Nephrology Flashcards
1
Q
Late complication of HPP
A
Severe disabling proximal lower extremity weakness
2
Q
Episodic weakness after 25 is still periodic paralysis
A
NO, Episodic weakness AFTER 25, almost never periodic paralyses, except thyrotoxic periodic paralysis
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
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
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
6
Q
What SBP does renal autoregulation fail?
A
Renal autoregulation: fails once the SBP falls below 80mmHg
7
Q
Cardiac output and resting oxygen received by the kidneys?
A
20% of cardiac output
10% of resting oxygen consumption
8
Q
Definition of Acute Kidney Injury (3)
A
- Rise from baseline of at leats 0.3mg/dL within 48 hours
- Rise from baseline to 1.5 higher than baseline withi 1 week
- Reduction in UO <0.5mL/kg/hr longer than 6 hours
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
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
11
Q
Hallmark of acute kidney injury
A
Elevated BUN concentration (Buildup of nitrogenous waste products)
12
Q
Complications of AKI (10)
A
- Uremia
- Hypervolemia and Hypovolemia
- Hyponatremia
- Hyperkalemia
- Acidosis, elevation of anion gap
- Hyperphosphatemia and HypocalcemiaD-
- Bleeding
- Infections
- Cardiac complications
- Malnutrition
13
Q
Only indication for fluid administration in AKI
A
Intavascular hypovolemia
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.
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).
16
Q
Total energy intake of patients with AKI
A
20-30 kcal/kg/day
17
Q
Protein intake of patients with noncatabolic AKI without the need for dialysis
A
0.8-1.0 g/kg/day
18
Q
Protein intake of patients with AKI on dialysis
A
1.0-1.5 g/kg/day
19
Q
Protein intake of patients with hypercatabolic AKI and receiving continuous RRT
A
Maximum of 1.7 g/kg/day
20
Q
Treatment of uremic bleeding
A
Desmopressin and estrogen OR may require dialysis in long standing or severe uremia
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)
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
23
Q
Indications for referral to nephrologist in patients with CKD stage 3 and 4 (3)
A
- Declining GFR
- Albuminuria
- Uncontrolled hypertension
24
Q
Leading categories of etiologies of CKD (5)
A
Diabetic nephropathy
GN
HTN-associated CKD
ADPKD
Other cystic and tubulointerstitial nephropathy
25
When to start giving sodium bicarbonate supplement?
Replace if serum bicarb concentration falls below 20-23 mmol/L
> To avoid protein catabolic state
> Slow progression of CKD
26
Promotes phosphate excretion and is an independent RF for LVH and are associated with increased mortality
FGF 23
27
What is the bone histology finding of oteitis fibrosa cystica?
Abnormal osteoid bone and BM fibrosis; advance stage: formation of bone cysts and sometimes with hemorrhagic elements — brown tumor
classic lesion of secondary hyperparathyroidism
28
Presents with reduced bone volume and mineralization d/t excessive PTH production (Use of Vitamin D and excessive calcium exposure), chronic inflammation
Adynamic bone disease
29
Complications of adynamic bone disease (4)
1. Fracture
2. Bone pain
3. Vascular and cardiac calcification
4. Tumoral calcinosis
30
What compound does warfarin decrease causing calciphylaxis in CKD patients?
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
31
National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines recommend a target PTH level of ___
Target PTH level: 2 and 9 times the ULN
* Very low PTH: Adynamic bone disease and possible fracture and ectopic calcification
32
Stage of CKD where normocytic Normochromic anemia is seen universally?
Stage 4
* Normocytic, normochromic anemia:
* Stage 3: Observed as early
* Stage 4: Universal
33
Target hemoglobin of patients with CKD
110-115g/dL
34
Subtle neuromuscular disease in CKD starts at what stage and what are the early manifestation?
Stage 3
Mild disturbances in memory, concentration and sleep
* * Later manifestation: Hiccups, cramps and twitching
* * Advanced and untreated: Asterixis, myoclonus, seizures and coma
34
What stage of CKD does peripheral neuropathy and what is the presentation?
