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Rizk Review > Renal 1 > Flashcards

Renal 1 Flashcards

1
Q

Most important UA finding used to diagnosis nephritic syndrome?

A

RBC casts

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2
Q

Type of urine casts associated with nephrotic syndrome?

A

Fatty casts

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3
Q

3 lab findings associated with nephrotic syndrome?

A

Hypoalbuminemia, Hypogammaglobulinemia, Hyperlipidemia

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4
Q

What triggers hyperlipidemia in nephrotic syndrome?

A

Increased hepatic lipoprotein synthesis due to decreased oncotic pressure

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5
Q

2 endocrine changes associated with nephrotic syndrome?

A

Loss of thyroid globulin binding protein, Loss of iron binding globulin

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6
Q

Change to thyroid hormone nephrotic syndrome?

A

Decreased total thyroxine level

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7
Q

Change to serum iron level in nephrotic syndrome?

A

Decreased total serum iron level

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8
Q

Hematologic change associated with nephrotic syndrome?

A

Loss of antithrombin III, Protein C, Protein S … Hypercoagulable state

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9
Q

Patients with nephrotic syndrome are most likely to develop which complication of hypercoagulability?

A

Renal vein thrombosis

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10
Q

4 most common causes of nephritic syndrome?

A

Post-infectious glomerulonephritis, IgA nephropathy, Membranoproliferative glomerulonephropathy, Rapidly progressive acute glomerular nephropathy

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11
Q

Which type of infection can trigger Post-infectious glomerulonephritis?

A

Pharyngitis OR Skin infection

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12
Q

Change to complement levels in Post-infectious glomerulonephritis?

A

Low serum C3

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13
Q

Change to complement levels in IgA nephropathy?

A

Normal serum C3

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14
Q

2 types of IgA nephropathy?

A

Berger disease, Henoch-Schonlein Purpura

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15
Q

Description of Berger disease?

A

Hematuria that develops 1-2 days after URI

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16
Q

4 symptoms seen in Henoch-Schonlein Purpura?

A

Hematuria, Arthralgias, Abdominal pain, Purpura

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17
Q

Which condition is associated with BOTH nephrotic and nephritic symptoms?

A

Membranoproliferative GN

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18
Q

Etiology of Membranoproliferative GN?

A

Mixed essential cryoglobulinemia

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19
Q

2 conditions associated with Membranoproliferative GN?

A

Hepatitis C infection, SLE

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20
Q

Change to complement levels in Membranoproliferative GN?

A

Low serum C3

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21
Q

Best treatment for Membranoproliferative GN?

A

IFNa

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22
Q

Cause of Rapidly progressive acute glomerular nephropathy – Type 1?

A

Goodpasture Syndrome

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23
Q

Goodpasture Syndrome represents a Type ___ HSN reaction

A

2

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24
Q

Cause of Rapidly progressive acute glomerular nephropathy – Type 2?

A

SLE, Post-Streptococcal GN, Cryoglobulinemia GN

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25
Q

Cause of Rapidly progressive acute glomerular nephropathy – Type 3?

A

Vasculitis

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26
Q

6 types of nephrotic syndrome?

A

Membranous nephropathy, Minimal change disease, Focal segmental glomerulosclerosis, Diabetic nephropathy, Amyloidosis + Multiple Myeloma, HIV-associated nephropathy

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27
Q

3 infections associated with Membranous nephropathy?

A

Hepatitis B, Malaria, Syphilis

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28
Q

4 drugs associated with Membranous nephropathy?

A

Gold, Penicillamine, Captopril, NSAIDs

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29
Q

Patient presents with nephrotic syndrome; HX of solid tumors – what is most likely type of associated nephrotic syndrome?

A

Membranous nephropathy

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30
Q

1 exposure associated with Minimal Change Disease?

A

NSAIDs

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31
Q

1 condition associated with Minimal Change Disease?

A

Hodgkin Lymphoma

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32
Q

First step in workup for evaluation of possible secondary cause of minimal change disease?

A

CT scan of chest/abdomen

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33
Q

Appearance of light microscopy in Minimal Change Disease?

A

NML

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34
Q

Best treatment of Minimal Change Disease?

A

Oral prednisone 60mg daily for 4-6 weeks

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35
Q

3 epidemiology characteristics of Focal segmental glomerulosclerosis?

A

HIV, Heroin abuse, AA

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36
Q

Diabetic nephropathy is associated with RTA Type ___

A

4

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37
Q

Best treatment for Diabetic nephropathy?

A

ACEI, ARB

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38
Q

What are two conditions associated with light chain nephrotic syndrome?

A

Multiple myeloma, Amyloidosis

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39
Q

Best step of workup (before renal biopsy) for patient with suspected HIV nephropathy?

