the organisms that may lead to struvite stones?
Urea-splitting bacteria (Proteus, Klebsiella, or Pseudomonas)
Besides rhabdomyolysis, what three major conditions will produce blood in the urine without seeing RBCs in urine?
Contamination with povidine, vitamin C Excess, Paroxysmal nocturnal hemoglobinuria
Bence Jones protein in urine suggests what dz?
Multiple myeloma
What is the equation for osmolality?
(2xNa)+(gluc/18)+(BUN/2.8)+(EtOH/3.7)
What is the urine anion gap Equation?
Urine Na+ urine K - urine Cl
Which medicine when given with CCB can reduce peripheral edema?
Ace inhibitors
Absolute iron deficiency in patients with CKD is suggested by what 2 parameters?
Ferritin less than 200 (in hemodialysis patients) and transferrin saturation less than 20%
All patients with end stage renal disease on erythropoietin stimulating agents should be given IV iron unless what?
Ferritin is greater than 500
Topamax and acetazolamide cause what acid/base disturbance?
Non-anion gap metabolic acidosis
Na>145 with urine osm less than serum osm rules out what Dx? Suggests what Dx?
primary polydipsia; central DI
