UWorld 2017

Question 1

Renal artery stenosis

Answer 1

Marked unilateral kidney atrophy
Elderly: atherosclerotic changes in arterial intima
Women 20-30yo: fibromuscular dysplasia

Question 2

Minimal change disease

Answer 2

Systemic T cell dysfunction
Production of glomerular permeability factor
Podocyte foot process fusion + decreased anionic properties of GBM
Loss of - charge: selective albuminuria

Question 3

Idiopathic membranous nephropathy

Answer 3

Ass w/ circulating IgG4 Ab to phospholipase A2 receptor

Question 4

Pauci-immune rapidly progressive glomerulonephritis (crescentic)

Answer 4

Manif. of (ANCA) antineutrophil cytoplasmic Ab-associated vasculitides (Wegener or microscopic polyangiitis)
Crescent formation + No Ig + No complement deposits
Renal failure, pulmonary+upper resp symptoms

Question 5

Complications of invasive vascular procedures when hyperlipidemia

Answer 5

Atheroembolic renal ds (acute kidney injury: oliguria, azotemia)
AE in GI, CNS, skin
Light microsc: partially/completely obstructed arterial lumen w/ needle-shaped cholesterol clefts in atheromatous thrombus

Question 6

Nephrotoxicity of Amphotericin B

Answer 6

Decrease in GFR + increase in distal tubular membrane permeability
Anemia + electrolyte abnormalities (hypoK + hypoMg)

Question 7

Lithium-induced diabetes insipidus

Answer 7

Lithium’s antagonizing effect on the action of vasopressin on principal cells (collecting duct syst)

Question 8

Renal papillary necrosis

Answer 8

In ptts w/ sickle cell ds/trait, db, analgesic nephropathy, severe obstructive pyelonephritis
Gross hematuria, acute flank pain, tissue fragments in urine

Question 9

Calcium regulation in chronic kidney ds

Answer 9

Hyperphosphatemia (binds Ca)
Low vitD (low Ca absorption + release from bone)
So hypoCa + high PTH (secondary hyperparaT)

Question 10

Clear cell carcinoma

Answer 10

Most common renal malignancy
From proximal tubular cells
Rounded/polygonal cells + abundant clear cytoplasm
Cells w/ high glycogen or lipid
Metastases: lungs, bones, adrenals, liver

Question 11

Lab findings in poststreptococcal glomerulonephritis

Answer 11

High ASO
High anti-DNase B
Low C3 + total complement levels
Normal C4
Cryoglobulins +

Question 12

Erythropoiesis-stimulating agents

Answer 12

Improve anemia symptoms
In chronic kidney disease + dialysis
But increased risk for HTN + thromboembolic events

Question 13

Renal damage due to ethylene glycol ingestion

Answer 13

Toxic, acute tubular necrosis
Vacuolar degeneration + ballooning of proximal tubular cells
High anion gap metabolic acidosis
Calcium oxalate crystals in urine

Question 14

Urothelial, transitional cell carcinomas

Answer 14

Painless gross hematuria

Penetration of bladder wall: major determinant of prognosis