Rx_2.9 (Renal)

Question 1

Hemoptysis + anemia + renal fail ==> dx/

Answer 1

• goodpasture’s syndrome (most likely)
  
  • consider vasculitis
• anti-GBM antibodies ==> damage @ lung and kidney basement membranes

Question 2

First-line therapy for UTIs

Answer 2

TMP-SMZ

Question 3

TMP-SMZ: MOA, SE

Answer 3

• MOA: inhibits folate synthesis ==> inhibition of of nucleotide synthesis
• SE
  
  • megaloblastic anemia
    
    • enlarged red cells
    • PMN w/hypersegmented nucleus

Question 4

Adult polycystic kidney disease inheritance

Answer 4

AD

Question 5

Biopsy findings in PSGN

Answer 5

• enlarged, hypercellular glomeruoli
• dense humps on epithelial side of GBM

Question 6

alpha-ketoacid dehydrogenase deficiency ==> Dx?/Tx?

Answer 6

• Maple Syrup Urine Disease
• enzyme deficiency ==> inability to catabolize branched-chain amino acids
  
  • Isoleucine
  • Leucine
  • Valine
  • (“I Love Vermont’s Maple Syrup)
• Tx = avoid consumption of these amino acids

Question 7

Presentation of cystinuria

Answer 7

• defect @ amino acid reabsorption @ proximal tubule ==> wasting of lysine, arginine, cystine, ornithine
• elevated cystine ==> recurrent nephrolithiasis formation

Question 8

Tx of cystinuria

Answer 8

• hydration
• acetazolamide ==> alkalization of urine

Question 9

Dosage adjustments in patients w/impaired renal or hepatic fxn

Answer 9

• same loading dose, decreased maintenance dose
• LD = (C_P x V_d)/F
• MD = (C_p x CL x t)/F
  
  • CL = clearance
  • t = dosing interval

Question 10

First step in MCD

Answer 10

• immediate tx w/steroids
• renal biopsy indicated if failure of steriods

Question 11

Tx for goodpasture’s

Answer 11

• corticosteroids
• cyclophosphamide

Question 12

Alport disease presentation

Answer 12

• inherited mutation @ Type IV collagen
  
  • important @ eyes, ears, kidneys
• present @ early childhood w/:
  
  • ocular defects
  • defness
  • hematuria