Renal

Question 1

4 subtypes of Rapidly progressive glomerulonephritis

Answer 1

• Diffuse proliferative
• Goodpastures (anti-GBM)
• Microscopic polyangitis
• Granulomatosis with polyangitis

Question 2

Nephrotic syndrome with hepatosplenomegaly most likely what?

Answer 2

Amyloidosis

Question 3

Acanthocytes are found in nephritic or nephrotic syndrome?

Answer 3

Nephritic

Question 4

Most common viral infection after organ transplant?

Answer 4

CMV

Question 5

Tetrad of symptoms in IgA vasculitis (nephropathy) (HSP)? (1 sign on bloods as well)

Answer 5

• Non-thrombocytopenic palpable purpura,
• Arthritis or arthralgia
• Abdominal pain
• Renal disease

Question 6

All patients with CKD should be started on this drug?

Answer 6

Atorvastatin

Question 7

A GFR of between 60 - 90 with no clinical signs/symptoms is what?

Answer 7

Normal kidney function (NOT CKD 1 or 2)

Question 8

Causes of transient or spurious non-visible haematuria (4)

Answer 8

• UTI
• Menstruation
• Vigorous exercise (this normally settles after around 3 days)
• Sex

Question 9

AKI definition (creatinine, urine output) (3)

Answer 9

• Rise in serum creatinine of 26 micromol/litre or greater within 48 hours
• > = 50% rise in serum creatinine in past week
• Fall in urine output to less than 0.5 ml/kg/hour for more than 6 hours in adults

Question 10

Name the 1st and 2nd line drug for proteinuric CKD (> 30 mg/mmol)

Answer 10

• ACEi or ARB
• SGLT2i

Question 11

Drugs which may cause AIN

Answer 11

• Penicillin
• Rifampicin
• NSAIDs
• Allopurinol
• Furosemide

Question 12

AIN histology findings

Answer 12

Marked interstitial oedema and interstitial infiltrate in the connective tissue between renal tubules

Question 13

What disease will have sterile pyuria,
white cell casts an allergic feel (fever, rash, arthralgia, eosinophilia) and HTN?

Answer 13

AIN

Question 14

Non-drug causes of AIN

Answer 14

• Systemic disease: SLE, sarcoidosis, and Sjögren’s syndrome
• Infection: Hanta virus , staphylococci

Question 15

What drugs cause Hyaline casts in urine?

Answer 15

Loop diuretics (Furosemide) (can be normal)

Question 16

Acute tubular necrosis, what is seen in urine?

Answer 16

Brown granular casts

Question 17

What is seen in urine of Prerenal uraemia

Answer 17

‘bland’ urinary sediment

Question 18

Red cell casts seen in what condition (or group of conditions)?

Answer 18

Nephritic

Question 19

Management of high phosphate in CKD
- what is the 1st line MEDICAL management?

Answer 19

• Reduced dietary intake of phosphate (1st line)
• Phosphate binders: Sevelamer (non-calcium based phosphate binder)
• Aluminium and calcium-based binders (less commonly used)

Question 20

How to prevent contrast-induced nephropathy

Answer 20

IV 0.9% NaCl at a rate of 1 mL/kg/hour for 12 hours pre- and post- procedure

Question 21

All mostly nephritic syndromes (4 or 7)

Answer 21

• PSGS
• IgA nephropathy (HSP)
• Alport Syndrome (collagen IV)

Rapidly progressive GN
- Goodpastures
- Diffuse proliferative
- Granulomatosis w. polyangitis
- Microscopic polyangitis)

Question 22

All nephrotic syndromes (5)

Answer 22

• FSGS
• Minimal change
• Membranous nephropathy
• Diabetic glomerulonephropathy
• Amyloidosis

Question 23

Nephritic syndrome with hearing loss

Answer 23

Alports

Question 24

Hemoptysis + Nephritic syndrome

Answer 24

Goodpastures (anti-GBM)
(type of rapidly progressive GN)

Question 25

Nephrotic syndrome associated with spike and dome and Malignancy

Answer 25

Membranous nephropathy

Question 26

Neprhritic syndrome + Crescent formation in Bowmans space and fibrin or macrophage based crescentric expansion

Answer 26

Rapidly progressive GN (Goodpastures, Microscopic polyangitis, granulomatosis w. polyangitis, diffuse proliferative GN)

Question 27

ADH receptor antagonist used in ADPKD and ?SIADH?

Answer 27

Tolvaptan

Question 28

Bacteria associated with bloody diarrhoea and renal impairment

Answer 28

E. coli 157:H7 (HUS syndrome)

Question 29

SIADH causes Hyo or Hypernatremia?

Answer 29

Hyponatremia, high Na+ in urine

Question 30

Nephrogenic DI management

Answer 30

- Thiazides - Low salt/protein diet

Question 31

How is nephrogenic DI inherited?

Answer 31

X linked recessive (usually)

Question 32

Clinically relevant level of ACR (albumin:creatinine) ratio

Answer 32

3 mg/mmol

Question 33

1st line testing of ADPKD

Answer 33

Abdo US

Question 34

Carbamezapine can cause what disease

Answer 34

SIADH

Question 35

How is Henoch-Schonlein purpura usually treated? (Berger's disease), (IgA mediated small vessel vasculitis)

Answer 35

Supportive

Question 36

Chromosome responsible of ADPKD (type 1 and 2)

Answer 36

- Type 1: chr 16 - Type 2: chr 4

Question 37

Anti-phospholipase A2 antibodies cause the idiopathic disease of what?

Answer 37

Membranous nephropathy

Question 38

CKD usually causes small kidneys (AKI, large) - what conditions are an exception to this rule?

Answer 38

- ADPKD - Diabetic nephropathy (early stages) - amyloidosis - HIV-associated nephropathy

Question 39

What nephrotic syndrome is usually seen in kids but has an association with Hodgkins lymphoma/

Answer 39

Minimal change

Question 40

The rapidly progressive GN disease (4 of them) have different features on immunofluorescence, what are they?

Answer 40

- Granulomatosis with polyangitis: Negative or pauci immune - Microscopic polyangitis: Negative or pauci immune - Goodpastures: Linear - Diffuse proliferative: Granular

Question 41

What nephritic syndrome has thickening of glomerular capillaries (e.g. wire loops) and an association with SLE?

Answer 41

Diffuse proliferative GN

Question 42

Management of SIADH (4)

Answer 42

- Correction must be done slowly to avoid precipitating central pontine myelinolysis - Fluid restriction - Demeclocycline: reduces the responsiveness of the collecting tubule cells to ADH - ADH (vasopressin) receptor antagonists (Tolvaptan)

Question 43

Stage 1, 2 and 3 AKI according to creatinine levels

Answer 43

- Stage 1: 1.5-1.9 times baseline (or increase in creatinine by ≥26.5 µmol/L) - Stage 2: 2.0 to 2.9 times baseline - Stage 3 ≥ 3.0 times baseline

Question 44

Stage 1, 2 and 3 AKI according to urine output

Answer 44

Reduction in urine output to <0.5 mL/kg/hour for ≥ 6 hours Reduction in urine output to <0.5 mL/kg/hour for ≥12 hours Reduction in urine output to <0.3 mL/kg/hour for ≥24 hours

Question 45

What is the other criteria beyond urine output and creatinine that can define stage 3 AKI? (2)

Answer 45

- Initiation of kidney replacement therapy - In patients <18 years, decrease in eGFR to <35 mL/min/1.73 m2