Renal

Question 1

what is glomerulonephritis?

Answer 1

a group of disorders where damage to the glomerular filtrating apparatus causing a leak of protein, with or without blood.

Question 2

what is the commonest cause of nephrotic syndrome in adults?

Answer 2

membranous GN

Question 3

what is the general treatment for any type of GN?

Answer 3

fluid and salt restriction
immunosuppression (steroids and cyclophosphamide)
ACEIs

Question 4

which GN has a particularly poor response to steroids?

Answer 4

membranous

Question 5

a young adult presents with haematuria following a URTI is more likely what diagnosis?

Answer 5

IgA nephropathy (Berger’s disease)

Question 6

what kind of casts are seen in GN?

Answer 6

RBC casts

Question 7

what kind of casts are seen in pyelonephritis and tubulointerstitial nephritis?

Answer 7

white blood cell casts

Question 8

what kind of casts are seen in acute tubular necrosis?

Answer 8

granular muddy brown casts

Question 9

why might a patient in AKI be breathless?

Answer 9

metabolic acidosis

pulmonary oedema

Question 10

what are the long-term effects seen in CKD, not usually seen in AKI?

Answer 10

Anaemia, hypoclacaemia, hyperphosphataemia

Question 11

what does a super high creatinine compared to urea imply?

Answer 11

rhabdomyolysis

Question 12

what are the criteria for dialysis in AKI?

Answer 12

Refractory hyperkalaemia or volume overload. severe acidaemia (<7.2) or uraemia complications (encephalopathy, pericarditis).

Question 13

what is CKD?

Answer 13

> 3m history of kidney damage leading to abnormal structure, function of GFR <60mL/min.

Question 14

what is ESRF?

Answer 14

GFR <15ml/min or needing renal replacement therapy.

Question 15

what are the three most common causes of CKD?

Answer 15

diabetes, hypertension, glomerulonephritis.

Question 16

what are the extra-renal features of CKD?

Answer 16

hypertension, anaemia, fluid retention, uraemia encephalopathy, renal osteodystrophy and secondary hyperparathyroidism, uraemia cardiomyopathy and atherosclerosis.

Question 17

what is the most common cause of death in patients with CKD?

Answer 17

CVD

Question 18

what would you see on the ABG of a patient with CKD?

Answer 18

metabolic acidosis

Question 19

what are two ways of estimating GFR?

Answer 19

MDRD - looks at creatinine (wide variance because of muscle mass), age, gender and race.
Cockcroft-Gault equation - looks at creatinine clearance and takes into account weight

Question 20

what is the difference between haemofiltration and dialysis?

Answer 20

haemofiltration gets rid of toxins via convention rather than both that and osmosis as in dialysis

Question 21

what are the contraindications to renal transplant?

Answer 21

active sepsis, expected survival <5y (not HIV, not bmi >30), active malignancy, malignancy in last 5y, active vasculitis or recent anti-GBM disease

Question 22

which kidney is preferably transplanted into patients?

Answer 22

the left, because of the longer renal vein. when transplanted into patients, it is transplanted usually on the right side.

Question 23

how large a growth of organisms qualifies as a UTI?

Answer 23

10^5/mL

Question 24

what are the risk factors for UTI?

Answer 24

urinary obstruction, immunosuppression, sexual intercourse in women, renal tract abnormalities, pregnancy, foreign body (i.e. catheterisation), spermicide use, menopause

Question 25

common causes of UTI?

Answer 25

E Coli, Staph Saprophyticus. Proteus and Klebsiella in hospital acquired.

Question 26

what length of antibiotic course should you give to men with a UTI?

Answer 26

7d (as opposed to 3d in uncomplicated women)

Question 27

from which cell do renal cell carcinomas develop?

Answer 27

proximal renal tubular epithelium

Question 28

how is RCC staged?

Answer 28

``` Robson's staging I - confined to kidney II - involves perinephric fat but does not spread beyond garota's fascia III - spread to renal vein IV - adjacent / distant organ ```

Question 29

what is the classic triad of RCC?

Answer 29

haematuria, flank pain (capsular stretch) and abdominal mass

Question 30

why is hypertension sometimes seen in RCC patients?

Answer 30

renin secreting tumour

Question 31

what does a triple phase CT look at in RCC?

Answer 31

non-contrast phase - looks for fat in tumour arterial phase - assesses vascular supply venous phase - asses local invasion, thrombi

Question 32

what are the indications for a partial nephrectomy over a total nephrectomy in RCC?

Answer 32

small tumour (<3cm) bilateral masses solitary kidney poor renal function

Question 33

what are the medical options in RCC?

Answer 33

medroxyprogesterone acetate, IL2 and IFN (20% remission using these 2 meds), mTOR inhibitors such as Temsirolimus, Bevacizumab (anti-VEGF)

Question 34

how do you score prognosis in RCC?

Answer 34

``` Mayo prognostic score (SSIGN) stage size grade necrosis ```

Question 35

what kind of tumour is a Wilm's tumour?

