Renal

Question 1

Severe crush injury causes what? Test? Rx?

Answer 1

Hyperkalemia can cause Rabdomyolysis as well. EKG and potassium level. Cpk has to be 10,0000. Hyperkalemia can cause spiked t waves prolong PR interval wide QRS leading to cardiac arrest. Rx: IV Calcium Gluconate.

Question 1

Young black male with painless hematuria. Dx?

Answer 1

Sickle cell anemia causing papillary necrosis ischemia.

Question 2

After post strept glomerulonephritis patient develops chest pain that is relieved by leaving forward and worse with inspiration. EKG shows st elevations in all leads and PR segment elevation in lead aVR. Dx? Rx?

Answer 2

Uremic pericarditis. Hemodialysis.

AEIOU.

Question 4

Seen in black ( HIV and IV Drug use, SS and obesity) ppl. They have protineuria, hematuria and resistant hypertension. Dx? Test? Rx?

Answer 4

FSGS. Glomerula sclerosis. Biopsy shows sclerosis. Steroids and cytoxic therapy.

Question 5

Systemic T cell dysfunction seen in children produces nephrotic syndrome. Selective loss of albumin but no globulins. Associated with Hodgkin lymphoma. Dx? Test? Rx?

Answer 5

Minimal Change Dz. Effacement of foot processes/podocytes on EM. Good prognosis responds to steroids. Can occur in adults as well especially if they develop hodgkin lymphoma.

Question 6

Secondary causes of Nephrotic/Nephritic Syndrome: 1. DM + hyalinization and nodular glomerulosclerosis 2. SLE + proteinuria w/ RBCs on UA 3. MM, or chronic inflammatory dz, causing deposition of protein in beta pleated sheet in basement membranre.

Answer 6

1. DM Nephropathy. 2. Lupus nephritis 3. Renal Amylodosis.

Question 7

Caused by Hep B, C, SLE, tumors, drugs, common in white older adults but can occur in kids. Dx? Rx?

Answer 7

Membranous Nephropathy fair prognosis. Spike and Dome appearance on EM. Steroids + cytotoxic therapy.

Question 8

After Hep C and Hep B infection, SLE, Tumor, drugs Patient develops nephrotic or nephritc syndrome associated with cryoglobulinemia. What are the two types? Test? Rx?

Answer 8

Memboproliferative Type 1 and 2. Subendothelial deposits “tram track appearance” on EM. Type 2 has C3 nephritic factor. Cause decrease in C3 and low complement. Poor prognosis. Steroids + cytotoxic therapy.

Question 9

Pt with rheumatoid arthritis. Has generalized edema, hepatomegaly, enlarged kidney and proteinuria. Dx? Test?

Answer 9

Amyloidosis (AL primary or AA secondary) Amyloid deposits show apple-green birefringence under polarized light after staining with Congo red. Abdominal fat pad.

Question 10

After angiography pt develops blue/purplish skin lesions on fingers and toes as well as occular lesions. Dx? What are the names of the lesions? Most accurate test? Best initial test? Rx?

Answer 10

Cholesterol emboli plaques. Livedo reticularis. Labs will show eosinophila, eosinophiluria, low complement. Biopsy of the skin lesions will show cholesterol crystals. No specific therapy.

Question 11

Presents with fever, sudden onset of flank pain and hematuria. Necrotic material present on UA (Muddy Brown Cast). Associated with DM, SS, NSAID use. Best initial test? Most accurate Test? Rx?

Answer 11

Papillary necrosis (a form of analgesic Nephropathy) Best initial is UA (shows WBCs and necrotic material from sloughing off of cells due to direct vascular insufficiency, Muddy Brown Cast/ATN.) Negative Culture. Most accurate is CT scan which shows abnormal internal structures of the kidney from the loss of the papillae (bumpy counter of the papillae of the kidney. No specific therapy.

Question 11

What is Hypertensive Urgency? What is Hypertensive Emergency (Malignant HTN)? Rx?

Answer 11

These are both forms of Hypertensive crisis. 180/120. Urgency has NO end organ damage, it can present with HA and Syncope and Emergency HAS End Organ damage (stroke, MI, renal failure, blurry vision) Labatelol.

Question 12

Lung and kidney involvement (hematuria, proteinuria <1.5g/day) no upper respiratory involvement (hemoptysis). Dx? Best initial test? Most accurate test? Rx?

