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PSBIM 2025 > Nephrology > Flashcards

Nephrology Flashcards

1
Q

Late complication of HPP

A

Severe disabling proximal lower extremity weakness

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2
Q

Episodic weakness after 25 is still periodic paralysis

A

NO, Episodic weakness AFTER 25, almost never periodic paralyses, except thyrotoxic periodic paralysis

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3
Q

Serum Creatinine (2) and Urine Output (1) findings of Stage 1 Acute Kidney Injury

A

Serum Creatinine
* 1.5 to 1.9 times baseline
* >/= 0.3 mg/dL (>/= 26.5Umol/)

Urine Output
< 0.5mL/kg/hr for 6-12 hours

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4
Q

Serum Creatinine (1) and Urine Output (1) findings of Stage 2 Acute Kidney Injury

A

Serum creatinine
* 2.0 to 2.9 times baseline

Urine Output
<0.5mL/kg/hr for >/= 12 hours

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5
Q

Serum Creatinine (3) and Urine Output (2) findings of Stage 3 Acute Kidney Injury

A

Serum creatinine
* 3.0 times baseline
* Increase in serum creatinine to >/= 4.0mg/dL or >/= 353.6Umol/L)
* Initiation of RT therapy
* <18: Decrease in eGFR <35

Urine Output
* <0.3mL/kg/hr for >/= 24 hours
* Anuria >/= 12 hours

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6
Q

What SBP does renal autoregulation fail?

A

Renal autoregulation: fails once the SBP falls below 80mmHg

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7
Q

Cardiac output and resting oxygen received by the kidneys?

A

20% of cardiac output
10% of resting oxygen consumption

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8
Q

Definition of Acute Kidney Injury (3)

A
  1. Rise from baseline of at leats 0.3mg/dL within 48 hours
  2. Rise from baseline to 1.5 higher than baseline withi 1 week
  3. Reduction in UO <0.5mL/kg/hr longer than 6 hours
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9
Q

Clues suggestive of CKD

A

Radio: Small, shrunken kidneys with cortical thinning on renal ultrasound or evidence of renal osteodystrophy
Labs: Normocytic anemia in the absence of blood loss; Secondary hyperparathyroidism with hyperphosphatemia and hypocalcemia

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10
Q

Presents with Pigmented ‘muddy brown’ gradual casts and tubular epithelial cell casts

A

AKI from ATN d/t ischemic injury, sepsis or certain nephrotoxins

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11
Q

Hallmark of acute kidney injury

A

Elevated BUN concentration (Buildup of nitrogenous waste products)

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12
Q

Complications of AKI (10)

A
  1. Uremia
  2. Hypervolemia and Hypovolemia
  3. Hyponatremia
  4. Hyperkalemia
  5. Acidosis, elevation of anion gap
  6. Hyperphosphatemia and HypocalcemiaD-
  7. Bleeding
  8. Infections
  9. Cardiac complications
  10. Malnutrition
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13
Q

Only indication for fluid administration in AKI

A

Intavascular hypovolemia

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14
Q

Recommended for hypovolemic hypochloremic patients

A

0.9% saline

  • Excessive chloride administration from 0.9% saline may lead to hyperchloremic metabolic acidosis and may impair GFR.
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15
Q

Definitive treatment for Hepatorenal Acute Kidney Injury

A

Orthotopic liver transplantation

  • Bridge therapies
    1. Terlipressin (a vasopressin analog), with albumin,
    2. combination therapy with Octreotide (a somatostatinanalog) and Midodrine (an 21-adrenergic agonist), in combination with intravenous albumin (25–50 g, maximum 100 g/d).
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16
Q

Total energy intake of patients with AKI

A

20-30 kcal/kg/day

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17
Q

Protein intake of patients with noncatabolic AKI without the need for dialysis

A

0.8-1.0 g/kg/day

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18
Q

Protein intake of patients with AKI on dialysis

A

1.0-1.5 g/kg/day

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19
Q

Protein intake of patients with hypercatabolic AKI and receiving continuous RRT

A

Maximum of 1.7 g/kg/day

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20
Q

Treatment of uremic bleeding

A

Desmopressin and estrogen OR may require dialysis in long standing or severe uremia

