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Boards Studying > Nephrology > Flashcards

Nephrology Flashcards

1
Q

Poorly controlled DM and HTN with low Na+, high K+, low HCO3

A

RTA type 4

  • hypoaldosteronism
  • can be caused by DM
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2
Q
  1. Muddy brown granular casts
  2. RBC casts
  3. WBC casts
  4. Fatty casts
  5. Broad & waxy casts
A
  1. ATN
  2. glomerulonephritis
  3. interstitial nephritis & pyelonephritis
  4. nephrotic syndrome
  5. chronic renal failure
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3
Q

Within 5 days of upper respiratory tract infection, young adult men, gross hematuria, normal complement levels

A

IgA nephropathy

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4
Q

Nephro risk with acyclovir

A

kidney rapidly excretes it in the urine, but the drug has low urine solubility –> obstruction

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5
Q

Prevent uric acid stones

A

alkalinize urine with potassium citrate

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6
Q

child with edema, hypoalbuminemia, elevated urine protein and Hepb +

A

membranous nephropathy

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7
Q

Pt with HTN, DM 2, HLD, and CKD has a K+ of 6.0. Only sx are mild fatigue. Next best step

A

Review current medications

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8
Q

Pt with CKD starts bleeding from blood draw site

A

Uremic coagulopathy - platelet dysfunction (platelet-vessel wall and platelet-platelet interaction) due to uremic toxins (guanidinosuccinic acid)
tx = DDAVP

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9
Q

18 yo AA male with polyuria and nocturis despite fluid restriction. Normal sodium and low urine osmolality. Mom died from sickle cell disease and stroke

A

Hyposthenuria - inability of kidneys to concentrate the urine (seen in SCD and SCT)

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10
Q

Fever, tinnitus, tachypnea in an overdose patient

A

ASA toxicity - mixed respiratory alkalosis and anion gap metabolic acidosis

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11
Q

gross hematuria in African American male with no other sx or lab abnormalities

A

Renal papillary necrosis - associated with sickle cell dz

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12
Q

Patient with recurrent sinusitis and otitis media with 2+ protein and blood on UA.

A

Granulomatosis with polyangiitis

  • upper resp: sinusitis/otitis, saddle nose
  • lower resp: lung nodules, cavitation
  • renal: rapidly progressive GN
  • skin: levido reticularis, nonhealing ulcers
  • ANCA: PRS, MPO
  • tx: steroids, immunomodulators
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13
Q

how to calculate serum osmolal gap

A

measured serum osmolality - calculated serum osmolality

calculated = (2*Na) + (glucose/18) + (BUN/2.8)

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14
Q

high anion gap metabolic acidosis with osmol gap

A
  • ethylene glycol (urinary calcium oxalate crystals)
  • methanol (blindness)
  • propylene glycol
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15
Q

Pt with hx of RA presents with 4+ proteinuria, hepatomegaly and enlarged kidneys

A

Amyloidosis

- amyloid deposits that stain with Congo Red that demonstrate an apple green birefringence under polarized light

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16
Q

kidney dz most likely associated with HIV

A

FSGS

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17
Q

Pt with nephrotic syndrome is at risk for developing

A

Hypercoagulability - urinary loss of antithrombin 3, altered levels of protein C and S, increased platelet aggregation, hyperfibrogenemia due to increased hepatic synthesis

  • protein malnutrition
  • iron-resistant microcytic hypochromic anemia
  • increased susceptibility to infection
  • vit D deficiency
18
Q

Pt whos on cannabinoids and cocaine with CK of 26000 is at risk for

A

acute renal failure

19
Q

What you see in the kidneys due to HTN

A

arteriosclerotic lesions of the afferent and efferent arterioles and glomerular capillary tufts

20
Q

What you see in kidneys due to DM

A

increased extracellular matrix, BM thickening, mesangial expansion, fibrosis

21
Q

Tx to aid in passage of a stone in distal ureter

A

Tamsulosin

- alpha receptors are found in distal ureter and relaxing them allows passage of stone

22
Q

Effect of fibromuscular dysplasia on the kidneys

A

Decreases perfusion to kidneys –> increased aldosterone and renin (secondary hyperaldosteronism)