A

Renal US

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40
Q

Appearance of renal US in setting of HIV nephropathy?

A

Large echogenic kidneys

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41
Q

Diagnostic test for HIV nephropathy?

A

Renal biopsy

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42
Q

Appearance of renal biopsy for HIV nephropathy?

A

Collapsing focal glomerulosclerosis with tubular microcyst formation

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43
Q

In addition to HAART, which medication should be used to treat HIV nephropathy?

A

ACEIs

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44
Q

What type of metabolic acidosis is associated with RTA?

A

Normal anion gap

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45
Q

Change.to serum Cl- in all types of RTA?

A

High

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46
Q

2 conditions associated with RTA – Type 1?

A

SLE, Sjogren

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47
Q

2 medications associated with RTA – Type 1?

A

Amphotericin B, Lithium

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48
Q

Location of RTA – type 1?

A

Distal convoluted tubule

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49
Q

Change to urine pH in RTA – type 1?

A

High

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50
Q

Change to serum K+ in RTA – type 1?

A

Low

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51
Q

2 conditions associated with RTA – Type 2?

A

Fanconi Syndrome, Multiple Myeloma

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52
Q

Description of Fanconi Syndrome?

A

PCT disorder associated with decreased resorption of glucose, AA, urea, HCO3-

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53
Q

2 medications associated with Fanconi Syndrome?

A

Tetracycline, Tenofovir

54
Q

1 condition associated with Fanconi Syndrome?

A

MGUS

55
Q

Inheritance pattern of Fanconi Anemia?

A

AR

56
Q

What is Fanconi Anemia?

A

Aplastic anemia

57
Q

3 medications associated with RTA – Type 2?

A

Acetazolamide, 6-MP, Topiramate

58
Q

Location of RTA – type 2?

A

Proximal convoluted tubule

59
Q

Change to urine pH in RTA – type 2?

A

Low

60
Q

Change to serum K+ in RTA – type 2?

A

Low

61
Q

2 conditions associated with RTA – Type 4?

A

Aldosterone deficiency, DM

62
Q

1 medication associated with RTA – Type 4?

A

Aldosterone antagonists

63
Q

Location of RTA – type 4?

A

Distal convoluted tubule

64
Q

Change to urine pH in RTA – type 4?

A

Low

65
Q

Change to serum K+ in RTA – type 4?

A

High

66
Q

Best treatment for RTA – Types 1 & 2?

A

HCO3-

67
Q

Best treatment for RTA – Type 4?

A

K+ restriction

68
Q

What is best treatment for acute hyperkalemia?

A

Calcium gluconate, Insulin, Dextrose

69
Q

Role of calcium gluconate in setting of hyperkalemia?

A

Cardio-protection

70
Q

Electrolyte change associated with cisplatin?

A

Hypomagnesemia

71
Q

Why is hypomagnesemia commonly associated with hypocalcemia?

A

Mg2+ is required for NML function of PTH

72
Q

What are the 3 medications that can cause hypo-Mg2+?

A

Gentamicin, Cisplatin, Amphotericin B

73
Q

Most common type of kidney stone?

A

Calcium oxalate

74
Q

3 lab values associated with increased risk of developing kidney stones?

A

Hyperoxaluria, Hypocitraturia, High protein

75
Q

Treatment of choice for struvite stone?

A

Ceftriaxone OR Gentamicin + TMP-SMX for 14 days

76
Q

HIV medication associated with increased kidney stones?

A

Indinivir

77
Q

What is first imaging study to order for patient with suspected kidney stones?

A

XR

78
Q

In pregnant patient, what is first imaging study to order for suspected kidney stones?

A

US

79
Q

What is best imaging study to ID suspected uric acid kidney stones?

A

CT, IV pyelography

80
Q

Which extremity condition are patients with CKD at greater risk for?

A

Carpal tunnel syndrome

81
Q

What accounts for increased incidence of Carpal Tunnel in patients with CKD?

A

Deposition of b2 microglobin

82
Q

What is optimal HGB level for patient with CKD on EPO?

A

11

83
Q

Patient with CKD receives EPO; Labs show persistently-low HGB – etiology?

A

Iron deficiency anemia … due to EPO use

84
Q

Etiology of Ostitis Fibrosa Cystica?

A

Secondary hyper-PTH

85
Q

Best treatment for renal osteodystrophy?

A

Low PO3- diet; PO3- binders; Vitamin D supplementation

86
Q

Definition of ESRD?

A

GFR < 15

87
Q

What is most common cause of death in patients with ESRD?

A

CVD

88
Q

AE of azathioprine?

A

Myelosuppression

89
Q

Which medication is associated with increased myelosuppression in setting of azathioprine use?

