Urology 4

Question 1

pre renal AKI

Answer 1

decreased renal perfusion with nephrons still structurally intact

Question 2

causes of pre renal AKI

Answer 2

hypovolemia
afferent arteriole vasoconstriction - NSAIDs
efferent arteriole dilation - ACEI, ARBs
hypotension

Question 3

dx pre renal AKI

Answer 3

BUN:creatinine ratio > 20:1
Fractional excretion of sodium < 1%

high urine specific gravity > 1.020 and increased urine osmolality > 500 mOsm/kg

Question 4

tx pre renal AKI

Answer 4

volume relation - normal saline

Question 5

MC type of intrinsic AKI

Answer 5

acute tubular necrosis

Question 6

causes acute tubular necrosis

Answer 6

prolonged pre renal AKI
radiocontrast dye

Question 7

UA acute tubular necrosis

Answer 7

renal tubular epithelial cell casts and granular (muddy brown) casts

low urine specific gravity
low urine osmolarity < 500
fractional excretion of sodium > 2%

Question 8

tx acute tubular necrosis

Answer 8

remove offending agent + IV fluids

Question 9

acute interstitial nephritis is characterized by

Answer 9

a type of intrinsic AKI characterized by inflammatory or allergic tubulointerstitial injury

Question 10

MC cause of acute interstitial nephritis

Answer 10

drug hypersensitivity

Question 11

sx acute interstitial nephritis

Answer 11

fever
transient maculopapular rash
arthralgia

Question 12

dx acute interstitial nephritis

Answer 12

UA - white cells, red cells, white cell casts, proteinuria

Serum - increased creatinine, peripheral blood eosinophilia, increased IgE

Question 13

tx acute interstitial nephritis

Answer 13

supportive

Question 14

post renal AKI is characterized by

Answer 14

obstruction of the passage of urine
both kidneys need to be obstructed

Question 15

dx post renal AKI

Answer 15

increased serum creatinine
US
postvoid residual > 100 mL

Question 16

tx post renal AKI

Answer 16

remove obstruction - catheterization

Question 17

CKD staging

Answer 17

stage 1 - proteinuria, abnormal UA or imaging with normal GFR > 90

stage 2 - GFR 89-60

stage 3 - 59-30

stage 4 - 29-15

stage 5 - GFR < 15 - requires dialysis and/or transplant

Question 18

most common cause of end-stage renal disease

Answer 18

DM

HTN - second most common

Question 19

dx CKD
+ what type of casts

Answer 19

proteinuria - best predictor of disease progression

spot urine album/ urine creatinine ratio > 24 hour urine collection

broad waxy casts

US - small kidneys

Question 20

tx CKD

Answer 20

BP goal < 140/90
proteinuria - ACEI or ARB
DM - A1C < 7%
vit D and calcium

Question 21

MC cause of secondary HTN

Answer 21

renovascular HTN - renal artery stenosis

Question 22

causes renovascular HTN (renal artery stenosis)

Answer 22

atherosclerosis MC in elderly
fibromuscular dysplasia MC in women < 50 years

Question 23

pathophys of renal artery stenosis

Answer 23

decreased renal blood flow –> activation of RAAS –> increase in angiotensin II –> vasoconstriction and sodium retention (aldosterone) –> HTN

Question 24

sx renal artery stenosis

Answer 24

abdominal bruit
AKI after ACEI

Question 25

dx renal artery stenosis

Answer 25

hypokalemia CT angiography - noninvasive renal catheter angiography - defintiive - invasive

Question 26

tx renal artery stenosis

Answer 26

ACEI or ARB - contraindicated if b/l stenosis or solitary kidney bc they can cause AKI due to reduced blood flow