Nephrology

Question 1

Hyponatremia should be classified as what three things?

Answer 1

hypovolemia, hypervolemia, euvolemia

Question 2

What should be seen for hyponatremia?

two lab tests, one clinical item

Answer 2

Serum Osmolality
Volume Status
Look at urine sodium

Question 3

What are the AKI definitions?

Answer 3

Increased Creatinine by 0.3 in 48 hours
Creatinine increases 1.5 times versus baseline, in the previous 7 days

Question 4

Urine Volume less than 0.5 cc/mL/hour for six hours is what?

Answer 4

AKI

Question 5

What BP med can cause diarrhea problems or loss of protein in diarrhea?

Answer 5

Olmesartan

Question 6

What is the K cut off for Spironolactone?

Answer 6

5.5, look at BMP every 2 weeks

Question 7

What medication can be used 50mg BID for BP and Gout?

Answer 7

Losartan

Question 8

Patient has the following:
GI symptoms
Arthritis
Palpable Purpura
Hematuria, Proteinuria, and Elevated Creatitine

What is this? Think autoimmune

Answer 8

IgA vasculitius or Henoch Schonlein Purpura

Question 9

IgA nephropathy vs. PSGN, when does what show up?

Answer 9

PSGN is usually after 3-6 weeks + cellulitus or strept throat
IgA Nephropathy is after 1 week + URI

Question 10

Patient has a varicocele and asymptomatic. What routine screening should the patient have done?

Answer 10

Semen Analysis every 2 years

Question 11

SLE Lupus nephritis treatment:

What is the induction therapy?

What is the Maintenace therapy?

Answer 11

Induction: steroids + Cyclophosphamide/mycophenalate

Maintence: Mycophenolate Mofetil or Azathioprine

Question 12

What disease has effacement of epithelial foot processes on EM?

Answer 12

Minimal Change Disease

Question 13

What kidney pathology will most likely have antibody to M-type phospholipase A2 receptor?

Answer 13

Membranous nephropathy

Question 14

Flank Pain, hematuria, AKI, what am I thinking about?

Answer 14

Renal Vein Thrombosis

Question 15

When a patient has CKD, anemia, and may need iron replacement, what are the iron study goals?

Answer 15

Transferrin Saturation less than 30%
Ferritin percentage less than 500

Question 16

CKD has what hemoglobin goal?

Answer 16

Hemoglobin goal > 10

Question 17

If a patient has acute hyponatremia with seizures or coma, what should be done?

Answer 17

100 cc of 3% saline
Additional Administration of desmopressin makes treatment safer
Can be repeated every 10 minutes if symptoms persist

Desmopressin inhibits ADH, prevents rapid sodium correction

Question 18

These three medications help do what?

Sevelamer
Lanthum
Calcium acetate

Answer 18

Decrease Phosphate, phosphate binder

Question 19

Patient has pituitary apoplexy, stalk compression, and visual symptoms, what is the next step?

Answer 19

Surgery

Question 20

When a patient has monthly iron infusions, what is one phosphate problem?

Answer 20

Accidental phosphate wasting

Question 21

If a patient has chronic bacterial prostatitis, what is the typical antibiotic regimen?

Answer 21

4-6 weeks of fluroquinolones (levofloxacin) or Bactrim

Question 22

What type of incontinence has urgency and frequency, day or night?

What is the treatment?

Answer 22

Urge Incontinence (Detrusor Overactivity)

Tx: Anticholinergics

Question 23

What type of incontinence has a poor stream or incomplete emptying?

Answer 23

Overflow Incontinence

Tx: Alpha-Adrenregic blockers

Question 24

What is this? What is the treatment?

More than 2 episodes of acute simple cystitis in 6 months
or
More than 3 episodes of acute simple cystitis in 12 months

Answer 24

Recurrent Cystitis

Daily Bactrim or Macrobid abx

Question 25

If a patient has a suspected kidney stone what is the next best test?

Answer 25

CT Abdomen/Pelvis w/out contrast or Kidney Ultrasound

Question 26

If an older patient has cysts on their kidney, what is the most likely etiology?

