Renal

Question 1

Estimation of GFR

Answer 1

The CKD-EPI equation is better than the Modification of Diet in Renal Disease (MDRD) or Cockcroft-Gault at higher normal levels of Cr and GFR

Question 2

Kidney response to metabolic acidosis

Answer 2

Should increase ammonium excretion, the amount of this is determined by either the urine anion gap or the urine osmolal gap

Question 3

Urine anion gap

Answer 3

UAG= Na + K - Cl
If negative it means has a good amount of NH4, appropriately acidifying urine
If positive or 0 then kidneys are NOT properly responding

Question 4

Urine osmolal gap

Answer 4

Urine osm gap = measured - calculated
calculated = 2(Urine Na + Urine K) + Urine Urea/2.8 + Urine glucose/18
Urine ammonium = urine osmolal gap/2
Urine ammonium >80 means extra-renal loss,

Question 5

Type 2 RTA

Answer 5

Urine pH

Question 6

Type 1 RTA

Answer 6

urine pH > 5.5, urine potassium wasting, hypokalemia

serum bicarb is profoundly low

Question 7

Type 4 RTA

Answer 7

2 types:

• hypoaldo urine pH 6 and hyperkalemia (treat hyperkalemia)
• other type is d/t tubulointersitial injury

Question 8

IgA nephropathy

Answer 8

gross hematuria after URI

Question 9

Postinfectious glomerulonephritis

Answer 9

Latency between infection and onset of kidney disease. Low complement levels and elevated antistreptolysin O antibodies when d/t strep.

Question 10

Primary membranous glomerulopathy management

Answer 10

Mild proteinuria (4 g and even with some renal dysfunction monitor on ACE and IF worsens then use immunosuppressive therapy
High rate of spontaneous resolution, hence try and delay treatment

Question 11

Incidental renal mass

Answer 11

Obtain and ultrasound to see if a cyst. Then get a CT with contrast if any question. If >3 cm no need to biopsy go right to resection. Smaller can be biopsied and

Question 12

Hypercalciruia

Answer 12

> 300, would want to treat with thiazide if having kidney stones

Question 13

Management of kidney stones

Answer 13

Hyperoxaluira with calcium carbonate supplementation
Thiazides increase urine calcium
Potassium citrate is used for management of uric acid stones

Question 14

BK virus nephritis

Answer 14

Can cause graft dysfunction. First thing is to try and reduce immunosuppression. Can treat with fluroquinolones, leflunomide and cidofivir

Question 15

Acute post streptococcal glomerulonephritis

Answer 15

Hematuria 1-3 WEEKS after sore throat
Low serum complement levels
+ anti-DNAse B assay

Question 16

IgA nephropathy

Answer 16

Hematuria 1-2 DAYS after sore throat
IgA deposits on biopsy
Most common

Question 17

Idiopathic membranoproliferative glomerulonephritis

Answer 17

low complement

Thickened capillary loops

Question 18

Secondary MPGN

Answer 18

Seen with chronic infections (HCV, endocarditis, HIV, syphilis), systemic disease (DM, RA), drugs (NSAIDS, penicillamine) and solid tumors

Question 19

ANCA associated glumerulonephritis

Answer 19

proliferative and positive ANCA

Question 20

Anti-GBM disease

Answer 20

glomerulonephritis + pulmonary involvement

Question 21

Glomerulonephritis and cryoglobulinuemia

Answer 21

palpable purpura, arthritis neuropath, digital ischemia

Question 22

Focal segmental glomerulosclerosis

Answer 22

Can be primary, run in families or in HIV. Focal scaring on biopsy.

Question 23

Membranous glomerulopathy

Answer 23

• can go into spontaneous remission
• can be primary or secondary to SLE, Hep B/C, malaria, malignancies
• look out for renal vein thrombosis

Question 24

Minimal change disease

Answer 24

• associated with atopic diseases and lymphoma

- no changes on light microscopy

Question 25

Systemic diseases that cause nephrotic syndrome

Answer 25

DM
Amyloid
Multiple myeloma
HIV
Hep B

Question 26

Treatment of class I and II lupus nephritis

Answer 26

ACE or ARBS

Question 27

Workup of metabolic alkalosis?

Answer 27

Measure urine sodium and chloride to help determine cause. Low urine chloride suggests volume depletion, vomiting, NG suctioning. If high then break down by BP, if BP high think primary hyperaldo, cushings, too much ACTH, Liddle. If low BP think bartter or gitelman

Question 28

Hypercalcuria?

Answer 28

> 300 mg/24 hours. If having stones treat with thiazide.