Renal

Question 1

oedema, proteinuria, hypoalbuminaemia

Answer 1

nephrotic syndrome

Question 2

haematuria, HTN, RBC casts, oliguria

Answer 2

nephritic syndrome

Question 3

nephrotic and nephritic syndrome are both types of

Answer 3

glomerulonephritis

Question 4

3 types of nephrotic syndrome

Answer 4

Minimal change disease (children)
Membranous glom
Focal segmental glom

Question 5

Subtypes of nephritic syndrome

Answer 5

Post-strep (1-4 weeks post infection)
IgA nephropathy (1-2 days post infection)
Alport syndrome
Goodpastures (autoimmune)
ANCA +ve vasculitis (GPA/Wegner’s, MPA, EGPA/Churg strauss)

Question 6

Features of Alport syndrome

Answer 6

Nephritic syndrome plus sensorineural hearing loss and ocular disturbances

Question 7

What do ‘muddy casts’ suggest

Answer 7

acute tubular necrosis

Question 8

Nephrotic syndrome is at risk of what

Answer 8

VTE

Question 9

AKI diagnostic criteria

Answer 9

↑ creatinine > 26µmol/L in 48 hours
↑ creatinine > 50% in 7 days
↓ urine output < 0.5ml/kg/hr for more than 6 hours

Question 10

When is asymptomatic bacteruria treated

Answer 10

pregnant

prior to urological procedures

infant

Question 11

Canon ball mets suggests

Answer 11

Renal cell carcinoma

Question 12

Urine ACR for CKD diagnosis- what levels = what action

Answer 12

<3- no action
3-70 repeat in 3m
>70 no need to repeat- refer to renal

Question 13

CKD can be ruled out in bloods and urine ACR if

Answer 13

if the eGFR is persistently greater than 60 mL/min/1.73 m2,
and/or the urinary ACR is persistently less than 3 mg/mmol, and there are no other markers of kidney damage.

Question 14

Diagnosis of CKD?

Answer 14

eGFR is less than 60 and/or proteinuria (urinary ACR is greater than 3 mg/mmol) lasting for at least three months.

Question 15

All CKD patients should be offered

Answer 15

statin (20mg atorva)
aspirin

Question 16

polycystic kidney disease inheritance

Answer 16

autosomal dominant

Question 17

abrupt onset of haemoptysis, cough, shortness of breath, peripheral oedema, dark urine and oliguria

Answer 17

Goodpastures

Question 18

antibodies in Goodpastures

Answer 18

Anti-GBM antibody
ANCA in 30%

Question 19

What does renal biopsy show in goodpastures

Answer 19

Crescentic glomerulonephritis

Linear IgG staining on immunofluorescence

Question 20

How to differentiate goodpastures vs wegners (GPA)

Answer 20

renal biopsy shows no immune complex deposition in wegners

Wegners ANCA positive

Question 21

GPA (Wegners) investigations

Answer 21

ANCA positive

epithelial crescents in Bowman’s capsule on biopsy

May have cavitating lesions on CXR

Question 22

Vasculitis with a prodromal asthma/allergic phase

Answer 22

Eosinophilic granulomatosis with polyangiitis (Churg Strauss)

Question 23

‘spike and dome’ on renal biopsy

Answer 23

Membranous glomerulonephritis

Question 24

All patients with membranous glomerulonephritis should recieve

Answer 24

ACE inhibitor or an angiotensin II receptor blocker

Question 25

Membranous glomerulonpehritis prognosis

Answer 25

one-third: spontaneous remission one-third: remain proteinuric one-third: develop ESRF

Question 26

ANCA positive vasculitis affecting many different systems eg cutaneous and neuro manifestations

Answer 26

Microscopic polyangiitis

Question 27

present with oedema, proteinuria, hypoalbuminemia, and hyperlipidemia.

Answer 27

Minimal change

Question 28

Mx post-streptococcal glomerulonephritis

Answer 28

generally supportive initially

Question 29

visible haematuria following a recent URTI

Answer 29

IgA nephrop

Question 30

HSP overlaps with what renal disease

Answer 30

IgA nephrop

Question 31

Renal diet involves

Answer 31

Low protein Low phosphate Low sodium Low potassium

Question 32

First line mx of htn in renal disease

Answer 32

ACEi

Question 33

you start an acei to treat hypertension in ckd, however the egfr drops, what is the action

Answer 33

a decrease in eGFR of up to 25% or a rise in creatinine of up to 30% is acceptable`

Question 34

hyperacute rejection in renal transplant mx

Answer 34

no treatment available- remove graft

Question 35

rising creatinine, pyuria and proteinuria a few months post renal transplant

Answer 35

acute graft failure, may be reversible with steroids and immune suppressants

Question 36

CKD on haemodialysis most likely cause of death

Answer 36

IHD

Question 37

haematuria, loin pain, abdominal mass pyrexia of unknown origin left varicocele

Answer 37

renal cell carcinoma

Question 38

Most common cause of intrarenal aki

Answer 38

acute tubular necrosis

Question 39

acute tubular necrosis what happens to urinary sodium

Answer 39

high as can't conc the urine