Highs and Lows
Rx
Filter Fiascos!
I Spy
At your own risk?
100
Name 3 causes of hyponatremia
SIADH, cirrhosis, CHF, glucocorticoid deficiency
100
First line therapies for HTN in pregnancy
Labetalol, nifedipine, methyldopa
100
Nephrotic syndrome is associated with what 3 features
Urine protein excretion >3500mg/24 or urine protein creatinien ratio >3500mg/g, hypoalbuminemia (<3.0g/dL), edema, hypercholesterolemia
100
Identify the cell in the image
What are they associated with
What is an Acanthocyte
Glomerular hematuria/bleed from glomerular disease
100
7.5/48/85
Na+ 143, K+ 2.8, Cl-98, Bicarb 38
metabolic alkalosis
200
Name 3 EKG manifestations of hypokalemia
ST segment depression, decreased T wave amplitude and increased U wave amplitude
200
Why is fineronone used over spironolactone or epleronone to prevent CKD progression?
Fineronone is less like to cause hyperkalemia compared to spironolactone/epleronone
200
Membranous Nephropathy treated conservatively includes what (2/3)?
RAS blockade, statin and edema management
200
What are Struvite Stones
Struvite crystals typically have a “coffin lid” appearance. Struvite stones occur in the presence of urea-splitting bacteria, such as Proteus, Klebsiella, or, less frequently, Pseudomonas species.
urine pH will be greater than 7.5.
200
Screening test for ADPKD patients, and what are you looking for
MRA, cerebral aneurysm
300
isovolemic hypotonic hyponatremia with urine osm <100
Psychogenic polydipsia
300
Name 2 medications that can decrease proximal tubule secretion of creatinine
cimetidine, trimethoprim, cobicistat, dolutegravir, bictegravir, tyrosine kinase inhibitors, pyrimethamine
300
What are the indications for immunosupression in membranoproliferative glomerulonephritis?
Bonus: 2 types of membranoproliferative glomerulonephritis
Nephrotic range proteinuria, or progressive decline in kidney function
Bonus:
Immune-complex forms
Complement-mediated forms
300
A 40-year-old woman is evaluated for progressive edema and proteinuria. A urinalysis is performed, and this finding is observed under polarized light.
What is the diagnosis?
Bonus: what is the finding called?
Nephrotic syndrome
"Maltese cross" created by oval fat bodies
Usually a result of increased glomerular permeability
300
Associated with positive urine anion gap, urine pH <5.5 with increased serum potassium
Type 4 hyperkalemic RTA
400
The gold standard test to distinguish between renal and extrarenal causes of potassium depletion
Bonus: Alternative?
24-hr urine potassium (30mmol/d)
Spot urine potassium creatinine ratio (<13mEq/g identifies hypokalemia secondary to lack of intake, transcellular shifts or GI losses)
400
Name the trials that show the benefit of fineronone in CKD to reduce cardiovascular and renal disease
FIGARO-DKD, FIDELIO-DKD
400
What is the diagnostic definition of Rapidly Progressive Glomerulonephritis
1. Minimum of 50% decline in GFR over says to weeks
2. Extensive glomerular crescents seen on pathology
focal rupture of the glomerular capillary walls, allowing fibrin in the urinary space eventually causing compression
400
The following image is associated with what condition:
Bonus: name an etiology
AIN
WBC casts
Etiologies: NSAID, penicillins, cephalosporin, allopurinol, legionella, CMV
Urine eosinophils lack specificity and sensibility for diagnosis
400
Patient with past medical history of CKD (GFR 20), presents with suspected multiple sclerosis and imaging is performed. What complication is this patient at increased risk for in the future?
Nephrogenic systemic fibrosis
500
Hypercalcemia, elevated PTH, low 24-hour urine calcium secretion
What is the diagnosis?
Bonus: what is the pathology?
Familial hypocalciuric hypercalcemia
Defect in calcium-sensing receptor (CaSR)
500
What is the first line treatment for patients with FSGS who are resistant to glucocorticoids
Calcineurin inhibitors
Other immunosuppressive agents are second line but without high quality data
500
Patient has newly diagnosed Lupus nephritis, with kidney biopsy revealing Class IV LN. What therapies would you begin?
Glucocorticoid + Mycophenolate, Cyclophosphamide, Calcineurin inhibitors
500
Uric acid crystals under polarized light
500
What medication was derived from the bark of the apple tree?
SGLT inhibitors