Stage 4
Sensory > motor; LE > UE; distal > proximal
34
Management of patients with Nephrogenic Fibrosing Gadolinium
* Recommendation:
* CKD Stage 3 (30-59) MINIMIZE use
* CKD Stage 4-5 (<30): AVOID use
* If needed, rapid removal with HD
35
Contraindication of Kidney Biopsy in CKD patients (6)
1. Small kidneys
2. Uncontrolled HTN
3. Active UTI
4. Bleeding diathesis
5. Ongoing anticoagulation
6. Severe obesity
36
Dialysate used in dialysis
* Potassium: 0-4 mmol/L
* Calcium: 1.2 mmol or 2.5mEq/L
* Sodium: 136-140mmol/L
37
How to do sodium modeling for patients with frequent hypotension during dialysis
* 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
38
An access where cephalic vein is anastamosed end-to-side to the radial artery
Brescia Cimino Fistula
39
What is a frequent complication of subclavin vein catheter?
Subclavian stenoses
40
Determinant of dialysis dose (4)
size, residual kidney function, dietary protein intake, degree of anabolism or catabolism and presence of comorbid conditions
41
Management of hypotension during HD (3)
1. Discontinue ultrafiltration
2. admin of 100-250mL of isotonic saline
3. admin of salt-poor albumin
42
Strategies to prevent muscle cramps during dialysis (3)
1. Reduce volume during dialysis
2. Ultrafiltration profiling
3. Sodium modeling
43
What is the pathophysiology of type A reaction to dialyzer?
IgE mediated intermediate hypersensitivity reaction to ethylene oxide
Occurs soon after initiation of a treatment —> Full blown anaphylaxis
Tx: Steroids of epinephrine
44
What is the pathophysiology of type B reaction?
Complement activation and cytokine release
* Nonspecific chest and back pain
45
Major complication of peritoneal dialysis (5)
1. Peritonitis
2. Catheter-associated non peritonitis infections
3. Weight gain
4. Metabolic disturbances
5. Residual uremia
46
How to diagnose peritonitis in patients on peritoneal dialysis?
Elevated peritoneal fluid leukocyte count (100/mm3), 50% PMN neutrophils
* Presentation: Pain, cloudy dialysate, fever and other constitutional symptoms
47
What is the most common culprit involved in peritoneal dialysis?
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
48
Most common renal infection of patients with PKD
Infected cyst and acute pyelonephritis
* Often due to Gram negative bacteria
49
Major cause of mortality in patients with ADPKD
Cardiovascular complications
50
Risk Factors of progression of ADPKD to ESRD (5)
1. Early diagnosis of ADPKD
2. HTN
3. Gross hematuria
4. Multiple pregnancies
5. Large kidney size
51
Most common extrarenal complication of ADPKD
Liver cysts from biliary epithelia
52
Diagnosis of ADPKD
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
53
This is used as a presymptomatic screening tool for patients at risk for ADPKD
Renal ultrasonography:
* CT scan and T2-MRI with gadolinium as a contrast agent: Detect cysts in smaller size
54
What is the management for infected renal cyst?
* Lipid-soluble antibiotics against gram negative enteric organism: TMP-SMX, quinolone, chloramphenicol
* Treatment duration: 4-6 weeks
55
Hallmark of ADRPKD
Biliary dysgenesis d/t primary ductal plate malformation with associated peri portal fibrosis
56
Most common kidney finding of Tuberous Sclerosis
Angiomyolipomas
57
Prophylactic measure in patient with renal angiomyolipmas >4cm in Tuberous Sclerosis
Surgical removal
58
Postreptococcal GN due to pharyngitis develops __ weeks after infection and ___ weeks after impetigo
throat: 1-3 weeks
skin: 2-6 weeks
59
Lab findings of PSGN
* Decreased CH50, decreased C3, (+) RF, cryoglobulins, immune complexes, ANCA against myeloperoxidase
60
When do we expect the complete resolution of azotemia, hematuria and proteinuria?
