Renal

Question 1

Types of glomerulonephritis

Answer 1

Minimal change disease
Focal segmental glomerulosclerosis
Membranous GN
IgA Nephropathy
Goodpasture's syndrome 
Etc

Question 2

What is nephritic syndrome?

Answer 2

Inflammation in the kidneys, causing haematuria, oliguria, proteinuria, fluid retention

Question 3

Criteria for Nephrotic syndrome

Answer 3

1. Peripheral oedema
2. Proteinuria
3. Low serum albumin
4. Hypercholesterolaemia

Question 4

What is the most common cause of Primary Glomerulonephritis?

Answer 4

IgA Nephropathy

Question 5

What is the most common cause of Glomerulonephritis overall?

Answer 5

Membranous glomerulonephritis

Question 6

At what age does Membranous glomerulonephritis peak?

Answer 6

Bimodal peak- 20s + 60s

Question 7

What is found on histology in Membranous glomerulonephritis?

Answer 7

IgG and complement deposits in basement membrane

Question 8

What is Polycystic Kidney Disease?

Answer 8

Genetic condition where kidneys develop multiple fluid-filled cysts

Question 9

What is the inheritance pattern of Polycystic Kidney Disease?

Answer 9

There is an autosomal dominant and an autosomal recessive type
- AD more common

Question 10

How is Polycystic Kidney Disease diagnosed?

Answer 10

Kidney USS

Genetics

Question 11

Which chromosome is affected in Autosomal recessive Polycystic Kidney Disease?

Answer 11

Chromosome 6

Question 12

Features of Autosomal recessive Polycystic Kidney Disease

Answer 12

Oligohydramnios in pregnancy –> underdevelopment of lungs –> respiratory depression shortly after birth
Dysmorphic features- low set ears, flat nasal bridge
End-stage renal failure before adulthood

Question 13

Complications of Autosomal dominant Polycystic Kidney Disease

Answer 13

Chronic loin pain, hypertension, cardiovascular disease, gross haematuria, renal stones, end-stage renal failure

Question 14

Features of Autosomal dominant Polycystic Kidney Disease

Answer 14

Extra-renal manifestations- cerebral aneurysms, prostatic/ovarian/splenic/pancreatic/hepatic cysts, cardiac valve disease (MR), colonic diverticula, aortic root dilatation

Question 15

What is the mutated gene in Autosomal dominant Polycystic Kidney Disease?

Answer 15

PKD1/2

Question 16

Management of Polycystic Kidney Disease

Answer 16

Tolvaptan- slow progression of cysts and disease
Genetic counselling
Avoid anti-inflammatories + anticoagulation, contact sports
Analgesia for renal colic
Antihypertensives
Dialysis/transplant

Question 17

What regular monitoring is needed in Polycystic Kidney Disease?

Answer 17

USS, renal function, hypertension monitoring

MR angiogram- for intracranial aneurysms

Question 18

General management of Glomerulonephritis

Answer 18

Immunosuppression

BP control- ACEi + ARB

Question 19

Presentation of nephrotic syndrome

Answer 19

Oedema
Frothy urine (proteinuria)

Question 20

Complications of nephrotic syndrome

Answer 20

Thrombosis
Hypertension
Hyperlipidaemia

Question 21

What is the most common cause of nephrotic syndrome in i) children and ii) adults?

Answer 21

Children- Minimal change disease

Adults- Focal segmental glomerulonephritis

Question 22

What is the peak age for IgA nephropathy (Berger’s disease)?

Answer 22

20s

Question 23

Histology findings in IgA nephropathy (Berger’s disease)

Answer 23

IgA deposits and glomerular mesangial proliferation

Question 24

Causes of Membranous glomerulonephritis

Answer 24

Mostly idiopathic

Secondary to malignancy, rheumatoid disorders and drugs (NSAIDs)

Question 25

What is post-streptococcal glomerulonephritis?

Answer 25

Presents 1-3 weeks after strep infection eg tonsilitis/impetigo Nephritic syndrome

Question 26

Aetiology of Goodpasture syndrome

Answer 26

Anti-glomerular basement membrane antibodies attack glomerular and pulmonary basement membrane

Question 27

Features of Goodpasture syndrome

Answer 27

1. Glomerulonephritis | 2. Pulmonary haemorrhage (haemoptysis)

Question 28

Causes of Chronic Kidney Disease

Answer 28

Diabetes, hypertension, age, glomerulonephritis, polycystic kidney disease, meds eg NSAIDs, PPIs, lithium

Question 29

Risk factors for Chronic Kidney Disease

Answer 29

Diabetes, hypertension, age, glomerulonephritis, polycystic kidney disease, meds eg NSAIDs, PPIs, lithium Smoking

Question 30

Presentation of Chronic Kidney Disease

Answer 30

Usually asymptomatic | Pruritus, loss of appetite, nausea, oedema, muscle cramps, peripheral neuropathy, pallor, hypertension

Question 31

How is Chronic Kidney Disease diagnosed?

Answer 31

eGFR- 2 tests 3 months apart

Question 32

Investigations of Chronic Kidney Disease

Answer 32

Urinalysis- proteinuria (urine albumin:creatinine ratio >=3), haematuria eGFR Renal USS

Question 33

Classification of Chronic Kidney Disease

Answer 33

``` By eGFR: 1) >90 2) 60-89 3) 30-59- mild-moderate 4) 15-29- severe 5) <15- kidney failure By albuminuria: 1) Albumin < 30 - A:Cr <3 2) Albumin 30-300 - A:Cr 3-30 3) Albumin < 300 - A:Cr >30 ```

Question 34

Management of Chronic Kidney Disease

Answer 34

``` Slow progression: - Control diabetes + HTN - Treat glomerulonephritis Reduce risk of complications: - Exercise, healthy diet, stop smoking - Reduce water intake - Atorvastatin Treat complications: - Metabolic acidosis- sodium bicarbonate - Anaemia- iron supplement + erythropoeitin - Renal bone disease- vitamin D - Dialysis in end-stage - Renal transplant ```

Question 35

Indications for acute renal dialysis

Answer 35

AEIOU: - Acidosis - Electrolyte abnormality - Intoxication - Oedema - Uraemia

Question 36

What is Acute Kidney Injury?

Answer 36

Acute drop in kidney function - Cr rise >= 25mmol/L in 48hrs - Cr rise >50% in 7 days - Urine output < 0.5ml/hr/kg for 6 hours

Question 37

Risk factors for Acute Kidney Injury

Answer 37

CKD, heart failure, diabetes, liver disease, age > 65, cognitive impairment, nephrotoxic meds (NSAIDs, ACEi), contrast

Question 38

Causes of Acute Kidney Injury

Answer 38

Pre-renal: dehydration, hypotension, heart failure Renal: glomerulonephritis, interstitial nephritis, Acute tubular necrosis Post-renal: kidney stones, masses in abdomen/pelvis, ureter/urethral strictures, enlarged prostate/prostate cancer

Question 39

Investigations of Acute Kidney Injury

Answer 39

Urinalysis, USSKUB

Question 40

Management of Acute Kidney Injury

Answer 40

IV Fluid rehydration Stop nephrotoxic meds Relieve obstruction eg catheter Severe- dialysis

Question 41

Complications of Acute Kidney Injury

Answer 41

Hyperkalaemia, fluid overload, metabolic acidosis | Uraemia --> encephalopathy/pericarditis