Nephrology

Question 1

What is Henoch-Schonlein purpura?

Answer 1

Henoch-Schonlein purpura (HSP) is an IgA mediated small vessel vasculitis. There is a degree of overlap with IgA nephropathy (Berger’s disease). HSP is usually seen in children following an infection. It affects the skin, kidneys and gastro-intestinal tract. The condition is often triggered by an upper airway infection or gastroenteritis. It is most common in children under the age of 10 years.

Question 2

What are the features of Henoch-Schonlein purpura?

Answer 2

palpable purpuric rash (with localized oedema) over buttocks and extensor surfaces of arms and legs
abdominal pain
polyarthritis
features of IgA nephropathy may occur e.g. haematuria, renal failure

Question 3

What is the treatment for Henoch-Schonlein purpura?

Answer 3

Treatment
analgesia for arthralgia
treatment of nephropathy is generally supportive. There is inconsistent evidence for the use of steroids and immunosuppressants

Question 4

What is the prognosis for Henoch-Schonlein purpura?

Answer 4

usually excellent, HSP is a self-limiting condition, especially in children without renal involvement
blood pressure and urinanalysis should be monitored to detect progressive renal involvement
around 1/3rd of patients have a relapse

Question 5

Which of the following is the most appropriate initial management option for anaemia in CKD?

Answer 5

the 2011 NICE guidelines suggest a target haemoglobin of 10 - 12 g/dl
determination and optimisation of iron status should be carried out prior to the administration of erythropoiesis-stimulating agents (ESA).
oral iron should be offered for patients who are not on ESAs or haemodialysis. If target Hb levels are not reached within 3 months then patients should be switched to IV iron
patients on ESAs or haemodialysis generally require IV iron
ESAs such as erythropoietin and darbepoetin should be used in those ‘who are likely to benefit in terms of quality of life and physical function’

Question 6

What drugs cause nephrogenic diabetes insipidus?

Answer 6

Lithium and demeclocycline

Question 7

What is the most common cause of peritonitis secondary to peritoneal dialysis

Answer 7

Coagulase-negative staphylococcal species such as Staphlyococcus epidermis

Answer 8

Consider fibromuscular dysplasia in young female patients who develop AKI after the initiation of an ACE inhibitor