Renal

Question 0

ARF w/ abnormal urinalysis:

a. Bacteria
b. WBC, casts, eosinophils
c. RBC
d. RBC casts, Proteinuria

Answer 0

a. Pyelonephritis
b. Interstitial nephritis
c. Renal artery or vein occlusion
d. Glomerulonephritis, vasculitis (after renal biopsy)

Question 1

Distinguish CRF and ARF

Answer 1

CRF :
small kidneys, thin cortex, bland sediment, isosthenuria, <3.5 g protein

ARF :
normal size kidneys, intact parenchyma

Question 2

Pre-Renal Azotemia vs Actute Tubular Necrosis

Answer 2

Pre-Renal Azotemia:
Electrolytes:
NaFe < 1%
U Osmolarity > 500 mosmol

Acute Tubular Necriosis
NaFe > 1%
U Osmolarity < 350 mosmol
Muddy brown casts, amorphous sediment + protein

Question 3

Etiologies of Pre-Renal Azotemia

Answer 3

a. Decreased circulating blood volume (gastrointestinal hemorrhage, burns, diarrhea, diuretics)
b. Volume sequestration (pancreatitis, peritonitis, rhabdomyolysis)
c. Decreased effective arterial volume
d. Decreased CO due to vasodilation (e.g. sepsis, drugs) and vasoconstriction (eg. NSAIDS)

Question 4

Requirement for Obstructive Acute Renal Failure

Answer 4

a. obstruction at the urethra or bladder outlet
b. bilateral ureteral obstruction
c. unilateral obstruction in a patient with a single functioning kidney

Question 5

Causes of Acute Renal Injury

Answer 5

a. drug-induced interstitial nephritis (especially antibiotics, NSAIDs, and diuretics)
b. severe infections (both bacterial and viral)
c. systemic diseases (e.g., systemic lupus ery- thematosus)
d. infiltrative disorders (e.g., sarcoid, lymphoma, or leukemia)

Question 6

Renal artery thrombosis vs Renal vein thrombosis on proteinuria and hematuria

Answer 6

RAT - mild

RVT - severe

Question 7

Compounds used to indirectly measure GFR

Answer 7

Inulin
Iothalamate
Cystatin C
Creatinine
*small, freely filtered, not reabsorbed in the tubules

Question 8

URINE OUTPUT

a. Normal
b. Obligatory
c. Anuria
d. Oliguria
e. Nonoliguria

Answer 8

24-hour

a. Normal : 700-2000mL
b. Obligated: 500mL
c. Anuria : =400mL, w/ acute or chronic azotemia

Question 9

Normal Protein excretion

Answer 9

<30 mg/d of albumin.

Question 10

Selective proteinuria vs Non-selective proteinuria

Answer 10

Selective: glomerular diseases, such as minimal change disease, cause fusion of glomerular epithelial cell foot processes

Nonselective: combination of increased pressure and larger pores results in significant proteinuria

Question 11

Nephrotic Syndrome vs Nephritic Syndrome

Answer 11

Nephrotic Syndrome: 
protein >3.5 g
hypoalbuminemia
hyperlipidemia
edema

Nephritic Syndrome:
oliguria 
proteinuria usually < 3g/d 
edema
HPN

Question 12

What is hematuria? Common cause?

Answer 12

Hematuria: 2-5 RBCs per HPF
Common Causes:
stones, neoplasms, tuberculosis, trauma, and prostitis

Also from:
menstruation, viral illness, allergy, exercise, or mild trauma

Question 13

Hematuria…

a. w/ bactenuria and pyuria
b. isolated microscopic hematuria (dysmorphic RBC)
c. with dysmorphic RBCs, RBC casts, and protein excretion >500 mg/d

Answer 13

a. Infection
b. glomerular diseases
c. glomerulonephritis

Question 14

Common causes of:

a. Isolated glomerular hematuria
b. Isolated pyuria

Answer 14

a. IgA nephropathy, hereditary nephritis, and thin basement membrane disease
b. unusual since inflammatory reactions in the kidney or collecting system also are associated with hematuria

