Paulson - Kidneys 103

Question 1

renal cysts made of epithelial cells from renal tubules and collecting ducts

Answer 1

cystic kidney dz

Question 2

2 types of cystic kidney dz

Answer 2

simple cysts

complex cysts

Question 3

mc type of cystic kidney dz

Answer 3

simple cysts

Question 4

w. cystic kidney dz, you must differentiate btw (4)

Answer 4

malignancy

abscess

pkd

benign

Question 5

characteristics of simple cysts

Answer 5

think wall without septa, calcifications, or solid components

Question 6

simple cysts are mc in __

and pt’s older than __,

and are usually

Answer 6

men

50 yo

asymptomatic

Question 7

comorbidity possibly associated w. simple cysts

Answer 7

htn

Question 8

sx of ruptured simple cyst (2)

Answer 8

hematuria

flank pain

Question 9

complication of infected simple cyst

Answer 9

renal abscess

Question 10

diagnostic test for simple cyst (2)

Answer 10

US

CT

Question 11

characteristics of complex cysts

Answer 11

+/- septa, calcifications, or solid components

Question 12

complex cysts are associated w. increased risk for

Answer 12

malignancy

Question 13

what classification system is used for complex cysts

Answer 13

bosniak

Question 14

imaging for complex cysts

Answer 14

CT w. contrast

Question 15

inherited dz’s that cause renal cyst development and progressive renal faiure from continued enlargement of cysts

Answer 15

polycystic kidney dz (pkd)

Question 16

2 genetic mutations associated w. pkd

Answer 16

pkd 1

pkd 2

Question 17

50% of pkd pt’s get __ by age 60

Answer 17

esrd

Question 18

when does renal fxn begin to decline

Answer 18

4th decade of life → continues to decline 4-6 ml/min/year

Question 19

major sx of pkd

Answer 19

htn

Question 20

other possible sx of pkd (6)

Answer 20

hematuria

proteinuria

renal insufficiency on labs

flank pain

nephrolithiasis

renal cell carcinoma

Question 21

mc sx of pkd reported by pt’s

Answer 21

flank pain

Question 22

what causes flank pain in pkd (3)

Answer 22

renal hemorrhage

calculi

UTI

Question 23

2 mc types of renal stones associated w. pkd

Answer 23

uric acid

calcium oxalate

Question 24

extrarenal sx of pkd

Answer 24

cerebral aneurysms

hepatic cysts

pancreatic cysts

cardiac valve dz

colonic diverticula

abd wall and inguinal hernia

Question 25

most serious complication of pkd

Answer 25

SAH or ICH

Question 26

mc dx imaging for pkd

Answer 26

US

Question 27

most sensitive imaging for pkd (2)

Answer 27

CT MRI

Question 28

US findings of pkd

Answer 28

large kidneys extensive bilateral cysts

Question 29

indication for screening for pkd

Answer 29

positive fh

Question 30

screening for pkd recommended for younger pt's

Answer 30

genetic testing

Question 31

genetic type of pkd

Answer 31

autosomal dominant polycystic kidney dz (adpkd)

Question 32

tx for adpkd (3)

Answer 32

rigorous control of bp dietary Na restriction statin

Question 33

which tx for adpkd prevents progression of renal dz and decreases risk of CV mortality

Answer 33

rigorous control of bp

Question 34

initial bp control med for adpkd

Answer 34

ACEI

Question 35

t/f: adpkd is considered coronary heart dz risk equivalent in terms of statin recs

Answer 35

T!

Question 36

what class of drug is tolvapatan (samsca)

Answer 36

vasopressor

Question 37

indications for tolvapatan (samsca) in pkd

Answer 37

18-55 yo GFR \>25 high risk for progression to esrd

Question 38

how are tolvapatan indications established (2)

Answer 38

total kidney volume (tkv) CT or MRI

Question 39

what drug is dz modifying for pkd and slows progression

Answer 39

tolvapatan (samsca)

Question 40

pt ed for tolvapatan (samsca)

Answer 40

adequate PO water intake

Question 41

contraindications for tolvapatan (samsca) (3)

Answer 41

liver failure hypovolemia hypernatremia

Question 42

s.e of tolvapatan (samsca) (5)

Answer 42

liver toxicity → increasted LFTs polyuria polydipsia cp ha

Question 43

non pharm tx for pkd

Answer 43

increased fluid intake → 3L/day dialysis kidney transplant pain mangament → surgical aspiration

Question 44

how does increased fluid intake inhibit cyst growth

Answer 44

suppresses ADH levels

Question 45

mc cause of death in pkd pt's

Answer 45

**cardiac** other: neurologic from ruptured intracranial aneurysm/hemorrhage