Systemic Disease Affecting the Kidneys

Question 1

What defines renovascular disease?

Answer 1

Stenosis of the renal artery or one of its branches

Question 2

What is the most common cause of renovascular disease?

Answer 2

Atherosclerosis

Question 3

What is the second most common cause of renovascular disease after atherosclerosis?

Answer 3

Fibromuscular dysplasia

Question 4

What demographic is fibromuscular dysplasia most likely to affect?

Answer 4

Females aged < 50

Question 5

What percentage of cases of fibromuscular dysplasia are familial? What is significant about these cases?

Answer 5

10% - they are often bilateral

Question 6

In those with bilateral renal artery stenosis, what happens after treatment is given with an ACE inhibitor or ARB?

Answer 6

Decline in renal function, possible AKI

Question 7

How does renovascular disease most commonly present?

Answer 7

Hypertension which is resistant to treatment

Question 8

Patients with renovascular disease can experience ‘flash’ pulmonary oedema - what is meant by this?

Answer 8

Sudden onset pulmonary oedema, with no LV impairment on ECHO

Question 9

What sign of renovascular disease may be detectable on abdominal examination?

Answer 9

Abdominal bruit

Question 10

What is the first line imaging investigation for renovascular disease?

Answer 10

Renal ultrasound + Doppler

Question 11

What happens to the size of a kidney affected by renovascular disease?

Answer 11

It is small

Question 12

What is the gold standard imaging investigation for renovascular disease?

Answer 12

CT/MR angiogram

Question 13

What is the treatment of choice for hypertension management in those with unilateral renal artery stenosis?

Answer 13

ACE inhibitor or ARB

Question 14

When are ACE inhibitors and ARBs contraindicated in renovascular disease?

Answer 14

If the condition is bilateral

Question 15

What are some interventional options for the management of renovascular disease?

Answer 15

Transluminal angioplasty / revascularisation surgery

Question 16

Kimmelstiel-Wilson nodules seen on histology suggests what underlying pathology?

Answer 16

Diabetic nephropathy

Question 17

What are the 4 main stages of diabetic nephropathy?

Answer 17

Elevated GFR / glomerular hyperfiltration / microalbuminuria / nephropathy

Question 18

What defines microalbuminuria?

Answer 18

30-300mg of albumin passed in 24h

Question 19

Patients with diabetes should be screened annually for what, to detect early evidence of renal damage?

Answer 19

Microalbuminuria

Question 20

In diabetics, microalbuminuria gives early warning of impending renal problems, but is also a strong independent risk factor for what?

Answer 20

Cardiovascular disease

Question 21

How can microalbuminuria be detected?

Answer 21

By using specialised dipsticks or an albumin: creatinine ratio

Question 22

In diabetic patients who are positive for microalbuminuria, what treatment is required?

Answer 22

ACE inhibitor or ARB

Question 23

An albumin: creatinine ratio of what suggests microalbuminuria?

Answer 23

> 2.5mg/mmol

Question 24

What is the target blood pressure for all diabetic patients?

Answer 24

< 130/80

Question 25

What is the target blood pressure for diabetic patients with microalbuminuria?

Answer 25

< 125/75

Question 26

Once an ACE inhibitor or ARB has been started, what blood test should be monitored periodically?

Answer 26

U&Es

Question 27

If a diabetic patient is started on an ACE inhibitor or ARB, the medication should be stopped if there is a rise in creatinine of more than what?

Answer 27

20%

Question 28

Other than blood pressure control, what are some other areas of management for microalbuminuria in diabetics?

Answer 28

Good glycaemic control and management of CV risk factors

Question 29

What is an option for RRT in type 1 diabetic patients which is not available to type 2 diabetic patients?

Answer 29

Simultaneous kidney-pancreas transplant

Question 30

What is the most common class of lupus nephritis?

Answer 30

Class IV

Question 31

What is meant by class IV lupus nephritis?

Answer 31

Diffuse proliferative glomerulonephritis

Question 32

Glomeruli showing a 'wire loop' appearance on histology is suggestive of which pathology?

Answer 32

Lupus nephritis

Question 33

How is lupus nephritis managed?

Answer 33

Immunosuppression and tight control of hypertension

Question 34

cANCA and anti-PR3 antibodies are suggestive of which small vessel vasculitis?

Answer 34

GPA

Question 35

pANCA and anti-MPO antibodies are suggestive of which small vessel vasculitis?

Answer 35

MPA and EGPA

Question 36

How is small vessel vasculitis managed?

Answer 36

Immunosuppression +/- plasma exchange

Question 37

What is the 'classic' presentation of myeloma?

Answer 37

Back pain and renal failure

Question 38

What are the two main signs which can be detected on blood testing that are suggestive of myeloma?

Answer 38

Anaemia and hypercalcaemia

Question 39

What blood testing is done specifically to detect myeloma?

Answer 39

Protein electrophoresis and serum free light chains

Question 40

What urine testing is done specifically to detect myeloma?

Answer 40

Bence-Jones proteins

Question 41

How should hypercalcaemia caused by myeloma be managed?

Answer 41

Saline +/- bisphosphonates

Question 42

What are the definitive management options for myeloma?

Answer 42

Chemotherapy or stem cell transplant

Question 43

Regardless of the underlying cause, what are the two main features of haemolytic uraemic syndrome?

Answer 43

Thrombocytopenia and AKI

Question 44

90% of cases of haemolytic uraemic syndrome are due to what?

Answer 44

Infection with E. coli O157

Question 45

If haemolytic uraemic syndrome is caused by infection, what other clinical features will be present?

Answer 45

Abdominal pain and bloody diarrhoea

Question 46

What will be seen on a blood film of someone with haemolytic uraemic syndrome?

Answer 46

Fragmented RBCs (schistocytes)

Question 47

What will be seen on urinalysis of someone with haemolytic uraemic syndrome?

Answer 47

Proteinuria and haematuria

Question 48

What are the two major abnormalities that will be seen on an FBC of someone with haemolytic uraemic syndrome?

Answer 48

Low Hb and platelets

Question 49

The mortality of thrombotic thrombocytopenic purpura is reduced from > 90% to 20% with what treatment?

Answer 49

Plasma exchange

Question 50

The unexplained occurrence of thrombocytopenia and anaemia should prompt immediate consideration of what diagnosis?

Answer 50

Thrombotic thrombocytopenic purpura

Question 51

What additional symptoms may Henoch-Schonlein purpura have over IgA nephropathy?

Answer 51

Purpuric rash (on extensor surfaces), polyarthritis and abdominal pain

Question 52

Immunofluorescence will be positive for what in a skin or renal biopsy of someone with Henoch-Schonlein purpura?

Answer 52

IgA and C3

Question 53

Anti-GBM disease is caused by autoantibodies to what?

Answer 53

Type IV collagen

Question 54

Other than the kidneys, what other body systemic is affected by anti-GBM disease and what symptom does it usually cause?

Answer 54

Respiratory - causes haemoptysis

Question 55

Patients with anti-GBM disease usually present with what?

Answer 55

Haematuria, or nephritic syndrome

Question 56

How is anti-GBM disease treated?

Answer 56

Plasma exchange, steroids +/- cytotoxic immunosuppressants

Question 57

How does amyloidosis affecting the kidneys present?

Answer 57

Proteinuria, or nephrotic syndrome

Question 58

What happens to the size of the kidneys affected by amyloidosis?

Answer 58

Large

Question 59

A renal biopsy which shows positive Congo-red staining with red-green birifringence under polarised light microscopy suggests what diagnosis?

Answer 59

Amyloidosis