Renal

Question 1

HUS presentation

Answer 1

AKI
Thrombocytopenia
Microangiopathic haemolytic anaemia

Question 2

HUS bugs

Answer 2

STEC most-commonly (0157:H7)
Pneumococcal infection
HIV
SLE, drugs, cancer
Primary (atypical) due to complement dysregulation

Question 3

HUS Ix

Answer 3

Blood film - Coombs -ve haemolysis with schistocytes, anaemia, thrombocytopenia
AKI
Stool culture for STEC, PCR for Shiga toxin

Question 4

HUS Mx

Answer 4

Supportive if diarrhoea (no abx)
If no diarrhoea, exchange transfusion or eculizumab (C5 inhibitor) in severe cases

Question 5

AKI vs CKD

Answer 5

B/l small kidney in CKD except:
ADPKD
DM nephropathy (early)
Amyloidosis
HIV-associated nephropathy

Hypocalcaemia in CKD

Question 6

2ww haematuria

Answer 6

> 45yrs with unexplained visible haematuria without UTI/treated UTI
60yrs with non-visible haematuria + dysuria/raised serum WCC

Question 7

AKI criteria

Answer 7

26 increase in Cr in 48h
50% Cr rise in 7d
UO<0.5ml/kg/hr in 6hrs (8hrs in kids)
25% drop in eGFR in 7d in kids

Question 8

AKI staging

Answer 8

KDIGO criteria

1 - Cr 1.5-1.9x baseline
26.5 Cr rise
UOP<0.5ml/kg/hr for 6hrs

2 - Cr 2-2.9x baseline
UOP<0.5ml/kg/hr for 12hrs

3 - Cr>3x baseline
353.6 Cr rise
UOP<0.3ml/kg/hr for 24hrs
started RRT
In <18yrs, eGFR<35

Question 9

Tacrolimus SE

Answer 9

Impaired glucose tolerance/DM

Question 10

Ciclosporin SE

Answer 10

Hyperlipidaemia
HTN

Question 11

MMF SEs

Answer 11

Bone marrow suppression
GI issues

Question 12

Sirolimus SE

Answer 12

Hyperlipidaemia

Question 13

Complications of immunosuppression

Answer 13

CVD
Renal failure
Malignancy - SCC top, BCC, lymphoma, cervical

Question 14

Importance of HLA antigens in renal transplant hierarchy

Answer 14

DR
A
B

Question 15

Hyperacute renal transplant rejection

Answer 15

Minutes to hours
Due to pre-existing ABO/HLA Abs
T2 hypersensitivity
Widespread thrombosis of graft vessels, ischaemia and necrosis of graft
No Rx, remove graft

Question 16

Acute renal transplant rejection

Answer 16

<6mths
Usually mismatched HLA or CMV infection
T-cell mediated (T4 hypersensitivity)
Asymptomatic, found by rising Cr, pyuria, proteinuria
Can be reversible with immunosuppressants/steroids

Question 17

Chronic renal transplant failure

Answer 17

> 6mths
Ab and cell mediated mechanisms cause fibrosis
Often recurrence of original disease (MCGN>IgA>FSGS)

Question 18

Anion gap formula

Answer 18

K+Na - (HCO3+Cl), normal gap 8-14

Question 19

Minimal change Rx

Answer 19

Steroids
Cyclophosphamide if steroid resistant

Question 20

PD peritonitis bug and Rx

Answer 20

Staph epidermis most common, then staph aureus
Vanc + ceftazidime with dialysis fluid
Or vanc with fluid, cipro PO

Question 21

PKD screening

Answer 21

US abdo, criteria is +ve FHx +
2 cysts <30yrs
2 cysts per kidney 30-59yrs
4 cysts per kidney 60+yrs

Question 22

ADPKD types

Answer 22

1 - Chromosome 16, 85% of cases, renal failure earlier
2 - Chromosome 4, 15% of cases

Question 23

ADPKD mx

Answer 23

Tolvaptan only if all of:
CKD 2/3 at start of Rx
Rapidly progressive disease
Discount for pt access scheme by company

Question 24

Rhabdo bloods

Answer 24

CK >5x upper limit
HypoCa (Ca binds myoglobin which is excreted)
Raised PO4 (released from mycocytes)
Metabolic acidosis

Question 25

CKD dx

Answer 25

eGFR >59 with U&E derangement/proteinuria eGFR <60

Question 26

Post-strep GN features

Answer 26

7-14d post strep A Visible haematuria + proteinuria Bloods - raised anti-streptolysin O titre, also low C3

Question 27

Renal biopsy post-strep GN

Answer 27

Acute diffuse proliferative GN - endothelial proliferation with neuts Subepithelial humps from immune complex deposits on electron microscopy Granular/starry sky immunofluorescence

Question 28

What is HSP and features

Answer 28

IgA mediated small vessel vasculitis Overlap with IgA nephropathy (Berger's disease) Palpable purpuric rash Abdo pain Polyarthritis

Question 29

Diabetic nephropathy kidney size

Answer 29

B/l large

Question 30

AIN features

Answer 30

Fever, rash, arthralgia Eosiniphilia HTN + mild renal impairment

Question 31

AIN causes

Answer 31

Drugs - penicillin, NSAIDs, rifampicin, allopurinol, furosemide SLE/sarcoid/Sjogren's Hanta virus, Staphylococci

Question 33

What is TINU

Answer 33

Tubulointerstitial nephritis with uveitis Fevers, weight loss, red eyes in young females Urine - + for leuc + prot

Question 34

eGFR calculated using

Answer 34

Creatinine Age Gender Ethnicity

Question 35

Renal cell carcinoma presentation

Answer 35

Abdo mass, loin pain, haematuria Pyrexia unknown origin L varicocele Endo effects - polycythaemia from EPO, hyperCa from PTH, renin, ACTH

Question 36

Renal diet

Answer 36

Low Na, K, PO4, protein