Question 15

Mechanisms of Polyuria

Answer 15

1. excretion of insoluble solutes
2. excretion of water

*average person excretes between 600 and 800 mosmol of solutes per day, primarily as urea and electrolytes

Question 16

Water diuresis vs Solute diuresis

Answer 16

Water diuresis: urine output is >3 L/d and the urine is dilute (3 L/d and urine osmolality is >300 mosmol/L
causes: poorly uncontrolled DM; mannitol administration, radiocontrast media, and high-protein feedings (enterally or parenterally)
salt-wasting disorders : Cystic renal diseases or Bartter’s syndrome or during the course of a tubulointerstitial process (such as resolving ATN)

Question 17

Best method to distinguish Central and Nephrogenic DI? Causes of each

Answer 17

plasma vasopressin level

Causes of Central DI
- posthypophysectomy, trauma, supra- or intrasellar tumor / cyst histiocystosis or granuloma, encroachment by aneurysm, Sheehan’s syndrome, infection, Guillain-Barré, fat embolus, empty sella

Causes of Nephrogenic DI

• Acquired tubular diseases: pyelonephritis, analgesic nephropathy, multiple myeloma, amyloidosis, obstruction, sarcoidosis, hypercalcemia, hypokalemia, Sjögren’s syndrome, sickle cell anemia
• Drugs or toxins: lithium, demeclocycline, methoxyflurane, ethanol, diphenylhydantoin, propoxyphene, amphotericin
• Congenital: hereditary, polycystic or medullary cystic disease

Question 18

Hepatocellular Conditions That May Produce Jaundice

Answer 18

Hepatocellular Conditions That May Produce Jaundice

Viral hepatitis Hepatitis A, B, C, D, and E Epstein-Barr virus Cytomegalovirus Herpes simplex

Alcohol

Drug toxicity Predictable, dose-dependent (e.g., acetaminophen) Unpredictable, idiosyncratic (e.g., isoniazid)

Environmental toxins Vinyl chloride Jamaica bush tea—pyrrolizidine alkaloids Kava Kava Wild mushrooms—Amanita phalloides or A. verna

Wilson’s disease

Autoimmune hepatitis

Question 19

Cholestatic Conditions That May Produce Jaundice

Answer 19

Cholestatic Conditions That May Produce Jaundice

I. Intrahepatic A. Viral hepatitis 1. Fibrosing cholestatic hepatitis—hepatitis B and C 2. Hepatitis A, Epstein-Barr virus, cytomegalovirus B. Alcoholic hepatitis C. Drug toxicity 1. Pure cholestasis—anabolic and contraceptive steroids 2. Cholestatic hepatitis—chlorpromazine, erythromycin estolate 3. Chronic cholestasis—chlorpromazine and prochlorperazine D. Primary biliary cirrhosis E. Primary sclerosing cholangitis F. Vanishing bile duct syndrome 1. Chronic rejection of liver transplants 2. Sarcoidosis 3. Drugs G. Inherited 1. Progressive familial intrahepatic cholestasis 2. Benign recurrent cholestasis H. Cholestasis of pregnancy I. Total parenteral nutrition J. Nonhepatobiliary sepsis K. Benign postoperative cholestasis L. Paraneoplastic syndrome M. Venoocclusive disease N. Graft-versus-host disease O. Infiltrative disease 1. TB 2. Lymphoma 3. Amyloid P. Infections 1. Malaria 2. Leptospirosis II. Extrahepatic A. Malignant 1. Cholangiocarcinoma 2. Pancreatic cancer 3. Gallbladder cancer 4. Ampullary cancer 5. Malignant involvement of the porta hepatis lymph nodes B. Benign 1. Choledocholithiasis 2. Postoperative biliary structures 3. Primary sclerosing cholangitis 4. Chronic pancreatitis 5. AIDS cholangiopathy 6. Mirizzi’s syndrome 7. Parasitic disease (ascariasis)