Nephrology

Question 1

What is post-streptococcal glomerulonephritis?

Answer 1

Type of glomerulonephritis that occurs 1-2 weeks after a URTI and sore throat - causes haematuria, oliguria, oedema, hypertension, variable proteinuria and abnormal renal function

Question 2

What are the causes of acute glomerulonephritis?

(6)

Answer 2

• Post-streptococcal
• C3 glomerulopathy
• IgA nephropathy
• SLE
• Subacute bacterial endocarditis
• Shunt nephritis

Question 3

What investigations should be done for suspected post-strep glomerulonephritis?

(4)

Answer 3

• Urine dip (haematuria +/- proteinuria) and microscopy (RBC casts)
• Throat swabs
• Bloods (FBC, U&Es, bone profile, ASOT/anti-DNAse B, complement C3/C4, autoantibody screen incl. ANA)
• Renal USS

Question 4

What is the management of post-streptococcal glomerulonephritis?

(4)

Answer 4

• Accurate fluid balance with daily weights
• If oliguric - fluid restrict to insensible losses (400ml/m2) + urine output
• Consider furosemide (1-2mg/kg BD)
• 10 day course of penicillin

Question 5

What is Alport Syndrome?

Answer 5

Genetic condition caused by mutations in the COL4A(3/4/5) genes resulting in abnormal type IV collagen affecting ears/eyes and kidneys

Question 6

What age group does Alport Syndrome tend to present in?

Answer 6

Infancy/teenage years
- this is because type IV collagen subunit 3,4 and 5 only form in this age group (it’s subunits 1 and 2 that are present in babies)

Question 7

What are the presenting features of Alport syndrome?

Answer 7

Kidney - microscopic (progressing to gross) haematuria +/- proteinuria
Eyes - myopia, nearsightedness, lens opacification
Ears - sensioneural hearing loss

Question 8

How is the diagnosis of Alport syndrome confirmed?

Answer 8

Kidney or skin biopsy sent for immunohistochemistry

Question 9

What is the management of Alport syndrome?

(3)

Answer 9

Kidney - ACE inhibitors; or dialysis/transplant if severe

Eyes - replacement lens for anterior lenticonus

Question 10

How do you differentiate between cranial DI and nephrogenic DI?

Answer 10

When desmopressin is given:
- if there is no response to urine osmolality (ie. kidneys still aren’t able to concentrate urine) = nephrogenic DI
- if there is a response to urine osmolality = cranial DI

Question 11

What are the indications for albumin infusion in nephrotic syndrome?

Answer 11

Symptomatic hypovolaemia (eg CRT 5secs)
Severe diuretic-resistant oedema