Renal

Question 0

When is surgery indicated for nephrolithiasis?

Answer 0

No passage after 4-6 w of medical management

Increased Cr (AKI)

Question 1

Calcium stone size that indicates stone will pass spontaneously in 4-5 days

Answer 1

<4-5 mm (99%)

or

5-7 mm (60%) AND at the UVJ jxn (80%)

Question 2

Complications seen in adult PCKD

Answer 2

MVP
Aortic Regurgitation
Intracranial aneurysms (with possible subarachnoid hemorrhage)

Question 3

Difference in Hb and EPO in patients with: PCKD vs RCC

Answer 3

Polycystic kidney disease: anemia 2/2 low EPO

RCC: polycythemia 2/2 HIGH EPO

Question 4

Type of AKI with following labs:

FENa <1%

Answer 4

Pre-renal (hypovolemia, sepsis, renal a. stenosis, drug toxicity)

Question 5

FENa > 2%
BUN/Cr < 20/1
Muddy brown casts
Granular casts or renal tubule cells
No blood
Trace protein

Dx? Cause of AKI?

Answer 5

ATN (intrarenal AKI)

• ischemic (severe decline in RBF)
• nephrotoxic (ABX, radiocontrast, NSAIDs, rhabdo, chemo, MM light chains)

Question 6

Struvite stones:

• cause?
• specific bacteria?
• radiopaque or radiolucent?
• urine pH will be….?
• how common are they?

Answer 6

• UTI 2/2…urease + bacteria
• Urease +: proteus and klebsiella
• Basic urine (pH) > 7.0
• 2nd most common

Question 7

Urge incontinece

• Dx
• Tx

Answer 7

Clinical Dx (go go go 2/2 detrusor overactivity)

Tx: bladder training (timed voiding) x 3 months

then try: oxybutinin/tolteridine/trospium/solifenacin
(Anti-muscurinics)

Question 8

Definitive diagnosis for urothelial carcinoma

Answer 8

Cystoscopy w/Bx

Question 9

BPH Medication that gives rapid relief of symptoms

Answer 9

Alpha-1 Receptor Blockers
(Terazosin & Tamsulosin)

“Tera and Tammy Take away the Sx by relaxing the prostate.”

Question 10

NSAIDs vs ACE-Is

Effect on kidneys

Answer 10

NSAIDs: afferent arteriolar vasoconstriction (inhibits Pg)

ACE-Is: efferent arteriolar vasodilation (blocks A-II)

Both causing ⬇️GFR

Question 11

Equation for serum osmolality

Answer 11

Sosm= 2Na + BUN/2.8 + Glucose/18

Next step in evaluating hyponatemia: fluid status (hypo, euvolemic, hyper)