Glomerulonephritis/ Polycystic kidneys

Question 1

What is the normal excretion level of protein in the urine?

Answer 1

< 150mg

Question 2

What is the gold standard test for measuring protein levels in the urine?

Answer 2

24hr urine collection

Question 3

What is the standard practice for the assessment of protein levels in the urine?

Answer 3

1. ACR - Urine albumin creatine ratio

2. PCR - Urine protein creatine ratio

Question 4

Name 5 potential syndromes that abnormalities occurring in the glomerulus may present with

Answer 4

1. Isolated haematuria/ proteinuria or haematoproteinuria
2. Nephrotic syndrome
3. Acute glomerulonephritis (acute nephritic syndrome)
4. Rapidly progressive glomerulonephritis
5. Chronic kidney disease including ESRD

Question 5

What is the most common cause of nephrotic syndrome in children?

Answer 5

Minimal change disease

Question 6

Suggest 2 medications which may cause nephrotic syndrome

Answer 6

1. NSAIDS

2. Penicillamine

Question 7

What are Kimmelstiel-Wilson lesions?

Answer 7

Mesangial nodules seen on renal biopsy that are associated with diabetic nephropathy

Question 8

Outline the classical presentation of a patient with IgA nephropathy

Answer 8

Haematuria occurring 1-3 days after an upper respiratory tract infection

Question 9

Give 2 examples of large vessel vasculitis

Answer 9

1. Takayasu

2. Giant cell arteritis

Question 10

Give 2 examples of medium vessel vasculitis

Answer 10

1. Polyarteritis nodosa

2. Kawasaki disease

Question 11

Recall the 4 types of ANCA associated vasculitis

Answer 11

1. Granulomatosis with polyangitis (Wegener’s)
2. Microscopic polyangitis
3. Eosinophilic granulomatous polyangitis (Churg-Strauss syndrome)
4. Renal limited vasculitis

Question 12

Uric acid crystals on urine microscopy is most commonly seen in what condition?

Answer 12

Tumour lysis syndrome

Question 13

Why do we consider anti-coagulation in heavily proteinuric patients?

Answer 13

Heavy proteinuria causes loss of antithrombin III, proteins C and S through the tubules

Question 14

Outline the 5 management components of a patient with nephrotic syndrome

Answer 14

1. Salt restriction - Advised no salt diet
2. Fluid restriction to 1-1 1/2 L per 24hrs
3. Diuretics
4. Add ACEi/ARB
5. Role of anticoagulation

Question 15

Name 4 autosomal dominant causes of renal cystic disease

Answer 15

1. ADPKD
2. Tuberous sclerosis
3. Von Hippel Lindau Disease
4. Medullary cystic disease

Question 16

Give 2 autosomal recessive causes of renal cystic disease

Answer 16

1. ADPKD

2. Juvenile onset Nephronphthisis

Question 17

Name 2 X linked causes of renal cystic disease

Answer 17

1. Orofacial digital syndrome

2. Chromosomal disorders (Trisomy 13/18/21)

Question 18

Name 3 developmental causes of renal cystic disease

Answer 18

1. Medullary sponge kidney
2. Multicystic dysplastic kidney
3. Pyelocalyceal cysts

Question 19

Name 3 causes of acquired cysts

Answer 19

1. Simple cysts
2. Acquired renal cystic disease
3. Hypokalaemia related cysts

Question 20

Name 3 precautions required for patients that are taking Tolvaptan

Answer 20

1. Patient needs regular blood tests including renal and liver function
2. Patient needs to drink plenty of fluid
3. Annual MRI volume measurement of the kidneys is required