nephro

Question 1

adult fluid/e-/glucose requirements a day

Answer 1

25-30 ml/kg/day of water and

approximately 1 mmol/kg/day of potassium, sodium and chloride

and
approximately 50-100 g/day of glucose to limit starvation ketosis

Question 2

in AKI, urine osmolality ____, urine sodium ____

Answer 2

low, high

Question 3

How do you work out the urea:creatinine ratio?

Answer 3

plasma urea (mmol/L) / (plasma creatinine (μmol/L) divided by 1000)

Question 4

How can you use urea:creatinine ratio to work out cause of AKI?

Answer 4

> 100 – pre-renal cause (urea absorption increased compared to creatinine)

40-100: – normal or post renal cause of AKI

<40 - intrinsic renal damage (urea unable to be absorbed -> become like creatinine -> ratio gets closer to 1)

Question 5

This patient presents with the classical symptoms and history of the disease: a young child with recurrent episodes of macroscopic haematuria, typically associated with a recent respiratory tract infection and mild proteinuria.

Answer 5

IgA nephropathy

Question 6

how to differentiate IgA nephropathy and post-strep glomerulonephritis

Answer 6

It is important to not confuse IgA nephropathy with post-streptococcal glomerulonephritis, which is caused by immune complex (IgG, IgM, and C3) deposition in the glomeruli. This happens more slowly, typically 7-14 days following a group A beta-hemolytic Streptococcus infection and causes proteinuria. To remember the different presentations you can think that IgA is a shorter word so presents after a few days, whereas post-streptococcal is a longer word so presents after many

Question 7

__________________is an indication for dialysis

Answer 7

Uraemia (encephalopathy or pericarditis)

Question 8

1st line tx in minimal change disease

Answer 8

prednisolone

Question 9

stages of churg-strauss + what serology is it associated with?

Answer 9

1. rhinitis/asthma, nasal polyps
2. eosinophilia
3. vasculitis: AKI

p-ANCA

Question 10

Tricyclic antidepressants can cause ________incontinence (anticholinergic effect)

Answer 10

overflow

Question 11

Type 1 renal tubular acidosis (distal) complication -

Answer 11

renal stones

also associated with autoimmune conditions

Question 12

Bartter’s syndrome -

Answer 12

autosomal recessive disorder which causes renal tubular disease

hypokalemia, hypochloraemic, renal stones

Question 13

Fanconi syndrome

Answer 13

RTA T2, osteomalacia

Question 14

asymptomatic bacteria in catheterised Pts?

Answer 14

don’t treat?

Question 15

Tx for HUS?

Answer 15

• supportive
• eculizumab

Question 16

what is HSP? Px?

Answer 16

• IgA mediated small vessel vasculitis
• seen in children after infection

Haematuria
Surfaces - arms, legs, buttockd
Palpabile purpuric rash, polyarthritis

Question 17

hyperK features on ECG?

Answer 17

• tall tented T waves
• broad QRS complexes
• loss of P waves

Question 18

hypoK features on ECG?

Answer 18

• U waves
• small/absent T waves
• prolonged PR intervals

Question 19

hypoK predisposes Pts to _______ toxicity

Answer 19

digoxin

Question 20

post-streptococcal glomerulonephritis is associated with low ____________ levels

Answer 20

complement

Question 21

‘tram track’ appearance of kidneys on electron microscopy indicates

Answer 21

T1 membranoproliferative glomerulonephritis

Question 22

what does MCD show on renal biopsy?

Answer 22

fusion of podocytes and effacement of foot processes

Question 23

Tx for MCD?

Answer 23

1. oral corticosteroids
2. cyclophosphamides

Question 24

nephrotic syndrome - extrarenal effcts?

Answer 24

1. loss of antithrombin-lll –> fibrinogen levels rise, more thrombosis
2. loss of thryoxine-binding globulin –> total thryoxine levels decreased
3. hyperlipidaemia

Question 25

how to minimise risk of nephrotoxicity due to contrast media?

Answer 25

1. use of 0.9% NaCl for 12h before and after procedure

Question 26

most common cause of peritonitis in peritoneal dialysis? + Tx

Answer 26

staph epidermis vancomycin

Question 27

what biopsy finding do rapidly progressing glomerulonephritis cause? What are some causes?

Answer 27

crescents in glomeruli Goodpastures, Wegner's, SLE

Question 28

features of RAS (triad)

Answer 28

- HTN - CKD - flash pulmonary oedema

Question 29

hyperacute, acute and chronic graft rejection in renal transplant

Answer 29

1. hyperacute: minutes to hours - pre-exisitng ABO/HLA Ab - no tx, remove graft 2. acute: <6 months - reversible with steroids or immunosuppressants 3. chronic: >6 months

Question 30

immunosuppression for renal transplant

Answer 30

ciclosporin, tacrolimud, monoclonal antibodies

Question 31

which 2 drugs when co-prescribed can cause rhabdomyolsis?

Answer 31

statin + clarithryomcyin

Question 32

causes of rhabdo?

Answer 32

seizure, coma/collapse, crush injury, drugs, ecstasy

Question 33

7Ps of Signs and Sx of CKD

Answer 33

1. Pallor - anaemia 2. Pruritus - uraemia 3. Paraythyroid overactivity - hypoC 4. Pulmonary oedema - fluid overload 5. Pericarditis - fluid overload 6. Peripheral Nueropathy 7. Painful big toe (gout)

Question 34

Acute interstitial nephritis causes an 'allergic' type picture consisting usually of raised urinary

Answer 34

WCC and eosinophils, alongside impaired renal function

Question 35

'Muddy' brown casts represent

Answer 35

secretions of necrotic cells in the urine

Question 36

Renal transplant + infection =

Answer 36

CMV

Question 37

All patients with chronic kidney disease should be started on a ____

Answer 37

statin

Question 38

All diabetic patients with a urinary ACR of 3 mg/mmol or more should be

Answer 38

started on an ACE inhibitor or angiotensin-II receptor antagonist

Question 39

Henoch-Schönlein purpura presents with

Answer 39

the triad of purpuric rash, joint pain, and abdominal pain. There is also often renal involvement, causing haematuria.

Question 40

IgA nephropathy classically presents as

Answer 40

visible haematuria following a recent URTI

Question 41

NSAIDs should be stopped in AKI except

Answer 41

aspirin at cardio-protective dose

Question 42

The patient is deficient in the enzyme porphobilinogen deaminase - Tx?

Answer 42

acute attack of acute intermittent porphyria (AIP) Intravenous haem arginate

Question 43

Mx of renal stones

Answer 43

Stone <5mm = expectant treatment Stone <2cm = lithotripsy (wave to break stone) Stone <2cm + pregnant = uteroscopy Stone complex = nephrolithotomy (invasive) hydronephrosis/infection = nephrostomy

Question 44

Most patients presenting with symptomatic renal cell carcinoma have stage _________ disease

Answer 44

stage IV

Question 45

Post-streptococcal glomerulonephritis: ________________are used to confirm the diagnosis of a recent streptococcal infection

Answer 45

raised anti-streptolysin O titres

Question 46

Pt with microscopic haematuria with +blood, +leukocytes on MC&S - Mx?

Answer 46

old patient: refer to urology young patient: refer to nephro

Question 47

___________________is frequently associated with malignancy (protein in urine)

Answer 47

Membranous nephropathy