Nephrology

Question 1

What does proteinuria mean in glomerular disease?

Answer 1

Glomerular injury

Nephrotic syndrome

Question 2

What causes haemolytic uraemic syndrome?

Answer 2

Acute kidney injury

Question 3

What are 5 functions of the kidneys?

Answer 3

Waste handling
Water handling
Salt balance
Acid/base control
Endocrine

Question 4

What are some endocrine functions of the kidneys?

Answer 4

Red cells
Blood pressure
Bone health

Question 5

What are podocytes?

Answer 5

Specialized epithelial cells that cover the outer surfaces of glomerular capillaries

Question 6

What do podocytes produce?

Answer 6

Podocin

Nephrin

Question 7

What is the GBM?

Answer 7

Glomerular basement membrane (GBM) is the extracellular matrix component of the selectively permeable glomerular filtration barrier
Made of type IV collagen and laminin

Question 8

What does the GBM do?

Answer 8

Separates vasculature from urinary space

Synthesis of podocytes and endothelial cells

Question 9

What do mesangial cells do?

Answer 9

Glomerular structural support
Embedded in GBM
Regulates blood flow of the glomerular capillaries

Question 10

What are some signs of nephritic syndrome?

Answer 10

Increasing haematuria

Intravascular overload

Question 11

What are some signs of nephrotic syndrome?

Answer 11

Increasing proteinuria

Intravascular depletion

Question 12

Which component is affected in minimal change disease?

Answer 12

Epithelial cell

Podocyte

Question 13

Which component is affected in post infectious glomerulonephritis (PIGN)?

Answer 13

Basement membrane

Endothelial cell

Question 14

Which component is affected in haemolytic uraemic syndrome (HUS)?

Answer 14

Endothelial cell

Question 15

Which component is affected in HSP or IgA nephropathy?

Answer 15

Mesangial cells

Question 16

What is a drawback of dipstix for measuring proteinuria concentration?

Answer 16

False positives and negatives

Question 17

What is the gold standard for measuring proteinuria concentration?

Answer 17

24hr urine collection

Question 18

What is the nephrotic range in protein creatinine ratio testing?

Answer 18

> 250mg/mmol

Question 19

How does nephrotic range proteinuria affect fluid?

Answer 19

Hypoalbuminaemia

Results in oedema and increasing 3rd space fluid volume

Question 20

How might nephrotic range proteinuria present?

Answer 20

Pale
Inflated weight
Periorbital oedema
Pitting oedema
Ascites
Pleural effusion
Low BP
Frothy urine

Question 21

How would bloods be affected in nephrotic syndrome?

Answer 21

Normal creatinine

Low albumin

Question 22

How do we manage nephrotic syndrome?

Answer 22

Prednisolone 8 weeks

Question 23

What are some possible causes of haematuria?

Answer 23

Clotting disorders
Glomerulonephritis
Wilm's tumour
Cyst
Sarcoma
Stones
UTI
Trauma
Urethritis

Question 24

What are some consequences/features of nephritic syndrome?

Answer 24

Haematuria
Proteinuria
Reduced GFR
Oliguria
Fluid overload
HT

Question 25

What are the usual causes of acute post-infectious glomerulonephritis?

Answer 25

Usually group A strep | Beta hemolytic

Question 26

What is the go-to imaging technique for glomerulonephropathy?

Answer 26

Renal USS

Question 27

How is Acute Post-Infectious Glomerulonphritis diagnosed?

Answer 27

Bacterial culture Positive ASOT Low C3 normalises

Question 28

How is Acute Post-Infectious Glomerulonphritis managed?

Answer 28

Self-limiting Antibiotic Electrolytes to support renal function Diuretics to help fluid overload

Question 29

What is the most common glomerulonephritis?

Answer 29

IgA nephropathy

Question 30

How do we diagnose IgA nephropathy?

Answer 30

Negative autoimmune workup | Confirmation biopsy

Question 31

How do we treat proteinuria in IgA nephropathy?

Answer 31

ACEi

Question 32

What is KDIGO?

Answer 32

KDIGO defines AKI as any of the following: Increase in serum creatinine by 0.3mg/dL or more within 48 hours or Increase in serum creatinine to 1.5 times baseline or more within the last 7 days or Urine output less than 0.5 mL/kg/h for 6 hours

Question 33

What is Henoch Schonlein purpura?

Answer 33

IgA related vasculitis

Question 34

How does Henloch Schonlein purpura present?

Answer 34

Abdominal pain Renal involvement Arthritis/arthralgia 4-6 weeks duration

Question 35

How does AKI present?

Answer 35

Anuria/oliguria HT with fluid overload Rapid rise in plasma creatinine

Question 36

What are some features of HUS?

Answer 36

Haemolysis Thrombocytopenia AKI

Question 37

What are 5 things to monitor in HUS?

Answer 37

``` Fluid balance Electrolytes Acidosis Waste Hormones ```

Question 38

Which factor may cause presentation of CKD to vary?

Answer 38

Kidney functions affected

Question 39

How might a uraemic cause of CKD present?

Answer 39

Weight loss Loss of appetite Itch

Question 40

How might a water handling problem causing CKD present?

Answer 40

Polyuria

Question 41

Which functions may be affected when CKD presents with lethargy?

Answer 41

Salt balance | Acid/base

Question 42

How might an endocrine caused CKD present?

Answer 42

Lethargy | Reduced effort tolerance

Question 43

Why is papilla shape significant in UTI?

Answer 43

Concave associated with intra renal reflux and found in the renal poles The most common place for renal scaring

Question 44

What are some useful antibiotics if UTI causing HUS?

Answer 44

Trimethoprim Co-amoxiclav Cephalosporin

Question 45

What are some bloods in metabolic bone disease?

Answer 45

High phosphate Increase PTH High PTH causes metabolic bone disease and CV disease

Question 46

What are some treatment principles of metabolic bone disease?

Answer 46

Low phosphate diet Phosphate binders Active Vitamin D