,KSAP 2024 (NEPHROLOGY BOARDS)
QUESTIONSBANK WITH COMPLETE
SOLUTIONS, GRADED A+
Which factors in the nonneoplastic portion of the nephrectomy specimen
correlated with progressive loss of renal function after nephrectomy for renal
cell cancer? Answer - 1. Diabetic nephropathy
2. >10% tubulointersititial fibrosis or atrophy
3. > 5% glomerulosclerosis
4. Severe arterial or arteriosclerosis
In patients with symmetric renal function, radical nephrectomy results in an
immediate reduction in renal function by 50%, but compensation through
hypertrophy and hyperplasia results in recovery such that the final GFR is often
80% of the prior baseline, which may be above the GFR threshold for a
diagnosis of CKD.
Compared with partial nephrectomy, radical nephrectomy has been shown
through retrospective studies, population-based studies, and meta-analysis to
be an independent risk factor for CKD after cancer nephrectomy.
In AVF cannulation which technique can be used if AVF is only a short segment
or aneurysm is present in other areas? Answer - Buttonhole technique
- track is created with repetitive cannulation of the same path by sharp
needles, followed by blunt needle cannulation
- reduce pain, unsuccessful attempts, bleeding, hematoma, and aneurysm
formation
- higher incidence of infection (poor cannulation technique)
,- preferred technique for self cannulation
Dialysis patient with MSSA bacteremia treat with which antibiotic? Answer - IV
cefazolin (preferred) after each dialysis or nafcillin (frequent dosing Q6H; less
preferred)
- 15-20 mg/kg IV after each dialysis for cefazolin
___ has demonstrated to result in substantial and sustained weight loss among
obese dialysis patients thus increasing the opportunity for transplation in this
population Answer - bariatric surgery
__ can lead to hypovolemia, hypochloremia, and metabolic alkalosis. Low urine
chloride. Patient with history of bulimia. Answer - Vomiting - chlorine
responsive metabolic alkalosis
Patient with CKD, proteinuria, and microtubular structures on EM is ___. EM
showing organized fibrillar deposits > 30 nm in diameter, arranged in parallel
arrays of microtubular structures. Answer - Immunotactoid glomerulonephritis
(GN)
- associated with autoimmune conditions, plasma cell dycrasias, or malignancy
Case reports describe the use of rituximab, corticosteroids, cyclophosphamide,
and mycophenolate to treat immunotactoid GN, but no therapy should be
initiated prior to investigation for an underlying cause.
Amyloidosis, fibrillary, and cryoglobulinemic glomerulopathy also present with
fibrils on electron microscopy, but the size of fibrils and their structure are
different.
, What are the sizes of each? Answer - AL, or light chain-mediated, amyloidosis
demonstrates 10-nm fibrils
Fibrillary GN shows 20-nm fibrils
Cryoglobulinemic glomerulopathy shows 40-nm fibrils (frequently with a
"fingerprint" pattern).
The most appropriate regimen to prevent AV graft failure in a patient with a
history of graft thrombosis is ___ and ___. Answer - Dipyridamole and Aspirin
____ congenital disorder characterized by cystic dilation of the terminal
collecting ducts. It is commonly associated with nephrocalcinosis and recurrent
calcium stones. Answer - Medullary sponge kidney
The diagnosis has historically been made by IV pyelography, which
demonstrates pooling of contrast material within the cystic dilations, creating a
characteristic appearance that may be compared to a "paintbrush" or a
"bouquet of flowers."
CT scanning without radiocontrast can detect medullary nephrocalcinosis,
which suggests medullary sponge kidney, but tubular ectasia is not well
visualized.
Kidney ultrasound may show cysts with calcified sediment, which forms a fluid
level in the dependent portion of the cyst; this may be described as a cyst with
"milk of calcium."
The kidney stones are primarily composed of calcium oxalate, calcium
phosphate, or both.
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