Renal Flashcards
1
Q
BUN/Creatinine for Prerenal AKI?
A
> 20 (high)
2
Q
FENA for Prerenal AKI?
A
<1% (low)
3
Q
Urine osmolarity for Prerenal AKI?
A
> 500 (high)
4
Q
Best management for Prerenal AKI?
A
IV fluids
5
Q
BUN/Creatinine for Acute Tubular Necrosis?
A
10-15 (NML)
6
Q
FENA for Acute Tubular Necrosis?
A
> 2% (high)
7
Q
Urine osmolarity for Acute Tubular Necrosis?
A
300
8
Q
Appearance of urine microscopy for Acute Tubular Necrosis?
A
Muddy brown casts
9
Q
Most common cause of postrenal AKI?
A
Obstruction
10
Q
Best treatment for postrenal AKI?
A
Relieve the obstruction
11
Q
2 most important factors in matching kidney donor to recipient?
A
Human Leukocyte Antigen (HLA), ABO compatibility
12
Q
2 absolute contraindications to kidney donation?
A
Age < 18 yo, Untreated psychiatric disease
13
Q
Wheezing in a hemodialysis patient prior to initial of HD is suspicious for …
A
Volume overload
14
Q
3 aspects of clinical presentation for anaphylaxis in hemodialysis patient?
A
Wheezing, hypotension, flushing
15
Q
Best management of anaphylaxis in hemodialysis patient?
A
Epinephrine
16
Q
Triad of clinical symptoms seen in pyelonephritis?
A
NV, Fever, Flank pain
17
Q
2 risk factors for development of pyelonephritis in children?
A
Female sex, HX of bladder/bowel dysfunction (constipation)
18
Q
Describe association between constipation and pyelonephritis in children?
A
Fecal retention causes rectal distention … Obstruction of bladder emptying … Incompetent voiding leads to stagnant urine
19
Q
4 situations in which IV in ABX are indicated for pediatric patients with pyelonephritis?
A
Age < 2 mo, Failure to improve on PO ABX, Hemodynamic instability, Inability to tolerate PO medications (vomiting)
20
Q
Best strategy for prevention of recurrent episodes of pyelonephritis in children?
A
Laxative use, Increase dietary fiber + water intake
21
Q
What is the only chance of cure for patients with renal cell carcinoma?
A
Surgical excision
22
Q
Definition of Stage 1 renal cell carcinoma?
A
Renal mass is confined with the renal capsule
23
Q
Best treatment for Stage 1 renal cell carcinoma?
A
Partial nephrectomy
24
Q
Definition of Stage 2 renal cell carcinoma?
A
Renal mass extends through renal capsule, but not beyond Gerota’s fascia
25
Best treatment for Stage 2 renal cell carcinoma?
Radical nephrectomy
26
In a patient with ADPKD, what might account for LV hypertrophy on exam?
Long-standing HTN
27
Complication of ADPKD?
Progressive renal insufficiency
28
Diagnostic test for ADPKD?
Renal US
29
Best management of ADPKD?
Aggressive HTN control with ACEIs
30
Additional management of ADPKD?
Aggressive control of HLD with Statins … to limit risk of cardiovascular risk
31
Clinical triad seen in setting of Renal Cell Carcinoma?
Flank pain, Palpable abdominal mass, Hematuria
32
What accounts for hematuria seen in setting of Renal Cell Carcinoma?
Polycythemia caused by EPO over-production
33
Exposure that increases risk of Renal Cell Carcinoma?
Smoking
34
Diagnostic test for Renal Cell Carcinoma?
CT abdomen
35
Appearance of Renal Cell Carcinoma on CT abdomen?
Enhancing complex mass with thick, irregular septations
36
Treatment of choice for Renal Cell Carcinoma?
Nephrectomy
37
If a patient presents with (+) result for blood on UA, what are 3 differential diagnoses?
