#1
#2
#3
#4
#5
100
Squee Warmnut has an abd bruit indicative of renal stenosis. What drug should she definitely NOT take?
BONUS: What's the mechanism?
BONUS 2: What if Squee warmnut is a 25 y/o F who doesn't smoke and is generally healthy aside from a very high BP, what disease they got?
ACE inhibitor or an ARB (angiotensin receptor blocker) - Bonus: Give me the drug naming convention for these drugs!
More important for bilateral renal stenosis But can be an issue if they have a solitary kidney. NOTE: Renal stenosis causes a difference in Kidney size!!
BONUS 1 Mechanism: Renal artery stenosis → RAAS activation → Angiotensin II constricts efferent arteriole to maintain GFR → ACE inhibitor/ARB blocks angiotensin II → Efferent dilation → Decreased GFR and acute kidney injury.
BONUS 2: Fibromuscular dysplasia. MAKE SURE TO LOOK AT AGE BEFORE PULLING TRIGGER!!!!
Other causes of renal stenosis compression: Vascular thrombosis, Outside compression like tumor or retroperitoneal fibrosis, radiation induced damage, trauma, ane.
100
Hearing issues is associated with what kidney disease (give me the other sx as well) and what diuretic?
1. Alport Syndrome: Hematuria, Loss of hearing and visual disturbances --> thinning and thickening and splitting of GBM. “Basket-weave”
2. Loop diuretics
Quick which of these is a loop diuretic --> Acetazolamide, Bumetanide, Torsemide, Ethacrynic acid, Chlorthalidone, Metolazone, Eplerenone, Triamterene.
100
Contrast Dye for CT or Aminoglycosides (name em) causes what? And see what on Microscopic UA?
Acute Tubular Necrosis (ischemia, nephrotoxins) --> Muddy brown casts --> 3 phases of incident, maintenance, recovery
- Mnemonic MAULED
- Myoglobinemia
Aminoglycosides
Uric Acid
Lead
Ethylene Glycol
Dye
100
Flank pain and Crohns disease
You tell me the shape/s
Calcium Oxalate Stone
Oxalate is bound by calcium in the gut, preventing its absorption: Crohn's --> malabsorption of fats --> calcium binding to fats instead of oxalate --> allowing oxalate to be freely absorbed
This can also occur in other malabsorptive conditions (e.g., gastric bypass)
100
PAH is used to calc what?
Inulin is used to Calc what?
Get me CO from PAH and HCT!
Effective Renal Plasma Flow
Glomeular Fiiltration Rate
CO = RBF / ~.2 = eRPF / (1 - HCT) * .2= .[U] * V / (1-HCT) * .2 * [P]
200
Jiminy Cockroach has a kidney issue strongly associated Cerebral Aneurysms. What kidney issue he got and what vital reading should I always check if I suspect this kidney disease?
Bonus: What is 1 heart and 1 liver issue issue associcated with this disease?
Autosomal Dominant Polycystic Kidney Disease
In the question: ALWAYS LOOK FOR HTN. Every question I saw had a mention of HTN for ADPKD. Almost always 30-50 y/o
Remember look for sudden death in the fam, saccular ane, or Sub Arachnoid hemorrhage in the question too.
Bonus: MVP and Hepatic Cysts
200
1. What drug causes Gynecomastia?
Bonus: What specific edematous pathology is this drug more associated with and you should immediately think this drug when you see it?
1. Spironolactone due to antiandrogenic effects.
2. Heart failure or ascites!
Aldosterone Antagonist
Give me the names of all K sparing Diuretics and their assoc mechanism.
200
Woodrow Butnopadl is a religious smoker, has painless hematuria and works in a textile factory with many analine dyes. What does he have?
Urothelial Carcinoma or Transition Cell Carcinomas
200
Apple-green birefringence or Congo Red Staining under polarized light
Amyloidosis
May be positive for lambda and kappa light chains AA amyloidosis
Mesangial expansion by amyloid fibrils
200
Billy the 2 year old has edema and frothy urine. What he got?
Minimal Change
300
Tobin Flatfoot has polyuria, polydipsia, dehydration, hypernatremia, and decreased urine osmolality (< 300 mOsmol/kg). What does he probably have, and where is the issue in the kidney? (There is an umbrella term for these disorders, give me it!)
Bonus: What drug is commonly assoc cause with this disease, and what is a treatment
Nephrogenic DI / Arginine Vasopressin Disorders
1. Lithium. ALWAYS LOOK FOR LITHIUM OR THE TERM PSYCHIATRIC DRUG! (Bonus Bonus: Which renal tubular acidosis may be caused by lithium toxicity?)
Central DI: ADH deficiency → Responds to ADH replacement (e.g., desmopressin).
Nephrogenic DI: ADH resistance → Does not respond to ADH; requires treatments like low-salt diet, thiazide diuretics, or correction of underlying causes. (N for No response to ADH)
Indomethacin can treat nephrogenic DI because of its ability to inhibit renal prostaglandin synthesis, which promotes the action of ADH on the collecting ducts --> dec diuresis.
