Acute kidney injury workup, electrolyte disorder management, and dialysis indications tested on USMLE Step 2 CK.
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- What formula calculates the fractional excretion of sodium (FENa)?
- (Urine Na x Plasma Cr) / (Plasma Na x Urine Cr) x 100
- A FENa below 1% suggests which category of acute kidney injury?
- Prerenal azotemia
- A FENa above 2% suggests which category of acute kidney injury?
- Intrinsic AKI (e.g., acute tubular necrosis)
- In prerenal azotemia, the BUN to creatinine ratio is typically ____.
- greater than 20:1
- Which urine sediment finding is classic for acute tubular necrosis?
- Muddy brown granular casts
- Which urine sediment findings suggest acute interstitial nephritis?
- White blood cell casts and urine eosinophils
- Which urine sediment findings suggest glomerulonephritis?
- Red blood cell casts and dysmorphic red blood cells
- Name two drug classes that commonly cause acute interstitial nephritis.
- NSAIDs and beta-lactam antibiotics (e.g., penicillins)
- What is the initial imaging study of choice for suspected postrenal AKI?
- Renal ultrasound (looking for hydronephrosis)
- When does serum creatinine typically peak after contrast-induced nephropathy?
- About 3 to 5 days after contrast exposure
- What is the best strategy to prevent contrast-induced nephropathy in at-risk patients?
- IV isotonic fluids given before and after the procedure
- What urine sediment finding is characteristic of rhabdomyolysis-induced AKI?
- Pigmented muddy brown granular casts, with a urine dipstick positive for blood but no RBCs on microscopy
- Which lab is markedly elevated in rhabdomyolysis and correlates with AKI risk?
- Creatine kinase (CK)
- What does the mnemonic AEIOU represent in nephrology?
- The indications for emergent (urgent) dialysis
- In the AEIOU dialysis mnemonic, what does A stand for?
- Severe metabolic acidosis refractory to medical therapy