PA urinalysis

Question 1

What electrolyte disorder to ARBs and ACEi’s cause?

Answer 1

Hyperkalemia

Question 2

What electrolyte disorder to most diuretics cause?

Answer 2

Hypokalemia

Question 3

Red/brown urine with NO blood/RBCs suggests:

Answer 3

Rhabdomyalysis

Question 4

What electrolyte disturbance often accompanies Rhabdomyalysis?

Answer 4

Hyperkalemia (due to muscle cell lysis)

Question 5

Muddy brown granular casts are pathognomonic for:

Answer 5

Acute tubular necrosis

Question 6

WBC casts are suggestive of:

Answer 6

Pylonephritis OR Allergic Interstitial Nephritis

Question 7

Fatty casts and oval fat bodies are pathognomonic for:

Answer 7

Nephrotic syndrome

Question 8

Calculate FENa:

Answer 8

PcrUna/PnaUcr

Question 9

What does a FENa<1% suggest in AKI?

Answer 9

PreRenal origin.

Question 10

What can diphenhydramine do to the kidneys?

Answer 10

Damage them via post-renal obstruction. Prevents passage of urine. Tx with Foley.

Question 11

What can you always expect Furosemide (Lasix) to do to BMP?

Answer 11

Increase serum Cr (dilutional)

Question 12

RBC casts are pathognomonic for:

Answer 12

Glomerulonephritis (nephritic syndrome)

Question 13

Kid comes in with nephritic syndrome after having a sore throat…what is it?

Answer 13

Post-streptococcal glomerulonephritis.

Question 14

Kid comes in with swollen feet (no blood in urine). What is it?

Answer 14

Minimal change disease (until proven otherwise)

Question 15

What causes AKI and elevated serum Ca?

Answer 15

Multiple myeloma

Question 16

How do you treat someone with HTN and elevated sCR (or albuminuria)?

Answer 16

Ace inhibitor! Will lower BP AND decrease albumin in urine. (Check K at 2 weeks though).

Question 17

What will ACE inhibitors and ARBs due to SCr?

Answer 17

Increase up to 20-30%

Question 18

What must you always do to a serum Na in diabetic patients with high glucose?

Answer 18

Correct it for blood glucose. they are competitive.

Question 19

A young (20-40 yo), healthy patient with blood in urine but no casts, WBCs, or protein probably has:

Answer 19

IgA nephropathy. Don’t be fooled by lack of protein in urine. Sometimes it’s just blood. It’s a nephritic syndrome.

Question 20

How does increased distal Na delivery cause K+ wasting?

Answer 20

Increased distal Na will increase activity of Aldosterone and ENaC channels which will make the endothelial cells less polarized and encourage K+ secretion.

Question 21

Liddle’s syndrome

Answer 21

Hypokalemia, metabolic alkalosis and HTN. Due to overactive Na channel in CD (and compensatory K+ excretion)

Question 22

Bartter’s syndrome

Answer 22

Hypokalemia, NO HTN. Also associated with hypercalciuria. mutation in transporter in thick ascending loop causes decreased Na absorption. (like a loop diuretic)

Question 23

Gitelman’s syndrome

Answer 23

Mutation in thiazide-sensitive Na-Cl transporter in DCL causes decreased Na reabsorption, increased K secretion, DECREASED calcium secretion.
Pt. has hypokalemia but is normotensive with HYPOcalciuria.

Question 24

Licorice toxicity presents like which other disease?

Answer 24

Liddle’s

Question 25

How is serum K affected by acidosis?

Answer 25

Cells act as buffer. So H+ is taken in, K+, na+ are excreted into ECF.

Question 26

How is serum K affected by alkalosis?

Answer 26

Cells act as buffer. H+ leaves cells, K+ and Na+ are absorbed to compensate for electronegativity change.

Question 27

Steps for workup of suspected metabolic acidosis:

Answer 27

1. Is there a normal or high anion gap (>11)?
2. Is it compensated?
3. Is there a high anion gap and a normal anion gap process occurring (delta gap)? Should be 1. If >2 a metabolic alkalosis coexists. If <1, a non-anion gap metabolic acidosis coexists.
4. Is it adequately compensated? If not, mixed!

Question 28

What are some causes of high anion gap metabolic acidosis?

Answer 28

Uremia, Ketoacidosis, Lactic Acidosis, Salicylate poisoning. ethylene glycol

Question 29

What are some normal anion gap causes of metabolic acidosis?

Answer 29

Renal tubular acidosis

Question 30

What are type I, II, III, and IV RTAs?

Answer 30

I- HCO3 wasting in proximal tubule
II- impaired H+ excretion at Distal tubule
III-mixed
IV- due to aldosterone deficiency or aldosterone resistance (less H+ secretion in DT and CD).

Question 31

List some causes of metabolic alkalosis:

Answer 31

1. Volume depletion (high bicarb)
2. Hypokalemia (K+ moves into cells, H+ out to compensate)
3. Hypercalcemia (increases H+ secretion)
4. GI/Renal H+ losses (diuretics, vomiting)
5. Refeeding syndrome (Insulin spike causes intracellular movement of H+)
6. Hyperaldosteronism (increases H+ ATPase activity and enhances Na+ reabsorption