Renal

Question 1

Reoccurrence of renal disease following renal transplant

Answer 1

Fastest - FSGS

Won’t reoccur - Alport’s disease

Question 2

Primary action of vasopressin?

Answer 2

Acts on renal collecting ducts via V2 receptors to increase water permeability (cAMP-dependent mechanism) which leads to decreased urine formation

Question 3

Mechanisms regulating release of vasopressin

Answer 3

Hypovolemia decreases firing of arterial stretch receptors = increased ADH
Hypotension decreases arterial baroreceptor firing = enhanced sympathetic activity = increased AVP release
Hypothalamic osmoreceptors stimulate ADH release when osmolarity rises
Angiotensin II receptors in the hypothalamus - increased angiotensin II = ADH release

Question 4

Features of Fanconi Syndrome

Answer 4

Type 2 (proximal) renal tubular acidosis
Polyuria
Aminoaciduria 
Glycosuria
Phosphaturia
Osteomalacia

Question 5

Nephrotic Syndrome

Answer 5

= proteinuria, oedema, hypoalbuminemia
Minimal change 
Membranous GN
FSGS
Amyloidosis
Diabetic Nephropathy

Question 6

Nephritic Syndrome

Answer 6

= haematuria, hypertension
IgA nephropathy
Rapidly progressive GN
Alport

Question 7

Rapidly progressive GN

Answer 7

ANCA associated vasculitis (most common) - pauci immune, necrosis and eosinophils
Anti GBM disease - linear IgG on IF
SLE - mixed, complement and antibodies

Question 8

ANCA associated vasculitis

Answer 8

Granulomatosis with Polyangitis
- granulomatous
- cANCA - cytoplasms PR3 = worse prognosis
Microscopic Polyangitis
- no granulomas
- pANCA - perinuclear - MPO
Eosinophilic Granulomatosis with Polyangitis 
- asthma, eosinophilia, granulomas
- either PR3 or MPO

Question 9

Alport’s Syndrome is due to a defect in

Answer 9

Type IV collagen

Question 10

AL (primary) Amyloidosis

Answer 10

Most common form
L for immunoglobulin Light chain fragment
Due to myeloma, Waldenstrom’s, MGUS
Features: nephrotic syndrome, cardiac and neuro involvement, hepatosplenomegaly, macroglossia

Question 11

AA (secondary) amyloid

Answer 11

A for precursor serum amyloid A protein, an acute phase reactant
Seen in chronic infection / inflammation
E.g. TB, RA, bronchiectasis, Crohn’s, ank spond, psoriatic arthritis
Features: renal involvement - often leads to ESRF

Question 12

Beta-2 microglobulin amylodosis

Answer 12

Precursor protein is beta-2 microglobulin = major part of HLA complex
A/w patients on dialysis

Question 13

Extra renal manifestations of ADPKD

Answer 13

Liver cysts
Berry aneurysms
Cardiovascular: mitral valve prolapse, mitral / tricuspid incompetence, aortic root dilatation, aortic dissection
Cysts in other organs: pancreas, spleen

Question 14

Genetic mutations in ADPKD

Answer 14

Chromosome 16 (PKD 1) = non clonal expansion of tubular epithelial cell types; polycystin 1 (mechanosensor)

Chromosome 4 (PKD 2)
Polycystin 2 (calcium channel ion)

Question 15

Tuberous sclerosis

Answer 15

Autosomal dominant
Mutations in TSC1 or TSC2 gene

Major criteria: facial angiofibromas, >3 hypomelanotic macules, kidney angiomyolipomas, retinal hamartomas
Minor criteria: nonrenal hamartomas, multiple kidney cysts, dental abnormalities

Question 16

Main site of potassium reabsorption in the kidney?

Answer 16

Proximal convoluted tubule

Question 17

As GFR declines, urinary creatinine clearance overestimates GFR because Cr is

Answer 17

Secreted by the tubules

Question 18

Drugs that can be cleared by haemodialysis

Answer 18

BLAST
Barbituate
Lithium 
Alcohol (methanol, ethylene glycol)
Salicylates 
Theophylline

Question 19

Main site of sodium reabsorption in the nephron?

