CKD
AKI
Acid/Base
Electrolytes and Glomerular Disease
Spooky Medicine
200
This classic complication of advanced CKD gives patients a "ghostly" pale appearance due to decreased erythropoietin (EPO) production and is treated with ESAs only when hemoglobin drops below this specific threshold?
What is 10 g/dL (consider treatment for < 10)?
200
This classic pre-renal "ghost" haunts the volume-depleted patient, tricking the kidneys into aggressively conserving sodium and water, resulting in a fractional excretion of sodium (FENa) dropping below this percentage.
What is < 1% (indeterminate 1-2%, intrinsic > 2%)?
200
A patient presents with a spooky hangover after a Halloween party with persistent vomiting. Her labs reveal a bicarbonate of 30 and a urine chloride and sodium both < 15. What is the treatment of choice to correct the metabolic alkalosis?
What is 0.9% normal saline?
200
The insidious nature of this most common glomerular pathology includes a creeping presence of microscopic hematuria, often intermittent and post-infectious, although more aggressive presentations may occur?
What is IgA nephropathy?
200
Bivalirudin is synthesized from a natural variant found in the saliva of this medieval blood sucker.
What is the leech?
400
To ward off the "bone-chilling" vascular calcifications and secondary hyperparathyroidism in CKD, nephrologists restrict dietary intake of this spooky mineral and use non-calcium-based binders like sevelamer.
What is phosphorus?
400
To unmask the true culprit behind a "frightening" rise in creatinine after a CT scan with contrast, clinicians look for muddy brown casts under the microscope, which are the hallmark of this most common intrinsic cause of hospital-acquired AKI.
What is acute tubular necrosis (ATN)?
400
This nefarious cause of an AGMA is often seen in patients with pathology like SIBO and may be missed on standard laboratory assays and sneaks past the “MUDPILES” pneumonic.
What is D-lactate (standard lab only measures L-lactate)?
400
These factors of what cascade that has caused many a sleepless night for countless medical students and induces the thousand-mile stare in medical residents are often critical in identifying glomerular pathology?
What is C3 and C4 of the complement cascade?
400
This local desert “monster” produces a salivary peptide known as exendin-4 to induce hypoglycemia in prey, after which its discovery led to the development of exenatide (byetta), the first GLP-1 approved by the FDA.
What is the Gila monster?
600
This class of blood pressure medications is a double-edged sword in CKD: while they provide protection against glomerular hyperfiltration and proteinuria, they can give clinicians a fright by causing an acute, acceptable serum creatinine bump of up to this percentage? (both the class and the percentage)
What are ACE/ARBs and what is 30%?
600
This urinary diagnostic index remains reliable even when loop diuretics ruin the utility of standard urine studies.
What is Fractional excretion of urea (FEUrea)?
600
To determine if the respiratory compensation in a metabolic acidosis is "frighteningly" inadequate or if a mixed disorder is lurking, residents apply this classic formula named after two physiologists
What is winters formula?
600
You’re alone on West Nights and receive an anonymous page to “order urine studies” for a sodium of 125 in an euvolemic elderly patient on SSRIs with pulmonary pathology. What urine studies do you order and what values rule in SIADH?
Urine osmolality (generally >100 mOsm/kg H2O meaning ADH is ON), urine sodium (generally > 20 mEq/L meaning aldosterone is OFF, variable in SIADH)
600
Captopril, the grandfather of ACE inhibitors, was originally developed by studying the bradykinin-potentiating peptides found in the venom of this slithering South American pit viper.
What is the brazilian pit viper?
800
To prevent a metabolic acidosis that accelerates bone resorption and muscle wasting in CKD, guidelines recommend initiating oral alkali therapy (like sodium bicarbonate) when serum bicarbonate drops below this critical level.
What is < 22 mEq?
800
Not to be overlooked, this “ghastly” etiology can elude the physician who anchors, particularly in older patients, with a bland urine and no response to fluids. A simple imaging test can identify this etiology. Name the test and the etiology.
What is post-renal and renal US (look for hydro)?
800
A disheveled haunt has the following labs. What might be the cause of his confusion, and why?
Labs: ABG pH 7.21, pCO2 30; Serum Sodium 138, K 4.2, Cl 98, HCO3 12, osmolality 345, lactate 2.3, glucose 126, BUN 28, sCr 1.1.
What is osmolal-active alcohol ingestion (e.g. ethylene glycol, methanol, etc)? Note, NOT ethanol. Because there is an osmolal gap (expected is 2*Sodium + Glucose/18 + BUN/2.8 + Ethanol/4.6). Here, that is 293, so the calculated osmolality (345) - expected osmolality (293) is 52.
800
When diagnosing the specific phantom of nephrotic syndrome in adults that is notorious for causing renal vein thrombosis, clinicians search for anti-PLA2R antibodies and subepithelial immune complex spikes on silver stain.
What is membranous nephropathy?
800
Draculin is an anticoagulant protein found in the saliva of this terrifying mammal that Mr. Stoker himself might be afraid of.
What is Vampire Bat? (Brian Stoker wrote Dracula)
1000
This novel, non-steroidal mineralocorticoid receptor antagonist provides cardiorenal protection in diabetic kidney disease with a lower propensity for hyperkalemia than spironolactone, but is contraindicated if the patient's baseline estimated glomerular filtration rate falls below 25.
What is finerenone?
1000
In a critically ill patient presenting with severe AKI, profound thrombocytopenia, and microangiopathic hemolytic anemia, identifying a profoundly suppressed activity level (< 10%) of this specific plasma metalloprotease confirms a "fatal" diagnosis of acquired TTP over atypical hemolytic uremic syndrome (aHUS).
What is ADAMTS13?
1000
What do the value ranges in the delta-delta ratio tell you?
Δ−Δ Ratio = Δ Anion Gap/Δ Bicarbonate = (Anion Gap – 12)/(25 – Bicarbonate)
What are a ratio < 1 meaning concurrent NAGMA, 1-2 confirming primary AGMA, >2 meaning possible concurrent metabolic alkalosis?
1000
This class of medication looms eerily in the back of nephrologists’ minds for refractory hyponatremia due to SIADH. While effective, they are often cost-prohibitive and can only be used for one month due to this deadly complication? (Must name both class of drugs and complication)
What are the -vaptans (ADH antagonists) and what is liver toxicity?
1000
Commonly blamed for outbreaks of "witchcraft" in 17th-century Salem, this grain fungus thrives in damp rye and contains natural precursors to LSD, causing hallucinations, severe vasospasm, and gangrene.
What is Ergot (Claviceps purpurea / Ergotism)?