Renal Questions

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Renal Questions
2014-03-31 15:58:19
renal internal medicine

Questions from internal med: renal
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  1. 35 year old with shortness of breath for 1 week. Blood tinged sputum and blood present in urinalysis. Infiltrates are seen in both lungs, IgG on glomerular membrane is positive. Patient has what and how do you tx?
    • Goodpasture's
    • Tx with plasma exchange, prednisone, and cyclophosphamide.
  2. Post-strep nephritic syndrome in a 9 year old, how do you treat?
    • Diuretics and anti-hypertensive medications.
    • Can't biopsy a swollen person (must control it first)
  3. 60 year old with fatigue, myalgias, weight loss, and 2+ protein, RBC, and erythrocyte casts. There's no hydronephrosis, but some patchy infiltrates (multilobular pneumonia). What should you do next? Creatinine is very high.
    Do emergency renal biopsy (high creatinine means going into renal failure)
  4. Most common complication of nephrotic syndrome?
    Renal vein thrombosis and chronic kidney disease
  5. Patient with hydrochlorothiazide has induced hyponatremia. How do you treat?
    Slowly increasing Na slowly with IV saline solution in 24 hours.
  6. Patient with hyperlipidemia, fatty casts, edema and massive proteinuria over 3.5 g/day.  Associated with hypercoagulable state. What does this pt have?
    nephrotic syndrome
  7. Patient with azotemia, oliguria, hypertension, slight proteinuria and RBC casts in urine.
    Nephritic syndrome
  8. Electrolyte disturbance characterized by flattened T waves, arrhythmias, and paralysis.small elevation of blood pressure,[3] and can occasionally provoke cardiac arrhythmias. Serum potassium concentrations of 2.5–3 mEq/L (Nl: 3.5–5.0 mEq/L), may cause muscle weakness, myalgia, and muscle cramps (owing to disturbed function of skeletal muscle), and constipation (from disturbed function of smooth muscle). DX?
  9. Low pH, decreased CO2, and decreased bicarb. What's the dx? What's the px compensation?
    • Metabolic acidosis.
    • Immediate hyperventilation.
  10. Increased pH, increased CO2 and increased Bicarb (primary disturbance). What's the dx? What's the px compensation?
    • Metabolic alkalosis.
    • Immediate hypoventilation.
  11. Decreased pH, and increased bicarb, originally caused by an increase in CO2. Dx? How does the px eventually compensate?
    • Respiratory acidosis.
    • Delayed renal bicarb reabsorption.
  12. If there is a decrease in respiratory CO2, and the pH increases, and bicarb decreases, what's the dx? How does the px compensate?
    • Respiratory alkalosis.
    • There will be eventual decrease in renal bicarb reabsorption.