classic presentations

Question 1

A 40-year-old man presents with nephrotic syndrome. Renal biopsy demonstrates sub-epithelial immune complex deposition in the glomerulus

Answer 1

membranous glomerulonephritis

Question 2

casts assoc with nephrotic syndrome

Answer 2

fatty casts

Question 3

A 30-year-old man who is known to have HIV presents with nephrotic syndrome

Answer 3

focal segmental glomerulosclerosis

Question 4

A 45-year-old woman with nephrotic syndrome is noted to have marked loss of subcutaneous tissue from the face

Answer 4

membranoproliferative glomerulonephritis (type II)

caused by persistant activation of alternative complement pathway

Question 5

A 15-year-old presents with nephrotic syndrome. Their blood pressure and renal blood tests are normal

Answer 5

minimal change disease

think kids!

Question 6

causes of rapidly progressive glomerulonephritis

Answer 6

goodpastures (haemoptysis)
wegners (vasculitis rash)
SLE

Question 7

features of rapidly progressive glomerulonephritis

Answer 7

nephritic syndrome
- haematuries with red cell casts, proteinuria, hypertension, oliguria

features specific to underlying cause

• haemoptysis = Goodpastures
• vasculitis rash = GPA

Question 8

longitudinal splitting of the lamina densa of the glomerular basement membrane, resulting in a ‘basket-weave’ appearance on electron microscopy

Answer 8

alports

Question 9

nephritis, sensorineural hearing loss

Answer 9

alports syndrome

Question 10

alports mode of inheritance

Answer 10

X-linked dominant

Question 11

A 30-year-old man presents with haematuria. He is already known to have bilateral sensorineural hearing loss and visual problems

Answer 11

alports

Question 12

5-year-old child develops acute renal failure shortly after being admitted with bloody diarrhoea and fever. Bloods show renal failure, thrombocytopaenia and anaemia

Answer 12

haemolytic uraemic syndrome

Question 13

sore throat two weeks before symptoms start, proteinuria > haematuria, low complement levels

Answer 13

post-streptococcal glomerulonephritis

Question 14

defect in the gene which codes for type IV collagen resulting in an abnormal glomerular-basement membrane (GBM). The disease is more severe in males

Answer 14

alports

Question 15

69 y/o man, lethargy, N+V. only past medical history is prostatism. distended, painful lower abdomen which is dull to percuss. hyperkalaemic, high urea, high creatinine. diagnosis?

Answer 15

obstructive uropathy
-> acute renal failure secondary to urinary retention

*prostatism is characteristic

Question 16

57y/o on haemodialysis, AV fistula in left forearm, pain in left hand + wrist, necrotic ulcer, power is normal + has no constitutional symtpoms. had uneventful dialysis the day before

Answer 16

STEAL syndrome (distal hypoperfusion ischaemic syndrome)

complication of AV fistula, distal ischaemia, pallor, pulseless, ulcers, necrosis