Nephrology 3

Question 1

Intermittent Hypokalemia with metabolic alkalosis in the absence of vomitting. Dx?

Answer 1

Surreptitous purging or Diuretic Use. (DO Urine Screen for Diuretics)

Question 2

Elevated insulin levels with low C-peptide. Dx?

Answer 2

Exogenous Insulin Abuse.

Question 3

1. Podocyte injury from circulating factor; immunoflourence is negative, Proteinuria. Associated with overt Nephrotic Syndrome.
   Dx?
2. Podocyte injury from glomerular hyperfiltration due to Obesity, (toxins) Heroin, (infectIon)HIV, nephrotic Proteinuria.
   Dx?
   Rx?

Answer 3

1. Primary FSGS. Steroids, Plasmapharesis (removal of antibodies)
2. Dx: Secondary FSGS. Treat underlying conidtion.
   Rx: Steroids will not be helpful because Secondary FSGS is not Immune (Antibody) mediated.

Question 4

Following CT Scan patient presents with AkI 24-48 hrs after. UA shows muddy brown cast. Dx?

Answer 4

Contrast Induced nephropathy.

Question 5

S/p endovascular procedure. Pt presents with AKI, sterile pyuria and WBC cast. Dx?

Answer 5

Cholesterol Embolization.

Question 6

Causes can be Abx, PPIs, NSAIDs, SS, SLE, infections. Pt presents with AKI, Hematuria, pyuria with WBC CAST, Peripheral eosinophilia and urine eosinophils. DX?

Answer 6

AIN. Acute interstitial Nephritis. (May not always present with fevers, rash and eosinophilia)

• look for DRUG, WBC CAST + AKI

Question 7

Management of Hypercalcemia?

When to avoid bisphosphenates?

Answer 7

IV NS. Calcitonin, Bisphosphenates

• Avoid if NON-Oncologic cause of hypercalcemia when Creatinine > 4.5, Cr Clearence < 35 ml/min

Question 8

Management of BPH.

Answer 8

1. Bladder training and fluid management strategies
2. Alpha-adgrenic antagonist (terazosin)
3. If symptoms are persistent then Post Void Residual and then Add Anti-muscarinic

Question 9

1. Management of Kidney stone < 10mm?
2. When to send for consult?

Answer 9

1. IV Hydration, Pain Control and Flomax
2. Stone > 10mm, AKI, Uncontrolled Pain, Does not pass 4-6weeks.

Question 10

Commonly seen in Children
Associated with < 1g of protein in urine a day
No hematuria or elevated creatinine

Dx?
Test?

Answer 10

Orthostatic Proteinuria.
Morning void low protein, Nightime void high protein.

Question 11

Women > 65, hx of chronic constipation, distended abdomen, hard stool in rectal vault presents with acute onset urinary incontinence. Dx? Rx?

Answer 11

Dx: Transient Incontinence ( Constipation, UTI, Medications).

Rx: Polyethylene Glycol.

Question 12

Pt presents with acute flank pain, dysuria, CVA tenderness after receiving Sulfadiazine.

Dx?
Rx?

Answer 12

Dx: Crystal Induced AKI due to sulfadiazine being poorly insoluble in an acidic urine pH.

Rx: Hydrate and Alkalinize the urine

Question 13

Next step in management with Cirrhotic patient presenting with worsening AKI.

Answer 13

IV Albumin.

If no improvement then it is HRS (Hepatorenal Syndrome) due to the NO vasodilation from Crrhosis causing the Kidney to compensatory Vasocontrict and lower GFR.

Give Miodrine and Octreotide for this.

Question 14

1. Associated with confusion in Beer and Wine
2. Associated with vision deficits in Winshield Wiper fluid
3. Associated Calcium Oxalate Crystals in Antifreeze
4. Associated with Confusion in Rubbing Alochol and Hand sanitizer.

Answer 14

1. Ethanol.
   Increased Osmolal Gap and Anion Gap
2. Methanol (Formic Acid)
   Increased Osmal Gap and Anion Gap
3. Ethylene
   Increase Osmolal Gap and Anion Gap.
4. Isopropyl alcohol
   Increased Osmolal Gap
   NORMAL Anion Gap