Myoglobinuria, hemoglobinuria, exercise-induced hematuria
38
If patient presents with (+) result for blood on UA with RBCs on microscopy, which 2 diagnoses are eliminated?
Myoglobinuria, hemoglobinuria
39
Risk factor for exercise-induced hematuria?
Running marathons
40
Etiology of exercise-induced hematuria after running a marathon?
Repetitive up-down trauma of bladder during running
41
Best management of exercise-induced hematuria?
Follow up UA in 1 week to ensure resolution of hematuria
42
Example of renal parenchymal disease?
Glomerulonephritis
43
Epidemiology of renal arteries stenosis vs. fibromuscular dysplasia?
FMD = younger patients; RAS = older
44
Clinical presentation of glomerulonephritis in young adults?
HTN, edema (leg swelling, facial puffiness)
45
What accounts for HTN in the setting of glomerulonephritis?
Increased renal Na+ absorption
46
8 contraindications to kidney donation?
Age < 18; Uncontrolled HTN, HIV, DM; Active CA; Acute infection; Donor coercion; Financial exchange from recipient; Uncontrolled psychiatric illness; Active substance-abuse
47
How can you correct serum Ca2+ based on serum albumin … in the setting of hypocalcemia and hypoalbuminemia?
Corrected Ca2+ = (total calcium) + [0.8 * (4 - serum albumin)]
48
Relationship between serum Ca2+ and serum albumin?
For every 1 unit drop in albumin, serum Ca2+ drops by 0.8
49
3 aspects of clinical presentation for mixed cryoglobulinemia syndrome?
Palpable purpura, arthralgias, glomerulonephritis
50
3 lab values associated with mixed cryoglobulinemia syndrome?
Elevated RF, Hypocomplementemia, Elevated serum cryoglobulin levels
51
Diagnostic test for mixed cryoglobulinemia syndrome?
Elevated serum cryoglobulin levels
52
Etiology of mixed cryoglobulinemia syndrome?
Deposition of immune complexes (IgG, IgM)
53
Condition associated with mixed cryoglobulinemia syndrome?
Hepatitis C
54
Best initial treatment of mixed cryoglobulinemia syndrome?
Immunosuppressive therapy (Rituximab + prednisone)
55
Best long-term management of mixed cryoglobulinemia syndrome?
Treatment targeting the underlying disease (antivirals)
56
53 yo male presents 8 months after kidney transplant with HA; BP is 180/110, creatinine is 1.1; Started on ACEI; Returns with creatinine 2.4 – what accounts for HTN in this patient?
RAS activation … due to renal artery stenosis … classic increase in creatinine after ACEI initiation
57
Change to C3 levels in poststreptococcal glomerulonephritis (PSGN)?
Decreased
58
Clinical presentation of poststreptococcal glomerulonephritis (PSGN)?
Hematuria, edema, HTN
59
Poststreptococcal glomerulonephritis (PSGN) can result from …
Impetigo, strep throat
60
Poststreptococcal glomerulonephritis (PSGN) represents a type of ___
Nephritic syndrome
61
4 poor prognostic factors for poststreptococcal glomerulonephritis (PSGN)?
Adults, CKD, metabolic syndrome, DM
62
What accounts for hyponatremia in the setting of bacterial PNA?
SIADH
63
What is considered low serum osmolarity?
Serum osmolarity < 275
64
What is considered high urine osmolarity?
Urine osmolarity > 40
65
How can you distinguish between unilateral kidney stone and NSAID induced nephropathy?
Unilateral kidney stones won’t cause increased creatinine
66
Pathology of kidneys associated with NSAID induced nephropathy?
Papillary necrosis
67
NSAID induced nephropathy can present with what change on UA?
Nephrotic-range proteinuria
68
48 yo male presents with bizarre behavior; HX of cirrhosis, Hep C infection; BP 96/56, HR 112; Labs show Na 132, Cr 2.8, T. bili 6.2, D. bili 3.7; Peritoneal fluid sampling yields 12 WBC, albumin 1.0 - diagnosis?