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21
Q

Persistent UACR ___ (Male) or __ (female) on 2/3 occasions as a maker for early detection of primary kidney disease and systemic microvascular disease

A

> 2.5 mg / mmol (Male)
3.5 mg / mmol (female)

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22
Q

Component of Kidney Failure Risk (KFR) equation (5)

A

Age, sex, region (North America vs Non-North America), GFR and UACR

Predict risk of progression to stage 5 dialysis-dependent kidney disease

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23
Q

Indications for referral to nephrologist in patients with CKD stage 3 and 4 (3)

A
  • Declining GFR
    • Albuminuria
    • Uncontrolled hypertension
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24
Q

Leading categories of etiologies of CKD (5)

A

Diabetic nephropathy
GN
HTN-associated CKD
ADPKD
Other cystic and tubulointerstitial nephropathy

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25
Q

When to start giving sodium bicarbonate supplement?

A

Replace if serum bicarb concentration falls below 20-23 mmol/L
> To avoid protein catabolic state
> Slow progression of CKD

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26
Q

Promotes phosphate excretion and is an independent RF for LVH and are associated with increased mortality

A

FGF 23

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27
Q

What is the bone histology finding of oteitis fibrosa cystica?

A

Abnormal osteoid bone and BM fibrosis; advance stage: formation of bone cysts and sometimes with hemorrhagic elements — brown tumor

classic lesion of secondary hyperparathyroidism

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28
Q

Presents with reduced bone volume and mineralization d/t excessive PTH production (Use of Vitamin D and excessive calcium exposure), chronic inflammation

A

Adynamic bone disease

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29
Q

Complications of adynamic bone disease (4)

A
  1. Fracture
  2. Bone pain
  3. Vascular and cardiac calcification
  4. Tumoral calcinosis
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30
Q

What compound does warfarin decrease causing calciphylaxis in CKD patients?

A

matrix GLA protein

  • Calciphylaxis: painful livedo reticularis and subcutaneous nodules that advance to patches of ischemic necrosis
    • Warfarin decrease the vitamin K-dependent activation of matrix GLA protein, which is important in preventing vascular calcification
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31
Q

National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines recommend a target PTH level of ___

A

Target PTH level: 2 and 9 times the ULN

  • Very low PTH: Adynamic bone disease and possible fracture and ectopic calcification
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32
Q

Stage of CKD where normocytic Normochromic anemia is seen universally?

A

Stage 4

  • Normocytic, normochromic anemia:
    • Stage 3: Observed as early
    • Stage 4: Universal
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33
Q

Target hemoglobin of patients with CKD

A

110-115g/dL

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34
Q

Subtle neuromuscular disease in CKD starts at what stage and what are the early manifestation?

A

Stage 3
Mild disturbances in memory, concentration and sleep

    • Later manifestation: Hiccups, cramps and twitching
    • Advanced and untreated: Asterixis, myoclonus, seizures and coma
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34
Q

What stage of CKD does peripheral neuropathy and what is the presentation?

A

Stage 4
Sensory > motor; LE > UE; distal > proximal

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34
Q

Management of patients with Nephrogenic Fibrosing Gadolinium

A
  • Recommendation:
    * CKD Stage 3 (30-59) MINIMIZE use
    * CKD Stage 4-5 (<30): AVOID use
    * If needed, rapid removal with HD
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35
Q

Contraindication of Kidney Biopsy in CKD patients (6)

A
  1. Small kidneys
  2. Uncontrolled HTN
  3. Active UTI
  4. Bleeding diathesis
  5. Ongoing anticoagulation
  6. Severe obesity
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36
Q

Dialysate used in dialysis

A
  • Potassium: 0-4 mmol/L
  • Calcium: 1.2 mmol or 2.5mEq/L
  • Sodium: 136-140mmol/L
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37
Q

How to do sodium modeling for patients with frequent hypotension during dialysis

A
  • Dialysiate Na is gradually lower from he range of 145-155 to isotonic concentrations 136-140mmol/L
    * Predispose to positive Na balance and increased thirst
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38
Q

An access where cephalic vein is anastamosed end-to-side to the radial artery

A

Brescia Cimino Fistula

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39
Q

What is a frequent complication of subclavin vein catheter?

