Renal

Question 1

What does doughy skin on exam indicate?

Answer 1

hypernatremia

Question 2

Tx for:
hypovolemic hypernatremia
euvolemic hypernatremia
hypervolemic hypernatremia

Answer 2

hypovolemic hypernatremia - Dw5 if unstable, or 0.9NaCl
euvolemic hypernatremia - hypotonic fluids (Dw5 or 0.45Na
hypervolemic hypernatremia - diuretics and Dw5

Question 3

What can happen if you correct hypernatremia too quickly (faster than 48-72h)

Answer 3

cerebral edema!

Question 4

What is normal serum osmolality? What are the causes of isotonic hyponatremia?

Answer 4

Normally 280-295. At this osmo, a hyponatremic state can be due to:

Hi lipids, glucose, protein, mannitol

Question 5

Algorithm for hypotonic (

Answer 5

Assess clinically the ECF volume status:

Low + Una 10 = diuretics, urinary obs, adrenal insuff, RTA, metabolic alk (too much bicarb!)

Normal = psycho poly, SIADH, drugs, hypothyroid, glucocorticoid def

Hi + Una 10 = AKI, CRF

Question 6

Algorithm for hypertonic (>295) hyponatremia Dx?

Answer 6

Glucose, mannitol, contrast agents

Question 7

What solution to use to replete hyponatremia? What happens if you do this too quickly?

Answer 7

Usually use NS, only use hypertonic saline if pt is having seizures (Na

Question 8

Tx for hyperkalemia?

Answer 8

C BIG K (albuterol can also be used to promote cellular reuptake of potassium)

Calcium
Bicarb
Insulin
Glucose
Kayexalate

Question 9

How does hypokalemia sensitize the heart to digoxin?

Answer 9

K binds to the same receptor as digoxin, so if you have less K, dig will bind to cells better (dangerous!) so you have to monitor K levels closely in pts taking dig.

Question 10

What does hypercalcemia do to the QT interval?

Answer 10

It shortens it

Question 11

Treatment of hypercalcemia?

Answer 11

IV hydration first
Furosemide to increase Ca excretion (avoid thiazides!)
calcitonin, bisphosphonates

Question 12

What can cause a falsely low Ca?

Answer 12

Hypoalbuminemia (this is why you always have to check ionized calcium)

Question 13

Kid with asthma comes in short of breath and his blood pH goes from 7.79 to 7.38, what do you do?

Answer 13

This could mean respiratory muscle fatigue, you have to intubate

Question 14

Types of RTA: I, II, IV

Answer 14

I: Distal; due to lack of H secretion. Low K, caused by cirrhosis, sjogrens, SLE

II: Proximal; due to lack of bicarb absorption. Low K, caused by fanconi’s anemia, CA inhibitors, Mult Myeloma

IV: Distal; due to aldosterone def/resistance. Hi K, caused by aldosterone def

Question 15

What do urine labs for ATN look like?

Answer 15

buN/Cr 1%
UNa >20
Uosm

Question 16

Microscopic Urine labs for AKI:
Hyaline casts -
RBC casts -
WBC, eosinophils -
Granular Casts -
WBC casts -

Answer 16

Hyaline casts - prerenal volume depletion
RBC casts - intrinsic Glomerulonephritis
WBC, eosinophils - intrinsic allergic interstitial nephritis
Granular Casts - intrinsic ATN
WBC casts - postrenal pyelonephritis

Question 17

What do urine labs look like for a prerenal azotemia?

Answer 17

FeNa 1.020
Uosm >500
BUN/Cr ratio > 20

Question 18

Compliment levels in poststrep glomerulnephritis?

Immunoflourecent findings?

Answer 18

low C3

lumpy bumpy immuno

Question 19

Who gets IgA nephropathy?

What is the dreaded result?

Answer 19

Men, pts who recently had URI or GI infections. Suspect in ppl who JUST got over a URI, not 20 days ago like post strep glom

Can cause ESRD in 20% pts

Question 20

immuno for goodpasteurs?

Answer 20

linear anti-GBM deposits

Question 21

What are the criteria for nephrotic syndrome?

Answer 21

proteinuria >3.5 g/day
edema
hypoalbuminemia
hyperlipidemia

Question 22

imaging of Minimal Change disease?

Answer 22

light microscopy is normal, but EM shows fusion of epithelial foot processes.

