Nephrology

Question 1

What are the main functions of the kidney?

Answer 1

Filtering water soluble salts and ions from the blood
Reabsorption of necessary small molecules
Dilution or concentration of urine to optimise fluid balance
Regulation of BP
Metabolism of vitamin D
Regulation of acid-base balance

Question 2

What is plasma creatinine a product of?

Answer 2

Muscle breakdown

Question 3

What is a MAG3 renogram and what does it test for?

Answer 3

Dynamic scan of isotope-labelled substance excreted from blood into urine
Can identify VUR during micturition in children >age 4.

Question 3

What are the negatives for performing an MCUG?

Answer 3

Invasive
Unpleasant
High radiation dose
Can introduce infection

Question 3

How is a micturating cystourthrogram
(MCUG) performed and what does it test for mainly?

Answer 3

Contrast in introduced to the bladder via a catheter and visualised bladder and urethral anatomy
Looks for VUR and urethral obstruction

Question 3

How is eGFR calculated?

Answer 3

31xheight(cm)/creatinine

Question 3

How is a DMSA scan performed and what does it look for?

Answer 3

TC99m dimercaptosuccinic acid static scan of renal cortex
Detects functional defects e.g. scars or non-functioning renal tissue

Question 3

How does renal agenesis usually present?

Answer 3

If bilateral with severe oligohydramnios and causes Potter syndrome which is fatal

Question 4

How does Potter syndrome present?

Answer 4

Low set ears
Beaked nose
Prominent epicanthic folds
Downward slant to eyes
Limb deformities
Failure of fetal lung development

Question 4

Which part of the nephron does ADH primarily work on?

Answer 4

Collecting duct

Question 4

What are the symptoms of post-streptococcal GN?

Answer 4

Haematuria
Oliguria
Oedema
Hypertension
Pulmonary oedema

Question 4

What is the CH50 test?

Answer 4

Measures total activity of all major complement proteins

Question 4

Wat would you expect to happen to CH50 levels in post-streptococcal GN?

Answer 4

Decrease

Question 4

Which hormones play a factor in the inguinoscrotal stage of testicular descent?

Answer 4

Testosterone
Calcitonin gene-related peptide

Question 4

What is nephronophthisis?

Answer 4

AR ciliopathy causing medullary cystic kidney disease

Question 4

What are the symptoms of nephronophthisis?

Answer 4

Polyuria
Polydipsia
Progressive renal failure

Question 4

What extra-renal features can be associated with nephronophthisis?

Answer 4

Hepatic fibrosis
Cardiac anomalies
Situs inversus

Question 4

What do struvite stones consist of?

Answer 4

Mg
Ammonia
PO4
Calcium apatite

Question 5

What typically causes struvite stones?

Answer 5

Proteus bacteria UTI

Question 5

What would typically be seen on electron microscopy in post-streptococcal GN?

Answer 5

Subepithelial humps - caused by immune deposits

Question 5

What is the defect associated with type I renal tubular acidosis?

Answer 5

Reduced H+ excretion in distal tubule

Question 5

What is the defect associated with type II renal tubular acidosis?

Answer 5

Impaired HCO3- reabsorption in the proximal tubule

Question 6

What is the defect associated with type IV renal tubular acidosis?

Answer 6

Impaired aldosterone action causing reduced H+ and NH3+ excretion

Question 7

What is the usual plasma HCO3- in type I renal tubular acidosis?

Answer 7

<10mmol/l

Question 7

What is the usual plasma HCO3- in type IV renal tubular acidosis?

Answer 7

Usually >15mmol/l

Question 8

What is the usual plasma K+ in type IV renal tubular acidosis?

Answer 8

High

Question 8

What is the usual plasma HCO3- in type II renal tubular acidosis?

Answer 8

Usually 10-20mmol/l

Question 9

What is the usual plasma K+ in type I renal tubular acidosis?

Answer 9

Low-normal

Question 10

What is the usual plasma K+ in type I renal tubular acidosis?

Answer 10

Low-normal

Question 11

What type of renal tubular acidosis is associated with nephrocalcinosis?

Answer 11

Type I

Question 12

What type of renal tubular acidosis is associated with high urine calcium:creatinine ratio?

Answer 12

Type I

Question 13

What are factors predictive of a poorer prognosis in HUS?

Answer 13

Non-Shiga toxin HUS Prolonged oliguria or anuria Severe hypertension Involvement of medium-sized arteries Severity of CNS symptoms Extensive glomerular involvement (>80%) Age >5years

Question 14

What are the indicators for renal biopsy in HSP?

