Renal

Question 1

Predictors for rapid renal disease progression in ADPKD - name 6

Which is the strongest predictor

Answer 1

Low water intake
Large kidney volume (strongest predictor)
Haematuria
Early onset of HTN
Early decrease in gfr
PKD1 mutation

Others - smoking, caffeine, high protein intake, proteinuria

Question 2

4. A 72-year-old man presents with acute kidney injury, haematuria and proteinuria. A renal biopsy shows membranoproliferative glomerulonephritis, with strong C3 staining on immunofluorescence. Staining for immune complexes was negative.
   Which of the following is most likely to be an associated underlying disorder?

A. Diabetes mellitus
B. Monoclonal gammopathy
C. Malignant hypertension
D. Hepatitis B

Answer 2

B. Monoclonal gammopathy

Membrnaoprolofierative GN with C3 staining can be seen with HBV but would stain positive for immune complexes

Question 3

Most common cause of death of people over 75 years of age on haemodialysis?

Answer 3

Withdrawal from dialysis

CVD in <75yo

Question 4

Which drugs can be cleared by haemodialysis?

Answer 4

Barbiturate
Lithium
Alcohol (methanol,ethylene glycol)
Salicylates
Theophyllines

Question 5

What is most likely to improve after adrenalectomy in unilateral adrenal hyperplasia?

Answer 5

Hypokalemia - improves in 100% of cases

Question 6

Name 4 drugs which increase lithium blood levels and 1 drug that decreases lithium blood levels

Answer 6

Diuretics acting at DCT increase levels: hydrochlorothiazide, spironolactone, triamterene

also frusemide increases levels

Diuretics acting at proximal tubule (site of lithium absorption) decrease lithium levels: acetazolamide

Question 7

Electrolyte abnormalities in Gittlemans syndrome + genetic mutation

Answer 7

Mimics THIAZIDES (Tim is a GIT MAN)

2 Ms, pee out C

Metabolic alkalosis
HypoMagnesemia
Hypercalcemia with hypocalcuria
Hypokalemia

Genetic mutation - NKCC1 loss of function mutation (gene coding for Na and Cl co transporter of DCT)

Question 8

Site of action of frusemide

Answer 8

Ascending loop of Henle
Blocks NKCC2 transporter

Question 9

Ferritin/transferrin targets in end stage renal failure patients

Answer 9

Ferritin >200
Transferrin saturation > 20%.

Question 10

Target hb range in CKD patients

Answer 10

> 110g/dL

Question 11

Role of principal cells in the nephron

Answer 11

Reabsorb sodium, secrete potassium

Question 12

Role of intercalated cells in the nephron

Answer 12

Type A (alpha): secrete Acid, reabsorb base (bicarb)

Type B (beta): secrete Bicarb (base), reabsorb acid

Question 13

Role of peritubular cells in the nephron

Answer 13

Synthesize EPO

Question 14

Electrolyte abnormalities in Barters syndrome

Hormone elevated in the urine?

Answer 14

Mimics actions of frusemide (defect in NKCC2)

Metabolic alkalosis, hypocalcemia, hypokalemia

Urine prostaglanin E elevated

Question 15

Name 3 causes of sterile pyuria

Answer 15

interstitial nephritis
renal tuberculosis
nephrolithiasis

Question 16

Recurrent haematuria after resp infections + family history renal failure

Answer 16

Alport syndrome

Question 17

Metabolic abnormalities in excess vomiting

Answer 17

metabolic alkalosis

Question 18

Metabolic abnormalities in diarrhea

Answer 18

NAGMA due to loss of bicarbonate

Also seen in ureterosigmoidostomyjejunal loop (not really done anymore - for this reason)

Question 19

Which RTA is associated with hypercalcuria?
Urine Ph in this RTA?

Answer 19

T2 RTA (distal)
Urine ph >5.5

Question 20

Mechanism of action of mycophenylate

Answer 20

Reversible inhibitor of Inositol Monophosphate Dehydrogenase(IMPDH) –> inhibits purine biosynthesis –> inhibits T + B cell proliferation

Question 21

Investigation of choice for light chain amyloidosis

Answer 21

Abdominal fat pad aspirate

Question 22

Most common histologic feature seen in chronic allograft nephropathy

Answer 22

Chronic interstitial fibrosis

Question 23

Which of the following is least useful in acute renal Tx rejection?
A. Tacrolimus
B. Sirolimus
C. MMF
D. Cyclosporine
E. Methylpred

Answer 23

D - Cyclosporin

Question 24

Name 4 advantages of cyclosporine over tacrolimus
Name 4 disadvantages

Answer 24

Cyclosporine advantages
- less diabetogenic
- less nephrotoxicity
- less neurotoxicity
- doesn’t cause hair loss

Cyclosporin disadvantages
- more hyperlipidemia and HTN
- causes gingival hyperplasia
- less potent
- more nephrotoxic

Question 25

Which of the following can be used in pregnancy?
A. MMF
B. MTOR inhibitoirs
C. CNI

Answer 25

C - CNI (cyclosporin>tacro)

Question 26

Drugs associated with FSGS

Answer 26

Heroin
bisphosphonates
interferon alpha
anabolic steroids

less clear link - sirolmus, lithium, CNI, anthracyclines

Question 27

Most common manifesation of lupus nephritis

Answer 27

proteinuria

Question 28

Therapies for acute antibody mediated rejection

cell mediated?

Answer 28

glucocorticoids, plasmapheresis, and intravenous immune
globulin

Cell mediated - steroids + antithymocyte globulin (high grade)

Question 29

Which GN is most likely to recur with transplant?
Which rercurs most rapidly

Answer 29

IgA nephropathy
FSGS most rapidly

Question 30

GN with greatest risk of VTE

Answer 30

Membranous

Question 31

A 37 year old male with a family history of Autosomal Dominant Polycystic Kidney Disease is inquiring about kidney donation to his affected sister with end stage kidney disease. Which family member should undergo genetic testing to guide transplant decisions?

Answer 31

She should - need to identify the gene.

Question 32

Major vascular bed controlling blood pressure at the renal level

Answer 32

afferent arteriole

Question 33

Afferent or efferent constriction or dilatation:
- NSAID
- ACE-I
- SGLT2

Answer 33

NSAID: afferent arteriole constriction (prevent PGE2 production–> inhibit vasodilation)

ACE-I: efferent arteriole vasodilation

SGLT2: afferent arteriole constriction