3 to 6 weeks from the onset of nephritis
61
What is the gross appearance of the kidney when they have endocarditis-associated GN?
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
What is the treatment for endocarditis-associated GN?
4 to 6 weeks of antibiotics
63
What is the LM and IF/EM presentation of class 1 lupus nephritis?
Light microscopy: Normal glomerular histology
IF/EM: Minimal messangial deposits
64
What is the LM and IF/EM presentation of class 2 lupus nephritis?
Mesangial immune complexes with mesangial proliferation
65
What is the treatment of lupus nephritis class III to 5?
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
What are the criteria for lupus nephritis remission (2)?
Return to near normal renal function and proteinuria of
67
When to perform dialysis or transplantation in patients with lupus nephritis?
Performed 6 months of inactive disease
68
Factors causing poor prognosis for patients with goodpastures syndrome (4)
1. > 50% crescents on renal biopsy with advanced fibrosis
2. Serum crea > 5-6 mg/dL
3. (+) oliguria
4. Need for acute dialysis
69
Treatment of patients with goodpastures for hemoptysis, less severe and maintenance
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
What is the kidney biopsy findings of IgA nephropathy?
Dominant or codominant mesangial IgA deposits, either alone or with IgG, IgM or C3
71
What is the greatest predictive power of adverse renal outcome among patients with IgA nephropathy?
Persistent proteinuria for >/= 6 months
72
What is MEST-C Score?
* M-Mesangial hypercellularity
* E-Endocapillary hypercellularity
* S- Segmental glomerulosclerosis
* T- Tubular interstitial fibrosis
* C- Crescents
73
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?
Patient has granulomatosis with polyangiitis (anti-PR3)
CXR: nodules and persistent infiltrates, sometimes with cavities
Biopsy: Small-vessel vasculitis and adjacent noncaseating granulomas
74
Characteristic of MPGN 2 of Dense Deposit Disease (2)
1. Low serum C3
2. Dense thickening of the GBM with dense deposits and C3
75
What predicts the progression of membranous GN?
Tubular atrophy or interstitial fibrosis
76
The presence of this findings strongly points to diagnosis of membranous lupus nephritis, may precede the extra renal manifestations of lupus?
Subendothelial deposits or the presence of tubuloreticular inclusions
77
What are the worst prognostic indicator of membranous glomerulonephritis (4)?
Male, older age, persistent nephrotic range proteinuria
78
What GN has the highest incidence of DVT, PE and renal vein thrombosis?
Membranous GN
* Prophylactic anticoagulation: Patients with hypoalbuminemia
79
What is a sensitive indicator for the presence of diabetes but correlates poorly with the presence of absence of nephropathy?
Thickening of the GBM
80
What is a Nodular glomerulosclerosis or Kimmelstiel-Wilson nodules?
Eosinophilic, PAS positive nodules
81
What is the single most important predictor of a faster decline in GFR in patients with DM nephropathy?
Albuminuria
82
What is the treatment for patients with primary amyloidosis?
Delay: Mephalan; autologous HSCT
Not HCT candidate: Bortezomib-based regimens
83
This treatment is a chaperone that facilitates trafficiking of alpha Gal-A, clears microvascular endothelial deposits of globotriaosylceramide from the
kidneys, heart, and skin?
Migalastat
84
What is the eye findings of patient with alport's syndrome?
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
What is the skin biopsy findings of patient with Alport's Disease?
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
What is the renal biopsy findings of patient with Alport's Disease?
Thinning mixed with splitting
** Early: Thin basement membrane >> 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
What is the biopsy finding of HIVAN?
FSGS, collapsing glomerulopathy with visceral epithelial cell swelling, microcytic dilatation of the renal tubules, tubuloreticular inclusion
88
What are renal findings associated with hepatitis B?
Polyarteritis nodosa, appearing 6 months after hepatitis B infection
> Renal artery infarct, scar, aneurysm
Children: MGN with predominant IgG1
deposition
Adult: MPGN
89
What are findings associated with hepatitis C?
