Renal

Question 1

RBC casts w/ hematuria, dysmorphic red cells

Answer 1

Acute glomerulonephritis (AGN) or vasculitis

Question 2

Muddy Brown or Epithelial cell Casts

Answer 2

ATN (acute tubular necrosis)

Question 3

White blood cell casts, pyuria

Answer 3

AIN (acute interstitial nephritis) or pyelonephritis or tubular dz

Question 4

Waxy Casts: acellular, sharp with edges

Answer 4

narrow waxy casts: chronic ATN/glomerulonephritis

broad waxy casts: end stage renal disease (tubular dilation)

Question 5

Fatty casts: “maltese crosses” oval fat bodies

Answer 5

Nephrotic syndrome (2/2 hyperlipidemia)

Question 6

Hyaline casts

Answer 6

nonspecific (normal urine)

Question 7

Normal or near normal UA

Answer 7

AKI - prerenal or postrenal

Hypercalcemia, multiple myeloma

Question 8

Hematuria & pyuria (excluding red casts)

Answer 8

UTI acute interstitial nephritis (AIN), glomerular disease, vasculitis

Question 9

Pyuria alone

Answer 9

MC due to infection

Question 10

Prerenal

Answer 10

Cr increases slower than 0.3mg/dL/day
Normal UA
Cr rapidly improves with IVF
BUN:Cr >20:1

Question 11

ATN

Answer 11

Cr increases at 0.3-0.5mg/dL/day
epithelial cells, granular casts, low specific gravity
creatinine doesn’t improve much with IVF
BUN:Cr 10-15:1

Question 12

ESRD

Answer 12

GFR <15
dialysis +/- transplant
DM, HTN, glomerulonephritis

Question 13

HYPOphosphatemia

Answer 13

increased urine excretion, primary hyperparathyroidism, vit D def, internal redistribution, decreased absorption

diffuse muscle weakness, flaccid paralysis

phosphate repletion - potassium or sodium phosphate

Question 14

HYPERphosphatemia

Answer 14

renal failure MC, primary hypoparathyroidism, vitamin D intoxication, rhabdo

soft tissue calcifications, heart block

renal failure= phosphate binders - calcium acetate, calcium carbonate
hydration, acetazolamide

Question 15

HYPOnatremia

Answer 15

impaired kidney free water excretion (increased ADH secretion), increased water intake

CNS dysfunction - cerebral edema

Serum NA<135

HYpotonic Hyponatremia - real
- isovolumeic, hypervolemic or hypovolemic
Hypertonic Hyponatremia
- normal saline, then 1/2 normal saline
Severe iso/hyper volemic hyponatremia 
- hypertonic saline + furosemide

Question 16

HYPERnatremia

Answer 16

MC caused by net water loss
sustained hypernatremia seen when appropriate water intake is not possible

CNS dysfunction - shrinkage of brain cells

Serum Na>145

Hypotonic fluids -PO preferred

Question 17

HYPOmagnesemia

Answer 17

GI losses, Renal losses, meds- PPI

increased DTR, tetany, hypocalcemia - T&C, palpitations

+/- hypokalemia & hypocalcemia

Prolonged PR & QT interval, Torsades

oral/IV magnesium (sulfate)

Question 18

HYPERmagnesemia

Answer 18

renal insufficiency or increased Mg intake

decreased DTR, N/V, skin flushing

+/- hyperkalemia & hypercalcemia

prolonged PR & QT interval, wide QRS

IV fluids & furosemide
Severe- calcium gluconate, dialysis

Question 19

HYPOkalemia

Answer 19

diuretic therapy, V/D, metabolic alkalosis

muscle wakeness, rhabdo, nephrogenic DI: polyuria, decreased DTR

potassium <3.5mEq/L, order mag, glucose and bicarb

T wave flattening (earliest change), prominent U wave

PO/IV KCL
spironolcactone, tx hypomagnesemia, nondextrose IV solutions (dont shift K into cells)

Question 20

HYPERkalemia

Answer 20

acute or chronic renal failure, decreased aldosterone, K+ supplements, sprionoclactone, cell lysis -rhabdo,metabolic acidosis

weakness,(ascending), palpitations, diarrhea

K >5.0

Tall peaked T waves, QR interval shortening, wide QRS, p wave flattening- sine wave

IV caclium gluconate - cardiac staiblity- when K >6.5
insulin shifts K into cells
Kayexalate - GI potassium excretion
Bicarb, loop diruetics, dialysis