AKI
What are the five classic categories of urgent dialysis indications?
A: Severe or refractory acidosis
E: Severe or refractory electrolyte abnormalities, hyperkalemia or hypercalcemia
I: SLIME
O: Refractory volume overload
U: Symptomatic uremia
What are the 2 most common causes of CKD?
Diabetes and HTN
What is the antibody associated with membranous nephropathy?
Anti-phospholipase A2 antibody
Can commonly see renal vein thrombosis
What is the most common type of kidney stone? What do they look like under microscopy?
Calcium oxalate. Envelopes or dumbbells
Tell us the coolest Nephrology case you've seen. If I like your answer, I'll give your team points.
*Hopefully something cool*
Which urine sediment finding is classically associated with acute tubular injury?
Muddy brown granular casts
What disorder is associated with certain gadolinium-based contrast agents in patients with advanced kidney dysfunction?
Nephrogenic systemic fibrosis, which can cause skin thickening, induration, and joint contractures
Group II gadolinium agents have the lowest risk of nephrogenic systemic fibrosis
Hemoptysis, rapidly rising creatinine, and RBC casts accompany linear IgG staining on kidney biopsy. Name the diagnosis.
Anti-glomerular basement membrane disease
Antibodies target type IV collagen.
What stone type is associated with urease-producing bacteria, and what is its composition? What is the classic organism?
Struvite, composed of magnesium ammonium phosphate. Proteus is a classic causative organism.
What are the two major considerations when a urine dipstick shows 3+ blood but microscopy shows no red blood cells?
Myoglobinuria from rhabdomyolysis and hemoglobinuria from intravascular hemolysis
What are the 3 classic findings of acute interstitial nephritis? Name 2 classes of medications that can cause AIN.
Fever, rash, and eosinophilia
Antibiotics, NSAIDs, PPI
Name this disorder: calcification and thrombosis of small dermal and subcutaneous vessels, producing severely painful lesions that can progress to necrotic ulcers. Sodium thiosulfate can be used off-label to treat this.
Calciphylaxis
What nephrotic syndrome is associated with HIV?
FSGS - Focal segmental glomerulosclerosis
What malignancy should be considered when a patient on long-term dialysis with acquired cystic kidney disease develops new gross hematuria?
Renal cell carcinoma
What lab can provide a more accurate estimate of kidney function than creatinine in patients with low muscle mass?
Cystatin C -- it is less affected by muscle mass. Low creatinine production can cause creatinine-based eGFR to overestimate kidney function in patients with sarcopenia, malnutrition, or amputations.
Which type of renal tubular acidosis causes hyperkalemia, and what hormonal abnormality underlies it?
Type 4 RTA, caused by aldosterone deficiency or resistance.
What is the most common malignancy in renal tranplant patients?
Cutaneous squamous cell carcinoma
Hepatitis C, palpable purpura, neuropathy, and rising creatinine, and microscopic blood on U/A.
What is the diagnosis?
Mixed cryoglobulinemic glomerulonephritis
Name two medications that inhibit carbonic anhydrase and can increase calcium phosphate stone risk.
Acetazolamide and topiramate. They promote alkaline urine and hypocitraturia.
What intracranial vascular abnormality is associated with autosomal dominant polycystic kidney disease, and what can occur if it ruptures?
An intracranial saccular (berry) aneurysm, which can cause subarachnoid hemorrhage
In what scenario would you calculate an osmolar gap? Explain what an osmolar gap is.
Calculate an osmolar gap when you suspect toxic alcohol ingestion (methanol or ethylene glycol) or are evaluating unexplained high anion gap metabolic acidosis.
The gap is the difference between measured serum osmolality and calculated serum osmolality.
What causes uremic bleeding, and what medication can temporarily improve it before an urgent procedure?
Platelet dysfunction, often despite a normal platelet count. Desmopressin (DDAVP) can temporarily improve platelet function.
Name 3 glomerulonephritis disorders with low complement levels.
Lupus nephritis, post-infectious GN, cryoglobulinemia
What is Stauffer syndrome?
Paraneoplastic hepatic dysfunction without liver metastases, associated with renal cell carcinoma.
How do you measure intra-abdominal pressure when evaluating suspected abdominal compartment syndrome, and what defines the syndrome?
Measure bladder pressure through a urinary catheter. Abdominal compartment syndrome is sustained intra-abdominal pressure >20 mm Hg with new organ dysfunction, such as AKI. Patient must be supine.