A

Subclavian stenoses

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40
Q

Determinant of dialysis dose (4)

A

size, residual kidney function, dietary protein intake, degree of anabolism or catabolism and presence of comorbid conditions

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41
Q

Management of hypotension during HD (3)

A
  1. Discontinue ultrafiltration
  2. admin of 100-250mL of isotonic saline
  3. admin of salt-poor albumin
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42
Q

Strategies to prevent muscle cramps during dialysis (3)

A
  1. Reduce volume during dialysis
  2. Ultrafiltration profiling
  3. Sodium modeling
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43
Q

What is the pathophysiology of type A reaction to dialyzer?

A

IgE mediated intermediate hypersensitivity reaction to ethylene oxide

Occurs soon after initiation of a treatment —> Full blown anaphylaxis
Tx: Steroids of epinephrine

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44
Q

What is the pathophysiology of type B reaction?

A

Complement activation and cytokine release

  • Nonspecific chest and back pain
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45
Q

Major complication of peritoneal dialysis (5)

A
  1. Peritonitis
  2. Catheter-associated non peritonitis infections
  3. Weight gain
  4. Metabolic disturbances
  5. Residual uremia
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46
Q

How to diagnose peritonitis in patients on peritoneal dialysis?

A

Elevated peritoneal fluid leukocyte count (100/mm3), 50% PMN neutrophils

  • Presentation: Pain, cloudy dialysate, fever and other constitutional symptoms
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47
Q

What is the most common culprit involved in peritoneal dialysis?

A

Gram positive cocci - Staph

  • Less common: Gram negative rod
  • Hydrophilic gram negative rods (Pseudomonas spp. or yeast): Catheter removal is required to ensure complete eradication
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48
Q

Most common renal infection of patients with PKD

A

Infected cyst and acute pyelonephritis

  • Often due to Gram negative bacteria
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49
Q

Major cause of mortality in patients with ADPKD

A

Cardiovascular complications

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50
Q

Risk Factors of progression of ADPKD to ESRD (5)

A
  1. Early diagnosis of ADPKD
  2. HTN
  3. Gross hematuria
  4. Multiple pregnancies
  5. Large kidney size
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51
Q

Most common extrarenal complication of ADPKD

A

Liver cysts from biliary epithelia

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52
Q

Diagnosis of ADPKD

A
  1. At least 2 renal cysts (unilateral or bilateral): 15-29 years of age
    * Sensitivity 96%
    * Specificity 100%
  2. 30-59: At lest 2 cysts in each kidney
    * May use to exclude if not reached
    * 0% false negative rate
  3. > /= 60: At least 4 cysts in each kidney
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53
Q

This is used as a presymptomatic screening tool for patients at risk for ADPKD

A

Renal ultrasonography:

  • CT scan and T2-MRI with gadolinium as a contrast agent: Detect cysts in smaller size
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54
Q

What is the management for infected renal cyst?

A
  • Lipid-soluble antibiotics against gram negative enteric organism: TMP-SMX, quinolone, chloramphenicol
    • Treatment duration: 4-6 weeks
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55
Q

Hallmark of ADRPKD

A

Biliary dysgenesis d/t primary ductal plate malformation with associated peri portal fibrosis

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56
Q

Most common kidney finding of Tuberous Sclerosis

A

Angiomyolipomas

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57
Q

Prophylactic measure in patient with renal angiomyolipmas >4cm in Tuberous Sclerosis

A

Surgical removal

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58
Q

Postreptococcal GN due to pharyngitis develops __ weeks after infection and ___ weeks after impetigo

A

throat: 1-3 weeks
skin: 2-6 weeks

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59
Q

Lab findings of PSGN

A
  • Decreased CH50, decreased C3, (+) RF, cryoglobulins, immune complexes, ANCA against myeloperoxidase
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60
Q

When do we expect the complete resolution of azotemia, hematuria and proteinuria?

A

3 to 6 weeks from the onset of nephritis

61
Q

What is the gross appearance of the kidney when they have endocarditis-associated GN?

A

Subscapular hemorrhages with a flea-bitten appearance

Renal Biopsy: focal proliferation around foci of necrosis associated with abundant mesangial, subendothelial, and subepithelial
immune deposits of IgG, IgM, and C3.

62
Q

What is the treatment for endocarditis-associated GN?

