Nephrology

Question 1

Imaging for atypical UTI in an unwell baby

Answer 1

Acute ultrasound before discharge

OP MCUG and DMSA

Question 2

Type of renal stone in Proteus infection

Answer 2

Struvite or triple stones

Question 3

Type of renal stone in CF patient

Answer 3

Calcium

Question 4

Type of renal stone in Lesch-Nyhan syndrome

Answer 4

Uric acid

Question 5

Type of renal stone in Crohns disease

Answer 5

Calcium oxalate

Question 6

Causes of metabolic alkalosis with volume contraction (normal or low BP)

Answer 6

Diuretics
Vomiting/laxatives
Bartter syndrome
Cystic fibrosis
Postnephrotic syndrome diuresis

Question 7

Causes of metabolic alkalosis with volume expansion (high BP)

Answer 7

Primary hyperaldosteronism
Renal artery stenosis
Pseudohyperaldosteronism
Renin producing tumour
Adrenal carcinoma
Liquorice

Question 8

What happens in renal osteodystrohpy?

Answer 8

Decreased renal excretion of phosphate
Reciprocal hypocalcaemia
Osteomalacia
Secondary hyperparathyroidism
Then causes bone resorption and osteoporosis
Decreased 1,25-dihydroxycholecalciferol
High ALP
Acidosis as kidneys can't excrete H+

Question 9

Grade I vesico-ureteric reflux

Answer 9

Into the ureter only on micturition

Question 10

Grade II vesico-ureteric reflux

Answer 10

Into the ureter, pelvis and calyces without dilatation on micturition

Question 11

Grade III vesico-ureteric reflux

Answer 11

Into the pelvis and calyces, but with mild dilatation

Question 12

Grade IV vesico-ureteric reflux

Answer 12

Moderate dilatation of the ureter, renal pelvis and obliteration of the sharp angle of fornices on micturition

Question 13

Grade V vesico-ureteric reflux

Answer 13

Gross dilatation and tortuosity with no papillary impression viable in calyces

Question 14

Treatment for hypertensive emergencies

Answer 14

IV labetalol
Sodium nitroprusside
Sublingual nifedipine

Question 15

Difference in urinalysis between Fanconi’s syndrome and nephrocalcinosis?

Answer 15

In nephrocalcinosis, the urine is not acidified

Question 16

Presentation of Gitelman syndrome

Answer 16

Hypokalaemia
Metabolic alkalosis
Hypomagnesaemia
Hypocalciuria
Normal blood pressure

Question 17

Presentation of Liddle syndrome

Answer 17

Hypokalaemia
Metabolic alkalosis
Hypertension
Hypernatraemia
Low to normal aldosterone levels

Question 18

Best investigation for pyelonephritis

Answer 18

DMSA

Question 19

Best investigation for obstructive renal disease

Answer 19

Diuretic scintigraphy

Question 20

Best investigation for horseshoe kidney

Answer 20

Intravenous urography

Question 21

Treatment for Bartter’s syndrome

Answer 21

Sodium supplements
Potassium supplements
Indometacin 2mg/kg/day

Question 22

Presentation of acute glomerulonephritis

Answer 22

Sudden onset haematuria
Proteinuria
Renal impairment
Hypertension
Oedema

Question 23

Features of distal renal tubular acidosis?

Answer 23

Hyperchloraemia
Hypokalaemia
Metabolic acidosis
Renal stones

Question 24

Suspect if there is localised posterolateral scrotal tenderness and the scrotum is red and swollen

Answer 24

Epididymo-orchitis

Question 25

Best investigation for obstruction

Answer 25

MAG3 scan

Question 26

Best investigation for renal scarring

Answer 26

DMSA

Question 27

Treatment for oxalosis

Answer 27

Liver and kidney transplantation

Question 28

Causes of low complement nephritis

Answer 28

``` Post infectious glomerulonephritis SLE Cryoglobulinaemia Shunt nephritis Membranoproliferative glomerulonephritis Infective endocarditis ```

Question 29

Causes of normal complement nephritis

Answer 29

``` HSP Goodpastures PAN Wegener's IgA nephropathy ```

Question 30

Biochemical features of Fanconi syndrome

Answer 30

Proximal RTA | Impaired reabsorption of glucose, bicarb, phosphate, potassium, sodium, and water

Question 31

Clinical features of Fanconi syndrome

Answer 31

``` Failure to thrive Vomiting Polyuria Polydipsia Hypokalaemia Hypophosphataemic rickets ```

Question 32

Causes of Fanconi syndrome

Answer 32

``` Cystinosis Lowe syndrome Wilson disease Tyrosinaemia Galactosaemia Hereditary fructose intolerance Toxicity to heavy metal e.g. lead ```

Question 33

Likely diagnoses if nephrotic syndrome not responding to prednisolone?

Answer 33

Focal segmental glomerular sclerosis | Mesangio-capillary glomerulonephritis

Question 34

Side effects of ciclosporin

Answer 34

``` Renal toxicity Hepatotoxicity Hypertrichosis Tremor Gingival hypertrophy Hypertension ```

Question 35

What is cystinuria?

Answer 35

Disorder of intestinal absorption and renal tubular reabsorption of the dibasic amino acids ornithine, arginine, lysin and cystine

Question 36

Complications of cystinuria?

Answer 36

Haematuria Obstructive uropathy Chronic renal failure

Question 37

Type of renal stones with chemotherapy/TLS

Answer 37

Uric acid stones

Question 38

Type of renal stones with renal tubular acidosis

Answer 38

Calcium stones

Question 39

What constitutes relapse of nephrotic syndrome?

Answer 39

3+ protein or more on dipstick for 3 or more days

Question 40

Features of nephronophthisis

Answer 40

``` Progressive symmetrical destruction of tubules and glomeruli Polyuria + polydipsia Isosthenuria Chronic renal failure NO hypertension or proteinuria ```

Question 41

Features of cystinosis

Answer 41

``` Polyuria + polydipsia Growth retardation Hypophosphataemic rickets Fair hair and skin Cystine in cornea causes photophobia, retinitis pigmentosa and blindness ```

Question 42

Features of Alports

Answer 42

Microscopic or gross haematuria Symptoms of chronic renal failure X-linked Develop CRF by 2nd or 3rd decade