FRACP questions

Question 1

Which immune cell population is the primary mediator of cellular rejection? (in acute + chronic rejection)

Answer 1

Question 2

Infections post renal transplant

Answer 2

Question 3

Sensitivity of renal US in detection of ADPKD in patients > 30 years old

Answer 3

Question 4

Renovaszularization strategy in renal artery stenosis, is it a thing?

Answer 4

Noo, not even - futile!

Question 5

Clues to diagnosis to this nephropathy - chornic inflammatory disorder plus proteinuria?

Answer 5

Amyloid nephropathy

Question 6

Sirolimius (rapamycin)

Answer 6

mTOR of rapamycin used in IS regimen in kdiney transplants.

Inhibits IL-2 mediated signal transduction which results in cell0cycle arrest in the G1-S phase.

Well known side effect = hyperlipidemia - dose related effect of sirolimus therapy that occur via the inhibition of lipoprotein lipase

Question 7

Glomerulonephritis’s most likely to recur post transplant

Answer 7

Question 8

Mesangial hypercellularity seen in what?

Answer 8

IgA nephropathy!

Question 9

Therapeutic options to preserve RRF (residual renal function)

Answer 9

Question 10

Nephritic or nephrotic in lupus nephritis

Answer 10

Nephrotic syndrome!

Question 11

Lupus nephritis stages

Answer 11

Question 12

Lupus nephritis histological features

Answer 12

Question 13

Treatment options in lupus nephritis

Answer 13

Question 14

Cyclophosphammide side effects

Answer 14

Question 15

MMF side effects

Answer 15

Question 16

Treatment for RPGN

Answer 16

Question 17

When does microalbuminuria occur in DM?

Answer 17

5-15 years of disease in T1DM

~10 years of disease in T2DM

Question 18

In presence of overt nephropathy in T1DM, usually associated with which complication?

Answer 18

Diabetic retinopathy!

Question 19

Definition of macroalbuminuria in diabetic nephropathy

Answer 19

Question 20

Which interventions slows the progression of diabetic nephropathy?

Answer 20

• BP control
• ACE inhibitors
• Glycaemic control
• smoking cessation
• lipid control

Question 21

Which medication has been proven to slow the progression of diabetic nephropathy in both T1DM and T2DM?

Answer 21

ACEi!

Also slows the progression of overt nephropathy to ESRF

Question 22

In a diabetic patient with NO evidence of albuminuria, which feature would support the use of ACEi in delaying the progression of microalbuminuria?

Answer 22

Presence of concurrent hypertension

Question 23

The use of ACEi/ARB in diabetic patients who are normotensive and normoalbuminemic is protective against what?

Answer 23

Retinopathy!!

Nothing else

Question 24

Opportunistic infection post renal transplant - what is the most common? how to treat?

Answer 24

Question 25

Goodpastures syndrome

Answer 25

**Anti-GBM disease** ## Footnote **Dehydration may decrease the likelihood** of a **pulmonary haemorrhage.** Pulmonary oedema is associated with an increased risk. Goodpastures syndrome is rare condition associated with both pulmonary haemorrhages and rapidly progressive GN. It is causes by anto-glomerular basement mebrane (anti-GBM) antibodies against type IV collagen. Goodpastures syndrome is more common in men (2:1) and has a bimodal age distribution. Is assoc with HLA DR2 **Features:** * - pulmonary haemorrhage * followed by RPGN Factors which increase likelihood of pulmonary haemorrhage * smoking * LRTI * pulmonary oedema * ihalation of hydrocarbons * young males Investigations * renal biopsy: **linear IgG depositis along basement membrane** * raised transfer factor secondary to pulmonary haemorrhages ​Management * plasma exchange * steroids * cyclophosphamide

Question 26

Glucose reabsorpiton?

Answer 26

PROXIMAL TUBULE 100%

Question 27

Sodium reabsorption

Answer 27

65% in proximal tubule, 25% thick ascending limb 5% in distal tubule and 5% collecting duct

Question 28

Potassium reabsoprtion?

Answer 28

65% in proximal convultued tubule 20% in thick ascening loop

Question 29

HCO3 reabsoprtion in kidney?

Answer 29

80-90% reabsorbed in proximal tubule

Question 30

Anion gap

Answer 30

Na - (Cl+ HCO3) Normal anion gap = 12

Question 31

Causes for a NAGMA?

Answer 31

**HARDUPS** * Hyperalimenation * Acetazolamide * Renal Tubular Acidosis * Diarrhoea * Uretero-Pelvic shunt * Post-hypocapnia * Spironolactone

Question 32

Causes for a HAGMA?

Answer 32

MUDPILERS * Methanol * Uraemia * DKA/alcoholic KA * Paraldehyde * Isoniazid * Lactic Acidosis * etoh * Rhabdo/renal failure * Salicylates

Question 33

As GFR declines, urinary creatine clearance overestimates eGFR because?

Answer 33

Creatinine is secreted by tubules

Question 34

Which medication can be cleared by haemodialysis?

Answer 34

**BLAST** * Barbiturate * Lithium * Alcohol (methanol. ethylene glycol) * Salicylates (aspirin) * Theophyllines

Question 35

Diagnosis of Conns syndrome - primary hyperaldosteronism

Answer 35

* **Diagnostic confirmation** –seated saline suppression test, renin suppressed by saline, not aldosterone in PA