Transcript AOA NEPHROLOGY REVIEW

March 18, 2009
AOA NEPHROLOGY REVIEW
A 29 year old woman is being evaluated to find the cause of her urine turning
a dark brown color after a recent upper respiratory tract infection. She has
been otherwise asymptomatic, and her blood pressure has been within
normal limits. Urinalysis finds moderate blood present with red cells and red
cell casts. Immunofluorescence examination of a renal biopsy reveals
deposits of IgA within the mesangium. These clinical findings suggest that her
disorder is associated with activation of the alternate complement system.
Which of the follow serum laboratory findings is most likely?
Serum C2
Serum C3
Serum C4
A

normal
normal
B
normal

normal
C
normal
normal

D

normal

E



A 28 year old man with a history of malaise and hemoptysis presents with the
acute onset of renal failure. Laboratory examination reveals increased serum
creatinine and BUN, but no antineutrophil cytoplasmic antibodies (ANCA) nor
antinuclear antibodies (ANA) are present. Urinalysis reveals the microscopic
presence of red blood cells and red blood cell casts, which a renal biopsy
reveals crescents within Bowman’s space of many glomeruli.
Immunofluorescence reveals linear deposits of IgG and C3 along the
glomerular basement membrane. Which of the following is the most likely
diagnosis?
A
Alport syndrome
B
Diabetic glomerulopathy
C
Goodpasture syndrome
D
Henoch-Schölein purpura
E
Wegener’s granulomatosis
A toddler is brought to you with swelling of the hands and face. The mother
says he was well but fell from his bike 2 weeks ago. Examination shows an
elevated blood pressure and an infected wound of the shin. Urinalysis shows
numerous red blood cells. Which statement is true?
A
Hypertension due to sodium retention
B
The causative organism is Staphylococcus
C
Complement levels will remain depressed for up to 6
months
D
The child will likely develop chronic renal failure if
untreated
E
The facial swelling is due to nephrotic syndrome
A 28 year old woman is brought to the ER after developing hypokalemic
paralysis. Arterial blood gas analysis shows a PaO2 of 102 mmHg and a pH of
7.1. She is diagnosed with type I renal tubular acidosis caused by Sjögren’s
syndrome (autoimmune tubulointerstitial nephropathy that damages the H+ATPase on the distal nephron). Which of the following laboratory
measurements will most likely be normal in this patient?
A
Net acid excretion
B
Aldosterone secretion
C
Serum bicarbonate
D
Urine ammonium
E
Anion gap
An elderly male presents with urinary frequency. Laboratory examination
showed an elevated serum creatinine. On physical examination you detect an
enlarged prostate. Which other finding is most likely?
A
Pain on urination
B
Oliguira
C
Hypokalemia
D
Metabolic acidosis
E
Normal renal ultrasound
A 23 year old male is brought to the ER after collapsing during basketball
practice. On admission he is lethargic and appears confused. His coach
reports that he was drinking a lot of water during practice. His symptoms are
most likely caused by increased:
A
Intracellular tonicity
B
Extracellular tonicity
C
Extracellular volume
D
Intracellular volume
E
Plasma volume
A 70 year old man presents to you because he has not been feeling well for
several months. He mainly complains of malaise and achiness. He takes
ibuprofen occasionally for these symptoms. His urine shows protein and
erythrocyte casts. A 24 hour urine shows 1g of protein per day. His creatinine
clearance is 24 ml/min. About 4 months ago, his serum creatinine was
normal. The most likely diagnosis is:
A
Amyloidosis
B
Light chain deposition disease
C
Non-steroidal induced interstitial nephropathy
D
Vasculitis
E
HIV nephropathy
A medical student presents to the ER with a 2 day history of severe vomiting
and orthostatic hypotension. What kind of metabolic abnormalities are most
likely in this patient?
A
Hypokalemia, hypochloremia, metabolic acidosis
B
Hyperkalemia, hyperchloremia, metabolic alkalosis
C
Normal serum electrolytes and metabolic acidosis
D
Normal serum electrolytes and metabolic alkalosis
E
Hypokalemia, hypochloremia, metabolic alkalosis
A 32 year old male with AIDS presents with moderate proteinuria and
hypertension. Histologic sections of the kidney reveal the combination of
normal appearing glomeruli that have deposits of hyaline material. No
increased cellularity or necrosis is noted in the abnormal glomeruli.
Additionally there is cystic dilation of the renal tubules, some of which are
filled with proteinaceous material. Electron microscopy reveals focal fusion
of podocytes, and immunofluorescence finds granular IgM/C3 deposits.
Which of the following is the most likely diagnosis?
A
Diffuse proliferative glomerulonephritis
B
Focal segmental glomerulonephritis
C
Focal segmental glomerulosclerosis
D
Membranous glomerulopathy
E
Minimal change disease
A patient with a history of cirrhosis and small cell lung cancer comes to the
office for routine bloodwork, which reveals of serum sodium of 120. Which
laboratory test is most useful in determining which of these two diseases is
the cause of the hyponatremia?
A
Serum osmolarity
B
Serum creatinine
C
Urine osmolarity
D
Urine sodium
E
Serum vasopressin