Nephrology

Question 1

Prerenal Azotemia

Dx parameters

Answer 1

Bun:Cr >15:1 and often >20:1

FEna <1%

Ur Na is low < 20
Ur osmolality > 500

Question 2

Intrarenal azotemia

Dx parameters

Answer 2

Bun: Cr 10:1

UrNa> 40

UrOsmolality< 350

Question 3

Reasons for dialysis

Answer 3

• hyperK
• uremia with encephalopathy/ malnutrition / pericarditis
• met acidosis
• lithium toxicity , ethylene glycol toxicity, Aspirin toxicity
• fluid overload

Question 4

Uremia manifestations and their Tx

Hyperphosphatemia
Hypermagnesemia
Hypocalcemia
Anemia

Answer 4

Ca acetate, Ca carbonate phosphate binders

Dietary Mg restriction

Vit D replacement

Epo replacement

Question 5

Central and Nephrogenic DI

Features
Response to DDAVP

Answer 5

Low UrNa
Low UrOsm
Increased urine volume

Central DI responds in getting desmopressin but nephrogenic DI doesn’t because the kidney is insensitive

Question 6

Hypervolemic hyponatremia

Hypovolemic hypoNa

Euvolemic hypoNa

Causes;

Answer 6

CHF
Nephrotic syndrome
Cirrhosis

Diuretics
Vomiting and diarrhea
Burns and sweating
… all give low ûrine sodium

SIADH
Hyperglycemia
Hypothyroidism
Psychogenic polydipsia

Question 7

SIADH

Causes
Parameters

Answer 7

Any lung disease
Any cns abnormality
Cancer
Meds like: sulfonylureas, SSRIs, carbamazepine

Inappropriately high UrNa (>20 mEq/P)
Inappropriately high urine osmolality(>100)
Low serum osmolality (<290)
Low serum uric acid
Normal bun/Cr And bicarbonate

Question 8

Renal Cystic disease

Answer 8

Recurrent hematuria
Stones
Infections

There are multiple extrarenal cysts:
Liver
Ovaries
Circle of Willis
MVP
Diverticulosis 

Mc site of extrenal cysts: Liver

Mcc of death: end stage renal disease

Question 9

Amphotericin causes low or high K

Low or high Mg

Answer 9

Low

Low

Question 10

Bartter syndrome

Secondary hyperaldo causing…

Answer 10

HypoK

Question 11

IV K replacement fast or slow

Avoid what

Answer 11

Slow to not cause an arrhythmia

Avoid glucose containing foods.

Question 12

Renal artery stenosis

Answer 12

Presents with hypoK

Best initial: kidney ultrasound

If a small kidney…
MRA
Duplex ultrasonogram
Nuclear renogram

Most accurate is renal angiogram

Tx with renal angioplasty and stenting

Question 13

HTN what to order on ccs

Answer 13

EKG
UA
Eye exam
Cv exam