Renal

Question 1

Xanthogranulomatous pyelonephritis

organisms

what does it cause

Answer 1

rare chronic granulomatous disease resulting in a non-functioning kidney.

Chronic/subacute infection by organisms such as Proteus mirabilis predispose to renal stones including staghorn calculi. Foamy (lipid laden) macrophages are typically seen.

Question 2

Diagnosis is usually based on the history of persistent haematuria, normal kidney function and family history of haematuria without kidney failure. It is generally a benign disorder and biopsy is rarely indicated.

Answer 2

Thin basement membrane disease

Question 3

Non-germ cell tumours include

Answer 3

Leydig cell tumours and sarcomas.

Question 4

Tumour markers
germ cell tumours

seminomas

Answer 4

seminomas: hCG may be elevated in around 20%

Question 5

Tumour markers
germ cell tumours

non seminomas

Answer 5

non-seminomas: AFP and/or beta-hCG are elevated in 80-85%

Question 6

Retroperitoneal fibrosis
Lower back/flank pain is the most common presenting feature. Fever and lower limb oedema is also seen in some patients.

what are the associations

RIP SD

Answer 6

Associations

Riedel’s thyroiditis
inflammatory abdominal aortic aneurysm
previous radiotherapy

sarcoidosis
drugs: methysergide

Question 7

Renal vascular disease Investigation

common presentation is a sharp rise in creatinine following the initiation of ACE inhibitor therapy (e.g. hypertension that may itself be linked to the underlying renal artery stenosis).

Answer 7

MR angiography is now the investigation of choice

Question 8

Renal transplant: immunosuppression Malignancy

Answer 8

• patients should be educated about minimising sun exposure to reduce the risk of squamous cell carcinomas and basal cell carcinomas

Question 9

hen HLA matching for a renal transplant the relative importance of the HLA antigens are

Answer 9

as follows DR > B > A

Question 10

Prevention of renal stones
Calcium stones may be due to hypercalciuria, which is found in up to 5-10% of the general population.

Answer 10

NICE
thiazides diuretics (increase distal tubular calcium resorption)

high fluid intake
add lemon juice to drinking water
avoid carbonated drinks
limit salt intake
potassium citrate may be beneficial

Question 11

Oxalate stones PREVENTION

Answer 11

cholestyramine reduces urinary oxalate secretion
pyridoxine reduces urinary oxalate secretion

Question 12

Uric acid stones
PREVENTION

Answer 12

allopurinol
urinary alkalinization e.g. oral bicarbonate

Question 13

Rapidly progressive glomerulonephritis

3 CAUSES

Answer 13

Causes
Goodpasture’s syndrome
Wegener’s granulomatosis
others: SLE, microscopic polyarteritis

formation of epithelial crescents in the majority of glomeruli.

Question 14

Peritoneal dialysis peritonitis

Answer 14

coagulase-negative staphylococci such as Staphylococcus epidermidis is the most common cause. Staphylococcus aureus is another common cause

Question 15

Acute interstitial nephritis

PRN AF - DRUGS

Answer 15

Causes
drugs: the most common cause, particularly antibiotics
penicillin
rifampicin
NSAIDs
allopurinol
furosemide

systemic disease: SLE, sarcoidosis, and Sjogren’s syndrome
infection: Hanta virus , staphylococci

Question 16

ADPKD type 1

Answer 16

Chromosome 16

Question 17

ADPKD type 2

Answer 17

Chromosome 4

Question 18

tolvaptan

Answer 18

For select patients, tolvaptan (vasopressin receptor 2 antagonist) may be an option.

they have chronic kidney disease stage 2 or 3 at the start of treatment
there is evidence of rapidly progressing disease

Question 19

the most common form of amyloidosis

Answer 19

AL amyloidosis

L for immunoglobulin Light chain fragment
due to myeloma, Waldenstrom’s, MGUS
features include: nephrotic syndrome, cardiac and neurological involvement, macroglossia, periorbital eccymoses

Question 20

AA amyloid

Answer 20

A for precursor serum amyloid A protein, an acute phase reactant
seen in chronic infection/inflammation
e.g. TB, bronchiectasis, rheumatoid arthritis
features: renal involvement most common feature

Question 21

Anion gap

EQUATION AND NORMAL

Answer 21

(sodium + potassium) - (bicarbonate + chloride)

A normal anion gap is 8-14 mmol/L

Question 22

Diabetes insipidus (DI) is a condition characterised by

Answer 22

deficiency in the action of antidiuretic hormone (ADH), also known as arginine vasopressin (AVP). ADH is synthesised by the magnocellular neurons in the supraoptic and paraventricular nuclei of the hypothalamus and stored in the posterior pituitary.

Question 23

cranial (central) DI,

Answer 23

A deficiency in ADH secretion

Question 24

nephrogenic DI

Answer 24

insensitivity of the kidney to ADH is known as nephrogenic DI (arginine vasopressin resistance, AVP-R).

Question 25

Causes of nephrogenic DI GENETIC

Answer 25

more common form affects the vasopression (ADH) receptor less common form results from a mutation in the gene that encodes the aquaporin 2 channel

Question 26

Causes of nephrogenic DI ELECTOLYTES

Answer 26

electrolytes hypercalcaemia hypokalaemia

Question 27

differentiate cranial from nephrogenic DI (

Answer 27

a desmopressin test can help differentiate cranial from nephrogenic DI (an increase in urine osmolality suggests cranial DI)

Question 28

diabetes insipidus INVESTIGATION

Answer 28

high plasma osmolality (often >295 mOsm/kg), low urine osmolality (often <300 mOsm/kg) a urine osmolality of >700 mOsm/kg generally excludes diabetes insipidus water deprivation test