Answer 35

nephroblastoma

Question 36

what kind of renal stones are there?

Answer 36

calcium oxalate (75%), magnesium ammonium phosphate, urate, hydroxyappetite, cystein

Question 37

where do renal stones form?

Answer 37

the collecting duct

Question 38

what are the three most common places for renal stones to deposit?

Answer 38

pelviureteric junction vesicoureteric junction pelvic brim

Question 39

what is the gold standard investigation for renal stones?

Answer 39

non-contrast spiral CT KUB

Question 40

what are the treatment options for renal stones?

Answer 40

if <5mm - just analgesia (diclofenac PR if creatinine normal, opioids if not) and high fluid intake if >5mm - tamsulosin or nifedipine (help relax smooth muscle) if <2cm - extracorporeal shock wave lithotripsy, if >2mm insert JJ stent first If in renal pelvis, calyces or upper ureter - percutaneous nephrolithotomy if stag horn - open nephrolithotomy

Question 41

what would you do if renal stones were causing obstruction?

Answer 41

percutaneous nephrostomy | insert JJ stent (wait 10d, then remove stent and do ureteroscopy)

Question 42

what is Alport's syndrome?

Answer 42

it is an x-linked mutation of type IV collagen which plays an important role in the basement membrane in kidneys, ears and eyes. It affects boys more severely than girls.

Question 43

what is the triad seen in Alport' syndrome?

Answer 43

haematuria, severe ocular abnormalities and sensorineural hearing loss (bilateral)

Question 44

what are the 2 mutations in PCKD?

Answer 44

PKD1 (85%) - onset at 50yo, chromosome 16 | PKD2 (15%) onset at 70yo, chromosome 4

Question 45

what is adult PKD associated with?

Answer 45

berry aneurysms (8%) and liver cysts (80%). can also get cysts in pancreas and ovaries.

Question 46

how does PKD present?

Answer 46

flank pain, haematuria, recurrent UTIs, ESRF, hypertension +/- LVH

Question 47

what is treatment for AKD?

Answer 47

conservative - increase fluid intake, decrease salt intake, genetic counselling, monitor U&Es, family screening medical - aggressive hypertension control (ACEI) surgical - transplant

Question 48

what are the causes of renal artery stenosis?

Answer 48

atherosclerosis (80%), fibromuscular dysplasia (10%), anti-phospholipid syndrome, takayasu's arteritis.

Question 49

how can renal artery stenosis present?

Answer 49

drug-resistant hypertension (failed to be controlled by combo of 3 drugs)

Question 50

where can renal bruits be heard and in what condition are they found?

Answer 50

they are heard in the mid-clavicular line at the costal margin, and are commonly heard in renal artery stenosis.

Question 51

what is the gold standard investigation for renal artery stenosis?

Answer 51

renal arteriography (but duplex USS is safer)

Question 52

what is better, a perfectly matched deceased donor kidney or a non-perfectly matched living donor kidney?

Answer 52

living donor

Question 53

what is the immunosuppression regime in kidney transplant?

Answer 53

induction with Basiliximab (anti-IL2R) | Maintenance with tacrolimus, azathioprine and prednisolone

Question 54

how do you treat acute t-cell mediated rejection?

Answer 54

high dose prednisolone and intensify immunsoppression

Question 55

how do you treat acute humoural rejection?

Answer 55

plasma exchange

Question 56

what are the drug toxicity effects associated with cyclosporin?

Answer 56

gum hypertrophy and hirsutism

Question 57

what are the drug toxicity effects associated with calcineurin inhibitors?

Answer 57

confusion, tremor.

Question 58

what is the train associated with nephrotic syndrome?

Answer 58

proteinuria, hypoalbuminaemia and oedema

Question 59

what causes nephrotic syndrome?

Answer 59

primary - minimal change disease, membranous, membranoproliferazive or focal-segmental GN secondary - SLE, DN, drugs (penicilliamine, gold, anti-TNF, NSAIDs), Alport's, amyloidosis.

Question 60

what counts of massive proteinuria in nephrotic syndrome?

Answer 60

>3.5g/24h of proteinuria or PCR of >300-350 mg/mmol.

Question 61

frothy urine is due to what?

Answer 61

protein