Nephrology

Question 1

What are the features of plasmodium malariae membranous glomerulonephritis?

Answer 1

Nephrotic syndrome
Travel/work in African fish farm
Chronic malaria: treated with chloroquine

Question 2

What happens in Gitelman syndrome?

Answer 2

Mutation in thiazide sensitive NaCl transporter
Hypokalemic metabolic alkalosis

Inv: Urinary chloride excretion increased

Rx: Potassium and Magnesium supplements/potassium sparing diuretics

Question 3

What is seen on kidney biopsy in sarcoidosis?

Answer 3

Granulomatous tubulo-interstitial nephritis

Question 4

What gene mutation is seen in Liddle syndrome?

Answer 4

Enac gain of function mutation

Question 5

What are the features of Gitelman syndrome?

Answer 5

hypokalemic metabolic alkalosis
HTN
Hypomagnesemia
Hypocalciuria (not in Bartter’s)

Question 6

What is the investigation of choice for hydronephrosis?

Answer 6

US renal tract

Question 7

One of the causes of cyclosporine toxicity causing renal injury?

Answer 7

Co- prescription with Diltiazem

Question 8

Features of rhabdomyolysis?

Answer 8

hyperkalemia
hypocalcemia
hyperphosphatemia

Question 9

What is associated with pure red cell aplasia?

Answer 9

EPO treatment for CKD

Question 10

What can carpal tunnel syndrome be associated with?

Answer 10

Beta 2 microglobulin deposition

Question 11

What is the active form of Vitamin D?

Answer 11

Alphacalcidol

Question 12

Sarcoidosis renal presentation

Answer 12

Granulomatous tubulo-interstitial nephritis
Polyuria, nocturia due to hypercalcemia

Question 13

What is the inactive form of Vitamin D?

Answer 13

Ergocalciferol

Question 14

Which drug causes retroperitoneal fibrosis causing AKI/hydronephrosis?

Answer 14

Beta blockers

Question 15

How is Alport syndrome mainly inherited?

Answer 15

X linked dominant

Question 16

In addition to IV fluids, what should you give for rhabdomyolysis?

Answer 16

Sodium bicarbonate (if bicarbonate <30)

Question 17

What does DM nephropathy cause?

Answer 17

Nodular sclerosis of glomeruli and diffuse mesangial expansion

Question 18

What is nephrogenic systemic fibrosis?

Answer 18

When CKD patients are exposed to gadolinium for MRI imaging

Question 19

Adult nephrotic syndrome- most common cause?

Answer 19

Young adult: Membranous
Old adult: Focal segmental glomerulosclerosis (esp black)

Question 20

Xanthogranulomatous pyelonephritis

Answer 20

Fever, weight loss, loin pain
Seen in DM, immuno-compromised and obstructive uropathy
M/C organism: Proteus
Treated with nephrectomy (medical management not enough)

Question 21

Renal tubular acidosis type 4

Answer 21

Hyperkalemia
Metabolic acidosis
Seen in DM, SLE etc
Precipitated by: ACE inhibitors, beta blockers, NSAIDs
Treated with Fludrocortisone

Question 22

Cholesterol embolism

Answer 22

AKI
Livedo reticularis
EOSINOPHILIA
Seen after stenting procedures
Or after initiation of warfarin

Question 23

Acute tubular necrosis

Answer 23

Prolonged hypotension
Ischaemia of renal tubules
Inability to concentrate urine
Low plasma sodium
High urine Na but low osmol and large output
Rx: fluid replacement

Question 24

Acute interstitial nephritis

Answer 24

EOSINOPHILIA
Drug induced

Question 25

Which type of GN is most likely to recur post renal transplant?

Answer 25

Membrano-proliferative

Question 26

What is important before starting EPO in CKD?

Answer 26

Iron stores must be replenished before starting EPO

Question 27

What endocrine association can CKD have?

Answer 27

Hyperprolactinemia; amenorrhoea

Question 28

Recurrent cystine stones despite alkalinisation?

Answer 28

Penicillamine

Question 29

CKD anaemia management

Answer 29

EPO with Hb target 110 after iron replenishment Ferritin >100 TSAT >20% <10% hypochromic cells

Question 30

What is post renal transplant Alport syndrome associated with?

Answer 30

Anti GBM disease

Question 31

Difference between ACE inhibitor induced and RTA after Ramipril?

Answer 31

If >30% rise in creatinine --> RTA

Question 32

What is Atazanavir (HAART) associated with?

Answer 32

Crystal nephropathy Increased plasma concentration due to Co-trimoxazole Rx: Hydration

Question 33

What are the subtle features of ADPKD?

Answer 33

Back pain Raised Hb (Raised EPO) Liver cysts

Question 34

First line for pyelonephritis?

Answer 34

Oral Cefalexin

Question 35

How often do you repeat US for ADPKD?

Answer 35

Once after 20 years of age if neg before

Question 36

Indications for urgent cadaveric renal transplant

Answer 36

Lack of dialysis access Severe psychological problems Hypotension or other complications from haemodialysis Uraemic poly neuropathy

Question 37

Treatment of Liddle’s syndrome?

Answer 37

Amiloride/ potassium sparing diuretics

Question 38

PSGN v/s IgA nephropathy

Answer 38

Low complements in PSGN And present after weeks

Question 39

How do you confirm pulmonary haemorrhage

Answer 39

Raised KCO Low Hb Nodular changes and cavitation on CXR

Question 40

How do you treat Goodpastures?

Answer 40

Steroids and plasma exchange

Question 41

Flash pulmonary edema

Answer 41

Young: Fibromuscular dysplasia Old: Renal artery stenosis

Question 42

Renal artery stenosis biochemistry

Answer 42

High renin High aldosterone Low potassium High normal sodium

Question 43

Familial Mediterranean fever

Answer 43

Confirmed on renal biopsy Mimics acute abdomen Risk of analgesic nephropathy because of NSAID use for pain AA amyloid deposition kidney disease M/C