Hepatorenal syndrome
69
___ refers to common cause of acute renal failure in patients with cirrhosis
Hepatorenal syndrome
70
48 yo male presents with bizarre behavior; HX of cirrhosis, Hep C infection; BP 96/56, HR 112; Labs show Na 132, Cr 2.8, T. bili 6.2, D. bili 3.7; Peritoneal fluid sampling yields 12 WBC, albumin 1.0 - what is next best step in confirming diagnosis?
Intravascular volume repletion
71
Step of diagnosis confirmation for Hepatorenal syndrome?
IVF bolus to confirm that acute renal failure is not secondary to intravascular volume depletion
72
Best treatment for Hepatorenal syndrome?
Midodrine, octreotide, albumin
73
24 yo male presents after PCP-associated seizure; UA shows large blood, but no RBCs - diagnosis?
Myoglobinuria due to rhabdomyolysis
74
Major complication of rhabdomyolysis?
AKI
75
DOC for preventing adverse outcome (AKI) in patients with rhabdomyolysis?
Isotonic saline infusion
76
34 yo male presents for 2 weeks of NV, abdominal pain; HX of ETOH use; HR 121, BMI 16; PE reveals epigastric TTP, dry MM; Labs show Mg 1.5; Treated with IVF, dextrose, thiamine, folate; On Day 2 of hospitalization, develops severe weakness, reporting that he cannot lift his arms - what accounts for his symptoms?
Hypophosphatemia
77
34 yo male presents for 2 weeks of NV, abdominal pain; HX of ETOH use; HR 121, BMI 16; PE reveals epigastric TTP, dry MM; Labs show Mg 1.5; Treated with IVF, dextrose, thiamine, folate; On Day 2 of hospitalization, develops severe weakness, reporting that he cannot lift his arms - etiology of hypophosphatemia in this patient?
Refeeding syndrome
78
Patients with DM should be screened yearly for diabetic kidney disease with …
/ Urine albumin-creatinine ratio
79
64 yo male presents for 2 days of NV, abdominal distension; Compression fracture 6 months ago; PE shows decreased dowel sounds, 1+ peripheral edema; Labs show Na 132, K 2.7; Abdominal XR shows diffuse bowel distension with gas in colon, rectum - diagnosis?
Hypokalemia-induced paralytic ileus
80
Initial therapy for correcting hyponatremia in a patient with decompensated CHF?
Water restriction
81
Therapy for correcting severe hyponatremia (Na < 120) in a patient with decompensated CHF?
Tolvaptan
82
MOA of Tolvaptan?
Vasopressin-2 Receptor antagonists
83
56 yo male presents for follow-up 2 weeks after renal transplant; Current medications include prednisone, tacrolimus, myophenylate; Labs show Cr 1.4 - which complication is patient at greatest risk of developing?
DM
84
What accounts for increased risk of DM for patients with recent renal transplant?
AE of immunosuppressants; Increased insulin excretion and glucogenesis by healthy kidney
85
Best management of asymptomatic bacteruria in pregnancy?
Oral cephalexin QID for 5 days
86
Definition of asymptomatic bacteruria?
Presence of >100,000 colony-forming bacteria without urinary symptoms
87
3 DOC for asymptomatic bacteruria in pregnancy?
Cephalexin, Amoxicillin-Clavulanate, Fosfomycin
88
18 yo male presents with flank pain, hematuria approximately 3 days after flu-like symptoms with rhinorrhea and throat pain; Cr 1.9; UA shows 1+ protein, 1+ ketones, many RBCs, RBC casts - diagnosis?
IgA nephropathy
89
Typical timinig of IgA nephropathy?
Days after URI
90
Typical timinig of post-streptococcal glomeruloneprhitis?
2-3 week after URI
91
Complement levels in IgA nephropathy?
NML
92
Complement levels in post-streptococcal glomeruloneprhitis?
