Renal Flashcards
8 yo boy is recovering from a URI. His mother has noticed swelling around his testicles and puffiness around his eyes, especially in the morning. Urinalysis shows: 3+ proteinuria and Maltese cross-shaped oval fat bodies. What is management of choice? A. prednisone B. cyclophosphamide C. simvastatin D. amoxicilln E. IV immunoglobulin
A, prednisone
*Edema, proteinuria and hyperlipidemia are hallmark for nephrOTIC syndrome!
(nephrotic syndrome in children is due to minimal change disease and tx is prednisone)
Edema, proteinuria and hyperlipidemia..think?
Nephrotic syndrome
During a neurological exam, tapping of the cheek over the facial nerve causes facial spasms. There are also carpal spasms with inflation of a BP cuff. Which of the following electrolyte abnormalities is responsible? A. hypernatremia B. hyperkalemia C. hypercalcemia D. hypomagnesemia E. hyponatremia
D, hypomagnesemia
These symptoms are CLASSIC WITH HYPOCALCEMIA! Because magnesium is needed to make PTH, hypomagnesemia is often associated with hypocalcemia!!
Hypomagnesemia is often associated with?
Hypocalcemia
A 36 yo male with a recent head trauma develops a stable epidural hematoma. He is placed on seizure prophylaxis and given hypotonic saline infusion. After the saline infusion, he develops nausea, weakness and headache. a CT show no change in the bleed. Labs show: serum Na of 125 (normal 135-145) and serum osmolarity of 268 (norm 280-290)
The serum sodium should be corrected no faster than 0.5 mEq/L per hour to prevent what?
A. seizures
B. cerebral edema
C. vision loss
D. vomiting
E. central pontine myelinolysis
E, central pontine myelinolysis
Demyelination occurs if hyponatremia is corrected too rapidly. Hyponatremia causes cerebral edema (due to hypotonicity) and the rapid correction leads to shrinkage of the brain cells with demyelination of the nerves
When can cerebral edema occur?
Rapid FLUID correction of hypernatremia
A 43 yo male presents to the ER with a fever and joint pains. The pt was recently treated for a dental infection with oral Penicillin VK. Pt is febrile and has a generalized maculopapular rash without target lesion appearance. Labs show an increased BUN and creatinine with an elevated WBC count and eosinophilia. A urinalysis shows 2 RBC/high power field and presence of many WBC casts. Which of the following is likely the dx? A. erythema multiforme minor B. erythema multiforme major C. acute tubular necrosis D. acute tubulointerstitial nephritis E. acute glomerulonephritis
D, acute tubulointerstitial nephritis
Acute tubulointerstitial nephritis is a rope of INTRINSIC acute kidney injury. It is due to an inflammatory or allergic response in the interstitium. 70% of AIN is due to drugs (such as penicillin). AIN is associated with ever, eosinophilia, arthralgias and a maculopapular rash
*WBC casts are hallmark for acute interstitial nephritis (AIN)
WBC casts in urinalysis are hallmark for…
Acute interstitial nephritis
Acute tubulointersitial nephritis is a type of _____ acute kidney injury
intrinsic
70% of acute interstitial nephritis is due to…
drugs (i.e. penicillin)
Fever, eosinophilia, arthralgias, maculopapular rash and WBC CASTS**
Acute interstitial nephritis
A 50 yo male smoker presents to clinic with painless gross hematuria that he says occurs from the start of urination through the end of urination. He states no hx of recent trauma. Prostate is firm and mobile with no nodules or tenderness. Urinalysis shows more than 10 RBCs per high power field but otherwise unremarkable. Which of the following is the most appropriate next step?
A. CT scan of abdomen and pelvis without contrast
B. CT scan of abdomen and pelvis with contrast and cystoscopy
C. Fasting plasma glucose
D. observation and nephrologist follow up in hematuria persists
E. kidney biopsy
B, CT scan of abdomen and pelvis with contrast and cystoscopy
In pts older than 40 who present with hematuria and a negative urinalysis, one MUST rule out malignancy. Cystoscopy allows for possible biopsy if bladder cancer is seen
What diagnostic should you run if you are suspecting nephrolithiasis (renal colic and constant abdominal pain that may radiate)
CT scan without contrast
Which of the following is not classically associated with pure pre-renal azotemia?
