Clinical Disorders

Question 1

What are the features of glomerulonephritis?

Answer 1

Haematuria
Proteinuria
Hypertension
Renal insufficiency

Question 2

Differential diagnosis for nephrotic syndrome?

Answer 2

Congestive heart failure

Hepatic disease

Question 3

Two classifications of glomerulonephritis?

Answer 3

Proliferative

Non-proliferative

Question 4

Diffuse?
Focal?
Global?
Segmental?

Answer 4

Diffuse >50% of glomeruli
Focal <50% of glomeruli
Global: all the glomerulus
Segmental: part of the glomerulus

Question 5

Types of proliferative glomerulonephritis?

Answer 5

Post infective
IgA nephropathy
Focal necrotising and crescentic
Anti-GBM disease

Question 6

Types of non-proliferative glomerulonephritis?

Answer 6

Minimal change disease
Focal and segmental
Membranous nephropathy

Question 7

How might proliferative glomerulonephritis present?

Answer 7

With nephritic syndrome
Blood on STIX
Variable proteinuria
Can cause rapid decline

Early diagnosis and treatment key

Question 8

How might non-proliferative glomerulonephritis present?

Answer 8

Present with nephrotic syndrome
Renal biopsy is key investigation
Identify cause if possible

Question 9

Post-infective glomerulonephritis treatment?

Answer 9

Antibiotics for infection
Loop diuretics for oedema (frusemide)
Vasodilators for hypertension (amlodipine)

Question 10

What is the commonest cause of glomerulonephritis?

Answer 10

IgA nephropathy

IgA deposition in mesangium

Question 11

Anti-GBM disease management?

Answer 11

Aggressive immunosuppression:
Steroids
Plasma exchange
Cyclophosphamide (cytotoxic)

Question 12

Crescentic glomerulonephritis management?

Answer 12

Immunosuppression:
Corticosteroids
Plasma exchange
Cyclophosphamide
B-cell therapy
Complement inhibitors

Question 13

Nephrotic syndrome management?

Answer 13

General measures:
Treat oedema, hypertension
Reduce risk of thrombosis, infection
Treat dyslipidemia (statins)

Question 14

Minimal change disease management?

Answer 14

Prednisolone, taper once remission achieved
Initial relapse treated with further steroids
Subsequent relapses cyclophosphamide, cyclosporin, tacrolimus

Question 15

Focal and segmental glomerulosclerosis management?

Answer 15

General measures
Trial of steroids
Alternatives: cyclosporin, cyclophosphamide, rituximab

Question 16

Membranous nephropathy management?

Answer 16

General measures for 6 months
Immunosuppression if symptomatic nephrotic syndrome
Cyclophosphamide and steroids alternate for 6 months
Cyclosporine, rituximab

Question 17

What crosses the glomerular basement membrane (GBM)?

Answer 17

Water
Electrolytes
Urea
Creatinine

Question 18

What crosses the GBM but is reabsorbed in the proximal tubule?

Answer 18

Glucose

Low molecular weight proteins (α₂ microglobulin)

Question 19

What does not cross the GBM?

Answer 19

Cells (RBC, WBC)

High molecular weight proteins (albumin, globulins)

Question 20

CKD definition?

Answer 20

Either:
eGFR<60 ml/min/1.73m²
or
The presence of kidney damage that is present for >3 months

Question 21

What is the clinical approach to CKD?

Answer 21

Detection of underlying aetiology
Slowing rate of renal decline
Assessment of complications related to reduced eGFR
Preparation for renal replacement therapy

Question 22

Investigations in CKD?

Answer 22

Bloods: EUC, FBC, COAG, LFT, CK, IGS, SEP, BIC
Urine: STIX, PCR, ACR, 24hr
Histology: Biopsy
Radiology: Ultrasound

Question 23

Slowing the rate of renal decline?

Answer 23

BP control
Control proteinuria
Treat underlying cause

Question 24

Complications related to reduced eGFR? and treatment?

Answer 24

Acidosis - bicarb
Anaemia - EPO and iron
Bone disease - diet and phosphate binders
CV risk - BP, aspirin, etc
Death and dialysis - counsel
Electrolytes - diet, drugs?
Fluid overload - salt, fluid restrictions, diuretics
Gout - optimise meds
Hypertension - weight, diet, fluid balance, drugs
Iatrogenic issues - be aware

Question 25

Preparation for end stage renal disease and replacement therapy?

Answer 25

Education

Selection of modality e.g. HD/PD/transplant/conservative

Question 26

AKI definition?

Answer 26

Increase in serum Creatinine by >26.5 within 48hrs or to >1.5x baseline within the last 7 days
or
Urine volume <0.5 ml/kg/h for 6 hours

Question 27

Dangerous consequences of AKI?

Answer 27

AEIOU
Acidosis
Electrolyte imbalance
Intoxication
Overload
Uraemic complications

Question 28

Three types of AKI?

Answer 28

Pre-renal
Intrinsic
Post-renal

Question 29

Causes of pre-renal AKI?

Answer 29

Volume depletion
Hypotension/shock
Congestive cardiac failure
Arterial occlusion
NSAIDs/ACE inhibitors

Question 30

Causes of renal (intrinsic) AKI?

Answer 30

Acute tubular necrosis
Toxin-related
Acute interstitial nephritis
Acute glomerulonephritis
Myeloma
Intra renal vascular obstruction

Question 31

Causes of post-renal AKI?

Answer 31

Obstruction

intraluminal, intramural, extramural

Question 32

What is radiocontrast nephropathy (RCN)?

Answer 32

AKI following administration of iodinated contrast agent
Usually transient, resolving in 72hrs
Can lead to permanent loss of function

Question 33

Risk factors for RCN?

Answer 33

Diabetes mellitus
Renovascular disease
Impaired renal function
Paraprotein
High volume of radiocontrast

Question 34

Patients at risk of AKI?

Answer 34

STOP
Sepsis
Toxins
Optimise BP and volume
Prevent harm

Question 35

5 R’s for IV prescribing?

Answer 35

Resuscitation
Routine maintenance
Replacement
Redistribution
Reassessment

Question 36

What is Goodpasture’s syndrome?

Answer 36

Nephritis with lung haemorrhage