Nephrology

Question 1

Best initial test for rhabdo

Answer 1

Ua with blood but no cells

Vs urine myoglobin is most accurate

Question 2

Rhabdo labs

Answer 2

K (high), ca (low bc bound by damaged mm), Chem (acidosis)

Question 3

Rhabdo tx

Answer 3

NS
Mannitol diur to decrease myoglobin contact time with tubule
Alkalinize urine to decrease precip of myoglobin

Question 4

Crystal renal failure - types and tx

Answer 4

• oxalate from antifreeze, agma, give ethanol or fomepizole with dialysis
• uric acid (eg tls), give fluids, allopurinol, rasburicase

Question 5

Nephritis vs nephrotic

Answer 5

GN blood in urine, mild proteinuria

Nephrotic lots of protein in urine (>3.5g per 24 hrs) and blood, hld, edema

Question 6

Goodpasture

Answer 6

GN plus lungs
Dx anti-BM, mpo-anca, renal bx with linear deposits
Tx plasmapheresis and steroids

Question 7

Eos granulomatosis with polyangiitis

Answer 7

GN plus asthma
Test with cbc (for eos) and bx
Tx pred, can add cyclophosphamide

Question 8

Gpa (wegener)

Answer 8

GN with upper and lower resp (sinusitis, otitis)
Test with c-anca, lung bx (safer than kidney, which is most acc)
Tx cyclophosphamide or ritux and steroids

Question 9

Polyarteritis nodosa

Answer 9

Systemic vasc causing GN and involving every organ EXCEPT lung

Motor and sensory neuropathy and pain are common

Dx esr (best initial), bx (most acc)
Tx cyclophosphamide and steroids

Question 10

HSP

Answer 10

Adol or child, GN with púrpura, abd and joint pain, bleeding
Dx is usu clinical, can bx to show iga deposits
Usually resolves spon, can give Acei, steroids if doesn’t resolve

Question 11

Tx for lupus nephritis

Answer 11

Bx to assess degree of damage
Sclerosis - don’t treat
Mild - steroids
Severe - mycophenolate mofetil and steroids

Question 12

Alport

Answer 12

GN (causing kidney failure in 20-30s) with eye and ear, congenital
No tx

Question 13

Tx aspirin overdose

Answer 13

Lactic acidosis from loss of aerobic metab
Resp acidosis from hypervent
Tx: bicarb

Question 14

Causes of AGMA vs NAGMA

Answer 14

Agma = mud piles
Methanol
Uremia
DKA
Paraldehyde and phenformin, paracetamol
Isoniazid
Lactic acidosis
Ethylene glycol
Salicylates

NAGMA = diarrhea or rta

Question 15

RTA types

Answer 15

Distal/type I - can’t excrete acid in distal tubule, test by administering acid

Próx/type II- can’t reabsorb bicarb so at first urine is basic then total body bicarb drops bc you peed it all out so serum and urine acidic, test by administering bicarb

Hyporeninemic hypoaldo (type iv)- elevated k, treat with fludrocort

Question 16

MCD dx and tx

Answer 16

Dx is clinical (low albumin, edema etc)
Tx is steroids for 2-3mo but high rate recurrence so monitor for proteinuria

Question 17

UA finding in rhabdo

Answer 17

Blood with no rbcs - myoglobinuria

Question 18

Psgn tx

Answer 18

Antibiotics for strep (pcn or erythro if allergy) and supportive

No steroids!

Question 19

Opioids that are ok in kidney disease

Answer 19

Fentanyl, dilaudid, methadone, bup

Question 20

Management of ain

Answer 20

Dc offending drug (usually abx, nsaids, ppi) and serially monitor kidney fxn, if doesn’t spon resolve, glucocorticoids

Question 21

Urine ph

Answer 21

Less than 5.5 is low
Higher than 5.5 is high

Question 22

Stones and urine ph

Answer 22

Utica acid and ca oxalate in low ph
Calcium in high ph with distal type 1 rta
Struvite with high ph and uti

Question 23

UA findings in AIN

Answer 23

Pyuria and wbc casts, possible mild proteinuria and hematuria, eos

Question 24

Drugs that most commonly cause ain

Answer 24

PPI, nsaid, PCN, diuretics

Question 25

Meds that cause htn

Answer 25

NSAIDs, decongestant, tcas and snris, ocp, systemic steroids, stimulants

Question 26

Hypona tx

Answer 26

First, water restriction if chronic, no neuro sx etc

Then salt, loop, demeclocycline or lithium to make tubules not respond to adh if siadh

Question 27

Thiazides vs loop vs mra cause renal loss of what electrolytes?

Answer 27

Na, also k and mg and HyperCa
Vs loop lose na, k, ca in urine
Vs mra are k sparing