Renal 3

Question 1

Simple renal cysts are almost always benign, asymptomatic, and treatment is ____.

They appear smooth, homogenous, and dark grey (no contrast enhancement) on imaging.

Answer 1

Not needed.

Question 2

Features concerning for malignant renal mass include a multilocular septated mass, irregular walls, ____ texture, and have contrast ____.

Answer 2

Heterogenous

enhancement (bright white mass)

Question 3

____ commonly presents with hypertension, hematuria, and recurrent flank pain in patients in their 30s or 40s.

Answer 3

Autosomal dominant polycystic kidney disease

Question 4

Treatment of Autosomal dominant polycystic kidney disease is mostly supportive (____, ____) , although _____ may slow disease progression in some patients.

Answer 4

Aggressive control of risk factors for CV & CKD
ACE inhibitors for hypertension

vasopressin-2 receptor antagonists ( tolvaptan)

Question 5

Hypertension in autosomal dominant polycystic kidney disease results from cyst expansion leading to localized renal ischemia and consequent increased ___ production

Answer 5

renin

Tx: ACE inhibitors (eg, lisinopril).

Question 6

_____ is a progressive disease that presents with recurrent hematuria (microscopic or gross) in boys age <10,
Nephropathy,
± Hypertension,
Bilateral sensorineural hearing loss,
Anterior (lens protrusion)

Family history of renal failure and/or hearing loss is present.

Answer 6

Alport syndrome

Question 7

Complement levels are normal
Renal biopsy shows longitudinal splitting of the glomerular basement membrane
Presents with ± Hypertension and Hematuria in young boys

Answer 7

Alport Syndrome

Question 8

Autosomal dominant polycystic kidney disease is commonly associated with _____ that may rupture and lead to intracranial bleeding.

Answer 8

cerebral aneurysms

Question 9

ATN (or instrinsic kidney damage) is characterized by high urine sodium (typically > __ mEq/L) and fractional excretion of sodium (>__) due to tubular damage limiting reabsorptive capacity.
BUN/creatinine ratio tends to be ____.

Answer 9

> 40

> 2%

(~10-15:1)

Question 10

Presents with AKI.
On UA: Hematuria, pyuria & crystals
in inpatient pts on medication. Diagnosis?

Answer 10

crystal-induced acute kidney injury

Acyclovir
Ethylene glycol toxicity
Uric acid (tumor lysis syndrome)
Sulfonamides, Methotrexate

Question 11

Mcc of crystal-induced acute kidney injury

Acyclovir
_____ toxicity
_____
Sulfonamides, Methotrexate

Answer 11

Uric acid (tumor lysis syndrome)
Ethylene glycol

Question 12

____ inhibit prostaglandin synthesis, which can cause prerenal azotemia in volume depleted patients.

Answer 12

NSAIDs

Question 13

Gastroenteritis (typically from ____) can trigger hemolytic uremic syndrome, a form of thrombotic microangiopathy in children.

Answer 13

Shiga toxin–producing Escherichia coli)

(or Shiga toxin produced by Shigella)

Question 14

Syndrome causes intrinsic renal disease via deposition of thrombi within glomerular capillaries in children

Labs reveal a BUN/Cr ratio of <20:1 and
UA reveals RBCs (schistocytes) and protein.

Answer 14

Hemolytic Uremic Syndrome

Question 15

Labs indicate evidence of hemolysis (↓ haptoglobin, ↑ LDH, ↑ indirect/unconjugated bilirubin, ↑ reticulocytes) + schistocytes

The typical presentation is a preschooler who has had a **diarrheal illness ** for the past 5–10 days and presents with fatigue, pallor, petechiae
(thrombocytopenia), jaundice (hyperbilirubinemia), and impaired renal function (Hematuria, proteinuria, Oliguria)

Answer 15

Hemolytic Uremic Syndrome

Question 16

Red/ Brown Urine with only 0-2 RBCs/hpf is NOT Hematuria. It is either Hemoglobinuria (obtain ___) or Myoglobinuria (obtain ___)

Answer 16

Hemoglobinuria (intravascular hemolysis)→ CBC

Myoglobinuria (Rhabdomyolysis) → Creatinine Kinase

Question 17

In the setting of renal dysfunction, urine white blood cells and WBC casts suggest ____ s/t Analgesic nephropathy

(mcc: Aspirin, NSAID, or Tylenol use)

Answer 17

tubulointerstitial nephritis

Question 18

History of chronic pain (headaches, lower back pain)
Urinalysis: WBCs & WBC casts ± mild proteinuria
Imaging: small kidneys ± papillary calcification & irregular contours

Diagnosis?

Answer 18

Analgesic nephropathy

UA shows Hematuria & urine RBCs if c/b papillary necrosis)

Question 19

Analgesic nephropathy (tubulointerstitial nephritis) can be complicated by ___.

Answer 19

Renal Papillary Necrosis

Question 20

Anion gap metabolic acidosis in a patient with altered mental status, sweet-smelling breath, envelope-shaped urinary crystals (eg, calcium oxalate crystals), and acute kidney injury is consistent with a toxic ingestion of ____.

Answer 20

ethylene glycol

Question 21

Early:
CNS sedation & inebriation, + osmolar gap

Late:
anion gap metabolic acidosis, compensatory tachypnea
Ocular toxicity (____ toxicity)
Urine oxalate crystals, hypocalcemia, AKI (____ toxicity)

Answer 21

methanol (Ocular toxicity)
ethylene glycol (urine oxalate crystals)

Question 22

Treatment for Ethylene Glycol or Methanol Toxicity

(3)

Answer 22

Fomepizole (inhibits ADHase) 1st Line
Ethanol solution (if no fomepizole)

IV sodium bicarbonate for acidemia (pH <7.3)

Hemodialysis for severe cases (end-organ damage)

Question 23

_____: windshield wiper fluid, contaminated homemade liquor
____: automotive coolant/antifreeze, brake fluid

Industrial solvents & deicing solutions may contain either toxic alcohol

Answer 23

Methanol

Ethylene glycol

Question 24

Patients with chronic obstructive pulmonary disease often have chronic CO2 retention, resulting in respiratory acidosis and compensatory metabolic alkalosis. Diuretics are often administered to treat cor pulmonale symptoms but must be used cautiously as they can lead to a reduction in cardiac output and subsequent development of prerenal acute renal injury.

Answer 24

EDIT

Question 25

Hepatorenal syndrome is characterized by a decrease in glomerular filtration in the absence of other causes of renal dysfunction, minimal hematuria, and lack of improvement with volume resuscitation. It occurs due to splanchnic arterial dilation, decreased vascular resistance, and local renal vasoconstriction with decreased perfusion.

Answer 25

EDIT

Question 26

What antibiotic can cause acute kidney injury in the form of toxic acute tubular necrosis?

Answer 26

Aminoglycosides (eg, amikacin)

Question 27

Acute _____ toxicity is often triggered by impaired hepatic clearance of the drug and presents with hypertension and prerenal acute kidney injury.

Answer 27

calcineurin inhibitor (Taco)