A

4 to 6 weeks of antibiotics

63
Q

What is the LM and IF/EM presentation of class 1 lupus nephritis?

A

Light microscopy: Normal glomerular histology
IF/EM: Minimal messangial deposits

64
Q

What is the LM and IF/EM presentation of class 2 lupus nephritis?

A

Mesangial immune complexes with mesangial proliferation

65
Q

What is the treatment of lupus nephritis class III to 5?

A

High-dose steroids with Mycophenolate Mofetil or Cyclophosphamide for 2-6 months, then maintenance of low dose steroids with Mycophenolate Mofetil or Azathioprine

** Avoid use of cyclophosphamide in patients of child bearing age without first banking eggs of sperm

66
Q

What are the criteria for lupus nephritis remission (2)?

A

Return to near normal renal function and proteinuria of </= 330mLg/dL/day

67
Q

When to perform dialysis or transplantation in patients with lupus nephritis?

A

Performed 6 months of inactive disease

68
Q

Factors causing poor prognosis for patients with goodpastures syndrome (4)

A
  1. > 50% crescents on renal biopsy with advanced fibrosis
  2. Serum crea > 5-6 mg/dL
  3. (+) oliguria
  4. Need for acute dialysis
69
Q

Treatment of patients with goodpastures for hemoptysis, less severe and maintenance

A

Hemoptysis: Plasmapheresis
Less severe: 8-10 tx of Plasmapheresis and oral prednisone and cyclophosphamide
Maintenance: LD immunosuppressants until with negative titers
* Rituximab, azathioprine, MMF
Kidney transplantation: wait 6 months and until serum negative

70
Q

What is the kidney biopsy findings of IgA nephropathy?

A

Dominant or codominant mesangial IgA deposits, either alone or with IgG, IgM or C3

71
Q

What is the greatest predictive power of adverse renal outcome among patients with IgA nephropathy?

A

Persistent proteinuria for >/= 6 months

72
Q

What is MEST-C Score?

A
  • M-Mesangial hypercellularity
    • E-Endocapillary hypercellularity
    • S- Segmental glomerulosclerosis
    • T- Tubular interstitial fibrosis
    • C- Crescents
73
Q

What is the CXR and biopsy findings of patient presenting with purulent rhinorrhea, nasal ulcers, sinus pain, polyarthralgias/arthitis, cough, hemoptysis, SOB, hematuria, subnephrotic proteinuria?

A

Patient has granulomatosis with polyangiitis (anti-PR3)
CXR: nodules and persistent infiltrates, sometimes with cavities
Biopsy: Small-vessel vasculitis and adjacent noncaseating granulomas

74
Q

Characteristic of MPGN 2 of Dense Deposit Disease (2)

A
  1. Low serum C3
  2. Dense thickening of the GBM with dense deposits and C3
75
Q

What predicts the progression of membranous GN?

A

Tubular atrophy or interstitial fibrosis

76
Q

The presence of this findings strongly points to diagnosis of membranous lupus nephritis, may precede the extra renal manifestations of lupus?

A

Subendothelial deposits or the presence of tubuloreticular inclusions

77
Q

What are the worst prognostic indicator of membranous glomerulonephritis (4)?

A

Male, older age, persistent nephrotic range proteinuria

78
Q

What GN has the highest incidence of DVT, PE and renal vein thrombosis?

A

Membranous GN

  • Prophylactic anticoagulation: Patients with hypoalbuminemia
79
Q

What is a sensitive indicator for the presence of diabetes but correlates poorly with the presence of absence of nephropathy?

A

Thickening of the GBM

80
Q

What is a Nodular glomerulosclerosis or Kimmelstiel-Wilson nodules?

A

Eosinophilic, PAS positive nodules

81
Q

What is the single most important predictor of a faster decline in GFR in patients with DM nephropathy?

A

Albuminuria

82
Q

What is the treatment for patients with primary amyloidosis?

A

Delay: Mephalan; autologous HSCT
Not HCT candidate: Bortezomib-based regimens

83
Q

This treatment is a chaperone that facilitates trafficiking of alpha Gal-A, clears microvascular endothelial deposits of globotriaosylceramide from the
kidneys, heart, and skin?

A

Migalastat

84
Q

What is the eye findings of patient with alport’s syndrome?