Answer 12

Goodpasture Syndrome. Anti-GBM. Kidney Biopsy. Linear anti-GBM deposits on immunoflorescen. Plasmapharesis.

Question 13

Asian pt was recumbent GROSS hematuria after 1 - 2 DAYS after URI or GI infection.

Answer 13

IgA. IgA levels (Only elevated in 50% of pts.) Most accurate is kidney biopsy . Immune-complexes and C3 mesengial deposits seen on EM. So hypocomplement. Supportive care.

Question 15

Pt presents with Dark cola colored urine, peri-orbital edema, HTN, 2 weeks after infection. Dx? Best initial test? Most accurate test? Name the 4 diseases associated with hypocomplement?

Answer 15

Post-strep glomerulonephritis. UA will show RBCs. ASO and Anti-DNase best initial test, Most accurate test is kidney biopsy (Immune complex, low C3, lumpy bumpy on immunoflouresence.)

Question 15

This stone is the only stone that forms in acidic urine and is radiolucent on US. Dx Rx?

Answer 15

Uric acid stone. Rx hyperurecemic issue (Gout, Tumor lysis) Hydration, alkalinize urine with Potassium Citrate!!!. Dietary purine restriction. Give Allopurinol before chemotherapy.

Question 16

Best initial test for PAN? Most accurate? Rx?

Answer 16

Angiography (looks at renal, mesenteric and hepatic arteries showing dilatations) 2. Kidney Biopsy most accurate. Prednisone + cytotoxic therapy.

Question 18

This stone is caused when pt develops UTI with Urease Positive Organisms.

Answer 18

Struvite stone (Magnesium stone) “staghorn caliculi” from Proetus. Hydration/Alkalinze urine. Need surgery for removal big stones. >3cm. ABX for organism.

Question 19

19 yo male presents with recurrent kidney stones and new onset left flank pain radiating down to groin. A Urinary Cyanide Nitroprusside test is Positive. CT confirms nephrolithiasis. Dx? Rx?

Answer 19

Cysteine stone from lack of absorption of cystinuria. Can see Hexagonal crystals on UA. Hydration/Alkalinize urine.

Question 20

Associated with flank pain, hematuria, HTN, hepatic, and splenic cysts. Dx? Test? Rx? What is important about dz?

Answer 20

ADPKD and ARPKD. Monitor w/ US. Can do genetic testing ADPKD 1 and ADPKD2. Try to prevent complications of ESRD. BP monitoring!!!!. If pt presents with new onset severe HA rule out SAH from berry aneurysm.

Question 21

Pt presents with epididymal tenderness, tender and enlarged testicles, fever, scrotal thickening, erythema and pyuria. Pain decreases with scortal elevation (Positive Prehn’s sign)

Answer 21

Epididymitis. UA, Urine culture. (E.coli, Neissiera, Chlymida) Abx.

Question 22

Pt presents with Intense Acute Onset Scrotal Pain that remains the same or increases with elevation (Negative Prehn’s sign) There is LOSS of the Cremaster Reflex. ?

Answer 22

Testicular torsion. Doppler. Surgical emergency.

Question 23

Test and treatment for Erectile Dysfunction.

Answer 23

Check for drug, hormones: Low Testosterone, Low GNRH, Elevated prolactin. Rule Psychological cause (nightime erection) then rx with Sildenafil.

Question 24

Present in old men and associated with urinary retention, reccurent UTIs, weak stream, renal calculi and hydrophenrosis, bladder fullness. Dx? Test? Rx?

Answer 24

Benign Prostatic Hypertrophy (BPH). Smooth enlarged prostate on DRE. Alpha blockers (Terazosin) 5 alpha reductase inhibitors (Finastride). TURP.

Question 25

2nd leading cause of Cancer after Lung cancer in men. Can present with urinary retention, distended bladder, back pain. Usually asymptomatic. Dx? Test? Rx? Prevention?

Answer 25

Prostate Cancer. DRE: irregular prostate with bumps. PSA level greater than 4ng/dl. Most accurate test is US-Guided Transrecatal Biopsy. Rx depends on aggression of cancer and age. Annual DRE by age 50 and stop at age 75. Earlier if African American and positive family hx.

Question 26

Pt presents with painless hematuria. Associated Smoking and Aniline dyes. Dx? Test? Rx?

Answer 26

Bladder cancer (Transitional cell carcinoma). Cystoscopy w/ biopsy. Radical cystecomy + radiation, chemo for mets.

