Nephrology

Question 1

What is the classic triad of features in nephrotic syndrome?

Answer 1

Oedema
Proteinuria
Hypoalbuminaemia

Question 2

Why are children with nephrotic syndrome more likely to develop clots?

Answer 2

Low levels of antithrombin III and protein C&S as these are lost across the leaky glomerular filtration system

Question 3

What is the most common cause for developing nephrotic syndrome in children?

Answer 3

Minimal-change disease

Question 4

Which features are considered atypical in nephrotic syndrome?

Answer 4

Age <1 or >10 years
Abnormal renal function
Hypertension
Abnormal complement levels or autoantibody +ve
Macroscopic haematura
Family history

Question 5

What is the treatment for first presentation of nephrotic syndrome

Answer 5

Prednisolone (minimum 16 week course)

Question 6

What is the treatment of steroid resistant nephrotic syndrome?

Answer 6

Steroid sparing agents e.g. tacrolimus, mycophenalate, levamisole, rituximab

Question 7

What is the treatment for frequently relapsing nephrotic syndrome?

Answer 7

Low dose alternative day prednisolone

Question 8

What are the typical presenting features of nephritic syndrome?

Answer 8

Haematuria
Oedema
Oliguria
Mild-Mod proteinuria
HTN

Question 9

What is the most common cause of nephritic syndrome?

Answer 9

Post-streptococcal GN

Question 10

What are the characteristic biochemistry changes in Bartter syndrome?

Answer 10

Low K
Low Cl
High Ca
Metabolic alkalosis

Question 11

What causes Bartter syndrome?

Answer 11

Defective functioning of the Na/K/Cl cotransporter due to a genetic mutation

Question 12

Which part of the nephron is affected in Bartter syndrome?

Answer 12

Thick ascending limb of the loop of Henle

Question 13

What are the characteristic facial features associated with neonatal onset Bartter syndrome?

Answer 13

Triangular face
Protruding ears
Large eyes
Strabismus
Drooping mouth

Question 14

What happens to renin and aldosterone levels in Bartter syndrome?

Answer 14

Elevated

Question 15

What supplements should be given in Bartter syndrome?

Answer 15

Sodium
Potassium chloride
Magnesium (not always)

Question 16

What would be expected in the urinalysis in nephritic syndrome?

Answer 16

RBCs
WBCs
Red cell casts

Question 17

What age does Post streptococcal GN typically effect?

Answer 17

5-9 years

Question 18

How long after a sore throat does Post streptococcal GN typically present?

Answer 18

10-14 days

Question 19

What causes nephritis in Post streptococcal GN?

Answer 19

Immune complex deposition

Question 20

What changes to complement levels are seen in Post streptococcal GN?

Answer 20

Low C3
Normal C4

Question 21

When would C3 be expected to normalise following Post streptococcal GN?

Answer 21

6 weeks

Question 22

If C3 does not normalise after 6 weeks in Post streptococcal GN, what alternative diagnosis shoudl be considered?

Answer 22

MPGN Type II

Question 23

What are the biopsy findings in HSP nephritis?

Answer 23

Polymeric IgA immune complex deposition

Question 24

What are the characteristics of IgA disease involving the kidneys?

Answer 24

Painless macroscopic haematuria precipitated by URTIs

Question 25

What are the complement findings in Type I MPGN?

Answer 25

C3 and C4 low

Question 26

What are the complement findings in Type II MPGN?

Answer 26

C3 low C4 normal

Question 27

What is the treatment for MPGN?

Answer 27

High dose steroids

Question 28

What are the complement levels in FSGS

Answer 28

Normal

Question 29

What are the complement levels in SLE renal disease?

Answer 29

C3 low C4 low

Question 30

What are the features of Alport syndrome?

Answer 30

Nephritis SN Deafness Anterior Lenticonus

Question 31

How is Alport syndrome inherited?

Answer 31

X-linked recessive

Question 32

What is the usual cause of Type I RTA?

Answer 32

Inherited genetic mutation

Question 33

What is usually the cause of Type II RTA?

Answer 33

Metabolic disorder

Question 34

What is the underlying issue in type I RTA which leads to aciduria?

Answer 34

Mutation of transporter on distal tubule, meaning hydrogen ions maintained

Question 35

What is the underlying issue in type II RTA which leads to aciduria?

Answer 35

Defective bicarbonate reabsorption

Question 36

What is usually the urinary pH in type I RTA?

Answer 36

>5.5

Question 37

What is usually the urinary pH in type II RTA?

Answer 37

<5.5

Question 38

How is RTA managed?

Answer 38

Lower dietary intake of acid-forming foods Medications to manage underlying condition Bicarbinate supplements

Question 39

How does RTA I present biochemically?

Answer 39

Severe acidosis with hypokalaemia

Question 41

In a child < 6 months with an E.coli UTI what further investigations should be performed?

Answer 41

USS within 6 weeks

Question 42

In a child < 6 months with a klebsiella UTI what further investigations should be performed?

Answer 42

USS during infection DMSA MCUG

Question 43

In a child >6 months but < 3 years with an E.coli UTI what further investigations should be performed?

Answer 43

Imaging is not usually needed

Question 44

In a child >6 months but < 3 years with a Kebsiella UTI what further investigations should be performed?

Answer 44

USS during acute infection DMSA scan within 4-6 months

Question 45

In a child >6 months but < 3 years with recurrent E.coli UTI what further investigations should be performed?

Answer 45

USS within 6 weeks DMSA scan 4-6 months after infection

Question 46

In a child >3 years with an E.coli UTI what further investigations should be performed?

Answer 46

Not usually indicated

Question 47

In a child >3 years with an recurrent UTI what further investigations should be performed?

Answer 47

USS within 6 weeks DMSA scan 4-6 months after infection

Question 48

In a child >3 years with abnormal kidney function with an e.coli UTI what further investigations should be performed?

Answer 48

USS during acute infection