A

Lenticonus of the anterior lens capsule
‘Dot and fleck retinopathy’ and rarely, leiomyomatosis

* hematuria, thinning and splitting of the GBMs, and mild proteinuria (<1–2 g/24 h) >>  chronic glomerulosclerosis >> renal failure in association with sensorineural deafness
85
Q

What is the skin biopsy findings of patient with Alport’s Disease?

A

Lack of the α5(IV) collagen chain on immunofluorescent analysis

  • a5(IV) collagen is expressed in the skin
  • Clinical evaluation: Careful eye exam and hearing tests
86
Q

What is the renal biopsy findings of patient with Alport’s Disease?

A

Thinning mixed with splitting

** Early: Thin basement membrane&raquo_space; thicken into multilamellations surrounding lucent areas that often contain granules of varying density (split basement membrane)
* a3 (IV) or a4(IV): Require renal biops

87
Q

What is the biopsy finding of HIVAN?

A

FSGS, collapsing glomerulopathy with visceral epithelial cell swelling, microcytic dilatation of the renal tubules, tubuloreticular inclusion

88
Q

What are renal findings associated with hepatitis B?

A

Polyarteritis nodosa, appearing 6 months after hepatitis B infection
> Renal artery infarct, scar, aneurysm
Children: MGN with predominant IgG1
deposition
Adult: MPGN

89
Q

What are findings associated with hepatitis C?

A

Type 2 Mixed cryoglobulinemia, nephrotic syndrome, microscopic hematuria, abnormal liver function tests, depressed C3 levels, anti–hepatitis C virus (HCV)

90
Q

What are renal findings associated with syphilis (2)?

A
  1. Nephrotic syndrome from MGN from treponema antigen
  2. Interstitial syphitilitic nephritis
91
Q

What species of Schistosomiasis is most commonly associated with clinical renal disease?

A

S. mansoni

92
Q

Urinalysis findings of patiets with acute interstitial nephritis

A

Pyuria with WBC casts and hematuria

Dx: Unexplained kidney injury with or without oliguria and exposure to a potentially offending agent
Biopsy: Extensive interstitial and tubular infiltration of leukocytes

93
Q

When is glucocorticoid indicated in patients with acute interstitial nephritis?

A

For severe kidney injury in which dialysis is imminent or if kidney function continues to deteriorate

94
Q

What are the absolute indications for glucocorticoids in patients with AIN (6)?

A
  1. Sjögren’s syndrome
  2. Sarcoidosis
  3. SLE interstitial nephritis
  4. Adults with TINU
  5. Interstitial nephritis from IgG4-related disease
  6. Idiopathic and other granulomatous interstitial nephritis
95
Q

What are the relative indications for glucocorticoids in patients with AIN (3)?

A
  1. Drug-induced or idiopathic AIN with:
    a. Rapid progression of renal failure
    b. Diffuse infiltrates on biopsy
    c. Impending need for dialysis
    d. Delayed recovery
  2. Children with TINU
  3. Postinfectious AIN with delayed recovery (?)
96
Q

What is the most common renal manifestation of Sjogren’s disease?

A

TIN with a predominant lymphocytic infiltrate

Others: impaired kidney function, distal RTA, and nephrogenic diabetes insipidus

97
Q

What is the hallmark of TINU?

A

Lymphocyte-predominant interstitial nephritis, painful anterior uveitis, often bilateral and accompanied by blurred vision and photophobia

98
Q

Treatment of fibrotic lesions found on patients with IgG4 related systemic disease?

A

Biopsy or excision

  • Fibrotic lesions forms pseudotumor —> Biopsy or excision d/t Fear of true malignancy
  • Presents with AI pancreatitis, sclerosing cholangitis, retroperitoneal fibrosis and a chronic sclerosing sialadenitis
99
Q

When does serum creatinine increase in patients with AIN with use of Immune Checkpoint Inhibitors?

A

within 15 weeks after starting therapy, but may occur later or 2 months after discontinuing

100
Q

Urinalysis of patients with Bence-Jones Protein?

A

Increased amount of protein in a spot urine specimen with negative dipstick

101
Q

What is the kidney ultrasound findings of VURD?

