Renal

Question 1

Milk-alkali Syndrome can lead to?

Answer 1

Acute Renal Failure

Question 2

When should you measure PTH levels in Milk Alkali Syndrome?

Answer 2

In milk-alkali syndrome, vigorous treatment of hypERcalcemia with saline diuresis and loop diuretics may lead to hypOcalcemia. With the hypocalcemia, PTH will rise and may reach levels above reference range. Therefore:
PTH levels should be determined BEFORE or AT THE INITIATION of tx.

Question 3

Gitelman Syn (Bartter Syn if

Answer 3

AR disorder of Na-Cl cotransporter at distal tubule in early adulthood

HyPOKalemia and AlkaLOsis
Hypercalciuria
Inc. Renin, Aldosterone, and HCO3
Weakness, fatigue, spasm

Question 4

CHF can lead to ischemia which can then lead to what in the kidneys?

What would you see on microscopic urine analysis?

Answer 4

Acute Tubular Necrosis

Muddy brown granular casts

Question 5

Pts. with ATN will typically have a FeUrea of what?

Answer 5

> 50%

Question 6

Cystinosis inheritance?

Answer 6

Auto Rec

Question 7

Cystinosis:
S&S
How does it cause problems?

Answer 7

Defective transport of cystine out of lysosomes that manifests as:
polyuria, polydipsia, dehydration,
non-anion gap met acidosis, rickets, FTT

Question 8

ADPKD keywords

Answer 8

Hypertension
Hematuria (episodic)
Stroke fam hx
Hepatic cysts on CT, One parent has renal cysts too
Chromosome 16
Berry aneurysms

30 y.o.

Question 9

What is the leading cause of death in ADPKD?

Answer 9

cardiovascular disease

Question 10

What is the 1st line tx for VUR?

Answer 10

Daily Amoxicillin, TMP-SMX, or Nitrofurantoin

Question 11

Medullary Cystic Disease

Answer 11

inc. uric acid –> gout in the young teen

eventual renal failure

Question 12

What has been shown to prevent Contrast-Induced Nephropathy?

Answer 12

Aggressive hydration

Question 13

Tx. Fibromuscular Dysplasia

Answer 13

Angioplasty + Renal A. Stent placement

Question 14

What diabetic drug can’t you give to someone with renal failure/impairment? Why?

Answer 14

Metformin –> Lactic Acidosis

Question 15

Car crash pt. –> brown urine is likely?

Appropriate dx. to confirm?

Answer 15

Rhabdomyolysis

elevated Creatinine Kinase

Question 16

Bladder pressure is used to dx. what?

Answer 16

Abdominal compartment syndrome

Question 17

Suprapubic abd pain + fever + dysuria + pneumaturia + urine per rectum would be indicative of?

Answer 17

Colovesical fistula

Question 18

What is the most common cause of colovesical fistula?

Answer 18

Acute diverticulitis

Question 19

Primary Hyperaldosteronism

Answer 19

adenoma of glomerulosa of adrenal gland

Question 20

Bartter Syndrome

Answer 20

Presents prior to 2 y.o.

Low Mg2+
High Urine Ca2+

Question 21

What is Winter’s Formula?

When is it used?

Answer 21

Expected pCO2 = [1.5 * HCO3-] + 8 +/- 2

During metabolic acidosis

Question 22

Tx. asymptomatic renal cyst

Answer 22

Nothing

Question 23

Triad of Renal Cell Carcinoma

Increased risk with?

To where does it usually metastasize?

Answer 23

Hematuria
Flank pain
Possible flank mass

Inc. risk with obesity and smoking

To lungs

Question 24

Drug given in Microalbuminuria

Answer 24

Lisinopril

Question 25

Most CKD pts. on dialysis die from?

Answer 25

cardiovascular disease

Question 26

Liddle Syndrome

Answer 26

``` AD mutation of ENaC channel in distal tubule HTN HypOkalemia and alkaLOsis HyPERnatremia Low Aldosterone ```

Question 27

What common medication should you remember can cause bladder distension via its anticholinergic side effects?

Answer 27

Benadryl

Question 28

Post-Strep Glomerulonephritis S&S Dx? What is a common consequence of PSGN?

Answer 28

Type 3 H.S. rxn periorbital edema, coca-cola urine, HTN UA CBC, complement levels (remember IgG, IgM, and C3 deposit on basement membrane), strep Ag assays, antiDnase B Abs "Lumpy bumpy" on immunofluorescence HTN

Question 29

Gentamicin is associated with what condition?

Answer 29

Renal Tubular Acidosis Type I --> Hypokalemia --> Flat T waves

Question 30

NephrOtic Syndrome keywords e.g.

Answer 30

prOteinuria 3.5 g/d and edema frothy urine + fatty casts decreased albumin increased lipids ``` e.g. Focal Segmental Glomerulosclerosis (FSGS) Minimal change dz Membranous nephropathy Amyloidosis Diabetic glomerulonephropathy ```

Question 31

Nephritic Syndrome keywords e.g.

Answer 31

``` Inflammation Azotemia Hematuria Oliguria hypertension granular casts ``` ``` e.g. Post-strep glomerulonephritis (PSGN) Rapidly progressive glomerulonephritis IgA Nephropathy (Berger Disease) Alport Syndrome Membranoproliferative Glomerulonephritis ```

Question 32

ARPKD keywords

Answer 32

Chromosome 6 | ARPKD in a full sibling

Question 33

Ethylene glycol poisoning

Answer 33

calcium oxalate crystals ("envelope")

Question 34

Rapidly Progressive (Crescentic) Glomerulonephritis keywords e.g. Tx

Answer 34

crescent moon hematuria, hemoptysis poor prognosis e.g. Goodpasture (pANCA+) Granulomatosis w/ polyangiitis (aka Wegener - cANCA+) Tx: Plasmapheresis

Question 35

Diffuse Proliferative Glomerulonephritis keywords

Answer 35

SLE's most common cause of death | "wire looping" of capillaries

Question 36

IgA Nephropathy keywords

Answer 36

mesangial proliferation immune complex deposits assoc. w/ Henoch Schonlein Purpura RBC casts

Question 37

Alport syndrome keywords

Answer 37

type IV collagen mutation X-Recessive "Basket weave"

Question 38

Membranoproliferative Glomerulonephritis (MPGN) keywords

Answer 38

Type I - Tram track Immune complex deposition, Hep B/ HepC | Type II - intramembranous immune complex "dense" deposits

Question 39

Focal Segmental Glomerulosclerosis keywords

Answer 39

Foot processes effacement African Americans, Hispanics HIV, Heroin, Interferon

Question 40

Minimal Change Disease keywords

Answer 40

children normal glomeruli Tx. Steroids

Question 41

Membranous Nephropathy keywords

Answer 41

GBM thickening Spike and Dome Caucasian adults

Question 42

Diabetic Glomerulonephropathy keywords

Answer 42

``` Kimmelsteil Wilson (eosinophilic nodular glomerulosclerosis) GBM thickening ```

Question 43

1st Line Tx. for non-pregnant woman with pyelonephritis requiring hospitalization?

Answer 43

Ciprofloxacin

Question 44

1st line Tx. for Acute cystitis?

Answer 44

TMP-SMX

Question 45

Staghorn calculi keywords

Answer 45

CVA tenderness (S&S nephrolithiasis) Alkaline urine pH, urease-producing Proteus Coffin-lid Mg-Ammonium-Phosphate crystals Radioopaque (seen on xray)

Question 46

What value for BUN:Cr would indicate pre-renal cause for Acute Kidney Injury?

Answer 46

BUN:Cr >20