NEPHROLOGY MAIN EXAM SCRIPT 2025/2026 QUESTIONS
AND SOLUTIONS GRADED A+ TIP
✔✔BUN:Cr ratio: post-renal - ✔✔>20:1
✔✔BUN:Cr ratio: intrinsic renal - ✔✔<20:1
✔✔Urine sodium: pre-renal - ✔✔<20
✔✔Urine sodium: intrinsic renal - ✔✔>20
✔✔FeNa: pre-renal - ✔✔<1%
✔✔FeNa: intrinsic renal - ✔✔>1%
✔✔Urine osmolality: pre-renal - ✔✔>500
✔✔Urine osmolality: intrinsic renal - ✔✔<300
✔✔what is the only significant manifestation of sickle cell trait? - ✔✔defect in renal
concentrating ability
✔✔which toxin causes very rapid onset of acute tubular necrosis? - ✔✔contrast
✔✔best way to prevent contrast-induced nephrotoxicity - ✔✔saline hydration before and
during administration
✔✔FeNa: contrast-induced ATN - ✔✔<1%
✔✔Urine specific gravity: contrast-induced ATN - ✔✔very high
✔✔Urine sodium: contrast-induced ATN - ✔✔very low
✔✔contrast causes _____ of the _____ arteriole - ✔✔constriction; afferent
✔✔dx: renal failure 2 days after initiation of chemotherapy - ✔✔hyperuricemia
✔✔name three therapies to given prior to chemotherapy prevent renal failure from
tumor lysis syndrome - ✔✔1. allopurinol
2. hydration
3. rasburicase
✔✔shape: oxalic acid crystals - ✔✔envelope shaped
, ✔✔how does ethylene glycol lead to acute kidney injury? - ✔✔oxalic acid precipitation
within the kidney tubules
✔✔electrolyte abnormalities seen in rhabdomyloysis (potassium, uric acid, calcium,
phosphate) - ✔✔potassium: high
uric acid: high
calcium: low
phosphate: high
✔✔three components of management of rhabdomyolysis - ✔✔1. saline hydration
2. mannitol
3. bicarbonate
✔✔name 5 indications to initiate dialysis for acute kidney injury - ✔✔1. fluid overload
2. encephalopathy
3. pericarditis
4. metabolic acidosis
5. hyperkalemia
✔✔name 5 drugs/toxins that can be removed w/ dialysis - ✔✔1. Salicylates
2. Lithium
3. Isopropanol
4. Methanol
5. Ethylene glycol
✔✔labs in hepatorenal syndrome match ____ renal AKI - ✔✔prerenal
✔✔name 3 treatments for hepatorenal syndrome - ✔✔1. midrodrine
2. octreotide
3. albumin
✔✔dx: AKI + blue/purple skin lesions in fingers and toes + livedo reticularis -
✔✔cholesterol emboli
✔✔peripheral pulses in cholesterol emboli - ✔✔normal
✔✔4 lab abnormalities seen in cholesterol atheremboli - ✔✔1. eosinophilia
2. low complement
3. eosinophiluria
4. elevated ESR
✔✔what cause of allergic interstitial nephritis will cause eosinophils in the urine? -
✔✔NSAIDs
AND SOLUTIONS GRADED A+ TIP
✔✔BUN:Cr ratio: post-renal - ✔✔>20:1
✔✔BUN:Cr ratio: intrinsic renal - ✔✔<20:1
✔✔Urine sodium: pre-renal - ✔✔<20
✔✔Urine sodium: intrinsic renal - ✔✔>20
✔✔FeNa: pre-renal - ✔✔<1%
✔✔FeNa: intrinsic renal - ✔✔>1%
✔✔Urine osmolality: pre-renal - ✔✔>500
✔✔Urine osmolality: intrinsic renal - ✔✔<300
✔✔what is the only significant manifestation of sickle cell trait? - ✔✔defect in renal
concentrating ability
✔✔which toxin causes very rapid onset of acute tubular necrosis? - ✔✔contrast
✔✔best way to prevent contrast-induced nephrotoxicity - ✔✔saline hydration before and
during administration
✔✔FeNa: contrast-induced ATN - ✔✔<1%
✔✔Urine specific gravity: contrast-induced ATN - ✔✔very high
✔✔Urine sodium: contrast-induced ATN - ✔✔very low
✔✔contrast causes _____ of the _____ arteriole - ✔✔constriction; afferent
✔✔dx: renal failure 2 days after initiation of chemotherapy - ✔✔hyperuricemia
✔✔name three therapies to given prior to chemotherapy prevent renal failure from
tumor lysis syndrome - ✔✔1. allopurinol
2. hydration
3. rasburicase
✔✔shape: oxalic acid crystals - ✔✔envelope shaped
, ✔✔how does ethylene glycol lead to acute kidney injury? - ✔✔oxalic acid precipitation
within the kidney tubules
✔✔electrolyte abnormalities seen in rhabdomyloysis (potassium, uric acid, calcium,
phosphate) - ✔✔potassium: high
uric acid: high
calcium: low
phosphate: high
✔✔three components of management of rhabdomyolysis - ✔✔1. saline hydration
2. mannitol
3. bicarbonate
✔✔name 5 indications to initiate dialysis for acute kidney injury - ✔✔1. fluid overload
2. encephalopathy
3. pericarditis
4. metabolic acidosis
5. hyperkalemia
✔✔name 5 drugs/toxins that can be removed w/ dialysis - ✔✔1. Salicylates
2. Lithium
3. Isopropanol
4. Methanol
5. Ethylene glycol
✔✔labs in hepatorenal syndrome match ____ renal AKI - ✔✔prerenal
✔✔name 3 treatments for hepatorenal syndrome - ✔✔1. midrodrine
2. octreotide
3. albumin
✔✔dx: AKI + blue/purple skin lesions in fingers and toes + livedo reticularis -
✔✔cholesterol emboli
✔✔peripheral pulses in cholesterol emboli - ✔✔normal
✔✔4 lab abnormalities seen in cholesterol atheremboli - ✔✔1. eosinophilia
2. low complement
3. eosinophiluria
4. elevated ESR
✔✔what cause of allergic interstitial nephritis will cause eosinophils in the urine? -
✔✔NSAIDs