Most common nephropathy in kids

Question 23

Imaging of Membranous Nephropathy?

Answer 23

Spike and dome appearance due to granular deposits of IgG and C3 at basement membrane

Question 24

Imaging in Membranoproliferative Nephropathy? WHAT DZ is it associated w/?

Answer 24

Tram/track double layered masement membrane w. LOW COMPLEMENT

Associated with HCV, cyroglobulinemia, SLE, and bacterial endocarditis

Question 25

What are most renal stones made of?

How does RTA I cause renal stones?

Answer 25

calcium oxalate (radiopaque stones, can be seen even on KUB, technically.)

RTA 1 = alkaline urinary pH and hypocitruria –> good place for stones

Question 26

Which bacteria are associated with staghorn calculi?

Answer 26

proteus (urease secreters make that urine alkaline (much like RTA 1)

Question 27

Tx of stones:
Calcium ox/phos:
Struvate:
Uric acid:
Cystine:

Answer 27

Calcium ox/phos: hydration, Na/protein restriction, thiazides, don’t limit Ca!

Struvate: hydration, surgery

Uric acid: hydration, alkalinize urine (citrate), purine restriction, allopurinol.
*THESE ARE RADIOLUISCENT, MUST GET CT TO SEE

Cystine: hydration, Na restriction, alk the urine, penicillamine
*DUE TO DEFECT IN RENAL TRANSPORT OF COLA AA’S(cysteine, ornithine, lysine, arginine) - Hexagonal crystals, +urinary cyanide nitroprusside test!

Question 28

Pts with ADPKD have a 50% of ESRD by age 60, but also have an increased risk of….

Answer 28

cerebral berry aneurysms, diverticulosis, MV prolapse

Question 29

Kid comes in with recurrent UTI’s, his prenatal U/S showed hydronephrosis. Dx?

Answer 29

Vesicouretral reflux. Will cause renal scarring

dx: voiding cysourethrogram as long as they are >2yo

Question 30

Male infat w/ distended, palpable bladder and low urine output?

Answer 30

Posterior urethral valves

Question 31

What is a risk factor for cryptorchidism (non descent of teste)

Answer 31

Low birth weight

Question 32

What do you do for a 12mo old w/ a hydrocele?

Answer 32

Nothing, will likely resolve in 12-18mo

If it does not resolve this is indication of processus vaginalis and can lead to inguinal hernias

Question 33

For teste pain, what is Prehn’s sign and when is it present?

Answer 33

= less pain w/ scrotal lifting (this is the case in epididymitis.)
It is negative in torsion (pain is bad in any position)

Question 34

MOA of terazosin

Finasteride

Answer 34

terazosin is an a-blocker, it relaxes SM in the prostate and bladder neck - don’t use if pt is ortho hypotensive!

finasteride is a 5a reductase inhibitor, which blocks production of dihydrotesosterone

Question 35

Why would DRE not detect BPH?

Answer 35

BPH most commonly occurs in the central prostate, DRE could miss it!

Question 36

In what context should PSA be used for prostate ca?

Answer 36

screening is ok, controversial ( can be + for other things)
follow up after therapy to evaluate for disease reoccurrence.

DRE annually starting at age 50. Earlier if +family hx

Question 37

What type of CA is RCC? How does it spread?

Answer 37

It is an adenocarcinoma of the tubular epithelial cells. It spreads via the IVC to the lung and bone.

Left sided varicocele is a sign b/c tumor blockage of the left renal vein! Right side doesnt happen b/c right gonadal vein empties straight into the IVC

Question 38

Most common type of teste cancer?

Answer 38

Germ cell derived (AFP will be elevated if not a seminoma, and particullarly in yolk sac tumors. If it is later in age (40-50 - it is a seminoma!)
*Check a bHCG as it is elevated in choriocarcinoma and 10% of seminomas!

Risk factors = cryptorchidism, klinefelters

Question 39

Tx for teste CA?

Answer 39

radical orchiectomy
platinum if a germ cell that is not a seminoma
chemo if seminoma

Question 40

What is the Dx and tx for rhabdo?

Answer 40

Dx: Urine dipstick will be + and brown/red. Pt may also have muscle pain/injury

Tx: rapid hydration, mannitol, bicarb

Get an EKG to r/o dangerous hyperkalemia!