Nephrology

Question 1

What is the main sign in nephrotic syndrome?

Answer 1

Proteinuria

Question 2

What is the main sign in nephritic syndrome?

Answer 2

Haematuria

Question 3

What are some acquired glomerulopathies?

Answer 3

Minimal change disease
Post-infectious glomerulonephritis
Haemolytic uraemia syndrome
IgA nephropathy

Question 4

What are some congenital glomerulopathies?

Answer 4

Congenital nephrotic syndrome
Alport syndrome
Thin basement membrane disease
Complement regulatory proteins

Question 5

What is the most common cause of post-streptococcal glomerulonephritis?

Answer 5

Beta-haemolytic streptococcal infection

Eg - strep throat, impetigo

Question 6

When do symptoms of post-streptococcal glomerulonephritis present?

Answer 6

Throat - 2-7 days

Skin 2-3 weeks

Question 7

What are the signs of post-streptococcal glomerulonephritis?

Answer 7

Frank haematuria
Oedema
Hypertension
Fever
Abdominal pain

Question 8

How is post-streptococcal glomerulonephritis investigated?

Answer 8

Urine dipstick - proteinuria, RBC casts, oliguria
Bloods - increased urea and creatinine, decreased C3
Anti-streptolysin raised
Bacterial culture

Question 9

How is post-streptococcal glomerulonephritis treated?

Answer 9

Diuretics
Anti-hypertensive
Penicillin - 10 days

Question 10

What type of glomerulonephritis is IgA nephropathy?

Answer 10

Nephritis

Most common glomerulonephritis

Question 11

What is the pathology of IgA nephropathy?

Answer 11

IgA deposits in the nephrons of the kidneys causes inflammation

Question 12

What are the signs of IgA nephropathy?

Answer 12

Frank haematuria

Abdominal swelling

Question 13

How is IgA nephropathy investigated?

Answer 13

Urine dipstick

Biopsy

Question 14

How is IgA nephropathy treated?

Answer 14

Steroids

Question 15

What is the pathology of Henoch Schonlein purpura IgA related vasculitis?

Answer 15

Inflammation and leaking of blood from small blood vessels

Question 16

What are the signs of Henoch Schonlein purpura IgA related vasculitis?

Answer 16

Purpura - legs
Joint pain
Abdominal pain
IgA nephritis

Question 17

How is Henoch Schonlein purpura IgA related vasculitis investigated?

Answer 17

FBC, CRP
Blood film
Blood culture
Urine dipstick
BP

Question 18

How os Henoch Schonlein purpura IgA related vasculitis treated?

Answer 18

Analgesia

Hydration

Question 19

What type of glomerulonephritis is minimal change disease?

Answer 19

Nephrosis

Question 20

What is the classic triad of minimal change disease?

Answer 20

Low serum albumin
Proteinuria
Oedema

Question 21

What are the signs of minimal change disease?

Answer 21

Oedema - peri-orbital
Anorexia
GI disturbance
Irritability
Ascites
Oliguria

Question 22

How is minimal change disease investigated?

Answer 22

Urine dipstick - frothy

Blood - decreased albumin

Question 23

How is minimal change disease treated?

Answer 23

Steroids - prednisolone

If steroid resistant - cyclophosphamide

Question 24

What is the pathology of haemolytic uraemia syndrome?

Answer 24

Thrombosis in small vessels throughout the body

Question 25

What is the classic triad of haemolytic uraemia syndrome?

Answer 25

Haemolytic anaemia Acute kidney injury Thrombocytopenia

Question 26

What causes haemolytic uraemia syndrome?

Answer 26

Typical - post-diarrhoea (Shiga toxin from E. Coli) Pheumococcal infection Drugs (risk period - 2 weeks)

Question 27

What are the signs of haemolytic uraemia syndrome?

Answer 27

``` Bloody diarrhoea Oliguria Haematuria Hypertension Abdominal pain Lethargy Irritability ```

Question 28

How is haemolytic uraemia syndrome treated?

Answer 28

Monitor 5 kidney functions | Maintain IV fluids

Question 29

What are the causes of acute kidney injury?

Answer 29

Rapid rise in creatinine or development of oliguria/anuria Causes: Diarrhoea/dehydration Glomerulonephritis Drug induced haemolysis Secondary to – cardiac surgery, bone marrow transplantation, toxicity (NSAIDs, aminoglycosides, vancomycin etc)

Question 30

What are the causes of chronic renal failure?

Answer 30

``` Congenital dysplastic kidneys Pyelonephritis Glomerulonephritis Recurrent infection Reflux nephropathy AKI leading to cortical necrosis ```

Question 31

What are the signs of UTI in a baby?

Answer 31

``` Non-specific Fever Lethargy Irritability Vomiting Poor feeding Frequency Smelly urine ```

Question 32

What are the signs of UTI in an infant?

Answer 32

Fever Abdominal/suprapubic pain Dysuria Frequency

Question 33

How is UTI investigated?

Answer 33

``` Urine sample (clean catch) - high nitrates and leukocytes Urine culture - mid-stream ```

Question 34

How are UTIs treated?

Answer 34

Lower tract - trimethoprim | Upper tract - 3rd generation cephalosporins

Question 35

When should UTIs be investigated further and what would be done?

Answer 35

If recurrent: Ultrasound Dimercapto-succinic acid scan (DMSA) Micturating cystourethro-gram (for vesico-ureteric reflux)

Question 36

When do infants have normal kidney function?

Answer 36

By age 2/3 - maturation over time

Question 37

What are the functions of the kidneys?

Answer 37

``` Waste handling Water handling Salt balance Acid base control Endocrine - red cells, BP, bone health ```

Question 38

What makes up the glomerular filtration barrier?

Answer 38

Endothelial cell GBM - type IV collagen and laminin Podocytes Mesangial cells

Question 39

What part of the nephron is affected in minimal change disease?

Answer 39

Epithelial cell (podocyte)

Question 40

What part of the nephron is affected in post-streptococcal glomerulonephritis?

Answer 40

Basement membrane

Question 41

What part of the nephron is affected in haemolytic uraemia syndrome?

Answer 41

HUS

Question 42

What part of the nephron is affected in IgA nephropathy?

Answer 42

Mesangial cell

Question 43

What are the causes of chronic kidney disease?

Answer 43

Congenital anomalies of the kidney and urinary tract (CAKUT) - 55% (reflux nephropathy, dysplasia, obstructive uropathy) Hereditary - 17% Glomerulonephritis - 10%