Answer 19

Proximal convoluted tubule

Question 20

Site of action for frusemide?

Answer 20

Thick ascending loop of Henle

Blocks Na-Cl cotransporter (NKCC2)

Question 21

Site of action for thiazides / indapemide?

Answer 21

Distal convoluted tubule

Question 22

Site of action for Spironolactone?

Answer 22

Collecting duct

Question 23

Lithium absorption

Answer 23

Reabsorbed in the proximal tubule
Lithium absorption follows sodium uptake
Therefore increased risk of toxicity with diuretics and hypovolemia

Question 24

Order of events in the renin-angiotensin system?

Answer 24

1. Kidneys sense low BP
2. Release renin into the blood
3. Renin causes production of Angiotensin I
4. ACE converts angiotensin I to angiotensin II
5. Angiotensin II stimulates the release of aldosterone, ADH and thirst
6. Water follows sodium
7. Blood volume goes up = BP goes up

Question 25

Which cell in the kidney makes erythropoietin?

Answer 25

Peritubular cell

Question 26

Urinary pattern of glomerular disease or vasculitis?

Answer 26

haematuria with red cell casts, dysmorphic red cells, heavy proteinuria or lipiduria

Question 27

Urinary pattern of acute tubular necrosis in renal failure?

Answer 27

Multiple granular and epithelial cell casts with free epithelial cells

Question 28

Secondary causes of membranous nephropathy

Answer 28

``` SLE Drugs - NSAIDs, penicillamine, gold Hepatitis B and C Malignancy- solid organ Timor’s HSCT Kidney transplant Syphilis ```

Question 29

Distal (Type 1) Renal Tubular Acidosis

Answer 29

Impaired secretion of hydrogen ions = urine pH >6.0, kidney potassium wasting, hypokalemia Usually secondary to autoimmune disease (Sjogrens most common, SLE, RA)

Question 30

Proximal (type 2) Renal tubular acidosis

Answer 30

Caused by reduction in bicarbonate reabsorption in the proximal tubule Causes urine pH<5.5 Causes Fanconi Syndrome

Question 31

Diagnosis of ADPKD

Answer 31

2 or more cysts in one kidney and at least one cyst in the contralateral kidney - young pt (by 30yo) 4 or more cysts in each kidney for patient more than 60yo

Question 32

Gitelman’s syndrome

Answer 32

Defect in distal tubule = thiazides | Normotensive, metabolic alkalosis, hypokalemia, hypomagnesemia, hypocalciuria

Question 33

Bartter’s Syndrome

Answer 33

Autosomal recessive Severe hypokalemia due to defective chloride secretion at the NKCC2 cotransporter in the ascending loop of henle (frusemide) Polyuria, polydipsia, hypokalemia, normotension, weakness

Question 34

Liddell Syndrome

Answer 34

Increased number Na channel in collecting duct which results in increased Na reabsorption and potassium excretion

Question 35

Fibromuscular dysplasia

Answer 35

Female Age 15-40 Severe HTN with evidence of target organ damage Mild hypokaklemic metabolic alkalosis and high renin suggest underlying renovascular hypertension Abdominal bruit Diagnosis: intracellular-arterial digital subtraction angiography - string of beads appearance

Question 36

Most common histology can feature in chronic allograft nephropathy?

Answer 36

Chronic interstitial nephritis

Question 37

Dent Disease

Answer 37

X-linked recessive disorder of the proximal tubules Proteinuria, hypercalciuria, nephrocalcinosis, kidney stones, renal failure, Ricketts Due to mutation in CLCN5 gene

Question 38

Familial renal glycosuria

Answer 38

Mutations in the SLC5A2 gene coding for SGLT2 in the proximal tubule Urine glucose excretion but normal BSL

Question 39

Actions of Atrial Natriuretic Peptide (ANP)

Answer 39

Causes marked natriuresis Lowers BP Inhibits secretion of renin and vasopressin Decreases responsiveness of the kidney to stimuli that would normally increase aldosterone secretion Increased ANP is a/w increased extra cellular fluid volume