Renal

Question 1

Nephritic syndrome: Symptoms

Answer 1

Haematuria ⬇️UO Facial swelling/edema Milder proteinuria Mild HTN

Question 2

Nephritic syndrome: Causes

Answer 2

Group A strep Bacterial (MRSA, pneumonia, IE) Viral (measles, mumps, hep) Toxo, malaria Good pasture, wegeners, SLE, HSP

Question 3

Nephrotic vs Nephritic syndrome

Answer 3

Main difference is haematuria –> nephritic Proteinuria is milder in nephritic Albumin and lipid changes and nephrosis

Question 4

Nephrotic syndrome: Symptoms/features

Answer 4

Proteinuria >3.5g/day Serum album

Question 5

Nephrotic syndrome: Management

Answer 5

Low salt high protein Diuretics, ACE inhibitors Steroids Immunosuppressants if steroids don’t work

Question 6

IgA nephropathy (Bergers disease): Symptoms

Answer 6

Gross haematuria +URTI/gastroenteritis

Question 7

IgA nephropathy: Ix

Answer 7

Renal biopsy is gold standard Measure protein excretion, if too high ?myeloma Urine microscopy Renal function

Question 8

Good pastures: Presentation

Answer 8

Massive pulmonary haemorrhage + acute glomerulnephritis

Question 9

Investigation for renal colic

Answer 9

Non-contrast CT

Question 10

Haemolytic Uraemic Syndrome: Typical/features

Answer 10

Acute renal failure+microangiopathic haemolytic anaemia + thrombocytopenia Usually post dysentery (typically E. coli) , if not cicoosporin, tumor, preg Needs FBC, U+E, stool culture Supportive management only

Question 11

Alports syndrome

Answer 11

Haematuria + progressive CKD + sensorineural hearing loss + ocular abnormalities X links dominant HTN and supportive tx

Question 12

Autosomal recessive poly cystic kidney disease

Answer 12

Rare Chr6 Pre/perinatal Bilateral masses, generally fibrosis

Question 13

Renal cancer: Endocrine complications

Answer 13

Erythropoietin- polycythaemia Parathyroid - high Ca

Question 14

PKD: Symptoms

Answer 14

Frequency Loin pain HTN Bilateral kidney enlargement UTI/pyelonephritis Gross haematuria following trauma Stones

Question 15

PKD: Extra renal manifestations

Answer 15

Liver cysts Pancreatic cysts Aneurysms: cardiac, berry Cardiac eg mitral valve prolapse

Question 16

PKD: Ix and target BP

Answer 16

USS is definitive scan Higher number of cysts needed for diagnosis as you get older due to naturally occurring cysts

Question 17

Muddy brown casts on microscopy

Answer 17

Acute tubular necrosis

Question 18

Post-streptococcal glomerulonephritis: Signs and symptoms

Answer 18

Post strep - sore throat, impetigo Haematuria, Oliguria, edema, HTN (ie Nephritic syndrome) + general malaise

Question 19

Most common viral infection in organ transplant

Answer 19

CMV

Question 20

Renal artery stenosis: Signs

Answer 20

HTN resistant to tx Worsening renal function in response to ACE Flash pulmonary edema Carotid/femoral bruit

Question 21

Renal Artery Stenosis: Ix

Answer 21

USS - smaller kidney Doppler - poor blood flow CT/MRI Renal angio - gold standard but invasive

Question 22

Renal tubular acidosis: Metabolic effect

Answer 22

Hyperchloraemic acidosis with normal anion gap

Question 23

Diabetic nephropathy stages

Answer 23

1) GFR elevated 2) glomerular hyperfiltration 3) microalbuminaemia 4) nephropathy

Question 24

Myeloma kidney

Answer 24

Antibodies and light chains accumulate and block tubules Causes acute tubular necrosis Tx - fluids and dialysis

Question 25

AKI: Risk factors

Answer 25

Diabetes Sepsis CKD Heart failure PVD Drugs Dehydration

Question 26

AKI: Pre renal causes

Answer 26

Renal hypoperfusion e,g from hypovolaemia, hypotension, sepsis, RAS

Question 27

AKI: Intrinsic causes

Answer 27

Acute tubular necrosis Autoimmune e.g SLE, HSP Drugs Vasculitis

Question 28

AKI: Post renal

Answer 28

Urinary tract obstruction

Question 29

AKI: Management/Investigations ABCDEU

Answer 29

**A**BG - degree of acidosis, K+ **B**loods - FBC, U+Es, cultures **C**atheter to assess fluid balance **D**ietary protein restriction and **D**rug r/v **E**lectrolytes and **E**CG - hyperkalaemia **U**ltrasound - obstruction, renal size

Question 30

AKI: Referral criterial

Answer 30

Hyperkalaemia and oligoanuric/unresponsive to Tx Urea\>40 or Uraemic Glomerulonephritis Systemic disease

Question 31

AKI: Dialysis criteria

Answer 31

Persistent hyperkalaemia Refractory pulmonary edema Severe acidosis Drug OD Uraemic complications

Question 32

eGFR \>90%

Answer 32

Stage 1 CKD - eGFR fine but other abnormalities

Question 33

eGFR 60-89

Answer 33

Stage 2 CKD: mild

Question 34

eGFR 30-59

Answer 34

Stage 3 CKD: moderate

Question 35

eGFR 15-29

Answer 35

Stage 4 CKD: severe

Question 36

eGFR \<15

Answer 36

Stage 5: end stage