Nephrology

Question 1

In what situations would you give IV fluids before and after contrast exposure?

Answer 1

Current AKI or GFR <30

Question 2

what data is there for HD after contrast exposure?

Answer 2

mixed results, no proven benefit (studies in early 2000s)

Question 3

what result indicates primary membranous nephropathy?

Answer 3

PLA2R Ag +

Question 4

What conditions may lead to secondary membranous nephropathy?

Answer 4

malignancy (solid tumor, lymphoma), lupus, hepatitis, drug-induced (NSAIDs, gold salts), infection (Hep B/C, syphilis, malaria)

Question 5

What increase in Cr 2-3 weeks after starting ACE/ARB indicates need for stopping or decreasing dose?

Answer 5

> 30% increase

Question 6

What are the indications for kidney biopsy?

Answer 6

-Glomerular hematuria
-Severely increased albuminuria
-AKI or CKD unclear cause
-Kidney transplant dysfunction or monitoring

Question 7

What is the risk of PPI to the kidneys?

Answer 7

increased risk of CKD and progression of CKD. Also will decrease Magnesium and Potassium levels.

Question 8

What size of stone is likely to require shock wave or laser lithotripsy?

Answer 8

> 10mm or 1 cm

Question 9

what symptoms and signs come with pathologic hypermagnesemia (usually levels >4.8), and what is the treatment?

Answer 9

weakness, hypotension, bradycardia (blocks Ca and K channels)

-Tx: IV calcium gluconate then HD

Question 10

How do you calculate the urine anion gap? What kind of metabolic derangement makes it helpful?

Answer 10

(UNa + UK) - UCl

-Non anion gap metabolic acidosis

Question 11

What does a positive urine anion gap mean? Explain.

Answer 11

Kidney is the cause of acidosis. Could indicate bicarbonate loss in the urine (invisible anions).

NeGUTive means cause is the gut (invisible positive ions like NH4+ means good kidney H+ secretion).

Question 12

What factors might make you suspect renovascular hypertension? Fill in the blanks.

1) Onset after age ___
2) AKI after ____ or ____
3) kidney measurement < ___ cm or a ___ cm difference in size between kidneys

Answer 12

1) 55
2) starting ACE/ARB, after achieving good BP control
3) 9, 1.5

Question 13

what is the time frame for start of AIN after exposure to:
1) PPI
2) NSAIDs

Answer 13

1) 10-11 weeks
2) 6-18 months

Question 14

What are the signs of CINAC

Answer 14

increased Cr, UA with leukocytes, low grade proteinuria, RUS with increased echogenicity, +/- HTN

(CIN agricultural communities, usually young to middle age males in agricultural communities. This often progresses to ESRD).

Question 15

what specialist should kidney transplant patients see regularly due to increased risk from medications?

Answer 15

Dermatologist, increased risk skin cancer

Question 16

How do you treat acute hyponatremia with severe symptoms?

Answer 16

100 mL bolus 3% NS

Question 17

Who is 5x more likely than whites to have FSGS?

Answer 17

African descent

Question 18

What are secondary causes of minimal change disease?

Answer 18

malignancy (Hodgkin lymphoma, thymoma) and meds (NSAIDs, Li, pamidronate, interferons)

Question 19

What are the urea splitting organisms?

Answer 19

Proteus, Klebsiella, Pseudomonas

Question 20

Which of the following is true? 1) IgA nephropathy usually progresses quickly to ESRD.
OR
2) IgA nephropathy is usually benign and does not progress to CKD.

Answer 20

2! IgA nephropathy usually has recurrent gross hematuria with only rare progression to CKD.

Question 21

What condition with renal injury has been associated with clopidogrel?

Answer 21

HUS

Question 22

How do you treat Salicylate toxicity?

Answer 22

IV sodium bicarbonate (increases urinary elimination) with goal of pH >7.5

-consult for HD right away if AKI, severe symptoms, high ASA levels

Question 23

What medications are useful for calciphylaxis?

Answer 23

Sodium thiosulfate. Cinacalcet helps to decrease PTH and has shown promise for prevention.

Question 24

What should you consider in woman <35 yo with abrupt onset HTN

Answer 24

Fibromuscular dysplasia

Question 25

What are the causes of Type 4 RTA (hyperkalemic distal) ?

Answer 25

aldosterone deficiency or resistance

-DM causes low renin –> low aldo
-Tubulointerstitial disease can cause aldo resistance (urinary obstruction, sickle cell, medullary cystic kidney disease, kidney transplant rejection)
-Drug induced (ACE/ARB, heparin, NSAIDs)

Question 26

what are the signs of immune-mediated necrotizing myopathy? What causes it?

Answer 26

-progressive proximal weakness with elevated CK, muscle biopsy with necrosis without inflammation
-caused by statins or paraneoplastic syndrome

Question 27

What are medications that decrease secretion of Cr without causing decrease in GFR or kidney injury? (i.e. don’t d/c these)

Answer 27

-Cimetidine
-Trimethoprim (in bactrim)
-Cobicistat (pharmokinetic enhancer for HIV meds)
-Dolutegravir
-Bictegravir
-Rilpivirine

Question 28

How might you distinguish electrolyte from nonelectrolyte diuresis (solute diuresis)? What labs do you order and how do you interpret them?

Answer 28

Urine osm, Urine electrolytes

if [2 x (UNa + UK)] is <1/2 urine osmolality, then consider urea or glucose as etiology.

Question 29

how do you define abdominal compartment syndrome?

Answer 29

sustained bladder pressure >20 + 1 organ dysfunction

Question 30

What drugs should be used to treat HTN in CKD?

Answer 30

ACE/ARB + CCB then loop diuretic

Question 31

What are the components of IgG4-related disease? How you you diagnose?

Answer 31

infiltration resulting in organ enlargement (idiopathic pancreatitis, sclerosing cholangitis, bilateral salivary or lacrimal gland enlargement, RP fibrosis, orbital pseudotumor, proptosis).
-Dx: most have IgG4 elevation but 20% don’t; need tissue biopsy to diagnose

Question 32

Treatment for GBM:

Answer 32

steroids, plasmapheresis, cyclophosphamide

Question 33

what lab value indicates pseudohyponatremia

Answer 33

Normal serum osmolality (isotonic hyponatremia)