Mksap 16 Q&a Nephro

Front 1

when is coronary artery calcium score indicated?

Back 1

asymptomatic patients with intermediate risk of CAD (10%-20% 10-year risk) --> high score (>400) is an indication for more intensive preventive treatment

Front 2

what is Fanconi syndrome?

Back 2

disease of proximal renal tubules; where BAGUP (bicarbonate, amino acids, glucose, uric acid, phosphate) are passed into the urine, instead of being reabsorbed

Front 3

findings in minimal change disease

Back 3

normal light and immunofluorescence microscopies; effacement of podocyte foot processes on electron microscopy.

Front 4

biopsy findings in primary membranous glomerulopathy

Back 4

diffuse glomerular membrane thickening without cellular infiltration, and coarsely granular deposits of IgG and C3 along the capillary loops by immunofluorescence microscopy. Electron microscopy shows moderate podocyte foot process effacement

Front 5

clinical clue to diagnosis of multiple myeloma

Back 5

elevated total urine protein, (quantifies both albumin and non-albumin protein (paraprotein)) with small amounts of protein on urine dipstick (measures only albumin)

Front 6

when to change HCTZ to furosemide

Back 6

GFR <30, HCTZ becomes ineffective as a diuretic

Front 7

kidney biopsy, what is an acceptable BP?

Back 7

<160/95

Front 8

contraindications to kidney biopsy (7)

Back 8

uncontrolled HTN, coagulopathy, thrombocytopenia, hydronephrosis, atrophic kidney, numerous kidney cysts, and acute pyelonephritis

Front 9

describe FENA in urinary obstruction

Back 9

in early obstruction, urine sodium and FENa may be low; in late obstruction, urine sodium and FENa may be high (tubular damage)

Front 10

lab findings in gentamicin toxicity

Back 10

hypokalemic metabolic alkalosis

Front 11

describe pathophysiology of gentamicin nephrotoxicity

Back 11

Aminoglycosides are divalent cations that activate calcium-sensing receptor in TALOH; this inhibits Na-K-Cl cotransporter, mimicking effect of loop diuretics and leading to hypokalemic metabolic alkalosis

Front 12

fibrosing skin disease caused by an inflammatory reaction to gadolinium that accumulates in the body due to kidney failure

Back 12

nephrogenic systemic fibrosis

Front 13

in DM, when to test for microalbuminuria?

Back 13

annual testing to assess urine albumin excretion in patients with type 1 diabetes of 5 years' duration and in all patients with type 2 diabetes starting at the time of diagnosis by measuring the albumin–creatinine ratio

Front 14

how is microalbuminuria diagnosed?

Back 14

albumin–creatinine ratio of 30 to 300 mg/g; diagnosis requires an elevated albumin–creatinine ratio on two of three random samples obtained over 6 months

Front 15

how do NSAIDs cause hyperkalemia?

Back 15

inhibit renin synthesis, resulting in hyporeninemic hypoaldosteronism, decreased potassium excretion, and hyperkalemia

Front 16

formula for TTKG

Back 16

TTKG = [Urine Potassium ÷ (Urine Osmolality/Plasma Osmolality)] ÷ Serum Potassium OR Uffine K / serum K all div by Uosm/Posm

Front 17

how to interpret TTKG?

Back 17

TTKG in patient on normal diet is 8 to 9; >10 in hyperkalemic states, reflecting excretion of excess potassium; if not then prob hypoaldosterone state

Front 18

fevers and leukopenia post kidney transplant

Back 18

CMV infection

Front 19

mechanism of kidney injury due to tenofovir

Back 19

drug-related damage to mitochondrial DNA (most significantly in renal tubules causing tubular dysfunction)

Front 20

mechanism of kidney injury due to Bactrim?

