Nephro-urology

Question 1

What condition is low C3 associated with?

Answer 1

Acute post-streptococcoal glomerulonephritis

Question 2

What imaging would you arrange for <6 month old with a non-atypical UTI?

Answer 2

Renal USS in 6 weeks
MCUG if abnormal

Question 3

What imaging would you arrange for a >6 month old with an atypical UTI

Answer 3

Renal USS with acute infection
DMSA in at 6 months

Question 4

Wht imaging would you arrange for <6 month old with a atypical UTI?

Answer 4

Renal USS with acute infection
MCUG when illness resolved
DMSA in 4-6 months

Question 5

What imaging would you arrange for a >6 month old with a non-atypical UTI

Answer 5

No imaging required if this is first infection
If recurrent USS in 6 weeks. DMSA at 4-6 months.

Question 6

What investigations would you arrange ? bilateral hydronephrosis

Answer 6

MAG3 or MCUG to ascertain whether the appearances are the result of obstruction or reflux.

Question 7

Describe posterior urethral valves

Answer 7

abnormal valves attach to the urethral wall leading to obstruction and dilatation of the posterior urethra. Over time the bladder detrusor muscle becomes hypertrophied.
Think if bilateral hydronephrosis

Question 8

What organism is most commonly impilcated in haemolytic uraemic syndrome?

Answer 8

Shiga toxin-producing Escherichia coli

Question 9

What are the causes of CKD?

Answer 9

congenital—malformations, obstructive uropathy, renal dysplasia, reflux nephropathy

metabolic—cystinosis, oxalosis, polycystic kidney disease

glomerulonephritis—focal segmental glomerulosclerosis, congenital nephrotic syndrome, IgA nephropathy

Question 10

Define primary and secondary enuresis

Answer 10

> 5 years and never been dry
5 years, has been dry over 6 months but now wetting.

Question 11

What are the treatement for nocturnal enuresis ?

Answer 11

Behavioural modifications such as regular bladder emptying, ‘lifting’ the children as parents go to bed and walking them to the toilet and motivational approach with ‘star charts’ for younger children. Enuresis alarms—’bell and pad alarm’
If older, small dose desmopressin
If due to bladder instability, oxybutynin

Question 12

What organism is most commonly implicated in formation of renal stones?

Answer 12

Proteus species

Question 13

Describe Alport Syndrome

Answer 13

X-linked dominant mutation (80% of time) of type IV collagen
Kidney failure, deafness, visual problems

Question 14

What are the laboratory findings of Distal RTA (type I)

Answer 14

Urine pH >5.5, hypokalaemia, metabolic acidosis

Question 15

How does RTA type one typically present?

Answer 15

Renal colic, renal stones, faltering growth

Question 16

What are the laboratory findings of Proximal RTA (type II)

Answer 16

Metabolic acidosis, hypokalaemia, Urine pH <5.5
Urine raised bicarb, glucose and amino acids

Question 17

How does Proximal RTA Type II present?

Answer 17

Fanconi Syndrome
Faltering growth and rickets

Question 18

What are the lab findings of Bartter Syndrome?

Answer 18

Hypokalaemic metabolic alkalosis,
May also: hyponatremia, hypochloraemia, hypercalciuria and nephrocalcinosis may also be observed

Question 19

What are the lab findings of RTA type IV?

Answer 19

hyPERkalaemia, mild metabolic acidosis

Question 20

Barter syndrome lab findings in older child suggests what?

Answer 20

Gitelman syndrome

Question 21

What supplements do you need to give patients with CKD? and why?

Answer 21

Iron and erythropoietin - broken kidney doesn’t make
Calcium and Vit D supplement - CKD causes herphosphataemia which leads to hypo calcaemia and vit D deficiency. May also need phosphate binders

Question 22

RTA type 1 is classified as what? and has What lab findings?

Answer 22

Failure to secrete H+ in distal convoluted tubule.
Metabolic acidosis, hyPOkalaemia and urine pH> 5.5

Question 23

RTA type 2 is classsified as what? What are the lab findings?

Answer 23

Failure to resorb bicarbonate in proximal convoluted tubule.
Metabolic acidosis, hyPOkalaemia and urine pH can be <5.5

Question 24

What are the types of polycystic kidney disease?

Answer 24

AR - PKHD1, 6p21–12
AD - PKD1 (16p13) or PKD2 (4q21–23)

Question 25

Describe AR PCKD

Answer 25

a/w with pulmonary hypoplasia due to oligohydramnios
multiple microcysts antenetally
HTN
Kidney failure +/- liver fibrosis and sequelea it (varices) in early childhood

Question 26

Describe AD PCKD

Answer 26

Macrocysts seen on USS
may be asymptomatic and indeed cystless until 4th decade of life
HTN
a/w cystic liver disease, pancreatic cysts and intracranial aneurysms