Nephrology

Question 1

what is the most common nephrological affliction in ageing?

Answer 1

membranous nephropathy which is when glomeruli become damaged and thickened and allow proteins to pass through

Question 2

what is ageing?

Answer 2

a slow inflammatory process

Question 3

give examples of drugs given post-renal transplant and their effects

Answer 3

basiliximab - anti CD25
anti-lymphocyte ab - against T cells
campath/alemtuzumab - anti-CD52
Rituximab - anti CD20
ecilizumab - anti C5

Question 4

what drugs are given as maintenance therapy for post-renal transplant

Answer 4

tacrolimus (cyclosporin)
antiproliferative: mycophenolate
prednisolone
mTOR inhibitors

Question 5

what are the signs of acute renal rejection?

Answer 5

abrupt rise in serum creatinine, fluid retention, fever, graft tenderness

Question 6

what is the management for acute renal rejection

Answer 6

pulse steroids and increase immunosupression

Question 7

what are absolute contraindications of renal transplantation patient

Answer 7

• untreated current infection
• maligancy with short lifespan
• lifespan<1yr
• active psychosis
• active substance abuse
• bilateral severe peripheral vascular occlusive disease

Question 8

what are contraindications of transplant donation

Answer 8

<18yrs
HTN with end organ damage
diabetes
active malignancies
evidence of donor coercion
low GFR by age

Question 9

what is gold standard treatment of CMV

Answer 9

IV ganciclovir or oral vlganciclovir

Question 10

when should one start dialysis

Answer 10

eGRF < 15ml/min per 1.73m2
intractable fluid overload, hyperkalemia
malnutrition due to uremia
uremic neurologic dysfunction
uremic sierostitis

Question 11

during dialysis are we giving acid or alkali to the patients

Answer 11

alkali

Question 12

where does the blood and dialysis fluid first meet

Answer 12

in the dialyser

Question 13

what is disequilibrium syndrome

Answer 13

a set of systemic, neurologic symptoms occur during/after dialysis. nausea, vomiting, restlessness, seizures, headaches. It is thought to be due to an acute increase in brain water content

Question 14

how is water purified?

Answer 14

treat with a water softener and carbon adsorption. Reverse osmosis and deionization. Distilation

Question 15

what is ADPKD

Answer 15

It is an inherited disorder that presents as cyst developing on the kidney surface

Question 16

what genes are associated with ADPKD and what proteins do they code for?

Answer 16

PKD1 (codes for PC1)

PKD2 (codes for PC2)

Question 17

what is the function of PC1?

Answer 17

it acts as a mechanosensor on cilium of the kidney. They can sense urine flow rate and convey this information to intracellular calcium signalling. These changes in calcium affect gene transcription

Question 18

relate ADPKD and corresponding levels of intracellular calcium

Answer 18

in ADPKD the levels of intracellular calcium are decreased due to loss of function of PC complex.

Question 19

what is another role of PC1

Answer 19

it helps formation of desmosomal junctions, adherens junctions.

Question 20

relate cAMP levels to ADPKD. Name a drug used for treatment

Answer 20

cAMP levels are increased in ADPKD. Tolvaptan

Question 21

list some extrarenal manifestations of ADPKD

Answer 21

Hepatic cysts
diverticulosis
pancreatic cysts, abdominal hernia, cholangiocarcinoma, liver fibrosis, cardiac valve abnormalities, aortic aneurysm, intracranial aneurysm

Question 22

what are vaptans

Answer 22

are vasopressin receptor 2 antagonists

Question 23

define hepatorenal syndrome type 1

Answer 23

acute, functional AKI developing close to deterioration of other organs.

Question 24

define hepatorenal syndrome type 2

Answer 24

renal imapairment that is less severe than that of type 1. Most common sign is ascites that is resistant to diuretics

Question 25

what do the kidneys look like in type 1 hepatorenal syndrome

Answer 25

normal. You must diagnose based on exclusion of other syndromes

Question 26

what are percipitating factors of type 1 HRS

Answer 26

severe alcoholic hepatitis, infection, large volume paracentesis w/out plasma expansion, GI bleed

Question 27

what are diagnosis criteria for HRS type1

Answer 27

cirrhosis with ascites, serum creatinine >133mmol/L, no shock, no parenchymal kidney disease

Question 28

signs of ANCA associated renal vasculitis

Answer 28

cutaneous purpura, nodules, ulceration, peripheral neuropathy, abdominal pain, blood in stool, hematuria, protienuria, necrotizing sinusitis, myalgia

Question 29

list histology findings of ANCA associated renal vasulitis

Answer 29

LM: necrotizing GN IF: neccrotizing vasculitis EM: diffuse foot process effacement

Question 30

what is the target of ANCA's

Answer 30

myeloperoxidase or proteinase 3

Question 31

how do you treat vasculitis

Answer 31

corticosteroids

Question 32

pathogenesis of lupus glomerulonephritis

Answer 32

``` autoantibodies against self DNA weird clearance of cellular debris loss of immune tolerance increase in cell death inflammation fibrosis and proliferation of endothelial and mesangial cells ```

Question 33

treatments of SLE nephritis

Answer 33

plasmapheresis, cyclophosphamide (rituximab), corticosteroids

Question 34

hypoalbuminema levels

Answer 34

less than 3.5g/dL

Question 35

presentation of Nephrotic syndrome

Answer 35

edema in legs, xanthelasma, periorbital edema in morning

Question 36

what are the 2 causes of nephrotic syndrome

Answer 36

glomerulonephritis, and systemic diseases

Question 37

what med do you give for alports

Answer 37

ACEi

Question 38

name the 3 benign renal tumors

Answer 38

renal papillary adenoma, angiomyolipoma, oncocytoma

Question 39

renal cell carcinoma is due to mutation in what gene

Answer 39

VHL

Question 40

prostate tumors are most often in the

Answer 40

peripheral zone