Question 27

Old person with hx of Smoking presents with hematuria, Flank pain and Palpable flank mass.

Answer 27

Renal Cell Carcinoma. CT/US of kidney. Kidney Resection + Radiation, Chemo for metastasis.

Question 28

Young males (15-34) present with Painless Enlarged Testis that does not transilluminate on US. Associated with Cryptorchidism and Klinfelter syndrome. Dx? Next step in management?

Answer 28

Testicular Cancer. Next step in Radical Orchiectomy. (HCG) present in Choriocarcinoma and Seminoma. Alpha feto protein (AFP) in yolk sac tumor.

Question 29

Defectamphotericin or autoimmune attack. The urine is alkaline because you can secrete H+ (acid) if no bicarb is being generated. Dx? Most accurate test? Rx?

Answer 29

Renal Tubular Acidosis Type 1. UA urine ph > 5.5 (Basic) 2. Most accurate test would be to give ammonium IV (weak acid) and the acidemia would rise and the urine would remain alkaline. Rx: Give more bicarb and the PT will absorb more and correct the acidosis in the blood.

Question 30

In this condition the ability to reabsorb bicarb is damage due to fanconi, amyloidosis. Bicarb 15 and Chloride 113. Thus urine ph > 5.5 and blood is acidic. Dx? Test? Rx?

Answer 30

Proximal Renal Tubular Acidosis Type 2. UA: urine ph > 5.5 2. Give Bicarb and see if the urine pH will decrease. It wont in RTA type 2. Rx: with thiazide diuretics they cause massive volume depletion. Volume depletion at the distal tubule will enhance bicarb reabsroption at PT.

Question 31

This conditions is associated with hypoaldosteronism which leads to decreased reabsorption of Na and increased uptake of K+. This condition occurs with diabetes. Dx? Test? Rx?

Answer 31

Renal Tubular Acidosis Type 4. Test: Na restriction and will still see high Na in blood. Rx: Fludrocortisone (only steroid close enough to mineralcorticoid)

Question 31

Name the test and treatment for each: 1. Lactate 2. Ketoacids 3. Oxalic acid 4. Formic acid 5. Uremia 6. Salicylates

Answer 31

1. Lactate level, correct hypoperfusion 2. Acetone level, Fluids and insulin 3. Rhomboid crystal on UA, Fomepizole 4. Inflammed retina, Fomepizole 5. Aspirin level, Alkalinize urine.

Question 32

How to distinguish Diarrhea from RTA?

Answer 32

Urine anion Gap. Urine sodium - urine chloride. Acid is NH4CL(Acid follows Cl- in urine). In RTA Type 1 you cant excrete acid so urine chloride remains low in urine and remains in blood with acid. UAG will be positive number. In diarrhea there is no problem with exretion so as you lose acid, you lose CL and you get a Negative UAG.

Question 33

Name the test and treatment for each: 1. Lactate 2. Ketoacids 3. Oxalic acid 4. Formic acid 5. Uremia 6. Salicylates

Answer 33

1. Lactate level, correct hypoperfusion 2. Acetone level, Fluids and insulin 3. Enveloped/Rhomboid crystal on UA, Fomepizole 4. Inflamed retina, Fomepizole 5. Hemodialysis 6. Aspirin level, Alkalinize urine. (Sodium Bicarbonate)

Question 35

When a pt presents with dysuria, urgency and frequency as well as Suprapubic Tenderness. UA is positive WBC, Leukocyte esterase and nitrates. Dx? What is the next step in management?

Answer 35

Uncomplicated Cystitis. Start treatment. Give Bactrim for 3 days, Nitrofurantoin for 5 days or 1 dose of Fosfomycin (pregnant pts.) Only culture in these patients when they fail initial therapy (after 2-3 days.)

Question 36

Pt presents with excruciating pain radiating to groin. What is the next best step in management? What is the most accurate test? Rx?

Answer 36

Nephrolithiasis (Most common is calcium oxalate due to alkaline ph.) Next step in management is keterolac (NSAID). CT is Most Accurate Test. Management depending on sizes of stone.

Question 37

2 Causes of Rental artery steonsis? Test and Rx? What treatment to avoid and why?

Answer 37

Fibromuscular dysplasia in young patient and atherosclorosis in old person. MRA and Doppler to diagnosis. Rx with stent placement. Dont give ACE-I if there is bilateral kidney disease. ACEI can accelerate kidney failure by causing vasodilation of the efferent arteriole which will further decrease GFR.