Nephrology

Question 1

Define Hydronephrosis

Answer 1

Unilateral or bilateral edema of the collecting system

Question 2

Indications for renal biopsy

Answer 2

1. Nephrotic syndrome
2. Acute nephritic syndrome
3. Unexplained acute renal failure

Question 3

Acute Kidney Injury (AKI)

Answer 3

• Abrupt (within 48 hrs) decline in renal filtration function
• Usually reversible

Question 4

Acute Renal Failure (ARF) criteria

Answer 4

1. Decrease in GFR and UOP (< 0.5 mL/kg/hr for >6 hrs)

2. Increase in urea and Creatinine. (azotemia)

Question 5

End stage renal disease time criteria

Answer 5

> 3 months

Question 6

What is the MC AKI?

Answer 6

Prerenal= 55-70%

Question 7

Define prerenal AKI

Answer 7

Hypoperfusion leading to decrease in renal perfusion

Question 8

List causes of prerenal AKI

Answer 8

1. Decrease in intravascular volume: Hemorrhage, dehydration, nephrotic syndrome
2. Change in vascular resistance: Cirrhosis, sepsis, anaphylaxis
3. Low CO: CHF, PE, tamponade

Question 9

What is the BUN/Cr ratio in Prerenal AKI

Answer 9

20:1

Question 10

What nephrotoxic drugs do you want to avoid?

Answer 10

1. NSAIDs
2. ACE-1
3. Digoxin

Question 11

What are some of the main causes of intrinsic AKI

Answer 11

1. Acute Tubular Necrosis. (ATN)
2. Interstitial (AIN)
3. Glomerular (GN)
4. Vascular

Question 12

What is the MC cause of intrinsic AKI?

Answer 12

Acute Tubular Necrosis. (ATN)

Question 13

Define ATN

Answer 13

Tubular damage due to:

1. Ischemia: Prolonged hypotension/hypoxemia
2. Nephrotoxins:
   - Aminoglycosides
   - Ampicillin
   - Vancomycin
   - IV contrast
3. Sepsis

Question 14

ATN treatment

Answer 14

1. Avoid volume overload
2. Avoid Hyperkalemia
3. Protein restrict
4. +/- diuretics

Question 15

What do you want to give to renal protect from radiographic contrast?

Answer 15

N-acetylcystine/IVF with bicarb

Question 16

What do you see in the urine in ATN?

Answer 16

Muddy brown casts

Question 17

Define interstitial intrinsic AKI

Answer 17

Inflammatory response leading to edema and possible tubular cell damage

Question 18

What is the MC of interstitial intrinsic AKI

Answer 18

Nephrotoxic drugs

Question 19

UA findings in interstitial intrinsic AKI

Answer 19

eosinophiluria

Question 20

interstitial intrinsic AKI treatment

Answer 20

1. Steroid

2. +/- dialysis

Question 21

Glomerulonephritis (GN) etiology

Answer 21

Immune complex deposition

Question 22

List the causes of glomerulonephritis

Answer 22

1. IgA nephropathy (Berger dz)
2. Postinfectious strep GN
   MPGN
3. Goodpastures (anti GBM), 4. Wegeners:Granulomatosis with Polyangiitis

Question 23

UA findings in glomerulonephritis

Answer 23

RBC casts

Question 24

Glomerulonephritis treatment

Answer 24

1. Steroids

2. Plasma exchange

Question 25

Postrenal AKI causes

Answer 25

Obstruction due to: 1. BPH 2. Urolithiasis 3. Bladder dysfunction (anticholinergic drugs) 4. Bladder CA

Question 26

MC sx in postrenal AKI

Answer 26

lower abdominal pain

Question 27

Postrenal Diagnostics

Answer 27

Bladder US

Question 28

Postrenal lab findings

Answer 28

elevated BUN: Cr ratio

Question 29

Postrenal tx

Answer 29

1. Catheter 2. Stent 3. Surgery depending on etiology

Question 30

Define Azotemia

Answer 30

- Nitrogen in the blood | - Occurs when renal function can no longer efficiently clear metabolites

Question 31

What does Azotremia lead to?

Answer 31

Uremia

Question 32

What are the markers of nitrogen accumulation?

Answer 32

1. Blood Urea Nitrogen (BUN) | 2. Cr

Question 33

Where is urea produced? Excreted? How is it monitored?

Answer 33

Produced by liver Excreted by urine Monitored with BUN

Question 34

What is the gold standard diagnostic test for CKD?

Answer 34

GFR

Question 35

CKD lab findings

Answer 35

1. Elevated BUN and Cr 2. Proteinuria 3. Microalbuminuria 4. Abnormal Hgb, Hct, electrolytes, UA

Question 36

CKD treatment

Answer 36

1. ACE-1 or ARBS 2. Antiplatelet therapy: ASA 3. Epo, FE 4. Low protein diet 5. Fluid restriction 6. Calcium and Vitamin D supplements 7. Consider dialysis/transplant

Question 37

ESRD/CKD causes

Answer 37

1. Polycystic kidney disease 2. DM 3. Glomerulonephritis 4. Hypertension 5. Systemic Lupus 6. Erythematosus 7. Nephrolithiasis

Question 38

SLE renal disease presentation

Answer 38

1. Nephritis | 2. Proteinuria

Question 39

What is the most common renal stone?

Answer 39

Calcium=75-85% (radiopaque)

Question 40

Nephritic syndrome clinical presentation

Answer 40

1. Hematuria 2. RBC casts 3. Mild proteinuria 4. HTN

Question 41

Nephritic syndrome treatment

Answer 41

1. Diuretics 2. Salt/water restriction 3. Dialysis

Question 42

Nephrotic syndrome etiology

Answer 42

1. Membranous Nephropathy: Immune complexed from infection 2. Amyloidosis 3. DM

Question 43

Nephrotic syndrome presentation

Answer 43

``` APLE A-hypoAlbuminermia P- Proteinuria P-hyperLipidemia E- Edema ```

Question 44

What are the 3 major causes of death for dialysis patients?

Answer 44

1. CV dz 2. Infection (S.aureus) 3. Dialysis withdrawal

Question 45

Hypercalcemia clinical presentation

Answer 45

1. Bones 2. Stones 3. Groans

Question 46

Hypercalcemia treatment

Answer 46

1. Primary hyperparathyroid | 2. Malignancies

Question 47

Hypocalcemia signs

Answer 47

1. Trousseau sign: carpal tunnel spasm) | 2. Chevostek sign: spasm of facial muscles

Question 48

Hyperphosphatemia cause

Answer 48

MC= secondary to CKD

Question 49

What is Hypophosphatemia associated with?

Answer 49

EtOH

Question 50

EKG findings in Hypomagnesemia

Answer 50

Widening of QRS

Question 51

Type 1 DM clinical presentation

Answer 51

1. Polydipsia 2. Polyuria 3. Nocturia 4. Weight loss 5. Blurred vision 6. Pruritus 7. Weakness 8. Postural hypotension 9. Gastroparesis