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Nephrology/Urology > Nephrology/Urology > Flashcards

Nephrology/Urology Flashcards

1
Q

What test can be done to evaluate urine dipstick + for blood with UA with no RBCs?

A

Urine ammonium sulfate test

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2
Q

Is FeNa > 1 or < 1 in prerenal azotemia and AGN?

A

<1

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3
Q

What does alkalemia do to calcium?

A

Increases bound calcium therefore decreases ionized calcium leading to hypocalcemia

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4
Q

What is normal osmolality?

A

285 +/- 10

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5
Q

What is the formula to calculate osmolality?

A

Osm = 2[Na+] + (glucose /18) + (BUN/2.8)

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6
Q

What are the two ways ADH levels are regulated?

A

1) Osmoreceptors in the hypothalamus

2) Volume (stretch) receptors in the LA and blood vessels

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7
Q

What are the three categories of hyponatremia?

A

Hypoosmolar
Hyperosmolar
Isoosmolar

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8
Q

What are the three categories of hypoosmolar hyponatremia?

A

Hypovolemic
Euvolemic
Hypervolemic

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9
Q

What is the common etiology of euvolemic hyponatremia?

A

SIADH or thiazide diuretics

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10
Q

If a patient is hyponatremic, what would a urine Osm of > 250 represent as an etiology?

A

SIADH

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11
Q

If a patient is hyponatremic, what would a urine Osm of <200 represent as an etiology?

A

Psychogenic polydipsia

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12
Q

How does hypothyroidism affect ADH release?

A

Decreased cardiac output –> carotid baroreceptors

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13
Q

What is the max rate of hyponatremia correction over 24 hours? What is the risk?

A

10meq/L over 24 hours maximum, 0.5meq/L per hour

Concern for osmotic demyelination syndrome

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14
Q

What electrolyte abnormalities may induce nephrogenic DI?

A

Hypercalcemia

Chronic Hypokalemia

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15
Q

What common medication can cause nephrogenic DI?

A

Lithium

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16
Q

What is the test to differentiate between central and nephrogenic DI?

A

Water restriction test

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17
Q

What is the treatment of mild cases of central DI?

A

Thiazides
Salt restriction
Can give desmopressin in resistant cases

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18
Q

What is the treatment of nephrogenic DI?

A

Thiazide diuretics or amiloride

Sodium restriction

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19
Q

What is the typical volume status of a patient with DI?

A

Euvolemic

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20
Q

What is the effect of renin on aldosterone release?

A

Increases aldosterone release

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21
Q

What is the effect of spironolactone on aldosterone release?

A

Blocks aldosterone receptor

Increase K+

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22
Q

What is the effect of Trimethoprim on K+ levels?

A

Causes hyperkalemia due to interference in distal tubule and collecting duct

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23
Q

Which type of RTA is associated with hyperkalemia?

A

Type 4

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24
Q

What impact do the syndromes Liddle’s, Barters and Gitelman’s have on potassium levels?

A

Cause hypokalemia

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25
Q

What are the three medicationss typically used to shift K+ into cells?

A

Insulin with glucose
Sodium bicarb
Albuterol

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26
Q

Which other electrolyte should always be replenished in hypokalemia?

A

Magnesium

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27
Q

What is the primary defect in Liddle’s syndrome?

A

Upregulation of Na+ channel –> primary Na+ retention

Leads to decreased renin and aldosterone levels

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28
Q

What are renin and aldosterone levels like in Barters and Gittelman’s syndrome?

A

Elevated due to sodium losses –> volume contraction –> elevated renin/aldosterone levels

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29
Q

Which kidney syndrome is often associated with hypercalciuria and nephrocalcinosis?

A

Bartter type 4

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30
Q

Where is the defect in Bartter syndrome?

A

Thick ascending loop of Henle

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31
Q

Where is the defect in Gitelman syndrome?

A

Na/Cl cotransporter in early distal tubule

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32
Q

Which diuretics to Bartter and Gitelman mimic?

A

Bartter –> loop diuretics

Gitelman –> Thiazide

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33
Q

What is the typical presentation of Gitelman’s?

A

muscle spasms and weakness due to hypomagnesemia

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34
Q

T/F: Gitelman’s and Barrter’s both often cause hypertension

A

False

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35
Q

What are the magnesium findings in Gitelman’s and Barrters?

