Nephrology & Genitourinary

Question 1

What is haemolytic uraemic syndrome?

Answer 1

• Haemolytic uraemic syndrome (HUS) is a triad of:
o Acute renal failure
o Haemolytic anaemia
o Thrombocytopenia

• Typical HUS is secondary to gastrointestinal infection with verocytotoxin-producing E. coli -> acquired through
contact with farm animals or eating uncooked beef, or, less often, Shigella

Question 2

What is the most common cause of acute glomerulonephritis in children?

Answer 2

Streptococcus such as strep pyogenes

Question 3

What are the main clinical signs of nephritis?

Answer 3

• Reduced kidney function
• Haematuria
• Proteinuria (although less than in nephrotic syndrome)

Question 4

What is the management of post-strep nephritis?

Answer 4

Supportive; ~80% of patients will make a full recovery

Question 5

What is IgA Nephropathy?

Answer 5

Also known as Berger’s disease.

A condition where IgA deposits within nephrons causing inflammation.

Histology from renal biopsy will show IgA deposits with glomerular mesangial proliferation.

Question 6

What is the management of IgA Nephropathy?

Answer 6

• Supportive treatment

- Steroid therapy/Immunosuppresants

Question 7

What are the signs and symptoms of a Wilms tumour?

Answer 7

• Abdominal pain
• Haematuria
• Lethargy
• Fever
• Hypertension
• Weight loss

Question 8

What is the classic triad of nephrotic syndrome?

Answer 8

• Proteinuria
• Low serum albumin
• Oedema

Question 9

What are three additional features of nephrotic syndrome?

Answer 9

• Deranged lipids (high levels of LDL, triglycerides and cholesterol)
• Hypertension
• Hypercoagulability

Question 10

What is the most common cause of nephrotic syndrome in children?

Answer 10

Minimal change disease

Over 90% of cases in children under 10

Question 11

What is minimal change disease?

Answer 11

A condition causing nephrotic syndrome in children - aetiology largely unknown and considered to be idiopathic

Question 12

What might urinalysis of a patient with minimal change disease show?

Answer 12

• Proteinuria (small molecular weight proteins)

- Hyaline casts

Question 13

What is the management of minimal change disease?

Answer 13

• Corticosteroids (i.e. prednisolone)
• Low sodium diet
• Diuretics for oedema
• Albumin infusion for severe hypoalbuminaemia

High dose steroids are given for 4 weeks then gradually weaned over 8 weeks.

Steroid resistant patients are given ACE inhibitors and immunosuppressants such as cyclosporine or tacrolimus.

Question 14

What are the complications of minimal change disease?

Answer 14

• Hypovolaemia
• Thrombosis
• Infection
• Acute/chronic renal failure
• Relapse