MSRA Nephrology

Question 1

Site of action: loop diuretics

Answer 1

Inhibit Na-K-Cl cotransporter (NKCC) in the thick ascending limb of the loop of Henle

Reduce absorption of NaCl

Question 2

Site of action: thiazide diuretics

Answer 2

Block NaCl symporter in distal convoluted tubule

Inhibit sodium reabsorption.

More sodium reaches collecting ducts > more potassium lost

Question 3

Site of action: potassium-sparing diuretics - spironolactone

Answer 3

Aldosterone antagonist

Inhibits NaK channels in distal convoluted tubule

Question 4

Site of action: potassium-sparing diuretics - amiloride

Answer 4

Blocks ENaC in distal convoluted tubule

Question 5

Immunosuppression for renal transplant - initial

Answer 5

ciclosporin/tacrolimus + monoclonal antibody

Question 6

Immunosuppression for renal transplant - maintenance

Answer 6

ciclosporin/tacrolimus + MMF/sirolimus

steroids for rejection/prophylaxis

Question 7

Causes of minimal change disease

Answer 7

-idiopathic
-NSAIDs, rifampicin
-Hodgkin’s lymphoma, thymoma
-infectious mononucleosis

Question 8

Features of minimal change disease

Answer 8

Children/young adults
-nephrotic syndrome
—only medium-sized proteins leak (albumin, transferrin)
-normotension
-EM: fusion of podocytes + effacement of foot processes

Question 9

Management of minimal change disease

Answer 9

-80% treated with steroids
-cyclophosphamide in resistant cases

Question 10

Minimal change disease - prognosis

Answer 10

1/3 one episode only
1/3 infrequent episodes
1/3 frequent episodes, stop before adulthood

Question 11

Features of HSP

Answer 11

-palpabel purpuric rash - buttocks and extensors
-abdo pain
-polyarthritis
-IgA nephropathy: haematuria, renal failure

Question 12

HSP prognosis

Answer 12

1/3 will have a relapse

Question 13

HSP treatment

Answer 13

analgesia for arthrlagia

Question 14

HSP pathophysiology

Answer 14

IgA mediated small vessel vasculitis

Often in children following an infection