A

Gitelman’s –> Hypomagnesemia

Bartter’s –> normal Mg

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36
Q

What study can be used to differentiate between diarrhea and RTA as an etiology of hypokalemia?

A

UAG

+ in RTA, - in diarrhea (neGUTive)

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37
Q

What magnesium levels can lead to hypocalcemia?

A

Hypermagnesemia

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38
Q

What is the calculation of UAG?

A

Na+ - K+ - Cl-

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39
Q

What is the likely etiology of HAGMA with calcium oxalate crystals?

A

Ethylene glycol

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40
Q

What is the likely etiology of HAGMA with visual symptoms?

A

Methanol

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41
Q

What toxicity would one be worried about with long infusions of lorazepam?

A

Propylene glycol

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42
Q

What is the standard of care for toxicity with methanol or ethylene glycol?

A

Fomepizole and dialysis

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43
Q

What is the treatment of salicylate poisoning?

A

sodium bicarbonate

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44
Q

Why do most diuretics cause K+ wasting?

A

Inhibit Na+ reabsorption in the PCT leading to increased na+ reabsorption in the DT and increased K+ excretion

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45
Q

What is the difference of thiazides and loop diuretics on Ca excretion?

A

Loop diuretics increase Ca excretion

Thiazides decrease Ca excretion

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46
Q

Which type of RTA has alkaline urine?

A

Type 1 RTA

47
Q

Which type of RTA has hyperkalemia?

A

Type 4 RTA

48
Q

Which type of RTA can be caused by Fanconi syndrome?

A

Type 2 RTA

49
Q

Which type of RTA is often associated with nephrocalcinosis?

A

Type 1

50
Q

Which type of RTA may be caused by ingestion of amphotericin ?

A

Type 1

51
Q

How soon after diagnosis of T1DM should albuminuria be screened for?

A

5 years

52
Q

T/F: antibiotic therapy in strep infection can prevent PSGN

A

False

Abx CAN preven rheumatic fever

53
Q

What is the typical latency period between acute strep infection and PSGN?

A

1-2 weeks

54
Q

Is the C3 level typically low, normal or high in PSGN?

A

Low

55
Q

What is the typical latency period between an infection and IgA nephropathy?

A

often concomitant with infection or a few days

56
Q

Are C3 levels low, normal or high in IgA nephropathy?

A

Normal

57
Q

On renal biopsy, what does HSP look identical to?

A

IgA nephropathy

58
Q

What are C3 and C4 levels typically in MPGN?

A

Low

59
Q

What is the anti-GBM disease with renal and pulmonary findings?

A

Goodpasture syndrome

60
Q

What is found on renal biopsy of anti-GBM disease?

A

linear deposits of IgG and C3 in the GBM

61
Q

What is the main therapy of Goodpasture syndrome?

A

Plasmapheresis

62
Q

What is the most common presentation of SLE in children?

A

Nephritis

63
Q

What are the 3 types of ANCA-associated focal necrotizing glomerulonephritis?

A
  • Eosinophilic granulomatosis w/ polyangiitis
  • Granulomatosis w/ polyangiitis (Wegener granulomatosis)
  • Microscopic polyangiitis/polyarteriitis
64
Q

What does a positive c-ANCE and anti-PR3 Ab indicate?

A

Wegener granulomatosis (Granulomatosis w/ polyangiitis)

65
Q

What is the main difference between microscopic polyangiitis and granulomatosis w/ polyangiitis?

A

There is no granulomatous disease of the lungs with microscopic polyangiitis

66
Q

c-ANCA and p-ANCA are often positive in what disease?

A

microscopic polyangiitis

67
Q

What is the most common organism to cause infection in those with nephrotic syndroms?

A

Strep. pneumo

68
Q

What is an important vaccine to give those with nephrotic syndrome?

A

Pneumococcal vaccine

69
Q

Where are the two most common sites of thrombotic disease in nephrotic syndrome?

A

Renal vein

Sagittal sinus thrombosis

70
Q

What is the most common cause of nephrotic syndrome in children?

A

Minimal change disease

71
Q

If nephrotic syndrome also presents with hypertension what is the more likely etiology?

A

FSGS

72
Q

What is the most common diarrheal illness that precedes HUS?

A

E. coli O157:H7 producing Shiga-like toxin

73
Q

What is the classic triad of HUS?

