Renal 2

Question 1

If a patient presents with hematuria, flank pain, and a renal palpable mass the most likely Dx is:

Answer 1

RCC - renal cell carcinoma

• Hematuria signifies tumor invasion into the collecting system.

Question 2

Why is a unilateral varicocele that fails to empty suspicious for RCC?

Answer 2

Varicoceles fail to empty when Pt is recumbent because tumor obstructs the gonadal vein (drains into renal vein). Can be confirmed w/CT abdomen

Question 3

What are the requirements for a Dx of orthostatic hypotension?

Answer 3

Drop of 20 mmHg sys, 10 mmHg diastolic

Question 4

Typical hexagonal crystals on urinalysis and a positive urinary cyanide nitroprusside test would indicate:

Answer 4

Cysteinuria. Due to altered AA absorption (dibasic AA transporter dysfunction in brush border of renal tubular and intestinal epithelial cells).

** Urinary cyanide helps detect elevated cysteine levels. Look for personal history of stone formation since childhood and family history of kidney stones.

Question 5

What is the functionality of calcium gluconate in hyperkalemia?

Answer 5

Ca gluconate stabilizes cardiac membrane and prevents bradycardia (sinus node dysfunction and AV block) and ventricular arrhythmias.

Question 6

Why does hypoalbuminemia have a tendency to cause peripheral edema but not pulmonary edema?

Answer 6

Alveolar capillaries have a high permeability to albumin (reducing oncotic pressure difference). They also have greater lymphatic flow than skeletal muscle, which helps protect the lungs from edema.

Question 7

Why do you typically get peripheral edema in cirrhosis but little pulmonary edema with cirrhosis?

Answer 7

Cirrhosis&raquo_space; portal HTN (scarred liver limits blood flow through scarred sinusoidal network). As a result, ^ venous pressure below liver&raquo_space; ascites and edema BUT venous pressure above hepatic veins (jugular vein) is slightly reduced/normal.

Question 8

If a patient presents with proteinuria (>3.5 g/day), hypoalbuminemia, edema, and hyperlipidemia/lipiduria then what is the most likely Dx?

Answer 8

Nephrotic syndrome. Path: Increased urinary loss of antithrombin III, decreased C and S, increased platelet aggregation, hyperfibrinogenemia due to ^ hepatic synthesis, and impaired fibrinolysis are all characteristics of nephrotic syndrome that promote hypercoagulability.

• minimal change dz (kids), membranous glomerulonephropathy, membranoproliferative glomerulonephritis, FSGS

Question 9

What renal side effect do you have to look out for with large dose IV acyclovir?

Answer 9

Crystal induced AKI. Kidney rapidly excretes acyclovir and it has low solubility&raquo_space; precipitation in renal tubules and intratubular obstruction and direct renal tubule toxicity.

Question 10

Why are post-op patients with oliguria given foley catheters instead of waiting for urine production?

Answer 10

Pt with urinary retention and distal obstruction are given foley cath to restore urine output and resolve/prevent hydronephrosis, tubular atrophy, and renal injury.
** Should always perform bladder scan first though.

Question 11

Why do NSAIDS&raquo_space; hyperkalemia?

Answer 11

NSAIDS inhibit local prostaglandin synth&raquo_space; reduced renin and aldosterone secretion

Question 12

Urge incontinence = detrusor overactivity&raquo_space; overactive bladder. If lifestyle modification fails how would you treat it pharmacologically?

Answer 12

With antimuscarininc drugs (oxybutynin)&raquo_space; increased bladder capacity and reduces detrusor contractions by reducing ACh activity.