Other Clin Med_hematuria, nephrotic syndrome, etc

Question 1

for hematuria - when do we refer to UROLOGY?

Answer 1

kidney stones, mass cysts

Question 2

for hematuria - when do we refer to NEPHROLOGY?

Answer 2

glomerular bleeding
elevated Creatinine
new or worsening HTN or edema

Question 3

CASTS

muddy brown casts

Answer 3

acute tubular necrosis

(PPP)

Question 4

CASTS

white blood cell casts

Answer 4

pyelonephritis

acute interstitial nephritis
PPP

Question 5

CASTS

red blood cell casts

Answer 5

acute glomerulonephritis

vasculitis
PPP

Question 6

four disorders classified as Critical Intrinsic Renal Disorders

Answer 6

vascular disorders
glomerular disorders
tubular disease
interstitial disorders

Question 7

name one Intrinsic Renal Disorder / Vascular Disorder

Answer 7

renal atheroembolism

Question 8

name two Intrinsic Renal Disorder / Glomerular Disorders

Answer 8

RPGN = Rapidly Progressive Glomerulonephritis

Thrombotic Microangiopathy

Question 9

name two Intrinsic Renal Disorder / Tubular Diseases

Answer 9

ATN = Acute Tubular Necrosis

Pigment Nephropathy/Rhabdomyolysis

Question 10

name one Intrinsic Renal Disorder / Interstitial Disorders

Answer 10

acute allergic interstitial nephritis

Question 11

iatrogenic damage from catheterization - usually free plaque/cholesterol crystals

Answer 11

renal atheroembolism

Question 12

blue toes

Answer 12

renal atheroembolism

Question 13

loss of 50% of GFR w/in 3 months

Answer 13

Rapidly Progressive Glomerulonephritis (RPGN)

Question 14

“crescent formation” in glomeruli

Answer 14

Rapidly Progressive Glomerulonephritis (RPGN)

Question 15

diagnosis of Rapidly Progressive Glomerulonephritis (RPGN)

Answer 15

biopsy

serological workup

Question 16

associated with Rapidly Progressive Glomerulonephritis (RPGN)

Answer 16

lupus (SLE)

Goodpasture syndrome

Question 17

treatment of Rapidly Progressive Glomerulonephritis (RPGN)

Answer 17

immunosuppressants, corticosteroids

Question 18

schistocytes

Answer 18

Thrombotic Microangiopathy

Question 19

inner surface of endothelial cells injured

or

prothrombotic agents disrupt smooth inner layer

Answer 19

Thrombotic Microangiopathy

Question 20

name six common causes for Acute Tubular Necrosis

Answer 20

aminoglycosides
vancomycin
acyclovir
HIV drugs
iodine contrast
rhabdo

Question 21

muddy brown casts

Answer 21

Acute Tubular Necrosis

Question 22

two main causes of Acute Tubular Necrosis

Answer 22

50% - ischemic

50% = toxic

Question 23

treatment of Pigment Nephropathy/Rhabdo

Answer 23

very aggressive ISOTONIC fluid for forced diuresis

Question 24

leukocyturia

Answer 24

Acute Allergic Interstitial Nephritis

Question 25

WBC casts in urine

Answer 25

Acute Allergic Interstitial Nephritis

Question 26

definitive imaging for post-renal acute kidney injury

Answer 26

bladder u/s

Question 27

two distinct findings for diagnosis of pre-renal acute kidney injury

Answer 27

BUN/Cr ratio >20/1 (nml ~15/1)

FENa (Fractional Excretion of Na) <1%

Question 28

edema/hypoalbuminemia
hyperlipidemia
proteinuria

Answer 28

Nephrotic Syndrome

Question 29

three main findings/presentations for nephrotic syndrome

Answer 29

edema/hypoalbuminemia
hyperlipidemia
proteinuria

Question 30

blood clots in urine/easy bruising

Answer 30

nephrotic syndrome

Question 31

three main etiologies for nephrotic syndrome

Answer 31

minimal change disease
focal segmental glomerular sclerosis
membranous nephropathy

Question 32

three important indicators of kidney disease that should not be overlooked

Answer 32

hematuria
proteinuria
Cr

Question 33

Can renal tubules heal?

Can nephrons regenerate?

Answer 33

Renal tubules can heal but NEPHRONS DO NOT REGENERATE.

Question 34

what is most common cause of CKD?

second most common cause?

Answer 34

DM

2nd - HTN

Question 35

S/S of CKD (four)

Answer 35

proteinuria (best predictor of disease progression)

urine: albumin/Cr ratio or protein/Cr ratio

U/A: metabolic acidosis

renal US: get one early to establish baseline
(have at least one US)

Question 36

Trtmt of CKD

Answer 36

lifestyle: reduce salt, eat nml amts of protein
get bp <140/90, ACE-Is or ARBs (renal protective) for the HTN/Proteinuria
A1C < 7.0% for the DM
met acidosis - fix it w/ diet

Question 37

stages of CKD

Answer 37

Stage 1 - nml GFR (120-130) but other signs are present)

Stage 2 - GFR 60-90
Stage 3 - GFR 30-60
Stage 4 - GFR 15-30
Stage 5 GFR <15

Question 38

when is dialysis considered for CKD?

Answer 38

hyperkalemia
fluid overload
uremia (Cr/urea in blood)

Question 39

PKD presentation

Answer 39

dilute urine/nocturnal/polyipsia (100%)
hematuria
proteinuria (mild, might have frothy urine)
nephrolithiasis/UTIs

HTN

large palpable kidney

Question 40

two types of PKD

Answer 40

type 1 -

• most common (75%)
• younger/earlier onset
  
  • more severe
    
    • larger cysts

type 2 -

 - less common
 - older onset
 - less severe

Question 41

life-threatening concerns for PKD pts

Answer 41

aneurysms
subarachnoid hemorrhages
mitral valve prolapses

Question 42

common comorbidities for PKD

Answer 42

hepatic cysts

colonic diverticula

Question 43

PKD U/A presentation

Answer 43

hematuria
proteinuria
low osmolarity
low specific gravity

Question 44

PKD management (6 things)

Answer 44

U/S: get at least one renal US

suppress ADH with high fluid consumption (ADH drives cyst growth)

Tolvaptan (ADH V2 receptor antagonist)

HTN management (target bp is lower than usual)
   - maybe add ACE-I or ARBs

manage pain

watch for aneurysms