Nephrology ILOs

Question 1

Define UTI, including complicated and uncomplicated

Answer 1

Uncomplicated occurs with structurally and functionally normal tissue, complicated occurs in the presence of underlying pathology

Question 2

Give 3 causative organisms of UTIs

Answer 2

E. coli
Klebsiella
Enterococcus

Question 3

Give 4 symptoms of a UTI

Answer 3

Dysuria
Urgency
Suprapubic pain
Pyrexia

Question 4

Give 2 investigations and 2 treatments for UTIs

Answer 4

Urinalysis + culture

ABX + IV fluid

Question 5

Define pyelonephritis and give 3 signs and symptoms

Answer 5

Severe infectious inflammatory disease of kidney

• Flank pain
• Costovertebral angle tenderness
• Fever

Question 6

Give 2 management options for pyelonephritis

Answer 6

ABX

Supportive care

Question 7

Give 3 risks of pyelonephritis

Answer 7

• UTI
• Diabetes
• Stress incontinence

Question 8

Define AKI and give one pre-renal, renal and post-renal cause

Answer 8

Acute decline in kidney function leading to raised creatinine and/or decreased urine output

1. Hypovolaemia
2. Drugs
3. Renal stones

Question 9

Give 3 signs of an AKI

Answer 9

• Hypotension
• Reduced urine output
• Symptoms of pulmonary oedema

Question 10

Give 3 investigations for an AKI

Answer 10

• U&Es ( increased creatinine, high K, metabolic acidosis)
• Blood culture for cause
• Urine culture

Question 11

Give 3 management options for an AKI

Answer 11

• Fluid resuscitation
• Medication review and stop nephrotoxins
• Vasopressor support if still hypovolaemic

Question 12

What is one life-threatening complication of an AKI which needs immediate correction?

Answer 12

Hyperkalaemia

Question 13

Give 3 causes of CKD

Answer 13

• Diabetes
• Hypertension
• Polycystic kidney disease

Question 14

Outline the pathology of CKD

Answer 14

Increased intra-glomerular pressure and increased angiotensin II production lead to collagen synthesis and renal scarring

Question 15

Outline the stages of CKD

Answer 15

1: eGFR >90
2: eGFR = 60-89
3a: eGFR = 45-59
3b: eGFR = 30-44
4: eGFR = 15-29
5: eGFR <15

Question 16

What 2 things may be seen on urinalysis in CKD?

Answer 16

Haematuria

Proteinuria

Question 17

Give 4 management options of CKD

Answer 17

• ACEI/ARB
• Statin
• Glycaemic control
• Dialysis

Question 18

Give 5 indications for renal replacement therapy

Answer 18

1. Medically resistant hyperkalaemia
2. Medically resistant pulmonary oedema
3. Medically resistant acidosis
4. Uraemic pericarditis
5. Uraemic encephalopathy

Question 19

Give 3 symptoms of uremia

Answer 19

Anorexia
Itch
Restless legs

Question 20

At what eGFR does dialysis typically occur?

Answer 20

5-10 but most start when eGFR =7

Question 21

Outline the 2 forms of dialysis

Answer 21

Haemodialysis: removes solute by diffusion and fluid by hydrostatic pressure

Peritoneal: peritoneum functions as filter

Question 22

Give 2 pros and 2 cons of renal transplant

Answer 22

Pros: no dialysis, better life expectancy

Cons: immunosuppressive medication, increased infection

Question 23

At what eGFR does glomerulonephritis occur and give 2 symptoms

Answer 23

eGFR <15

Visible haematuria
Synpharingitis (sore throat then Coca Cola urine)

Question 24

Give 3 investigations for glomerulonephritis

Answer 24

• U and E’s
• Urine dip for blood
• Immunology, myeloma and HbA1c screen

Question 25

Outline the 3 components of nephrotic syndrome

Answer 25

1. 3.5g proteinuria per 24hr 2. Serum albumin <30 3. Oedema

Question 26

Outline the 3 components of nephritic syndrome

Answer 26

1. Hypertension 2. Blood and protein in urine 3. Declining kidney function

Question 27

How does IgA nephropathy occur and what drug is used in it's management?

Answer 27

IgA deposited in mesangial cells which disrupts filtration barrier ACEI

Question 28

What is membranous glomerulonephropathy?

Answer 28

Occurs in adults presenting with nephrotic syndrome

Question 29

What occurs in minimal change disease I?

Answer 29

In children, podocytes fuse together

Question 30

What occurs in minimal change disease II?

Answer 30

Acutely normal/reduced eGFR

Question 31

Give 4 features of PKD

Answer 31

- Hypertension - Impaired renal function - Loin pain - Haematuria

Question 32

Which chromosomal gene mutations are implicated in PKD 1 and PKD 2 respectively?

Answer 32

16 and 4

Question 33

Outline the pathophysiology of PKD

Answer 33

- Cysts gradually enlarge and normal tissue replaced | - Kidney volume increases and GFR decreases

Question 34

Give 2 management options of PKD

Answer 34

Manage BP | Tolvaptan: vasopressin V2 receptor antagonist

Question 35

What happens when a patient suffers from vesicle-ureteric reflux?

Answer 35

Retrograde passage of urine from bladder to upper tract = scarring

Question 36

How does renovascular disease cause renal pathology?

Answer 36

Narrow renal arteries cause perfusion to fall = inflammation and fibrosis

Question 37

What is amyloidosis and what are the two types?

Answer 37

Deposition of insoluble protein material in extracellular space AA: systemic AL: immunoglobulin due to haem. condition e.g. MM

Question 38

How does SLE cause renal damage and what is the treatment?

Answer 38

Immune complexes activate complement (C4) causing renal damage Tx: immunosuppression