A

Asymmetric small kidneys with irregular outlines, thinned cortices, regions of compensatory hypertrophy

101
Q

Characteristics of analgesic nephropathy (3)

A
  1. Impaired kidney function
  2. Papillary necrosis
  3. Radiographic constellation: Small kidneys with papillary calcifications on CT
102
Q

What are the 2 causes of aristolochic nephropathy?

A
  1. Chinese herbal nephropathy
  2. Balkan endemic nephropathy
103
Q

Definitive diagnosis of aristolochic nephropathy?

A

2 out of 3:

  1. Characteristic histology on kidney biopsy: renal interstitial fibrosis with a relative paucity of cellular infiltrates
  2. Confirmation of aristlochic acid ingestuib
  3. Detection of aristolactam-DNA adducts in kidney or UT tissue
104
Q

Severe complications of aristolochic nephropathy?

A

Upper urinary tract urothelial cancers

  • Surveillance with CT, ureteroscopy and urine cytology
  • Tx: Bilateral nephroureterectomy once ESRD reached
105
Q

What is the most common renal sequelae of Lithium-Associated Nephropathy?

A

Nephrogenic DI presenting as polyuria and polydipsia

106
Q

What are the kidney biopsy findings of suggestive of Lithium-Associated Nephropathy?

A
  1. Interstitial fibrosis
  2. Tubular atrophy that are out of proportion to the degree of glomerulosclerosis or vascular disease
  3. Sparse lymphocytic infiltrate
  4. Small cysts or dilation of the distal tubule and collecting ducts
107
Q

What is the histologic finding of Calcineurin Inhibitor Nephrotoxicity?

A

Histology showed patchy interstitial fibrosis and tubular atrophy - striped pattern

108
Q

What is the early sign of heavy metal nephropathy?

A

Proximal tubule dysfunction, particularly hyperuricemia

109
Q

What is the triad to suspect lead exposure?

A

Saturine gout
HTN
Impaired kidney function

110
Q

What is the most striking defect associated with hypercalcemic nephropathy?

A

Inability to concentrate urine

111
Q

What is the PENTAD of TTP?

A

Pentad (FATRN)
1. Fever
2. MAHA
3. Thrombocytopenia
4. Renal Failure
5. Neurologic Symptoms

112
Q

What is the main cause of TMA associated with chemo and immunosuppressive agents?

A

Toxic endothelial damage

113
Q

What is the renal lesion associated with scleroderma?

A

Onion-skinning
Arcuate artery intimal and medial proliferation with luminal narrowing (Onion skinning) + Glomerular collapse due to reduced BF

114
Q

What is the antibody that is used to identify young patients at risk for sclerodermal renal disease?

A

Anti-U3 RNP

115
Q

Negative predictor for sclerodermal renal disease?

A

Anticentromere antibody

116
Q

What is HEELP syndrome?

A

Hemolysis
Elevated Liver enzymes
Low platelets

117
Q

What is POEMS and what is the hallmark of this disease?

A

POEMS:
Polyneuropathy
Organomegaly
Endocrinopathy
Monoclonal gammopathy
Skin changes

Hallmark: Peripheral neureopahy with severe motor-sensory deficit

118
Q

Dietary risk factors causing nephrolithiasis (5)

A

Animal protein
Sodium
Fructose
Sucrose
Oxalate

119
Q

Diet that lowers risk of having nephrolithiasis (3)

A

Calcium
Potassium
Phytate

120
Q

Strong risk factor for calcium oxalate

A

Urine oxalate

121
Q

Effects of urine pH on the formation of urine stones?

A

UA stones: Forms when pH </= 5.5
Calcium phosphate: Forms when pH >/= 6.5
Cysteine: Soluble at higher pH
Calcium Oxalate: Not affected by pH

122
Q

Two common presentation of patients with acute stone

A

Renal colic
Painless gross hematuria

123
Q

Pain radiaiton of nephrolithiasis depending on the stone location

A

Upper part of ureter: Anterior
Lower part of ureter:
Male - ipsilateral testicle
Female- ipsilateral labium
Right upper ureteropelvic junction: Acute cholecystitis
Right pelvic brim: Acute appendicitis
Left pelvic brim: Acute diverculitis
Ureterovesical junction: Urinaru urgency and frequency

124
Q

Indication of urgent urologic intervention (3)

A
  1. UTI - urologic emergency, pus under pressure
  2. Low probability of passage: >/= 6mm OR anatomic abnormality
  3. Intractable pain
125
Q

What is the procedure of choice for patients with large upper tract stones?

