332.2 🩺 國考版

332.2.1 高頻考點

332.2.1.1 eGFR

  • CKD-EPI 2021 race-free preferred
  • Cystatin C: muscle mass independent
  • < 60 = CKD (if persistent ≥ 3 mo)
  • Cockcroft-Gault still used for drug dosing

332.2.1.2 UACR

  • A1 < 30 mg/g (normal)
  • A2 30-300 mg/g (microalbuminuria)
  • A3 > 300 mg/g (macroalbuminuria)

332.2.1.3 Nephrotic vs Nephritic

Feature Nephrotic Nephritic
Proteinuria > 3.5 g/24h Variable
Hematuria Variable Common, RBC casts
Edema Severe Mild-moderate
HTN Less common Common
AKI Less common Common
Hypoalbuminemia Yes Variable
Hyperlipidemia Yes No

332.2.1.4 Urine Casts

  • Hyaline: normal
  • RBC: glomerular
  • WBC: pyelonephritis, AIN
  • Muddy brown granular: ATN
  • Waxy: chronic
  • Fatty: nephrotic

332.2.1.5 Electrolyte Quick Differential

  • Hyponatremia: SIADH, cirrhosis, HF, hypothyroid, adrenal
  • Hyperkalemia: AKI, CKD, ACE/ARB, RTA-IV
  • Hypocalcemia: hypoPTH, CKD, vit D def, hypomagnesemia
  • Hypophosphatemia: refeeding, alcohol, hyperPTH

332.2.1.6 Anion Gap (MUDPILES)

  • Methanol
  • Uremia
  • DKA
  • Paraldehyde
  • Iron, INH
  • Lactic
  • Ethylene glycol
  • Salicylates

332.2.1.7 Glomerular vs Non-Glomerular Hematuria

  • Glomerular: dysmorphic RBC, RBC casts, proteinuria
  • Non-glomerular: normomorphic RBC, no casts, less proteinuria; stones, infection, tumor

332.2.2 易混淆比范

Pattern Casts Cause
Glomerular RBC, dysmorphic RBC GN, vasculitis
Tubular (ATN) Muddy brown granular Ischemia, toxin
Interstitial WBC, eosinophils AIN, infection
UTI / pyelonephritis WBC casts Infection
Chronic kidney disease Waxy Long-term
Nephrotic Fatty (oval fat bodies) Heavy proteinuria

332.2.3 Special Topics

332.2.3.1 Race-Free eGFR 2021

  • Removed Black race coefficient
  • More equitable; less likely to under-diagnose CKD in Black patients
  • Combined Cr + cystatin C even better

332.2.3.2 APOL1 Risk Variants

  • G1, G2 variants
  • African ancestry
  • ↑ Risk: FSGS, HIV-associated nephropathy, lupus nephritis, hypertensive nephropathy
  • Genetic counseling

332.2.3.3 Cystatin C

  • Constitutive expression by nucleated cells
  • Less affected by muscle mass
  • More accurate in elderly, athletes, malnourished