Renal

Question 1

In ADPCKD, what causes progressive renal failure in patients? (2)

Answer 1

Patients get progressive renal failure from recurrent episodes of pyelonephritis and nephrolithiasis.

Question 2

What % of patients with ADPCKD develop ESRD and what happens to the remaining %?

Answer 2

50% of patients develop ESRD by their late 50s and 60s. The others have a normal lifespan.

Question 3

What five things does ADPCKD present with?

Answer 3

1. Flank pain
2. Hematuria
3. Infection
4. Kidney Stones
5. HTN

Question 4

What is one neurovascular complication of ADPCKD?

Answer 4

Intracerebral berry aneurysms (most do not rupture).

Question 5

What confirms a diagnosis of ADPCKD?

Answer 5

Ultrasound

Question 6

How does one treat ADPCKD

Answer 6

No curative therapy is available. Drain cysts if they are symptomatic, treat hypertension and infections

Question 7

What two pathological process categorize ARPCKD?

Answer 7

1. Hepatic fiborsis

2. Cysts in renal collecting ducts

Question 8

What are some hepatic complications of ARPCKD? (2)

Answer 8

Portal HTN and cholangitis

Question 9

What is the primary cause of morbidity and mortality in the neonatal period for patients with ARPCKD?

Answer 9

Pulmonary insufficiency from pulmonary hypoplasia

Question 10

Besides pulmonary insufficiency and liver diseases what is one major symptom of ARPCKD?

Answer 10

Hypertension

Question 11

What is seen in pregnant women with a baby with ARPCKD?

Answer 11

Oligohydramnios (decreased amniotic fluid)

Question 12

How is ARPCKD treated?

Answer 12

Manage respiratory issues in newborns, and treat ESRD with renal replacement therapy

Question 13

What is the underlying pathological cause of medullary sponge kidney?

Answer 13

Cystic dilation of the collecting ducts

Question 14

What types of diseases are associated with medullary sponge kidney?

Answer 14

Hyperparathyroidsm and parathyroid adenoma

Question 15

What are some symptoms of medullary sponge kidney?

Answer 15

Hematuria, UTI, kidney stones

Question 16

Simple renal cysts increase with ______

Answer 16

Age

Question 17

What is the treatment for simple renal cysts

Answer 17

Most are discovered incidentally and are usually asymptomatic. No treatment is necessary in most cases

Question 18

What are three broad categories of injuries that can lead to acute kidney injuries?

Answer 18

Pre-renal, intra-renal, post-renal

Question 19

What are 4 broad causes of pre-renal acute kidney injury?

Answer 19

1. Pump problems (affect heart) = MI, CHF
2. Leaky pipes (affect blood vessels) = nephrosis (nephrotic syndrome), gastrosis (GI loss of proteins), cirrhosis (loss of proteins), or malnutrition
3. Hole in pipe = diarrhea, dehydration, diuresis, hemorrhage
4. Clog = fibromuscular dysplasia in young women or atherosclerosis buildup in older person which leads to renal artery stenosis

Question 20

What are three broad causes of intrarenal acute kidney injuries?

Answer 20

1. Things that affect the glomerulus (glomerulonephritis)
2. Things that affect the tubules (acute tubular necrosis)
3. Things that affect the nephron’s interstitum (acute interstitial nephritis)

Question 21

What are three broad causes of post-renal acute kidney injury?

Answer 21

1. Affects ureter = cancer or stones
2. Affects bladder = cancer, stones or neurogenic bladder
3. Affects uretera = cancer, stones, BPH, or kinked foley

Question 22

What kind of casts are seen in glomerulonephritis?

Answer 22

RBC casts

Question 23

What kind of casts are seen in acute tubular necrosis?

Answer 23

Brown muddy casts

Question 24

What is seen in acute intersitital nephritis? (4)

Answer 24

inflammatory cells, WBCs, eosinophils, WBC casts

Question 25

What are two broad causes of acute interstitial nephritis?

Answer 25

1. Infection (seen in pyelonephritis = WBC Casts) | 2. Toxic agents

Question 26

What antibiotics are associated with acute interstitial nephritis? (3)

Answer 26

1. TMP-SMX 2. Penicillins 3. Cephalosporins

Question 27

What are two broad categories of causes for acute tubular necrosis?

Answer 27

1. Toxins (IV contrast or myoglobin) | 2. Prolonged prerenal ischemia

Question 28

What are the three stages of acute tubular necrosis?

Answer 28

1. increased Creatinine 2. Oliguric phase 3. Polyuric phase

Question 29

What are the acute indications for dialysis? (AEIOU)