Answer 14

Proteinuria (>200mg/mmol) with increasing trend >4weeks after diagnosis Nephrotic syndrome Nephritic syndrome Hypertension Macroscopic haematuria

Question 15

What are the features of nephrotic syndrome?

Answer 15

Low albumin Oedema Heavy proteinuria

Question 16

What are the features of nephritic syndrome?

Answer 16

Hypertension Haematuria Rapidly deteriorating renal function

Question 17

What are the typical features of Bartter syndrome?

Answer 17

Faltering growth Hypokalaemia Metabolic alkalosis with low chloride

Question 18

What is the treatment of Bartter syndrome?

Answer 18

Electrolyte replacement Potassium-sparing diuretics NSAIDs

Question 19

What is grade V VUR?

Answer 19

Grossly dilated ureter, pelvis and calyces along with loss of papillary impressions

Question 19

What is grade I VUR?

Answer 19

Urine which refluxes into a non-dilated ureter

Question 20

What is grade II VUR?

Answer 20

Reflux up into the pelvis and calyces with no dilatation

Question 20

What is grade III VUR?

Answer 20

Mild ureteric dilatation, renal pelvis dilatation and minimal calyceal blunting

Question 21

What is an absolute indication for renal biopsy in nephrotic syndrome?

Answer 21

Steroid resistant disease

Question 21

What are the inheritable renal cystic diseases?

Answer 21

Cysts associated with multiple malformations Infantile (AR) PCKD Adult (AD) PCKD

Question 21

What is grade IV VUR?

Answer 21

Reflux into dilater ureter, renal pelvis and calyces and moderate ureteral torturosity

Question 22

What is the best management for idiopathic hypercalciuria?

Answer 22

Thiazide diuretics

Question 23

How does Gitelman syndrome typically present?

Answer 23

Hypokalaemia Hypomagnesaemia Hypocalciuria Normotension Hypokalaemic metabolic alkalosis

Question 24

What causes Gitelman syndrome?

Answer 24

AR condition with a defect in the NaCl transporter in distal collecting tubules

Question 25

How is Gitelman syndrome treated?

Answer 25

Electrolyte replacement Potassium sparing diuretics

Question 26

What is seen in nephrotic syndrome on electron microscopy?

Answer 26

Foot process fusion of the glomerular epithelial cells

Question 27

How does IgA nephropathy typically present?

Answer 27

Recurrent episodes of macroscopic haematuria with infections

Question 28

In what conditions are oxalate stones due to secondary hyperoxaluria more common?

Answer 28

Short gut syndrome Crohns Pancreatitis CF

Question 28

What does CXR show in Goodpasture syndrome?

Answer 28

Bilateral diffuse infiltrates in lower zones

Question 29

What is the dose of levamisole when used in nephrotic syndrome?

Answer 29

2.5mg/kg taken on alternate days

Question 30

What pathological process occurs in nephrogenic diabetes insipidus?

Answer 30

Kidneys are resistant to effects of ADH therefore there is an inability to concentrate urine despite normal/high ADH

Question 31

What effect does desmopressin have on urine concentration in nephrogenic DI?

Answer 31

No effect

Question 32

What effect does AR PCKD have on the kidneys?

Answer 32

Cysts which occupy the collecting system and leads to dilatation of the ducts

Question 33

Which chromosomal defect is most common in ADPKD?

Answer 33

PKD1 on Ch16

Question 34

What structure does the mesonephric duct give rise to?

Answer 34

Seminal vesicles Epididymides Vas deferens Bladder trigone Renal pelvis Ureters

Question 35

What is the cause of cystinosis?

Answer 35

AR disorder caused by accumulation of cystine in lysosomes

Question 36

What are the features of cystinosis?

Answer 36

Faltering growth Low K Low PO4 Metabolic acidosis High urinary pH Multisystem disorder

Question 37

What is Fanconi syndrome?

Answer 37

Impairment of reabsorption in the proximal tubule

Question 38

What are the typical blood results in Fanconi syndrome?

Answer 38

Low PO4 Low K Low HCO3-

Question 39

What is the typical urinary results in Fanconi syndrome?

Answer 39

Polyuria Glycosuria Proteinuria

Question 40

How does a hydrocoele present?

Answer 40

Painless and fluctuant - most commonly following birth or post-trauma

Question 41

Which hormonal factor is primarily responsible for the transabdominal phase of testicular descent?

Answer 41

Insulin-like 3 protein