Decreased
93
62 yo female presents with 6 months of fatigue; HX of CKD; Labs show Hgb 9.2, MCV 84, Cr 2.9 - what is next step in management of patient’s anemia?
Evaluate iron stores … prior to initiation of EPO
94
52 yo female presents with fever, chills, N, R flank pain; T103, BP 90/70, HR 120; PE with CVA tenderness; CT scan shows R-sided proximal ureteral stone with dilated renal calyces - next step?
Percutaneous nephrostomy
95
Alternate name for Percutaneous nephrostomy?
Retrograde ureteral stent
96
At what BUN level does uremia typically occur?
BUN > 50
97
At what creatinine level does uremia typically occur?
Creatine > 7
98
Most common correctable cause of secondary HTN?
Renovascular HTN
99
Best workup for patients with suspected Renovascular HTN?
Renal duplex US, CT/MRI angiography
100
Lab finding seen in acute post-streptococcal glomerulonephritis?
Decreased complement
101
Best management of volume overload in acute post-streptococcal glomerulonephritis?
Loop diuretics
102
Risk associated with donor nephrectomy in females of childbearing age?
Increased risk of gestational complications – fetal loss, preeclampsia, gestational DM, gestational HTN
103
17 yo male presents for abnormal UA findings (protein 2+, casts); Reports lower back pain; 24-hour urine collection shows protein 600mg (normal <150mg) – diagnosis?
Orthostatic proteinuria
104
___ is the most common form of proteinuria in adolescents
Orthostatic proteinuria
105
Definition of Orthostatic proteinuria?
Increased protein excretion during day (when upright), but normal at night (when supine)
106
Next step of workup for suspected Orthostatic proteinuria?
Split day/night 24-hour urine collection … (elevated daytime protein excretion, but normal nighttime excretion)
107
When does Orthostatic proteinuria turn from mild moderate?
When adolescent develops other renal abnormalities (HTN, hematuria, AKI)
108
Best management of Orthostatic proteinuria?
Observation
109
58 yo male presents for initial evaluation; Exercise tolerance is 7 blocks before experiencing fatigue; HX of HLD, HTN, OA; Reports that his BP has always been difficult to manage; Reports family HX of renal failure; BP 156/88; EKG shows LVH; Labs show creatinine 2.0 (1 year ago was 1.6) – diagnosis?
CKD … likely caused by HTN
110
What is the best initial step of workup in patient with new-onset CKD?
Urine protein levels
111
What is significance of getting urine protein levels in new-onset CKD?
Proteinuria is associated with accelerated progression of CKD, guides management of anti-HTN therapy
112
What is goal BP for patient with new CKD?
130/80
113
What is goal urine protein for patient with new CKD?
500-1000 mg/day
114
Best management of new CKD with significant proteinuria?
ACEI + ARB
115
Which medications for gout should be avoided in patients with CKD?
NSAIDs, Colchicine
116
Best management of gout involving single joint in patient with CKD?
Intra-articular steroid injection
117
Best management of gout involving multiple joints in patient with CKD?
Systemic steroids (oral prednisone)
118
66 yo male develops seizure 1 day post-op; Labs show Na 114 - best management?
Hypertonic saline
119
Indication for hypertonic saline in treatment of hyponatremia?
Na < 120
120
36-year-old African-American female presents with severe, throbbing headache that began several hours ago; also has acute onset blurry vision with nausea; history of Raynaud's disease, heartburn; BP 200/110; PE reveals bilateral papilledema; serum creatinine 2.0; all lab values where WNL approximately 6 months ago; diagnosis?
Sclerodermal renal crisis
121
Clinical presentation of scleroderma renal crisis?
Severe hypertension, renal failure in patient with evidence of underlying scleroderma (crest syndrome)
122
What is best management of sclerodermal renal crisis?
ACE inhibitor
123
Which medicine should be used in addition to an ACE inhibitor in the setting of sclerodermal renal crisis with presence of papilledema or CNS manifestations?
Nitroprusside
