Renal 2

Question 1

​​Acute tubular necrosis/ Renal Tubular Injury

3 MCC:

Answer 1

Hypotension/Hemorrhage
Aminoglycosides
Contrast dye (iodinated)

muddy brown, granular casts

ATN will HACk your kidneys

Question 2

Glomerular immune complex deposition resulting in renal injury (rise in Cr & BUN)
can be caused by what type of syndromes?

Answer 2

Nephortic/Nephritic syndromes:

Ex:
- Membranoproliferative glomerulonephritis (HepC)
- Mixed cryoglobulinemia syndrome (an immune complex deposition disorder)

*UA = +/- dysmorphic red cells, red cell casts, or protein.

Question 3

Renal Interstitial inflammation commonly caused by (2)

Answer 3

Acute interstitial nephritis (AIN)
(ABxs or rheumatologic disease)
*UA = WBCs and WBC casts +/- eosinophils in the urine
⎯
Chronic interstitial nephritis
-Tubulointerstitial nephritis
-Analgesic nephropathy
s/t chronic use of combo analgesia w/ acetaminophen + aspirin or NSAID.
* UA= urine WBCs and WBC casts

Question 4

Tubular Obstruction can be caused by Methotrexate use and (3)

Answer 4

Chemotherapy, Tumor lysis syndrome, Chronic Gout
(Acute urate nephropathy )

Ethylene Glycol poisoning (Anti-Freeze)

Acyclovir (pt w/ recent viral hemorrhagic meningitis)

Question 5

Evidence of glomerular damage on urinalysis = dysmorphic red blood cells, red blood cell casts

suggests what general diagnosis?

Answer 5

Glomerulonephritis

Question 6

BUN/Cr ratio >20
& largely unremarkable UA/urine sediment

Diagnosis?

Answer 6

Prerenal AKI

Question 7

Nodular glomerulosclerosis occurs in diabetic nephropathy;
renal dysfunction typically develops over what time frame?

Answer 7

gradually (rather than over 1 month)

*and significant proteinuria is seen.

Question 8

Leukocyte casts on urinalysis + a skin rash = Diagnosis?

Answer 8

acute interstitial nephritis (AIN)

Question 9

Typically presents with HTN, hematuria, ↑ Cr

± dysmorphic RBCs on UA

Answer 9

Glomerulonephritis

Question 10

Perineal bruising accompanied by blood at the urethral meatus
and a high-riding prostate on digital rectal examination
Diagnosis? NBSIM?

Answer 10

posterior urethral injury
Retrograde urethrography

Question 11

Negative Fast Exam + bladder tear
Where is the tear?

Answer 11

Anterior Bladder Wall

Question 12

Postive Fast Exam + bladder tear
Where is the tear?

Answer 12

Bladder Dome

Question 13

suprapubic fullness and tenderness and gross hematuria in the setting of a pelvic fracture likely s/t a _____.
NBSIM?

Answer 13

bladder injury
Retrograde cystography

Question 14

screening for ____ cancer (urinalysis, urine cytology, tumor markers) has not been shown to improve outcomes and is not recommended.

Answer 14

bladder cancer

Question 15

40M Smoker presents with painless hematuria throughout micturition
± Irritative voiding symptoms (frequency, urgency, dysuria)
± suprapubic pain

Diagnosis and NBSIM?

Answer 15

Bladder Cancer
Flexible cystoscopy with biopsy

Hematuria can be microscopic

Renal Cancer does not usually have voiding sxs

Question 16

Treatment of Bladder Cancer
No muscle invasion: ____
Muscle invasion: ____
Metastatic: ____

Answer 16

TURBT = transurethral resection of bladder tumor
⎯
No muscle invasion → TURBT & intravesical Immunotherapy

Muscle invasion → Cystectomy & Chemotherapy

Metastatic → Immunotherapy & Chemotherapy

Question 17

Painless hematuria in an adult age >40 must be evaluated urgently with _____.

Answer 17

cystoscopy

Question 18

Manifestations of renal infarction include
flank pain, nausea, and vomiting

Urinalysis → hematuria and proteinuria w/o casts.

CT scan → wedge-shaped cortical infarction (dark grey triangle)

Renal infarctions can occur s/t ____. (~4)

Answer 18

Cardioembolic disease (A-Fib)
Infectious endocarditis (murmurs)
Polyarteritis nodosa
Fibromuscular dysplasia
Hypercoagulable states (antiphospholipid syndrome, polycythemia vera, factor V Leiden, cancer)
Marfan syndrome

Question 19

Patient s/p Hysterectomy develops large volume intraabdominal fluid (uroperitoneum), abdominal tenderness, with a normal UA.