A

Allopurinol

90
Q

Which medication should be substituted for allopurinol in setting of azathioprine use?

A

Mycophenolate mofetil

91
Q

2 examples of calcineurin inhibitors?

A

Cyclosporine, Tacrolimus

92
Q

AE of Cyclosporine?

A

Nephrotoxicity, Hirsuitism, Gingival hyperplasia

93
Q

AE of Tacrolimus?

A

DM

94
Q

FENa in setting of prerenal disease?

A

<1%

95
Q

Change to BUN/Cr ratio in prerenal disease?

A

High (>20:1)

96
Q

Effect of prolonged episodes of prerenal azotemia on FENa?

A

FENa will start low, but may increase

97
Q

Appearance of UA in prerenal azotemia?

A

Hyaline casts

98
Q

Which test would help differentiate between prerenal azotemia hepatorenal syndrome vs. intravascular volume depletion as cause of acute renal failure?

A

Urine bolus in response to IV fluid bolus … Renal failure will improve if due to intravascular volume depletion … Will NOT improve if due to hepatorenal syndrome

99
Q

Change to urine osmolarity in prerenal azotemia?

A

High

100
Q

FENa in setting of intrarenal disease?

A

>2%

101
Q

Change to BUN/Cr ratio in intrarenal disease?

A

Low (<15:1)

102
Q

3 drugs that lead to drug-induced ATN?

A

Amphotericin B, Aminoglycosides, Cisplatin

103
Q

Amphotericin B is associated with Renal Tubular Acidosis – Type ___

A

1

104
Q

Which portion of nephron is damaged with aminoglycoside use?

A

Proximal tubule

105
Q

Which portion of nephron is damaged with cisplatin use?

A

Distal convoluted tubule

106
Q

Electrolyte abnormality associated with cisplatin?

A

Hypomagnesemia … (due to magnesuria)

107
Q

Change to urine osmolarity in intrarenal azotemia?

A

Low

108
Q

Change to renal vasculature in setting of rhabdomyolysis?

A

Vasoconstriction

109
Q

Change to CPK level in statin-induced rhabdomyolysis?

A

CPK = High

110
Q

Another electrolyte abnormality seen in setting of rhabdomyolysis?

A

Hyperkalemia

111
Q

Change to CPK level in steroid-induced myositis?

A

CPK = NML

112
Q

2 treatments for rhabdomyolysis?

A

IV hydration; Alkalinize urine (pH > 6.5)

113
Q

45 yo male develops dark lesions on bottom of toes after percutaneous renal angioplasty; HX of HTN; CBC shows eosinophilia, Cr = 3.1 – diagnosis?

A

Cholesterol atheroembolic-induced renal failure

114
Q

Event that always precedes development of cholesterol atheroembolic-induced renal failure?

A

Invasive procedure

115
Q

Prognosis of Cholesterol atheroembolic-induced renal failure?

A

Irreversible

116
Q

2 lab changes seen in Cholesterol atheroembolic-induced renal failure?

A

Eosinophilia, Hypocomplementemia

117
Q

2 aspects of clinical presentation for Cholesterol atheroembolic-induced renal failure?

A

Emboli on fundoscopic exam, Microemboli of digits

118
Q

6 drugs associated with Acute Interstitial Nephritis?

A

TMP-SMX, NSAIDs, Cimetidine, Thiazides, Phenytoin, Allopurinol

119
Q

Triad of clinical symptoms seen in setting of Acute Interstitial Nephritis?

A

Fever, Rash, Eosinophilia

120
Q

UA finding associated with Acute Interstitial Nephritis?

A

Eosinophils in urine

121
Q

2 renal conditions associated with NSAID use?

A

Acute Interstitial Nephritis, Papilary necrosis

122
Q

In addition to NSAIDs, what is another exposure that can lead to papillary necrosis?

A

Lead

123
Q

FENa in setting of postrenal disease?

A

>2%

124
Q

Change to BUN/Cr ratio in postrenal disease?

A

~ 15:1

125
Q

UA shows muddy brown casts – diagnosis?

A

Acute tubular necrosis

126
Q

UA shows RBC casts – diagnosis?

A

Acute glomerulonephritis

127
Q

UA shows > 3+ proteinuria – diagnosis?

A

Nephrotic syndrome

128
Q

UA shows waxy (hyaline) casts – diagnosis?

A

Prerenal azotemia

129
Q

UA shows eosinophils + WBC casts – diagnosis?

A

Interstitial nephritis

130
Q

UA shows WBC casts – diagnosis?

A

Pyelonephritis

131
Q

2 additional PE findings seen in AD polycystic kidney disease?

A

Hepatic cysts + Cerebral aneurysm

132
Q

Best management of simple renal cyst?

A

Reassurance

Rizk Review (19 decks)

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