A

Thrombocytopenia
Microangiopathic hemolytic anemia
Acute renal failure

74
Q

What is often seen on peripheral smear of HUS?

A 
Burr cells (microangiopathy)
Schistocytes and fragmented RBCs
75
Q

T/F: Antibiotics should be used for EHEC causing HUS

A

False- antibiotics are contraindicated

76
Q

What is the X-linked syndrome with microhematuria, sensorineural deafness and ocular defects?

A

Alport syndrome

77
Q

What is the genetic transmission of thin basement membrane nephropathy?

A

Autosomal dominant

78
Q

Which syndrome presents with infant onset nephrotic syndrome?

A

Denys-Drash syndrome

79
Q

What are Denys-Drash syndrome patients at high risk for?

A

Ambiguous genitalia and Wilms tumor

80
Q

What is the deficiency found in Fabry disease?

A

alpha-galactosidasse A

81
Q

What is the gene involved with ARPKD?

A

PKHD1–> encodes fibrocystin

82
Q

What is the common liver finding in ARPKD?

A

hepatic fibrosis

83
Q

What is typically found on US for ARPKD?

A

Oligohydramnios leading to potter facies

84
Q

What is Caroli disease? What renal disease can cause it?

A

Dilation of biliary tree –> caused by hepatic fibrosis in ARPKD

85
Q

How to NSAIDs cause prerenal AKI?

A

Inhibit prostaglandins which typically are responsible for vasodilation

86
Q

What would be the possible etiology of prerenal AKI if it developed following the initiation of ACEI?

A

Renal artery stenosis (fibromuscular dysplasia)

87
Q

Why is the BUN:Cr ratio elevated in postrenal AKI?

A

urea diffuses back into the system

88
Q

What is the most common cause of AKI?

A

ATN

89
Q

What type of RTA does amphotericin cause?

A

Type 1

90
Q

What is the effect of cisplatin on magnesium levels?

A

Magnesium in the urine, therefore hypomagnesemia

91
Q

What renal syndrome does Mitomycin C cause?

A

HUS

92
Q

T/F: AIN is directly proportional to the antitbiotic dose and duration

A

False

93
Q

What is the most common cause of death in dialysis patients?

A

Cardiovascular disease

94
Q

What is the treatment of choice for end stage renal disease in children?

A

Kidney transplant

95
Q

What two medications are known to hypertrophy the gum?

A

Phenytoin

Cyclosporine

96
Q

What is the most significant side effect of azathioprine?

A

Leukopenia

97
Q

What is the main side effect of sirolimus?

A

Hyperlipidemia

98
Q

What is the effect of maternal anti-SSA/SSB antibodies on the fetus during pregnancy?

A

Neonatal heart block

99
Q

What type of kidney stones are common with Type 1 RTA? Why?

A

Calcium phosphate due to calciuria

100
Q

Which type of stone if often associated with infection?

A

Struvite

101
Q

What medication is given for uric acid stones?

A

Allopurinol

102
Q

What are the two types of stones where alkalinization of the urine does not help?

A

Struvite

Calcium phosphate

103
Q

What is the most common cause of hydronephrosis in children?

A

UPJ obstruction

104
Q

What syndrome consists of abdominal muscle deficiency, cryptorchidism, dilation of prostastic urethra & bladder?

A

Prune belly syndrome

105
Q

Is further imaging required for hypospadias?

A

No

106
Q

What is the ventral curvature of the penis called?

A

Chordee

107
Q

What is the most common cause of priapism?

A

Sickle cell disease

108
Q

What is the likely diagnosis of a swollen, discolored hemiscrotum in a neonate?

A

Neonatal testicular torsion

109
Q

What is the blue dot sign on a boy’s testicle?

A

Blue nodule on top of testicle due to testicular appendage torsion. Resolves spontaneously.

110
Q

What is the treatment of retractile testes?

A

NTD, eventually end up in the scrotum

111
Q

When is referral appropriate for cryptorchidism?

A

after 6 months of age

Orchiopexy completed between 6-18 months

112
Q

What is the common etiology of orchitis?

A

Viral mumps

113
Q

When do hydroceles require surgical repair?

A

If they last past 1 year of life

114
Q

Which side do varicoceles typically occur on? What age usually?

A

Usually adolescents

On left side

Nephrology/Urology (1 decks)

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