23
Q

How to prevent uric acid kidney injury with initiation of chemotheraphy

A

pretreatment with iv fluids and allopurinol

24
Q

Male with recurrent UTIs treated multiple times with abx and has minor improvement. Prostate is smooth and nontender. He has pain with ejaculation. External genitalia are normal. UA shows pyuria with bacteria

A

Chronic bacterial prostatitis

- tx with fluoroquinolones for 6 weeks

25
Q

Effect of trimethoprim on kidneys

A

blocks epithelial sodium channel in collecting tubule - leads to hyperkalemia

26
Q

Fluctuating fatigable extraocular and bulbar (dysarthria, dysphagia) muscle weakness as well as symmetrical proximal weakness of the neck and extremities

A

Myasthenia gravis

- problem with motor end plate/NM junction

27
Q

When urgent dialysis is required

A

AEIOU
Acidosis (metabolic) pH<7.1
Electrolytes (hyperkalemia - sx or >6.5)
Ingestion (toxic alcohols, salicylate, lithium, sodium valproate, carbamazepime)
Overload by fluids
Uremia (pericarditis, encephalitis, bleeding)

28
Q

Homeless man with hypocalcemia and calcium oxalate deposition in kidneys

A

Ethylene glycol ingestion

  • give fomepizole or ethanol to inhibit alcohol dehydrogenase
  • sodium bicarb to correct acidosis
  • dialysis
29
Q

management of kidney stones

A

< or = 5: will pass on own
6-10: can give alpha blocker
>10, refractory pain, anuria, AKI, urosepsis: urology consult

30
Q

4 month old with macrocytic anemia, reticulocytopenia, normal platelets and WBCs. Has triphalangeal thumbs and craniofacial abnormalities (cleft palate, webbed neck).

A

Diamond-Blackfan anemia

  • congenital erythroid aplasia
  • tx: corticosteroids and transfusions RBCs
31
Q

deposits on C3 in GBM with fatigue, LE edema and dark urine

A

Membranoproliferative glomerulonephritis

- activation of alternate complement pathway

32
Q

Well defined hypoechoic testicular mass with elevated bhcg and negative afp

A

seminoma

33
Q

Drugs that cause hyperkalemia

A

NSAIDs, TMP/SMX, ACEi, ARBs

sx: muscle weakness, cardiac arrhythmia, decreased DTRs

34
Q

Renal vein thrombosis is most common seen with

A

membranous glomerulopathy

  • loss of antithrombin III in the urine increases the risk
  • sudden abdominal pain, hematuria and fever
35
Q

Electron micro of alport syndrome

A

splitting of basement syndrome

36
Q

Acute interstitial nephritis

A
  • hypersensitivity to meds like NSAIDs and PPIs (also rifampin, penicillins, cephalosporins) or AI
  • rapid decline in renal function
  • Rash, fever and eosinophilia are the classic triad of symptoms
  • inflammatory infiltrate on biopsy
  • tx: steroids
37
Q

cause of HTN in ADPKD

A

renal ischemia –> increased renin release –> secondary hyperaldosteronism
-tx: ACEi

38
Q

hepatorenal syndrome

A

decrease in GFR without any other cause of renal dysfunction, mild hematuria, and lack of improvement with volume resuscitation
- due to splanchnic arterial dilation, decreased vascular resistance, and local renal vasoconstriction due to RAAD

39
Q

pancytopenia, intravascular hemolysis, and acute thrombosis. Flow cytometry demonstrates absence of CD55 and CD59.

A

paroxysmal nocturnal hemoglobinuria

40
Q

hypospadias is associated with

A

chordee, cryptorchidism, and inguinal hernias.

41
Q

patients with nephrotic syndrome are at increased risk of infection with

A 
encapsulated organisms (strep pneumo)
- vaccinate with PPV23
42
Q

He has right- and left-sided costovertebral angle tenderness. He gives a urine sample, which has a strong odor, like rotten eggs. When sodium cyanide-nitroprusside is added to his urine, the sample turns purple.

A

Cysteine stones - caused by renal defect in transport of certain amino acids (cystine, ornithine, lysine and arginine)

*COLA

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