Diagnosis?

Answer 19

Ureteral injury (laceration)

can occur during gynecologic surgery due to the proximity of the ureter to the ovarian and uterine vessels.

Question 20

RCC is sometimes discovered incidentally on abdominal imaging, but patients often have ≥1 the following:

Unintentional weight loss
Abdominal or flank mass (firm, nontender, and mobile)
Hematuria (_______),
anemia
Intermittent fever
Paraneoplastic syndromes (ectopic EPO, hypercalcemia)

Patients with suspected RCC usually require ____ & ____ for further evaluation.

Answer 20

Microscopic (not seen in urine)
or
Gross (Painless red pee)

Abdominal CT scan
Partial/complete nephrectomy

Question 21

How to tell bladder cancer and Renal Cell Carcinoma apart?

Answer 21

RCC does not have voiding symptoms (frequency, urgency, dysuria) and suprapubic pain. More common in bladder cancer.

Question 22

Chronic _____ often causes recurrent symptoms of urinary tract infection (dysuria, frequency, urgency) that improve with short courses of antibiotic therapy but then recur.
Urinalysis often shows pyuria and bacteriuria.

Answer 22

bacterial prostatitis

Question 23

WAGR syndrome/11p deletion syndrome is characterized by a predisposition to W____ and the presence of A____, G_____, and R____.

Consider in a child with 2 or more of the associated conditions.

Answer 23

Wilms tumor (Nephroblastoma)
Aniridia (no Iris)
Genital-Urinary defects/abnormalities
Retardation (Mental)

Question 24

Unilateral varicoceles that fail to empty when a patient is recumbent raise suspicion for ____

Answer 24

an underlying Tumor

such as renal cell carcinoma (RCC), that obstructs venous flow

Question 25

Causes of initial hematuria (2)

Answer 25

urethritis
Trauma (catheter insertion)

Question 26

Causes of terminal hematuria (3)

Answer 26

Urethral stone
Urethral cancer
Prostate cancer

Question 27

Causes of hematuria throughout urinary stream (6)

Answer 27

Glomerulonephritis
Kidney stones
UTI
Renal Papillary Necrosis
Cancer (Renal, bladder, urethral)
Trauma

Question 28

Initial hematuria suggests ____ damage, terminal hematuria indicates ___or ___ damage, and total hematuria reflects damage anywhere in the urinary tract.

Answer 28

Urethral (Initial)

Bladder/Prostatic (Terminal)

Question 29

Seen in children, typically presents with an asymptomatic unilateral abdominal mass.
± Abdominal pain, hypertension, hematuria

Answer 29

Wilms tumor (nephroblastoma)

most common renal malignancy in children.

(Unilateral → Nephrectomy)

(Bilateral → Immunosuppresion → Chemo → Radiation)

Question 30

Individuals with secondary polycythemia (elevated Hct) and no evidence of hypoxia (cardiopulmonary disease, obstructive sleep apnea) should undergo abdominal CT scan to evaluate for ____.

Answer 30

renal cell carcinoma

(Pheochromacytoma can do this too)

Question 31

Blunt trauma (eg, direct blow to the flank) can cause renal injury. Concerning clinical findings (eg, flank pain/ecchymosis) require prompt _____, regardless of whether hematuria is present.

Answer 31

CT scan of the abdomen and pelvis

Question 32

A _____ should be suspected in a prepubertal boy with a soft, coiled (“bag of worms”), right-sided scrotal mass that fails to decompress when supine.

NBSIM?

Answer 32

secondary varicocele

Abdominal ultrasound

(to evaluate for anatomical causes leading to venous compression (such as a renal tumor)

Question 33

painless, coiled (“bag of worms”) scrotal mass or swelling that does not transilluminate is most consistent with a ____.

Answer 33

varicocele
(a dilation of the pampiniform plexus surrounding the spermatic cord and testis)

Question 34

Typical presentation of a ___ is

an irregular, unilateral scrotal mass in an adolescent or adult patient that
increases with standing/Valsalva maneuver
and reduces when supine.

Answer 34

primary varicocele

Question 35

a varicocele s/t venous thrombus or extrinsic compression of the inferior vena cava (IVC) by a renal or retroperitoneal tumor is rare
but should be considered in the following circumstances:

Age Group: _____
_____-sided mass
Mass that fails to ____

Answer 35

Prepubertal boy

** Right** sided mass

decrease in size when supine