Nephrology

Question 1

common causes of non-gap metabolic acidosis

Answer 1

acetazolamide
topiramate
chemotherapy- ex cisplatin
abx- aminoglycosides, bactrim
amphotericin b
lithium
rifampin
inhaled toluene
pentamidine

Question 2

medical management of bilateral RAS

Answer 2

• ACE/ARB and diuretic

- do this prior to considering angiography and stenting

Question 3

causes of AIN

Answer 3

drugs- abx, NSAIDS, PPIs
infections- legionella, strep
- systemic/autoimmune disease- ex. sjogrens, SLE

Question 4

clinical features and lab findings of AIN

Answer 4

rash, fever, allergic sx.
new drug exposure
eosinophilia or urinary eosinophils, though these are not necessary
urine sediment with pyuria, WBC casts, hematuria, varying proteinuria, however can also be normal

Question 5

ESRD daily phos restriction?

Answer 5

900 mg/day

Question 6

ESRD choice of phos binder?

Answer 6

if Ca <9.5, calcium carbonate or acetate

> 9.5, sevelamer or lanthanum

Question 7

if ESRD patient is restricting dietary phos, on a phos binder, and PTH remains >300, what next?

Answer 7

if serum phos <5.5, and serum ca<9.5 –> vit D analog

if serum phos <5.5 and serum ca>9.5, or if serum phos is >5.5 –> cinacalcet

Question 8

How do calcimimetics like cinacalcet work?

Answer 8

increase the sensitivity of calcium sensing receptors on parathyroid glands and reduce serum PTH, ca and phos

Question 9

pathology findings of HSP in kidneys?

Answer 9

IgA immune complex deposition in small vessels and mesangium

Question 10

how does malabsorption in bariatric surgery pts or those with small bowel malabsorption issues lead to increased risk of kidney stones?

Answer 10

increased urinary oxalate: fat binds to calcium and leaves oxalate to be renally excreted or absorbed by colon

low urinary citrate: unclear pathophys, may be 2/2 hypokalemia leading to increased citrate absorption in kidney. citrate is an inhibitor of kidney stones

Question 11

How does polyoma virus (BK type) present in renal transplant pts?

Answer 11

most commonly after rejection and significant immunosuppression

patients develop tubulointerstitial nephritis w/ rising creatinine and intranuclear inclusions in urine cells

Question 12

clinical features of goodpasture syndrome?

Answer 12

pulmonary hemorrhage and glomerulonephritis

anti-GBM ab

Question 13

dietary interventions to reduce risk of calcium oxalate kidney stones?

Answer 13

decrease sodium
decrease animal protein
increase calcium- dietary, not supplemental (decreases oxalate absorption in GI tract)
increase fluids
increase citrate/fruits and vegetables

Question 14

extrarenal manifestations of polycystic kidney disease

Answer 14

hepatic cysts, pancreatic cysts, cerebral aneurysms, cardiac valvular disease and diverticulosis

Question 15

metabolic acidosis algorithm:

high anion gap w/ ketones

Answer 15

DKA
starvation
EtOH

Question 16

metabolic acidosis algorithm:

high anion gap, neg ketones

Answer 16

check serum osm:
high: methanol, ethylene glycol

normal: salicylate, paraldehyde

Question 17

metabolic acidosis algorithm:
normal anion gap
negative urine anion gap

Answer 17

GI losses- diarrhea, laxative abuse

enteric fistulas

Question 18

metabolic acidosis algorithm:
normal anion gap
positive urine anion gap

Answer 18

renal bicarb losses: RTA, carbonic anhydrase inhibitors, low aldosterone state

Question 19

renal abnormalities in pts with sickle cell trait

Answer 19

hematuria and inability to concentrate urine

development of renal medullary carcinoma