nephrology UWorld

Question 1

Diabetic nephropathy changes

Answer 1

GBM changes — glomerular basement membrane
Micro-angiopathy

1) glomerular hyperfiltration
2) Glomerular basement membrane fibrosis and thickening
3) interstitial fibrosis, mesangial thickening and nodules (kimmelstiel Wilson lesion)

Question 2

Question 3

<50% foot process effacement and severely obese

Answer 3

FSGS

lose weight

Question 4

complications of nephrotic syndrome

Answer 4

hypercoagulability: increased risk of thromboembolism d/t urinary loss of antithrombin III and hepatic synthesis of fibrinogen

hyperlipidemia: increase risk of atherosclerosis d/t hepatic synthesis of lipoproteins

Question 5

iga nephropathy vs post strep gn

Answer 5

Question 6

serum complement

Answer 6

Question 7

low C3, childbearing woman age, pancytopenia, can have joint pains, hx of sinusitis, no prior infection

Answer 7

lupus nephritis

Question 8

pt takes acyclovir, BUN:Cr 38:2.8 (13:1)

Answer 8

renal tubular obstruction

Question 9

pt has septic shock, gets antibiotics, then few days later gets FeNa>2%

Answer 9

ATN: drug induced Aki

Question 10

dialysis related amyloidosis

Answer 10

beta-2- microglobulin, can cause osteoarticular structural problems:
scapulohumeral periarthritis (deposits on imaging)
carpal tunnel: weakness of thenar eminence and atrophy
bone cysts

Question 11

pt with Rheumatoid arthritis, now has 4+ proteinuria

Answer 11

glomerular deposits seen after special (congo red) staining
amyloidosis

Question 12

pt with Rheumatoid arthritis, now has 4+ proteinuria

Answer 12

glomerular deposits seen after special (congo red) staining
amyloidosis

Question 13

CKD + excessive bruising and normal coagulation studies

Answer 13

platelet dysfunction

Question 14

advanced cirrhosis kidney injury

Answer 14

renal hypoperfusion
NO –> splanchnic dilation –> systemic vasodilation –> decreased peripheral vascular resistance and BP –> renal hypoperfusion

Question 15

chronic hypertension and kidneys

Answer 15

u/s: small atrophic kidneys, hyaline arteriosclerosis, glomerulosceloriss, bland UA with mild proteinuria <1g/day

Question 16

tall, peaked t waves with shortened qt interval, widened QRS

Answer 16

hyperkalemia
calcium gluconate + insulin/glucose

Question 17

management of hypercalcemia

Answer 17

normal saline

Question 18

rapid correction of hypo-natremia

rapid correction of hyper-natremia

Answer 18

osmotic demyelination

cerebral edema

Question 19

Question 20

chronic alcohol use with diffuse weakness and hyporeflexia hours after receiving IV fluids

Answer 20

refeeding syndrome
LOW PHOSPHOROUS, POTASSIUM, MAGNESIUM

Question 21

normal anion gap metabolic acidosis

Answer 21

Question 22

seizure activity (tonic clonic) now has metabolic acidosis

Answer 22

observe and repeat labs 2 hours later
post-ictal lactic acidosis d/t skeletal muscle hypoxia

Question 23

chronic alcoholism with constant low Potassium even though attempted to replenish K

Answer 23

hypomagnesemia

Question 24

Patient just started sertraline now has hyponatremia, serum osmolality 260, urine osmolality 500, urine Na 56

Answer 24

SIADH 2/2 SSRI

Question 25

hypernatremia

Question 26

causes of hyperkalemia

Answer 26

Question 27

hypovolemic hyponatremia in pt with diarrhea d/t c-diff, poor oral intake ADH Renin Aldosterone

Answer 27

ADH: HIGH renin: high aldosterone: high

Question 28

pt with pH>7.45 and serum bicarb > 24, with urine chloride<20

Answer 28

self-induced vomitting -- loss of Cl- and H+ (alkalosis) vs loop diuretic or thiazide diuretic overuse: loss of Cl- and retention of bicarb (alkalosis) -- will see lots of salt wasting so high sodium in urine serum chloride differentiates metabolic alkalosis from vomitting, barter/gitlemen(since Cl- can not be reabsorbed)

Question 29

hyponatremia

Answer 29

Question 30

metabolic acidosis with normal anion gap w/ patient who has Sjorgen syndrome

Answer 30

Renal tubular acidosis type 1 impaired H+ excretion by alpha-cells in distal tubule Hypo-K urine pH > 5.5

Question 31

RTA 1

Answer 31

Renal tubular acidosis type 1 impaired H+ excretion by alpha-cells in distal tubule Hypo-K urine pH> 5.5

Question 32

RTA 2

Answer 32

impaired Bicarb reabsorption in proximal tubule Hypo-K *** urine pH < 5.5

Question 33

RTA 4

Answer 33

reduced aldosterone impaired H+ and K+ excretion in collecting duct hyper-K**** urine pH<5.5

Question 34

DKA pH Bicarb PaCo2

Answer 34

ph: low bicarb: low paco2: low

Question 35

asymptomatic hypercalcemia and normal renal function

Answer 35

familial hypocalciuric hypercalcemia -- AD calcium sensing receptor

Question 36

mixed acid base

Answer 36

Question 37

chronic lithium use -- nocturne + dilute urine (urine osmolality < 200)

Answer 37

Nephrogenic DI collecting ducts**

Question 38

how to prevent calcium oxalate stones

Answer 38

decrease sodium increase potassium decrease animal protein chlorthalidone -- thiazides decrease calcium

Question 39

uric acid stone management

Answer 39

alkalinize urine -- potassium citrate

Question 40

diphenhdryamine (anti-histamine) and the cant pee

Answer 40

detrusor hypo contractility