Nephrology

Question 1

what are the causes of cranial DI?

Answer 1

• idiopathic
• post head injury
• pituitary surgery
• craniopharyngiomas
• infiltrative histiocytosis X/sarcoidosis
• haemochromatosis

Question 2

what are the causes of nephrogenic DI?

Answer 2

• genetic
• electrolytes (hypercalcaemia, hypokalaemia)
• lithium - desensitises kidney’s ability to respond to ADH in the collecting ducts
• demeclocycline
• tubulo-interstitial disease: obstruction, sickle-cell, pyelonephritis

Question 3

investigations for DI?

Answer 3

• high plasma osmolality, low urine osmolality
• urine osmolal >700mOsm/kg excludes DI
• water deprivation test

Question 4

what is the management of nephrogenic DI?

Answer 4

• thiazides
• low salt/protein diet

Question 5

what is membranous glomerulonephritis?

Answer 5

presents with nephrotic syndrome or proteinuria
commonest type of glomerulonephritis in adults
3rd most common cause of ESRF

Question 6

what are the causes of membranous glomerulonephritis?

Answer 6

idiopathic
infections - hep B, malaria, syphilis
malignancy - prostate, lung, lymphoma, leukaemia
drugs - gold, penicillamine, NSAIDs
autoimmune disease

Question 7

what is seen on renal biopsy in membranous glomerulonephritis?

Answer 7

spike and dome appearance - BM thickened with subepithelial electron dense deposits

Question 8

what is the management for membranous glomerulonephritis?

Answer 8

ACE-i or ARB
immunosuppression
consider anticoag

Question 9

what is the triad of HUS?

Answer 9

acute kidney injury
microangiopathic haemolytic anaemia
thrombocytopenia
-> usually post diarrhoeal illness

Question 10

what is the management for proteinuria in CKD? (ACR >30)

Answer 10

ace inhibitor eg ramipril

Question 10

what are the indications for haemodialysis in AKI?

Answer 10

hyperkalaemia
pulmonary oedema
acidosis
uraemia

Question 10

how does minimal change disease present?

Answer 10

nephrotic syndrome
normotension
highly selective proteinuria
renal biopsy - EM shows fusion of podocytes and effacement of foot processes

Question 10

how does IgA nephropathy present?

Answer 10

macroscopic haematuria in young people following an URTI

Question 11

how is anaemia managed in CKD?

Answer 11

1. correct iron deficiency
2. start erythropoiesis-stimulating agents

Question 13

What are the severe manifestations of uraemia?

Answer 13

Pericarditis
Encephalopathy

Question 14

How is potassium removed from the body after the initial tx for hyperkalaemia?

Answer 14

Calcium resonium
Enemas more effective than oral

Question 15

How does renal cell carcinoma present?

Answer 15

Triad - flank pain, flank mass and haematuria

Question 16

What are varicoceles sometimes associated with?

Answer 16

Renal cell carcinomas

Question 17

What medication should be used to prevent recurrent hyperkalaemia?

Answer 17

Calcium resonium

Question 18

Which medications may be stopped in AKI (depending on circumstances)?

Answer 18

MELD - MEtformin, Lithium, Digoxin

Question 19

Which medications should definitely be stopped in AKI?

Answer 19

NADA: NSAIDs, ACEI/ARBs, Diuretics (except some exceptions), aminoglycosides (eg gent)

Question 20

What is the most common viral infection in solid organ transplant recipients?

Answer 20

Cytomegalovirus

Question 21

When should aspirin be stopped in AKI?

Answer 21

When they’re on the 300mg analgesic dose not the 75mg prophylactic dose

Question 22

What are the causes of minimal change disease?

Answer 22

Drugs - NSAIDs, rifampicin Hodgkins lymphoma, thymoma Infectious mononucleosis

Question 23

What is 1st and 2nd line management for minimal change disease?

Answer 23

1. Prednisolone 2. Cyclophosphamide in steroid-resistant cases

Question 24

What do hyaline casts on urinalysis suggest?

Answer 24

Normal, after exercise, during fever or with loop diuretics

Question 25

What do brown granular casts suggest on urinalysis?

Answer 25

Acute tubular necrosis

Question 26

What is seen on urinalysis in pre renal uraemia?

Answer 26

Bland urinary sediment

Question 27

When are red cell casts seen?

Answer 27

Nephritic syndrome

Question 28

What is the best investigation for ADPKD?

Answer 28

Ultrasound

Question 29

What are the variables for calculating eGFR?

Answer 29

CAGE Creatinine Age Gender Ethnicity

Question 30

What renal condition is associated with HIV?

Answer 30

HIVAN - causes collapsing focal segmental glomerulosclerosis - presents as a nephrotic syndrome

Question 31

Which organism is most likely to cause peritonitis secondary to peritoneal dialysis?

Answer 31

Staph epiermidis (or other coagulase-negative staph)

Question 32

What investigation is performed in diabetics to assess for diabetic nephropathy?

Answer 32

ACR early morning specimen

Question 33

pulmonary haemorrhage, rapidly progressive glomerulonephritis

Answer 33

goodpasture's syndrome/anti-GBM disease

Question 34

findings on renal biopsy in anti-GBM?

Answer 34

linear IgG deposits along the basement membrane

Question 35

management for hyperacute transplant rejection?

Answer 35

removal of the transplant

Question 36

features of acute interstitial nephritis?

Answer 36

fever, rash, arthralgia eosinophilia mild renal impairment hypertension

Question 37

what is seen on urine microscopy in acute interstitial nephritis?

Answer 37

white cell casts

Question 38

IgA nephropathy presentation?

Answer 38

URTI preceding presentation by a couple of DAYS macroscopic haematuria

Question 39

post-strep glomerulonephritis presentation?

Answer 39

develops 1-2 WEEKS after URTI haematuria + proteinuria low complement

Question 40

screening test for adult PKD?

Answer 40

USS

Question 41

renal failure, sensorineural hearing loss and ocular abnormalities in a child?

Answer 41

alport syndrome

Question 42

management for minimal change disease?

Answer 42

prednisolone

Question 43

drug causes of polyuria?

Answer 43

lithium diuretics, caffeine, alcohol

Question 44

most likely organism in peritonitis secondary to Peritoneal Dialysis?

Answer 44

staphylococcus epidermis

Question 45

what is dialysis disequilibrium syndrome?

Answer 45

unclear mechanism post dialysis cerebral oedema

Question 46

formula for calculating the anion gap?

Answer 46

sodium and potassium minus chloride and bicarb (Na + K+) - (Cl + HCO3)

Question 47

clinical features of acute interstitial nephritis?

Answer 47

triad of rash, fever and eosinophilia