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Nephrology and Hypertension Flashcards

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  1. A 25-year-old woman is found to have BP of 170/100 mmHg on routine exam. Labs show hypokalemia, suppressed plasma renin activity, and elevated aldosterone. CT shows no adrenal mass. What is the best next diagnostic step?

    Answer: Adrenal vein sampling

    Adrenal vein sampling is the gold standard for differentiating unilateral aldosterone-producing adenoma from bilateral adrenal hyperplasia when CT is non-diagnostic.

  2. A 58-year-old man on hemodialysis for 8 years presents with bone pain and a serum calcium of 11.2 mg/dL, phosphorus of 5.8 mg/dL, and intact PTH of 850 pg/mL. What is this condition called and what surgical intervention may be needed?

    Answer: Tertiary hyperparathyroidism; parathyroidectomy if refractory to cinacalcet

    Tertiary hyperparathyroidism occurs in long-term dialysis patients when autonomous PTH hypersecretion persists and may require parathyroidectomy if calcimimetics fail.

  3. A 48-year-old HIV-positive man on tenofovir disoproxil fumarate presents with a proximal renal tubular acidosis, glucosuria with normal serum glucose, hypophosphatemia, and hypokalemia. What syndrome does this represent?

    Answer: Fanconi syndrome

    Tenofovir disoproxil fumarate can cause mitochondrial toxicity in proximal tubular cells, leading to Fanconi syndrome with global proximal tubule dysfunction.

  4. A 35-year-old woman with lupus nephritis class IV on mycophenolate and prednisone has a serum creatinine rise from 1.1 to 2.4 mg/dL over 3 months with worsening proteinuria. What is the best next step?

    Answer: Repeat kidney biopsy

    A repeat kidney biopsy in lupus nephritis is essential to determine whether the class has transformed, activity has increased, or chronic scarring has developed before changing therapy.

  5. A 66-year-old man with hypertension is started on chlorthalidone. Two weeks later he reports muscle cramps. Labs: Na 138 mEq/L, K 3.0 mEq/L, Cl 94 mEq/L, HCO3 29 mEq/L, urine Cl 60 mEq/L. What acid-base disorder is present?

    Answer: Metabolic alkalosis with appropriate respiratory compensation

    Thiazide diuretics cause metabolic alkalosis via volume contraction, increased aldosterone, and direct H+ and K+ loss in the collecting duct.

  6. A 72-year-old woman with stage 4 CKD is found to have serum bicarbonate of 18 mEq/L. Which intervention has been shown to slow CKD progression in addition to correcting the acidosis?

    Answer: Sodium bicarbonate supplementation

    Alkali therapy with oral sodium bicarbonate has been shown in multiple trials to slow GFR decline in CKD patients with metabolic acidosis.

  7. A 29-year-old man presents with painless hematuria. Urine microscopy shows dysmorphic RBCs and RBC casts. Serum complement C3 and C4 are normal. Kidney biopsy shows mesangial IgA deposits. His serum IgA level is elevated. What triggers commonly cause gross hematuria episodes in this condition?

    Answer: Concurrent upper respiratory infections (synpharyngitic hematuria)

    IgA nephropathy classically causes synpharyngitic hematuria (gross hematuria coinciding with mucosal infection) in contrast to post-streptococcal GN which has a latency period.