A

Percutaneous nephrostolithotomy

126
Q

What diagnostic test is the cornerstone on which therapeutic recommendations are based on patients with nephrolithiasis?

A

24-hour urine collection

127
Q

Medication that can reduce calcium oxalate store recurrence by > 50%

A

Chlorthalidone

** Thiazide diuretic higher than those used in hypertension: reduce urine calcium excretion

128
Q

What is the 2 main risk factors for having uric acid stones?

A

Low urine pH and high uric acid excretion

129
Q

What is the recommended pH goal in patients with uric acid stones?

A

pH of 6.5
* Supplement with bicarbonate or citrate

130
Q

How does amphotericin B cause AKI (5)?

A

Direct tubular toxicity; polyuria, hypomagnesemia, hypocalcemia, and nongap metabolic acidosis.

131
Q

Level of the serum bicarbonate and pH do you give IV sodium bicarbonate in acute kidney injury

A

a. HCO3 < 15 and pH < 7.20

132
Q

What are the symptoms of cauda equina syndrome (3)?

A
  1. Overflow urinary incontinence
  2. Sudden onset fecal incontinence
  3. Severe lower back pain
  4. Saddle anesthesia
133
Q

What is pathognomonic of vesicoureteral reflux?

A

Flank pain that occurs with micturition

134
Q

What should you do if suspecting UTO?

A

Insert bladder catheter

135
Q

This imaging is used to predict the reversibility of renal dysfunction.

A

Renal radionuclide scan

136
Q

This disease mimics the state of chronic loop diuretic intake?

A

Barrter

137
Q

What does Gittelma’s syndrome mimic?

A

Thiazide diuretic intake

138
Q

This immunosuppressive drug used after kidney transplant is a macrolide with good absorption. It blocks cytokine production, but stimulates TGF-B production. Unlike its counterpart, this drug does not produce hirsutism

A

Tacrolimus

139
Q

What antibiotics are preferred for renal cyst infection?

A

Lipid-soluble antibiotics against gram negative enteric organism:
TMP-SMX, quinolone, chloramphenicol: Preferred for cyst infection

Treatment duration: 4-6 weeks

140
Q

Considered in a patient with hypernatremia who responds with increased urine osmolality after desmopressin?

A

Central DI

141
Q

Major causes of death in chronic kidney transplant?

A
  1. Cardiovascular events (29%)
  2. Infection (18%)
  3. Malignancy (17%)
142
Q

Predisposing factor for contrast-induced nephritis?

A
  • CKD, often in association with congestive
    heart failure or other coexisting causes for ischemia-associated AKI.
  • Patients with multiple myeloma and/or renal disease
143
Q

Acute Kidney Injury with findings of calcium oxalate should alert clinician to r/o what disease?

A

Ethylene glycol ingestion

144
Q

What are the causes of false positive dipstick examination (3)?

A

Causes of false positive dipstick examination:
1. pH > 7.0
2. Very concentrate urine
3. Contaminated with blood

145
Q

Which stain is used to better identify basement membrane structure in kidney biopsies?

A

Jones methenamine silver

146
Q

Potent afferent vasoconstrictor of the afferent arteriole

A

Adenosine

147
Q

Indication of admission for patients with acute pyelonephritis (5)

A
  1. Cannot tolerate oral fluid or medication
  2. Compliance issue
  3. Complicating comorbidities
  4. Signs of sepsis, fever, debility
  5. Signs of preterm labor in pregnant patients
148
Q

Indications for radiologic evaluation for patients with acute pyelonephritis (3)

A
  1. urine pH <7.0
  2. History of urolithiasis
  3. Renal insufficiency
149
Q

Failure to treat asymptomatic bacteuria in pregnancy can result in the following (3)

A
  1. Maternal pyelonephritis
  2. Preterm delivery
  3. LBW babies
150
Q

Known sources of sensitization in KT (4)

A
  1. Blood transfusion
  2. Prior transplant
  3. Pregnancy
  4. Vaccination / Infection
151
Q
A

PSBIM 2025 (9 decks)

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