Answer 26

Autosomal Dominant Kidney Disease Autosomal Recessive Kidney Disease is usually younger patients

Question 27

# This triad is concerning for what? Hypertension Hematuria Edema

Answer 27

Glomerulonephritis

Question 28

A young patient with BPH, what is a good first line treatment?

Answer 28

Alfuzosin Mechanism: 5- alpha reductase inhibitor blocker

Question 29

# What non anion gap metabolic acidosis cause is this? Elevated Urine anion gap Urine pH > 5.5 Hypokalemia

Answer 29

RTA Type 1 Cannot excrete distal NH4 secretion (Failure to excrete H+ Secretion)

Question 30

# What non anion gap metabolic acidosis cause is this? Normal/negative urine anion gap hypokalemia urine pH < 5.5

Answer 30

RTA type 2 Cannot reabsorb bicarb in the promixal tubule (bicarbonate wasting)

Question 31

# What non anion gap metabolic acidosis cause is this? positive urine anion gap Hyperkalemia urine pH < 5.5

Answer 31

RTA type 4 MOA: no aldosterone, high K

Question 32

How do you calculate the serum anion gap? How do you calculate the urine anion gap?

Answer 32

Serum Anion Gap: Na - chloride - bicarb Urine Anion Gap: urine Na + urine K - urine chloride

Question 33

What is urine chloride surrogate?

Answer 33

Urinary Ammonium excretion

Question 34

Urine anion gap is negative points at what? Urine anion gap is positive points at what?

Answer 34

negative UAG: GI loss positive UAG: Renal acidification

Question 35

How does Sarcoid increase calcium?

Answer 35

Macrophages increase calcium via granulomas that secrete 1 alpha hydroxylase. 25 Vitamin D becomes 1,25 Vitamin D

Question 36

In a urine sample, if broad casts are seen, what disease is most likely?

Answer 36

CKD (chronic kidney disease)

Question 37

What type of stone is the following?

Answer 37

Calcium oxalate (Envelope shape) Radiopaque Stone

Question 38

What type of stone is the the following?

Answer 38

Calcium Phosphate (Needle/Star) Radiopaque Stone

Question 39

What type of the stone is the following?

Answer 39

Cystiene Stone (Hexagonal Stone) Radiolucent Stone

Question 40

What type of stone is this? What is the treatment?

Answer 40

Uric Acid Stone (Rhomboid) Radiolucent Stone Tx: Potassium Citrate, alkalize the urine

Question 41

What type of stone is this?

Answer 41

Struvite Stone (coffin lid) Magnesium Ammonium Phosphate, dense on Xrays, radiopaque

Question 42

What is hypertension prior to the 20th week of gestation with no previous diagnosis?

Answer 42

Chronic Hypertension

Question 43

What is hypertension during pregnancy that happens after 20 weeks?

Answer 43

Gestational Hypertension

Question 44

What is pre-eclampsia? What is eclampsia?

Answer 44

Pre-eclampsia is hypertension after 20 weeks with proteinuria Eclampsia is seizures in a pre-eclampsia patient

Question 45

# Multiple weeks of antibiotics given: Fever Skin Rash Eosinophils WBC casts in the UA, what is this?

Answer 45

Acute Interstitial Nephritis | Remember, fever, skin rash, and eosinophils are not always needed

Question 46

What is the desmopressin MOA?

Answer 46

Stimulates the release of Von Willebrand Factor from endothelial cells and reduces bleeding time

Question 47

Blood on UA dipstick in the absence of RBC on UA

Answer 47

Myoglobinuria, look out for rhabdomyolysis

Question 48

Patient has PTH independent Hypercalcemia, renal insufficiency, and alkalosis, what is the most likely diagnosis?

Answer 48

Milk-alkali Syndrome

Question 49

If a patient has sarcoid, calcium is elevated, what else will be low?

Answer 49

1,25 dihydroxyvitamin D level will be low

Question 50

# What disease has these signs: Hemangioblastomas of CNS Retinal Angiomas Pheochromocytoma Pancreatic Lesions Renal Cysts and Renal Cell Carcinoma

Answer 50

Von Hippel-Lindau Disease

Question 51

# What disease has the following: Renal Angiomyolipomas Retinal Harmatomas Mental Dysfunction Dental Pitting and Skin findings

Answer 51

Tuberous Sclerosis Complex