Nephrology Flashcards
Which of the following is true regarding the mean glomerular filtration rate (GFR)? (HPIM C305 P2111)
a. An increase in GFR is expected with aging
b. Mean GFR is lower in women than in men
c. A mild elevation in serum creatinine often signifies a substantial reduction in GFR in younger individuals
d. Relying on serum creatinine concentration is sufficient to stage chronic kidney disease (CKD)
b. Mean GFR is lower in women than in men
Which of the following disorders in CKD is associated with low bone turnover with low or normal parathyroid hormone (PTH) levels? (HPIM C305 P2114-2115)
a. Osteitis fibrosa cystica
b. Secondary hyperparathyroidism
c. Osteomalacia
d. Adynamic bone disease
d. Adynamic bone disease
HIGH BONE TURNOVER
Hyperparathyroidism
• Stimulated by increase in phosphate, uremic toxin
• Bone pain and fragility
• Brown tumors
• Compression syndrome (caused by brown tumors)
• EPO resistance
Osteitis fibrosa cystica
• caused by HYPERPARATHYROIDISM which stimulates increase bone turn over
• Formation of bone cyst
~ if with hemorrhage, hence termed as brown tumor
LOW BONE TURNOVER
Adynamic Bone Disease
• Reduced bone volume and mineralization due to excessive suppression of PTH secondary to the use of vitamin D preparations or excessive calcium exposure (im the form of calcium containing phosphate binders or high calcium dialysis solutions),
• Increased incidence of bone pain
• Increased vascular and cardiac calcification
• Muslce pain
Osteomalacia
• Softening of the bones
• Consequent to reduced production and action of 1,25 (OH)2 D3 leading to non-mineralized osteoid.
45-year-old male comes in for chest pain. He has been on dialysis for 5 years, but missed his past few sessions due to financial constraints. On examination, he had a friction rub with diffuse ST segment elevation and PR depression on ECG. Which of the following is true regarding the management? (HPIM C305 P2117)
a. This is a relative indication for intensification of dialysis prescription
b. This condition is more often observed in those starting dialysis, rather than in those underdialyzed, non-adherent patients
c. This condition is always associated with significant pericardial effusion
d. Hemodialysis should be done without heparin
Hemodialysis should be done without heparin
◇ Pericardial Disease
• Pericarditis, Pericardial effusion
• Observed in advanced uremia, underdialyzed and NONADEHERENT patients
• TREATMENT:
–> ABSOLUTE indication for urgent dialysis or ⬆️ intensity of current HD
–> Pericardial Drainage indicated in patients with recurrent pericardial effusion
What is the target BP in CKD patients with diabetes or proteinuria >1 g per 24 h? (HPIM C305 P2117)
a. <120/70 mmHg
b. <125/70 mmHg
c. <120/80 mmHg
d. <130/80 mmHg
d. <130/80 mmHg
¤ Target BP
• Proteinuria >1g/ 24 hour: <130/80 mmHg
• Proteinuria <1g/ 24 hour: <140/80 mmHg
• Lower target BP is not applicable because of the lack of autoregulation to maintain GFR in the face of low perfusion pressure.
Among the calcium channel blockers, which of the following may exhibit superior antiproteinuric and renoprotective effects?
¤ Calcium channel blockers
• Diltiazem, Verapamil
• Exhibit superior antiproteinuric and renoprotective effect
Most important complication of arteriovenous grafts is: (HPIM C305, P2123)
a. High output heart failure
b. Infection
c. Bleeding from rupture
d. Thrombosis of the graft
d. Thrombosis of the graft
69-year-old male CKD patient on chronic dialysis patient comes in for dyspnea after being unable to undergo his dialysis for 2 weeks. His ECG shows sinus rhythm, peaked T-waves, and widened QRS complexes. His potassium level is probably at what range? (HPIM C49 P309-311, F49-8)
a. 5.5-6.5 mmol/L
b. 6.5-7.5 mmol/L
c. 7.0-8.0 mmol/L
d. >8.0 mmol/L
7.0-8.0 mmol/L
5.5 - 6.5 Tall peaked T waves
6.6- 7.5 Loss of P waves
7.0- 8.0 Widened QRS complexes
> 8.0 mM Sine wave pattern
First step in the diagnostic evaluation of hyper- or hypocalcemia is to: (HPIM C50 P313)
a. Ensure that the alteration is not due to abnormal albumin concentrations
b. Ensure adequate hydration of the patient
c. Determine the baseline renal function
d. Rule out other electrolyte abnormalities
Ensure that the alteration is not due to abnormal albumin concentrations
Approach to Hypo or Hypercalcemia
(1) Calcium
(2) Albumin, phosphorus, and magnesium levels.