Answer 29

``` Acidosis Electrolytes (K+/Ca2+) Intoxication Overload Uremia ```

Question 30

What is the definition of acute kidney injury (give specific measurements for absolute and relative values)

Answer 30

A rapid decline in renal function with an increase in serum creatinine (relative increase in 50% or an absolute increase of 0.5 to 1.0 mg/dl)

Question 31

Define acute renal failure

Answer 31

Early stage of acute kidney injury where creatinine is normal (because it hasn't had a chance to accumulate in the body) and GFR is declining fast

Question 32

What occurs to BUN and Creatinine in Acute kidney injuries?

Answer 32

Increased BUN and Creatinine

Question 33

What can causes elevated creatinine levels in serum?

Answer 33

Muscle breakdown and acute kidney injury

Question 34

What can causes elevated BUN levels? (4)

Answer 34

Gi/soft tissue bleeding, acute kidney injury, increased protein intake and catabolic drugs (steroids)

Question 35

In patients with prerenal acute kidney injury what medications are potentially dangerous (2 and describe mechanism of action)

Answer 35

1. NSAIDs (constrict afferent arterioles) | 2. ACE Inhibitors (dilate efferent arterioles)

Question 36

What is seen on urinanalysis on pre-renal acute kidney injury (BUN/CR ratio, FENa, Urine Osmolality, and Urine Sodium) and why (explain these lab findings)

Answer 36

1. BUN/CR > 20:1 2. FENa < 1% 3. Urine Osmolality > 500 mOsm 4. Urine Sodium < 20 During prerenal acute kidney injury, renal blood flow decreases, however the renal parenchyma is undamaged, and tubular function (concentrating ability) is preserved. Therefore, the kidney responds appropriately conserving as much sodium and water as possible. The kidney has an increased BUN/CR ratio because the kidney is able to reabsorb urea It has an increased urine osmolality because the kidney is reabsorbing water. It has decreased urine sodium and a decreased FeNa because the kidney is reabsorbing any sodium

Question 37

What is one symptom ALWAYS found in prerenal acute kidney injury?

Answer 37

Oliguria

Question 38

What kind of casts are seen in prerenal acute kidney injury?

Answer 38

Hylaline casts (bland urine sediment)

Question 39

What is the most common cause of secondary HTN and describe the basic pathological steps?

Answer 39

Renal artery stenosis causes a decrease in blood flow to the JGA, as a result RAAS becomes activated, leading to HTN

Question 40

What are two general causes of renal artery stenosis and what patient populations do they affect?

Answer 40

1. Atherosclerosis - affects elderly men | 2. Fibromuscular dysplasia - seen in young females

Question 41

What are two common clinical features (1 is vital sign and the other is physical symptom) seen in patients with renal artery stenosis?

Answer 41

1. HTN - Look for a sudden onset of hypertension in a patient without a family history. The hypertension may be severe (malignant) and refractory to medical therapy. 2. Abdominal bruit is present in 50-80% of patients, and is more commonly seen in patients with fibromuscular dysplasia that causes renal artery stenosis

Question 42

What is the gold standard for diagnosing renal artery stenosis? What should you be worried about using this gold standard? Great secondary choice in patients with renal failure?

Answer 42

Renal arteriogram is the gold standard, however, contrast dye can be nephrotoxic so do not use it in patients with renal failure. Magnetic renal arteriogram has a high sensitivity and specificity and is not nephrotoxic

Question 43

How is renal artery stenosis treated? (3)

Answer 43

1. Revascularization with percutaneous transluminal renal angioplasty (PRTA) is the initial treatment in most patients, it has a higher success rate in fibromuscular dysplasia than the arterosclerotic type. 2. Surgery if PRTA is not successful (bypass) 3. Medical management with ACE inhibitors and calcium channel blockers may be tried

Question 44

How is renal vein thrombosis treated?

Answer 44

Anticoagulation to prevent pulmonary embolism

Question 45

What are some causes of renal vein thrombosis?

Answer 45

Pregnancy/oral contraceptives, invasion of renal vein by renal cell carcinoma, nephrotic syndrome

Question 46

What is atheroembolic disease of the renal arteries?

Answer 46

Showers of cholesterol crystals that dislodge from plaques in large arteries and embolize to the renal vasculature

Question 47

Define hypertensive nephroscolerosis?

Answer 47

Systemic Hypertension increases capillary hydrostatic pressure in the glomeruli leading to benign or malignant sclerosis

Question 48

What is the difference between benign nephrosclerosis and malignant nephrosclerosis?

Answer 48

In benign nephrosclerosis, thickening of the glomerular afferent arterioles develops in patients with long-standing HTN. It results in mild to moderate increase in creatinine levels, microscopic hematuria, and mild proteinuria. Malignant nephrosclerosis, can develop in a patient with long-standing benign HTN or in a previously undiagnosed patient. It is characterized by a rapid decrease in renal function and accelerated hypertension due to diffuse intrarenal vascular injury. Clinical Manifestations include: rapid increase in CR, proteinuria, and rapid increase in BP.

Question 49

What is the treatment for benign and malignant hypertensive nephrosclerosis?

Answer 49

Controlling the blood pressure

Question 50

Define sickle cell nephropathy? What part of the kidney does it affect? What % progress to ESRD? How is it managed?

Answer 50

Sickling of RBC in the microvasculature which leads to infarction. Affects renal papilla. 5% go to ESRD. Managed using ACE Inhibitors

Question 51

What causes testicular torsion?

Answer 51

Twisting of the spermatic cord leading to arterial occlusion and venous outflow obstruction, ischemia can lead to testicular infarction

Question 52

What are 3 clinical signs indicating testicular torsion? (3)

Answer 52

1. Acute severe testicular pain 2. Swollen and tender scrotum 3. Elevated testicle

Question 53

How is testicular torsion treated and what is the critical time value?

Answer 53

Surgery is treatment, if delayed longer than 6 hours, infarction may occur

Question 54

What is epididymitis?

Answer 54

Infection of the epididymis

Question 55

What is the most common cause of epididymitis?

Answer 55

E coli

Question 56

What are the clinical signs of epididymitis?

Answer 56

Swollen tender testicle, dysuria, fever, chills, scrotal pain and scrotal mass