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Questions and Answers
What urinalysis finding is commonly associated with acute tubular necrosis (ATN)?
Which clinical history is most associated with the risk of developing intrinsic renal disease?
What might a finding of eosinophilia indicate in the context of kidney diseases?
What is the significance of finding a urine sodium excretion (FENa) of 1-3%?
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Which symptom is least likely to be associated with kidney disease?
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What does the presence of dysmorphic red blood cells (RBCs) in urine typically suggest?
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Which condition is most likely to result in urine output characterized as oliguria?
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Which feature is indicative of atheroembolism in kidney disease?
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In the context of renal failure, what does the term 'kidney sweat' refer to?
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Which of the following urine chemistry results would most likely indicate renal failure?
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Study Notes
Presentation of Kidney Disease
- Abnormal laboratory results: Elevated BUN (blood urea nitrogen), serum creatinine, and decreased eGFR (estimated glomerular filtration rate).
- Asymptomatic findings: Microscopic hematuria, proteinuria, and microalbuminuria detected through urinalysis.
- Changes in urinary habits: Includes polyuria, hematuria, nocturia, and urgency.
- New-onset hypertension and worsening dependent edema may be indicators of renal issues.
- Non-specific symptoms: Nausea, vomiting, and malaise.
- Ipsilateral flank pain can suggest obstructing nephrolithiasis.
- Incidental imaging findings may show anomalies like horseshoe kidney, absent or ptotic kidney, and other masses or cystic conditions such as polycystic kidneys.
- Systemic disease symptoms may include skin changes, rash (often seen in scleroderma, vasculitis, or SLE), and joint issues (gout or SLE related).
Glomerular Filtration Rate
- Filtration in kidneys is influenced by hydrostatic pressure across the glomerular capillary wall.
- Oncotic pressure within the capillary acts to partially counterbalance the filtration process.
Disease Presentation and Diagnosis
- Renal and urinary system diseases can be asymptomatic and detected through lab tests or imaging.
- Non-specific symptoms, such as fatigue, can be associated with renal issues.
- Specific signs might indicate diagnosis: e.g., proteinuria is organ specific but non-diagnostic; polycystic kidney disease (PCKD) has identifiable characteristics.
- Comorbidities, like diabetes, warrant screening for renal issues.
Impact of Medications and Social History
- Some medications (e.g., lithium) can lead to increased urination, while exposure to substances like lead (Pb) may cause renal failure.
- Bladder cancers may be linked to aniline dye exposure.
Previous Medical History and Their Associations
- Conditions such as rhabdomyolysis, hemolysis, microangiopathy, and acute interstitial nephritis (AIN) may contribute to intrinsic renal disease.
- Atheroemboli can also impact renal function adversely.
Urinalysis Findings
- "Muddy brown" granular casts in urine sediment suggest acute tubular necrosis (ATN).
- Hematuria, dysmorphic red blood cells (RBCs), and RBC casts indicate glomerulonephritis (GN).
- White blood cell casts in AIN, alongside eosinophilia in atheroemboli.
- FENa values ranging from 1-3% and urine-to-plasma creatinine ratio <40 can indicate intrinsic renal failure.
- Urine output may vary: oliguria is an indicator of renal insufficiency, while polyuria may occur in other contexts.
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Description
Test your knowledge on nephrotoxicity and its implications in renal disease and urinary tract disease. This quiz is based on Harrison's Principles of Internal Medicine, 21st Edition, and will challenge your understanding of patient approaches in nephrology.
