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Step III
Step III - Renal 1
| Question | Answer |
|---|---|
| Hyaline casts, urine osm >500, FeNa <1%, urine Na <20 | Pre-renal |
| What are the causes of pre-renal azotemia | HYPO-volemia, HYPO-tn (<90), CHF, constrictive cardx, low onc pressure, renal aa stenosis |
| Causes of post-renal | Strictures, stones, CA bladder/prostate/cervix, neurogenic bladder |
| Muddy brown/granular casts | ATN |
| Hyaline casts | Pre-renal |
| What are the common causes of ATN | Toxic injury and HYPOperfusion |
| MCC toxin induced renal insufficiency | Aminoglycosides, amphotericin, chemo (cisplatin), IV contrast dye |
| What lab test can help in evalx ATN from contrast | Mg |
| Fever, Rash, Eosinophilia/uria, WBC casts. Exposure to drug or infection | AIN |
| What is the FeNa and urine Osm in AIN | FENa >2%, Dilute urine (Osm < 350) |
| h/o Abx (PCN, ceph, NSAIDs, phenytoin, diuretics, sulfa, quinolones) a/w what type intrarenal renal failure | AIN |
| h/o infection/autoimmune (SS, SLE, sarcoidosis) a/w what type intrarenal renal failure | AIN |
| What is the best initial test for AIN and what does it show | UA showing WBCs |
| Most accurate test for AIN | Wright stain OR Hansel’s stain of urine showing eosinophils |
| Tx for AIN | None; resolves on own |
| What drug causes hemorrhagic cystitis and NOT renal failure | Cyclophosphamide |
| What are some causes of rhabdo that lead to intrarenal failure | Seizures, crush injury, immobility in intoxicated pt, low K+ causing muscle necrosis, pt on statin |
| What is the best initial test for rhabdo induced intrarenal failure | UA showing large amounts RBCs but no cells |
| Most accurate test for rhabdo induced intrarenal failure | Urine myoglobin |
| Decreased bicarb, low Ca2+, incr K+ labs seen in what type of renal failure | rhabdo induced intrarenal failure |
| Tx for rhabdo induced intrarenal failure | Bolus nL saline, mannitol diuresis, alkalinization of urine |
| Pt in case has rhabdomyolysis. Most URGENT step in management and why | EKG; rhabdo causes HYPER-kalemia which is risk for arrthymia |
| Pt intoxicated from suicide attempt w/ antifreeze. What kind of renal failure | Crystal induced |
| What type of crystals are seen in ethylene glycol renal failure and what is the shape | Oxalate “envelope” crystals |
| What is the best initial test for crystal uropathy | UA |
| What is the best initial tx for crystal uropathy | Ethanol OR fomepazole w/ dialysis |
| What kind of crystals are seen in tumor lysis syndrome | Urate |
| Tx for urate crystal renal failure | Hydration and allopurinol |
| What can you give a pt that has DM/HTN who absolutely needs contrast dye | Hydrate w/ nL saline + bicarb/N-acetylcysteine |
| What are some kidney insults resulting from NSAIDs | ATN, AIN, nephrotic syndrome, afferent aa vasoconstrx |
| Red blood cells, red cell casts, proteinuria <2g in 24, edema | Glomerulonephritis |
| Most accurate test for glomerulonephrx | Kidney bx |
Created by:
DrINFJ
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