Type 2 Mixed cryoglobulinemia, nephrotic syndrome, microscopic hematuria, abnormal liver function tests, depressed C3 levels, anti–hepatitis C virus (HCV)
90
What are renal findings associated with syphilis (2)?
1. Nephrotic syndrome from MGN from treponema antigen
2. Interstitial syphitilitic nephritis
91
What species of Schistosomiasis is most commonly associated with clinical renal disease?
S. mansoni
92
Urinalysis findings of patiets with acute interstitial nephritis
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
When is glucocorticoid indicated in patients with acute interstitial nephritis?
For severe kidney injury in which dialysis is imminent or if kidney function continues to deteriorate
94
What are the absolute indications for glucocorticoids in patients with AIN (6)?
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
What are the relative indications for glucocorticoids in patients with AIN (3)?
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
What is the most common renal manifestation of Sjogren's disease?
TIN with a predominant lymphocytic infiltrate
Others: impaired kidney function, distal RTA, and nephrogenic diabetes insipidus
97
What is the hallmark of TINU?
Lymphocyte-predominant interstitial nephritis, painful anterior uveitis, often bilateral and accompanied by blurred vision and photophobia
98
Treatment of fibrotic lesions found on patients with IgG4 related systemic disease?
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
When does serum creatinine increase in patients with AIN with use of Immune Checkpoint Inhibitors?
within 15 weeks after starting therapy, but may occur later or 2 months after discontinuing
100
Urinalysis of patients with Bence-Jones Protein?
Increased amount of protein in a spot urine specimen with negative dipstick
101
What is the kidney ultrasound findings of VURD?
Asymmetric small kidneys with irregular outlines, thinned cortices, regions of compensatory hypertrophy
101
Characteristics of analgesic nephropathy (3)
1. Impaired kidney function
2. Papillary necrosis
3. Radiographic constellation: Small kidneys with papillary calcifications on CT
102
What are the 2 causes of aristolochic nephropathy?
1. Chinese herbal nephropathy
2. Balkan endemic nephropathy
103
Definitive diagnosis of aristolochic nephropathy?
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
Severe complications of aristolochic nephropathy?
Upper urinary tract urothelial cancers
* Surveillance with CT, ureteroscopy and urine cytology
* Tx: Bilateral nephroureterectomy once ESRD reached
105
What is the most common renal sequelae of Lithium-Associated Nephropathy?
Nephrogenic DI presenting as polyuria and polydipsia
106
What are the kidney biopsy findings of suggestive of Lithium-Associated Nephropathy?
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
What is the histologic finding of Calcineurin Inhibitor Nephrotoxicity?
Histology showed patchy interstitial fibrosis and tubular atrophy - striped pattern
108
What is the early sign of heavy metal nephropathy?
Proximal tubule dysfunction, particularly hyperuricemia
109
What is the triad to suspect lead exposure?
Saturine gout
HTN
Impaired kidney function
110
What is the most striking defect associated with hypercalcemic nephropathy?
Inability to concentrate urine
111
What is the PENTAD of TTP?
Pentad (FATRN)
1. Fever
2. MAHA
3. Thrombocytopenia
4. Renal Failure
5. Neurologic Symptoms
112
What is the main cause of TMA associated with chemo and immunosuppressive agents?
Toxic endothelial damage
113
What is the renal lesion associated with scleroderma?
Onion-skinning
Arcuate artery intimal and medial proliferation with luminal narrowing (Onion skinning) + Glomerular collapse due to reduced BF
114
What is the antibody that is used to identify young patients at risk for sclerodermal renal disease?
Anti-U3 RNP
115
Negative predictor for sclerodermal renal disease?
Anticentromere antibody
116
What is HEELP syndrome?
Hemolysis
Elevated Liver enzymes
Low platelets
117
What is POEMS and what is the hallmark of this disease?
