nephrology Flashcards
Salt supplements favored by many patients often are high in (what electrolyte?)
Salt supplements favored by many patients often are high in (potassium)
Principal cells of the collecting ducts becoming resistant to antidiuretic hormone describes what disease?
Nephrogenic diabetes insipidus
Which hormone abnormality typically causes euvolemic hypotonic hyponatremia?
SIADH
Patient with kidney disease on dialysis, longstanding hyperparathyroidism, and lytic lesions of the skeleton.
Diagnosis: Renal osteodystrophy
Reduced number of nephrons leads to a decrease in phosphate excretion ultimately leading to an increase in secretion of FGF 23 and PTH which both decrease phosphate excretion.
Serum osmole gap greater than 10 occurs with ethanol intoxication or with (what)?
ingestion of toxic alcohols.
What type of urinary casts/bodies will be seen in nephrotic syndrome?
oval fat bodies or fatty casts.
Thiazides can cause (hyper/hypo)calcemia.
Thiazides can cause (hyper)calcemia.
Obesity related glomerular hyperfiltration can damage the glomeruli eventually leading to what?
a rise in protein and creatinine.
The clinical features of nephrotic syndrome include?
hypoalbuminemia, edema, and nephrotic-range proteinuria (3500 mg/24hr)
may also see hyperlipidemia.
Chronic discomfort in pelvic or genital region with nonspecific urinary symptoms and no infection likely indicates what?
Likely diagnosis: Chronic pelvic pain syndrome
Polyuria in type 2 diabetes will typically show (higher/lower) urine osmolarity.
Polyuria in type 2 diabetes will typically show (higher) urine osmolarity.
Metabolic alkalosis can cause refractory hypokalemia by what mechanism?
As renal bicarbonate excretion increases, a cation such as sodium and potassium also needs to be excreted at the same time.
Three groups of medications that are often implicated in causing acute interstitial nephritis are?
NSAIDS, proton pump inhibitors, and antibiotics.
Painful, violaceous, nodules with CKD, hypercalcemia, hyperphosphatemia indicate what diagnosis?
DX: Calciphylaxis
Most appropriate test to establish cause of acute kidney failure in an old man with oliguria, suprapubic fullness, and tenderness?
kidney and bladder ultrasound.
Prednisone is the first-line therapy for which condition?
primary FSGS along with an ACE inhibitor.
An ethanol level greater than 300 is potentially fatal.
An ethanol level greater than 100 is the definition for what?
ethanol intoxication.
Nephritic syndrome with low complement levels 2-3 weeks after upper respiratory infection indicates what diagnosis?
Dx: PSGN
Evaluation of recurrent kidney stones should include?
metabolic panel, a CT, 24-hour urine studies, and stone analysis.
A high serum ethanol level with an osmole gap but no anion gap is consistent with what diagnosis?
ethanol intoxication.
Fever, skin rash, and peripheral eosinophilia are three classic findings in what condition?
acute interstitial nephritis.
Patient has a urostomy with stomal stenosis and a non-anion gap metabolic acidosis; what is the initial step?
placement of a Foley catheter.
Patient presents with polyuria and hypernatremia; what is the most appropriate next step?
to measure urine osmolality.
Obesity leads to an (increase/decrease) in glomerular pressures and hypertrophy of the glomeruli.
Obesity leads to an (increase) in glomerular pressures and hypertrophy of the glomeruli which results in hyperfiltration.
Diabetes insipidus during pregnancy is caused by what?
placental production of vasopressinase.
The best screening test for diabetic nephropathy is?
urine albumin to creatinine ratio.
Stagnant urine in the intestine can result in absorption of chloride in exchange for bicarbonate, resulting in what metabolic abnormality?
hyperchloremic metabolic acidosis.
Older man with dysuria, urinary urgency, no urinary incontinence, fever, and perennial tenderness likely has?
Diagnosis: Acute bacterial prostatitis.
Diagnostic test for acute bacterial prostatitis?
urine culture.
All patients presenting with gross hematuria will be evaluated first with?
CT urography followed by cystoscopy to rule out malignancy.