ADH made in the hypothalamus released by post pituitary
300
Dr. Prolap Sedeyeball has Eosinophiluria and a rash, what they got?
Acute Interstitial Nephritis (Type 4 Hypersens) and assoc with flank pain
- Mnemonic --> DRAINS
Diuretics
Rifampin
Abx (penicillin & cephalosporins) & allopurinol
PPI Inhibitors / Rarely Infection
NSAIDS
Sulfa Drug
300
Mrs. Espresso Bean forgot the name of her medication. Her labs show low Na, K and high Ca. What she taking? Does it cause inc or dec in serum pH?
Thiazides!
Inc in serum pH due to inc in RAAS causing contraction alkalosis from inc Bicarb resorb!
300
Fishy or Ammonia Smell & what stone?
Proteus! (Urease positive bugs promote struvite stones by alkalinizing urine).
Commons:
E. Coli: Gram Neg rod
Proteus: Gram neg rod, urease pos
Klebsiella: Gram Neg rod, urease pos
Staph Sapro: Gram pos cocci, urease pos, catalase pos
Pseudomonas: Gram neg rod, Oxidase Pos
Enterococcus faecalis: Gram pos cocci, catalase neg!
Almost all catalase pos except faecalis
Schistosoma haematobium is a worm associated with urothelial cancer. IF THEY ARE FROM SUB-SAHARAN AFRICA or MIDDLE EAST like Kenya or Egypt (ALARM BELLS)
300
Horace extreme is shredding mt everest until he gets headache, N, and fatigue. What do we give them?
Acetazolimide
400
Urinary cyanide nitroprusside positive is associated with what?
Cystine Kidney Stones
Commonly due to defective transport of dibasic amino acids (cystine, lysine, arginine, and ornithine); stones are classically hard and radioopaque
Bonus 1: Which is shape of Cystine Stones
Bonus 2: Can Cystine Stones form staghorn Clalc?
400
Frank Lee Deauxntgivadam has sickle cell, HIV and uses Heroin? What renal issue they got?
Focal Segmental Glomerulosclerosis
Associated with Podocyte Effacement, nothing on Immunofluorescence
Some say more in AA and Hispanics
400
Hemoptysis and hematuria
Goodpastures
1. Type 2 Hypersens
2. Linear deposition of immunoglobulin (IgG) along the glomerular and alveolar basement membranes
Proliferative glomerulonephritis (early) --> Necrosis and crescentic glomerulonephritis (late)
400
Hubby LeFlubbie has painless hematuria, an abdominal mass, and flank pain. His tumor has Large eosinophilic cytoplasm with abundant mitochondria without perinuclear clearing from epithelial intercalated tubular cells in the collecting duct
ONCOCYTOMA - same sx as renal cell carcinoma
PICTURE: A solid nest of tumor cells (without formation of glands or other structures) can be seen. The large tumor cells have a granular eosinophilic cytoplasm (examples indicated by arrowheads). Two atypical cells with hyperchromatic, pleomorphic nuclei (green overlay) are also visible.
400
WBC casts are associated with what diseases?
Acute Interstitial Nephritis
Pyelonephritis
500
Eosinophilic nodules within the glomeruli is associated with what disease team? Give me the other name for the nodules.
Diabetic Glomerulonephropathy can lead to eosinophilic nodular glomerulosclerosis, known as Kimmelstiel-Wilson nodules --> Nephrotic
Also associated with mesangial expansion and Thickening of GBM!
WHAT MED DO WE GIVE TEAM???????
https://assets.vogue.com/photos/64fe3ddfb668f782d8620072/1:1/w_2193,h_2193,c_limit/MCDTITA_FE018.jpg
500
Match em:
Subendothelial:
Subepithelial:
Mesangial:
Membranous Neph, PSGN, FSGS, IgA Neph, Lupus Neph, MPGN1, Minimal change, Amyloidosis, DM Nephropathy
NOTE: They might repeat or not apply!
Subendothelial: MPGN1, Lupus
Subepithelial: PSGN, Membranous Nephropathy
Mesangial: IgA nephropathy, Amyloidosis, DM Nephropathy
500
Urine osmolality of >500
Na+ (mEq/L) <20
FENa <1%
Serum BUN / CR > 20
Pre-renal AKI
Always look for the term MI (cardiogenic shock), heart failure, or severe trauma. Anytime you see these words ALARM BELLS
500
Urethral hypermobility or intrinsic sphincter deficiency
Stress incontinence (Urine with cof, sneeze, or laugh due to inc in intra-abd pressure)
Treatment: Pelvic floor muscle strengthening (Kegel) exercises, weight loss,
500
Limb deformities, low-set ears and retrognathia, flattened nose
Potter sequence --> Caused by chronic placental insufficiency or reduced fetal urine output, including ARPKD, obstructive uropathy (eg, posterior urethral valves), bilateral renal agenesis
POTTER sequence associated with: Pulmonary hypoplasia Oligohydramnios (trigger) Twisted face Twisted skin Extremity defects Renal failure (in utero)
BONUS: What artery messes up horshoe kidney's ascent?