Nephrology

Question 1

Leading cause of morbidity and mortality in CKD

Answer 1

Cardiovascular disease

Question 2

Most common complications of CKD

Answer 2

Hypertension and LV hypertrophyF

Question 3

First line of therapy in hypertension in CKD

Answer 3

Salt restriction

Target BP <130/80

Question 4

Target Hb in CKD

Answer 4

110-115g/LSpon

Question 5

Pregnancy is associated with high rate of spontaneous abortion at what eGFR

Answer 5

once eGFR reaches 40mL/min and lowerC

Question 6

Contraindications to renal biopsy

Answer 6

Uncontrolled hypertension
active UTI
Bleeding diathesis including ongoing anticoagulation
Severe obesity

*also not advised in bilaterally small kidneys

Question 7

HD access with the highest long term patency rate

Answer 7

Fistula

Question 8

Most important complciation of AV graft

Answer 8

Thrombosis of the graft and graft failure

Question 9

Peritoneal dialysis peritonitis defined by

Answer 9

Elevated peritoneal fluid leukocyte count (100/mm3) of which at least 50% are PMNs
Most common culprid - StaphC

Question 10

Causes of transient/functional proteinuria (<1g/24h)

Answer 10

Fever, exercise, obesity, sleep apnea, emotional stress, CHF

Question 11

Timing of post strep GN from impetigo

Answer 11

after 2-6 weeks

(vs 1-3 weeks from pharyngitis)

Question 12

Natural course of PSGN

Answer 12

Complete resolution of azotemia, hematuria, and proteinuria in majority of children occurs within 3-6 weeks of enset of nephritis

Elderly - high indicdence of azotemia, nephrotic range proteinuria, and ESRD

Treatment is supportiver

Question 13

Primary treatmetn in endocarditis-associated GN

Answer 13

Eradication of the infection with 4-6 weeks of antibiotics

Question 14

Most common presentations of IgA nephropathy

Answer 14

Recurrent episodes of macroscopic hematuria during or immediately following an URTI often accompanied by proteinuria

and

persistent asymptomatic microscopic hematuria

Question 15

Most common cause of nephrotic syndrome in elderly

Answer 15

Membranous GN

Question 16

GN associated with chronic hep C

Answer 16

Cryoglobulinemic GN
MGN
MPGN
in decreasing frequency
(PAN, IGA nephropathy, FSGS also reported)

Question 17

Schistosoma sp most commonly associated with clinical renal disease (GN)

Answer 17

Schistosoma mansoni

Question 18

Adynamic bone disease definition

Answer 18

Low bone turnover with low or normal pTH levels

Question 19

Two most common and well characterized rare monogenic disorders that lead to stone formation

Answer 19

Primary hyperoxaluria and cystinuria

Question 20

High oxalate foods to avoid to reduce risk of calcium ox stones

Answer 20

Spinach, rhubarb, almonds, potatoes

Question 21

Treatment of IgA nephropathy

Answer 21

No agreement on optimal treatment
Small studies support ACE inhibitors in paitents with proteinuria or declining renal function
Steroid tx or other immunosuppressives in those (+) proteinuria after ACEi

Question 22

RTA types

Answer 22

Type 1 Distal *hypokalemia, NAGMA, Low urinary ammonia excretion
(nephrolithiasis, nephrocalcinosis, hypocitraturia, hypercalciuria)

Type 2 Proximal *glycosuria, generalized aminoaciduria, phosphaturia

Type 4 Generalized distal RTA *hyperK disproportionate to reduction in GFR

Question 23

Most common causes of chronic hypokalemic akalosis

Answer 23

surreptitious vomiting, diuretic abuse, and GS

Question 24

Cornerstone of the therapy or chronic hyponatremia

Answer 24

Water deprivation

Question 25

Therapy for chronic hyponatremia when fluid restriction, potassium replacement, and/or increased solute intake fails

Answer 25

SIAD: oral furosemide, 20 mg twice a day (higher doses may be necessary in renal insufficiency),

and oral salt tablets

Demeclocycline - potent inhibitor of principal cells and can be used in patients whose Na levels do not increase in response to furosemide and salt tablets

Question 26

Factors measured in 24h urine collection in work up for nephrolithiasis

Answer 26

total volume, calcium, oxalate, citrate, uric acid, sodium, potassium, phosphorus, pH, and creatinine