Nephrology

Question 0

Maintenance sodium? Maintenance potassium?

Answer 0

3 mEq/kg/day

2 mEq/kg/day

Question 1

Maintenance fluid requirement?

Answer 1

100 mL per kilogram for first 10 kg
50 mL per kilogram or second 10 kg
20 mL per kilogram for subsequent kilos

Question 2

Phases of parenteral rehydration?

Answer 2

1. Emergency phase – 20 mL/Kg bolus of saline/LR

2. Repletion phase – over 24 hours (if acute hyponatremia) or over 48 hours (if hyperNa)

Question 3

Definition of microscopic hematuria?

Answer 3

> 6 RBCs per high-powered field on 3+ attempts

Question 4

False-negative urine dipstick for hematuria if?

Answer 4

Ascorbic acid ingestion

Question 5

UA – meaning of RBC morphology?

Answer 5

Dysmorphic – from glomerulus

Normal – lower urinary tract

Question 6

Definition of pathologic proteinuria?

Answer 6

> 100 mg/m²/Day

Question 7

False positive urinary dipstick for proteinuria if?

Answer 7

1. Urine concentrated – specific gravity >1.025
2. Alkaline – pH over 7
3. ?

Question 8

Most accurate method of measuring proteinuria? Most used method? Interpretation?

Answer 8

24-hour urinary protein collection

Random spot urine total protein: creatinine ratio

TP/CR normally under .5 until two years; under .2 over two years

Question 9

Diagnose orthostatic proteinuria with?

Answer 9

Normal total protein to creatinine ratio in the morning but elevated ratio in the afternoon

Question 10

Causes of tubular proteinuria? Characteristic lab funding?

Answer 10

Interstitial nephritis, acute tubular process, nephrotoxic drugs

Urinary levels of urinary B2-Microglobulin, aminoaciduria

Question 12

Poststreptococcal GN – when to do a biopsy? Typical biopsy findings?

Answer 12

Indication: significant impairment/nephrotic syndrome or complement fails to normalize within 8 weeks

Mesangial proliferation and increasing mesangial matrix

Question 13

Most of chronic GN worldwide? Clinical features? Biopsy shows? Management? Can progress to?

Answer 13

IGA nephropathy (burger disease)

Recurrent gross hematuria and respiratory infections

1. Real biopsy shows mesangial proliferation and increasing mesangial matrix
2. Immunofluorescent microscopy shows IgA

Supportive; ACE, steroids used in patients with renal insufficiency

End stage renal disease

Question 14

Henoch- Schonlein purpura - classification? characteristic features? Prognosis?

Answer 14

IgA-mediated vasculitis

1. Non-thrombocytopenic palpable purpura on butt/thighs
2. Gross hematuria
3. Arthritis
4. Abdominal pain

Recovery within three months

Question 15

MPGN – biopsy findings? Treatment?

Answer 15

Lobar mesangial hypercellularity and thickening of glomerular basement

No definitive treatment. May respond to corticosteroids

Question 16

Definition of nephrotic syndrome in children?

Answer 16

More than 50 mg/kg/day proteinuria

Question 17

Three basic categories of nephrotic syndrome?

Answer 17

1. Primary – not a consequence of systemic disease. 90% of all cases. (Includes MCD)
2. Results from other primary glomerular disease (IgA nephropathy, MPGN, PSGN)
3. Results from systemic disease – SLE, HSP

Question 18

Consequences of nephrotic syndrome?

Answer 18

1. Hypoproteinemia leading to hypercholesterolemia/edema (Losing albumin in urine)
2. Hypercoagulability (losing anti-thrombin in urine)
3. Increased risk for infection/sepsis (losing immunoglobulins in urine)

Question 19

Patients with steroid resistant/steroid dependent nephrotic syndrome eventually develop?

Answer 19

End-stage renal disease

Question 20

HUS – clinical features? Treatment? Poor prognostic signs? Causes of mortality?

Answer 20

1. Diarrheal prodrome
2. Triad - Hemolytic anemia, thrombocytopenia, acute renal failure

Do not give antibiotics for HUS (antibiotics for E. coli colitis increases chance of HUS)

High WBC count, prolonged oliguria

Toxic megacolon or cerebral infarcts

Question 21

Atypical HUS? Causes? Prognosis versus regular HUS?

Answer 21

HUS with absent diarrheal phase and more prominent proteinuria/hypertension

Drugs or inherited

Higher risk of progression to ESRD

Question 22

Drugs that can cause atypical HUS?

Answer 22

OCP
Cyclosporine
Tacrolimus
OKT3

Question 23

Alport’s syndrome – inheritance? Defect? Clinical features? Management?

Answer 23

X-linked dominant

Defects in of type IV collagen in the glomerular basement membrane leads to progressive hereditary nephritis

1. Renal – hypertension and hematuria
2. Hearing loss in childhood
3. Ocular abnormalities involving rent and retina

ACE inhibitors, renal transportation

Question 24

Newborn with unilateral flank mass – most common cause? Associated with?

Answer 24

Multicystic renal dysplasia; atretic ureter

Question 30

Most common form of GN in children? Clinical features? Diagnosis? Tx?

Answer 30

Poststreptococcal GN 1. 8-14 days after pharynx infection/3+ weeks after impetigo 2. Hematuria, proteinuria, hypertension 3. Low C3 that normalizes in 8 weeks 1. ASO titer (mostly after pharyngitis) 2. ADB titer (more reliable) Supportive