(3) PTH
• Central to the evaluation of hypocalcemia.
• ⬇️ Suppressed (or “inappropriately low”) PTH level in the setting of hypocalcemia establishes absent or reduced PTH secretion (hypoparathyroidism) as the cause of the hypocalcemia
• ⬆️ Elevated PTH level (secondary hyperparathyroidism) should direct attention to the vitamin D axis as the cause of the hypocalcemia.
(4) serum 25-hydroxyvitamin D levels
• assesses nutritional vitamin D deficiency
• reflect vitamin D stores
(5) serum 1,25(OH)2D levels
• In the setting of renal insufficiency or suspected vitamin D resistance,
What is the cell of origin of clear cell carcinoma? (HPIM C81 P617 T81-2)
a. Proximal tubule
b. Distal tubules
c. Cortical collecting duct
d. Medullary collecting duct
a. Proximal tubule
🌸 Clear cell carcinoma (70%)
• predominant histology in >80% of metastatic disease
• arise from the epithelial cells of the proximal tubule
🌸 Papillary carcinoma (10%)
• bilateral and multifocal
🌸 Oncocytomas (5-10%)
• benign neoplasms
🌸 Medullary carcinoma
• similar features with Bellini duct tumors
• associated with sickle cell trait
24-year-old female presents with a 3-day history of dysuria associated with frequency in urination. She has no fever nor vaginal discharge. Her LNMP was 1 week ago. According to the 2013 Philippine CPG in the Diagnosis and Management of UTI, what is the appropriate initial management in this patient? (Philippine CPG on the Diagnosis and Treatment of UTI in Adults. 2013 Update. P13, 21)
a. Request for a urinalysis
b. Perform dipstick test to confirm UTI
c. Treat with Fosfomycin 3 g, single dose
d. Start amoxicillin 500 mg/tab TID x 5 days
c. Treat with Fosfomycin 3 g, single dose
According to the 2015 Philippine CPG on the Diagnosis and Management of UTI, which of the following conditions define complicated UTI? (Philippine CPG on the Diagnosis and Treatment of UTI in Adults. 2015 Update. Part 2. P50)
a. Didelphys uterus
b. Urine culture finding of Candida species
c. History of UTI 3 months prior
d. Post-void urine of 50 mL on KUB ultrasound
Urine culture finding of Candida species
All of the following patients with recurrent UTI need further screening for urologic abnormalities EXCEPT: (Philippine CPG on the Diagnosis and Treatment of UTI in Adults. 2015 Update. Part 2. P23)
a. Persistent microscopic hematuria
b. Elevated serum creatinine
c. History of pyelonephritis
d. Multiple sexual partners
d. Multiple sexual partners
Which segment of the renal tubule is most sensitive to ischemia-related injury? (HPIM C304 P2102)
a. S3 segment of proximal tubule
b. Thin ascending loop of Henle
c. Thick descending loop of Henle
d. Collecting duct
a. S3 segment of proximal tubule
27/F presented with hypertension uncontrolled on hydrochlorothiazide, amlodipine, and losartan. Her eGFR doubled after one month of taking losartan and she was hospitalized twice for flash pulmonary edema. Which additional treatment would be most appropriate for her condition?
a. Clonidine
b. Spironolactone
c. Percutaneous renal artery angioplasty
d. Unilateral adrenalectomy
Percutaneous renal artery angioplasty
Which of these findings is most suggestive of chronic renal failure?
a. Osmolality > 500 mosm/L
b. Proteinuria < 3.5 g/24 hours
c. Urinary eosinophils > 10%
d. Urine sugar 2+
b. Proteinuria < 3.5 g/24 hours