Back 20

Trimethoprim, particularly in acid urine, blocks the epithelial sodium channel in the cortical collecting duct, leading to increased lumen positive potential, impaired potassium and proton secretion, hyperkalemia, and metabolic acidosis

Front 21

X-linked disease affecting basement membranes due to a collagen protein synthesis defect. Clinical disease is characterized by sensorineural hearing loss, ocular abnormalities, and a family history of kidney disease and deafness

Back 21

Alport syndrome

Front 22

differential diagnosis of combined increased anion gap metabolic acidosis and respiratory alkalosis

Back 22

salicylate toxicity, liver disease, and sepsis

Front 23

ferritin levels that exclude or diagnose iron deficiency

Back 23

>100ng/mL excludes and <15 diagnoses iron def

Front 24

formula for urine potassium–creatinine ratio

Back 24

Urine Potassium (meq/L) × 100 [(mg × L)/(dL × g)] ÷ Urine Creatinine (mg/dL)

Front 25

interpretation of urine K-crea ratio

Back 25

> 20 meq/g c/w kidney potassium wasting, << 15 meq/g suggests extrarenal potassium loss, cellular redistribution, or decreased intake

Front 26

metabolic alkalosis, urine cl levels low, differentials?

Back 26

vomiting or decreased effective arterial blood volume (prior diuretics)

Front 27

metabolic alkalosis, urine Cl levels high, differentials?

Back 27

on diuretics, Bartter or Gitelman syndrome

Front 28

define hypercalciuria

Back 28

urine calcium >300

Front 29

treatment of calcium stones with hypercalciuria

Back 29

thiazide diuretic, promotes distal reabsorption of calcium

Front 30

kidney injury which results when a patient with vascular risk factors and hypertension attains a blood pressure lower than usual measurements

Back 30

normotensive ischemic AKI

Front 31

time frame for AIN to occur

Back 31

1 week of exposure

Front 32

JNC 7 definition of prehypertension

Back 32

average blood pressure reading of 120 to 139 mm Hg systolic or 80 to 89 mm Hg diastolic

Front 33

blood pressure that is higher at home than in the office setting

Back 33

Masked hypertension

Front 34

White coat hypertension

Back 34

3 office BP >140/90 mm Hg, 2 home BP <140/90 mm Hg and no target organ damage.

Front 35

Resistant hypertension

Back 35

BP above goal despitee 3 antihypertensives, including 1 diuretic

Front 36

pathophysiology of Gitelman syndrome

Back 36

defect is due to inactivating mutations in the gene for the thiazide-sensitive sodium chloride cotransporter in the distal convoluted tubule, and the electrolyte profile is analogous to that induced by thiazide diuretics

Front 37

electrolyte and acid base abnormality in diuretic abuse and surreptitious vomiting

Back 37

hypokalemic metabolic alkalosis

Front 38

define gestational hypertension

Back 38

refers to hypertension that develops after 20 weeks' gestation in the absence of proteinuria or other maternal end-organ damage

Front 39

what is preeclampsia?

Back 39

new-onset hypertension accompanied by the development of proteinuria, develops any time after 20 weeks of pregnancy but usually occurs close to term.

Front 40

classic presentation of AIN

Back 40

fever, rash, and eosinophilia with elevated crea (only in 10%)

Front 41

how to interpret fractional excretion of urea

Back 41

<35% prerenal (less influenced by diuretics)

Front 42

propofol-related infusion syndrome is characterized by

Back 42

type B lactic acidosis, hypertriglyceridemia, rhabdomyolysis, and J-point elevation or a Brugada-like pattern on EKG

Front 43

treatment of primary membranous glomerulopathy

Back 43

control risk factors - ACEi for HTN and statin if HL

Front 44

differentiate type A and type B lactic acidosis

Back 44

Type A due to tissue hypoperfusion / hypoxia. Type B due to medication / toxin; or in advanced malignancy, liver disease, or G6PD def

Front 45

drugs that cause type B lactic acidosis

Back 45

linezolid, acetaminophen overdose, metformin, the NRTis stavudine and didanosine, propofol, and salicylates

Front 46

kidney stones that will pass and will not pass?

Back 46

5mm or less will pass, 10mm or more will not

Front 47

at what levels of creatine kinase should one suspect rhabdo?

Back 47

>5000

Front 48

abnormal ARR

Back 48

>25 considered abnormal

Front 49

when to start bicarbonate therapy in CKD?

Back 49

Stage 4-5 with bicarb 15-20 (delays progression of CKD)

Front 50

treatment of hyperoxaluria

Back 50

calcium carbonate supplements