Typical treatment for obesity related glomerular hyperfiltration includes?
either an ACE or an ARB.
Patient had gastric bypass surgery and multiple kidney stones; the most likely stone is made of?
calcium oxalate due to malabsorption of free fatty acids.
Asymptomatic SIADH is managed with?
limiting all fluids to less than 1L daily.
In secondary FSGS, treatment with an (what class?) drug and general blood pressure control (with/without) immunosuppressive therapy is the standard.
In secondary FSGS, treatment with an (ACE inhibitor) drug and general blood pressure control (without) immunosuppressive therapy is the standard.
Acute infection of the urinary tract alone rarely causes kidney dysfunction (T/F)?
(T) Acute infection of the urinary tract alone rarely causes kidney dysfunction.
Diagnostic test for vesicoureteral reflux?
voiding cystourethrogram.
Magnesium ammonium phosphate stones typically form in the setting of (what past medical history?)
recurrent UTI.
PPIs indirectly affect the luminal pH of the intestines which can potentially cause (hypo/hyper)magnesemia.
PPIs indirectly affect the luminal pH of the intestines which can potentially cause (hypo)magnesemia.
Lithium is known to cause what classic kidney disease?
Nephrogenic diabetes insipidus.
IV magnesium rarely works to maintain normal levels in hypomagnesemia because?
most the magnesium is filtered through the kidneys; the magnesium delivered exceeds the capacity of the kidneys to reabsorb.
Thiazides are used to (decrease/increase) urinary excretion of calcium.
Thiazides are used to (decrease) urinary excretion of calcium.
The best option outpatient for hypomagnesemia needing frequent replacements is?
sustained-release preparations taken in divided doses.
Topiramate can cause what renal abnormality?
Calcium phosphate kidney stones.
What are the clinical features of nephrotic syndrome?
Hypoalbuminemia, edema, and nephrotic-range proteinuria (3500 mg/24hr) may also see hyperlipidemia.
What can obesity-related glomerular hyperfiltration lead to?
Damage to the glomeruli, leading to a rise in protein and creatinine.
What is the next indicated step if chronic pelvic pain syndrome features in a male after a 6-week course of antibiotics did not work?
Start an alpha blocking agent such as alfuzosin.
What is the first line drug therapy for FSGS?
Prednisone along with an ACE inhibitor to reduce proteinuria.
What is the most appropriate initial diagnostic test for renal vascular hypertension and acute kidney injury?
Duplex ultrasonography of the renal arteries.
What acid-base abnormality may patients with an ileal or colonic conduit urinary diversion experiencing stomal stenosis have?
Hyperchloremic metabolic acidosis.
What is the likely diagnosis for multiple UTIs since childhood and current UTI as a young adult?
Vesicoureteral reflux.
What disease is the Streptozyme test commonly used to assess for?
Post-streptococcal glomerulonephritis (PSGN).
What is the most appropriate test to establish the cause of acute kidney failure in an old man with oliguria, suprapubic fullness, and tenderness?
Kidney and bladder ultrasound.
What should patients with intravascular volume depletion before IV acyclovir receive?
Fluid resuscitation sufficient to maintain a urine output of at least 75 mL/hour.
If a patient with primary FSGS does not respond to Prednisone or has contraindications, what initial treatment is reasonable to consider?
Initial treatment with a calcineurin inhibitor such as cyclosporine or tacrolimus.
What should evaluation of recurrent kidney stones include?
Metabolic panel, a CT, 24-hour urine studies, and stone analysis.
What may calciphylaxis patients experience in their fingers/extremities?
Pain secondary to ischemia.
What should older men with findings suggestive of prostate cancer undergo?
Evaluation with a transrectal prostate biopsy procedure regardless of prostate specific antigen level.
What should be considered in difficult to control hypertension in a patient already on multiple antihypertensives?
Consider adding a diuretic class of drug.
True or False: Older men with findings suggestive of prostate cancer should undergo evaluation with transrectal prostate biopsy regardless of prostate specific antigen level.
True.
What is cleared by the kidneys?
Gabapentin.