POEMS:
Polyneuropathy
Organomegaly
Endocrinopathy
Monoclonal gammopathy
Skin changes
Hallmark: Peripheral neureopahy with severe motor-sensory deficit
118
Dietary risk factors causing nephrolithiasis (5)
Animal protein
Sodium
Fructose
Sucrose
Oxalate
119
Diet that lowers risk of having nephrolithiasis (3)
Calcium
Potassium
Phytate
120
Strong risk factor for calcium oxalate
Urine oxalate
121
Effects of urine pH on the formation of urine stones?
UA stones: Forms when pH /= 6.5
Cysteine: Soluble at higher pH
Calcium Oxalate: Not affected by pH
122
Two common presentation of patients with acute stone
Renal colic
Painless gross hematuria
123
Pain radiaiton of nephrolithiasis depending on the stone location
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
Indication of urgent urologic intervention (3)
1. UTI - urologic emergency, pus under pressure
2. Low probability of passage: >/= 6mm OR anatomic abnormality
3. Intractable pain
125
What is the procedure of choice for patients with large upper tract stones?
Percutaneous nephrostolithotomy
126
What diagnostic test is the cornerstone on which therapeutic recommendations are based on patients with nephrolithiasis?
24-hour urine collection
127
Medication that can reduce calcium oxalate store recurrence by > 50%
Chlorthalidone
** Thiazide diuretic higher than those used in hypertension: reduce urine calcium excretion
128
What is the 2 main risk factors for having uric acid stones?
Low urine pH and high uric acid excretion
129
What is the recommended pH goal in patients with uric acid stones?
pH of 6.5
* Supplement with bicarbonate or citrate
130
How does amphotericin B cause AKI (5)?
Direct tubular toxicity; polyuria, hypomagnesemia, hypocalcemia, and nongap metabolic acidosis.
131
Level of the serum bicarbonate and pH do you give IV sodium bicarbonate in acute kidney injury
a. HCO3 < 15 and pH < 7.20
132
What are the symptoms of cauda equina syndrome (3)?
1. Overflow urinary incontinence
2. Sudden onset fecal incontinence
3. Severe lower back pain
4. Saddle anesthesia
133
What is pathognomonic of vesicoureteral reflux?
Flank pain that occurs with micturition
134
What should you do if suspecting UTO?
Insert bladder catheter
135
This imaging is used to predict the reversibility of renal dysfunction.
Renal radionuclide scan
136
This disease mimics the state of chronic loop diuretic intake?
Barrter
137
What does Gittelma's syndrome mimic?
Thiazide diuretic intake
138
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
Tacrolimus
139
What antibiotics are preferred for renal cyst infection?
Lipid-soluble antibiotics against gram negative enteric organism:
TMP-SMX, quinolone, chloramphenicol: Preferred for cyst infection
Treatment duration: 4-6 weeks
140
Considered in a patient with hypernatremia who responds with increased urine osmolality after desmopressin?
Central DI
141
Major causes of death in chronic kidney transplant?
1. Cardiovascular events (29%)
2. Infection (18%)
3. Malignancy (17%)
142
Predisposing factor for contrast-induced nephritis?
* 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
Acute Kidney Injury with findings of calcium oxalate should alert clinician to r/o what disease?
Ethylene glycol ingestion
144
What are the causes of false positive dipstick examination (3)?
Causes of false positive dipstick examination:
1. pH > 7.0
2. Very concentrate urine
3. Contaminated with blood
145
Which stain is used to better identify basement membrane structure in kidney biopsies?
Jones methenamine silver
146
Potent afferent vasoconstrictor of the afferent arteriole
Adenosine
147
Indication of admission for patients with acute pyelonephritis (5)
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
Indications for radiologic evaluation for patients with acute pyelonephritis (3)
1. urine pH <7.0
2. History of urolithiasis
3. Renal insufficiency
149
Failure to treat asymptomatic bacteuria in pregnancy can result in the following (3)
1. Maternal pyelonephritis
2. Preterm delivery
3. LBW babies
150
Known sources of sensitization in KT (4)
1. Blood transfusion
2. Prior transplant
3. Pregnancy
4. Vaccination / Infection
151