A. increased specific gravity of urine
B. fractional excretion of sodium greater than 2%
C. presence of Tamm-Horsfall proteins in urinalysis
D. BUN/Cr ratio greater than 20:1
E. decreased skin turgor
B, fractional excretion of sodium greater than 2%
Pre-renal is due to reduced renal perfuson. In pre-renal azotemia, there is no structural damage to the nephron. Because there is no structural damage, the natural response is for the kidney to try to maintain volume by increasing Na reabsorption and water, leading to a fractional excretion of sodium characteristically less than 1% and a concentrated urine (with a high specific gravity)
Can Tamm-Horsfall proteins be seen in normal urine specimens?
Yes! They are proteins that form hyaline casts that are nonspecific and can be seen in normal urine specimens
What is fractional excretion of sodium characteristically in pre-renal azotemia?
less than 1%
45 yo male with hx of diabetes mellitus and polycystic kidney dz is admitted to ICU for subarachnoid hemorrhage. He is placed on stool softness and seizure prophylaxis. His home meds are aspirin and chloropropramide. He has developed nausea and fatigue over last few days. Labs show: Serum glucose 128 (64-128 norm) Serum sodium 129 (135-145 norm) Serum BUN 7 (7-10 norm) Serum Cr 0.7 (0.8-1.4 norm) Serum osmolarity 257 (280-290 norm) Urine osmolarity 680 (300-900) Urine sodium 35 (norm 20) What is the following tx? A. hypertonic saline B. normal saline C. fluid restriction D. fluid and sodium restriction
C, fluid restriction
This pt has SIADH prob due to combination factors: intracranial bleed, antivonsulants and chloropropramide
(this is pretty complicated i think…dont think there will be Qs like this one)
A 37 yo male with a hx of chronic hep B presents to ER with SOB. Pt has dullness to percussion, decreased tactile remits and decreased breath sounds bilaterally with no crackles. There is bilateral peripheral and sacral edema. Labs are consistent with hypotonic hypervolemic hyponatremia and hyperlipidemia. Urinalysis shows: proteinuria, oval fat bodies and fatty casts. 24H urine protein collection shows 4g of protein. Which of the following would most likely be seen on biopsy?
A. IgA deposits in glomerulus
B. normal cellularity with thickened glomerular basement membrane
C. nodular glomerulosclerosis with pink hyaline material
D. hypercellularity with increased monocytes and positive immune humps
E. hypercellularity with presence of crescent shaped collapse of Bowman’s capsules
B, normal cellularity with thickened glomerular basement membrane
membranous nephropathy, which is one of the most common causes of primary nephrotic syndrome in adults, is often caused by viral hepatitis (this pt has viral hep B). membranous nephropathy is classically associated with basement membrane thickening on kidney biopsy.
*nephrotic syndrome is classically associated with proteinuria, hypoalbuminemia, edema and hyperlipidemia
Membranous nephropathy is a very common cause of what in adults?
Primary nephrotic syndrome
proteinuria, hypoalbuminemia, edema, hyperlipidema = nephrotic
IgA deposition in the glomerular is classic of…
Berger disease associated glomerulonephritis
Dysmorphic RBCs, RBC casts and HTN
Seen in glomerulonephritis (ie Berger dz)
Hypercellularity with the presence of crescent shaped collapse of the bowman’s capsules would be seen in what type of glomerulonephritis?
Rapidly progressing
A 43 yo female w hx of Ehlers-Dalos syndrome presents with a sudden onset of thunderclap headache. CT shows subarachnoid hemorrhage. Pt is admitted to ICU and is give phenytoin seizure prophylaxis along w bed rest. Which of the following electrolyte abnormalities are most likely to occur? A. hyperkalemia B. hypocalcemia C. hyponatremia D. hypokalemia E. hypernatremia
C, hyponatremia
Ehlers-Dalos syndrome is a connective tissue disorder that puts pts at risk of developing aneurysms. SIADH is often caused by CNS lesions (such as subarachnoid hemorrhage) as well as anticonvulsants. The increased ADH causes increased free water retention, which lowers serum sodium levels.
CNS lesions and anticonvulsant meds can cause…
SIADH
which causes too much ADH release, therefore leading to increased water retention and HypoNa
Staghorn calculi and struvite stones are composed of ammonium magnesium phosphate due to urea splitting organisms, which is most commonly associated with what type of bacteria?
Proteus mirabilis
proteus mirabilis are urea splitting organisms
a CT shows presence of staghorn calculi in R kidney measuring 1 mm. Stone is composed of ammonium magnesium phosphate (struvite). What organism likely causes?
Proteus mirabilis
Central diabetes insipidus is the absence of….
ADH
nephrogenic diabetes insipidus is kidney insensitivity to ADH
