Nephrology

Question 0

Alport’s patient

failing renal transplant

Answer 0

anti-GBM antibodies –> Goodpasture’s syndrome like picture

Question 1

What are the eGFR cut-offs for CKD?

Answer 1

1       > 90
2       60 - 90
3a     45 - 60
3b     30 - 45
4       15 - 30
5        < 15

Question 2

Hyperacute Graft Rejection

Answer 2

Mins - hrs
pre-existent antibodies against donor HLA type 1 antigens (a type II hypersensitivity reaction)
… rarely seen due to HLA matching

Question 3

Acute Graft Failure

Answer 3

< 6 months
May be reversible with steroids or immunosup

1. mismatched HLA –> CD8 Tc (cell mediated)
2. CMV infection

Question 4

Chronic Graft Failure

Answer 4

> 6 months

1. Antibody mediated
2. Cell mediated

Both –> fibrosis of transplant (allograft nephropathy)

3. Recurrence of original disease
   Minimal change > IgA > focal segmental

Question 5

Post renal transplant

Malaise, jaundice, lymphadenopathy, hepatomegaly

Answer 5

Cytomegalovirus

…most common and important viral infection in solid organ transplant recipients

Question 6

Renal Cell Carcinoma

Answer 6

Visible haematuria
loin pain
abdominal mass
pyrexia of unknown origin
left varicocele (due to occlusion of left testicular vein)
If secrete hormones:
-- polycythaemia (epo)
-- high calcium (PTH)
-- high BP (renin)
-- Cushing's (ectopic ACTH)

25% have metastases at presentation

Question 7

60-year-old
visible haematuria 
ache in loin 
left varicocele
Fever

Answer 7

Renal Cell Carcinoma

Question 8

Variables in MDRD equation for eGFR

Answer 8

Modification of Diet in Renal Disease equation (MDRD) = CAGE

Creatinine (serum)
Age
Gender
Ethnicity

Also affected by pregnancy, muscle mass (amputees, body builders) and red meat eaten 12h prior to sample.

Question 9

CKD Stage 1

Answer 9

GFR > 90
mild renal impariment (U&E, protein)

asymptomatic

Question 10

CKD Stage 2

Answer 10

GFR 60 - 89
mild renal impariment (U&E, protein)

hypertension, proteinuria

Question 11

CKD Stage 3

Answer 11

GFR 30 - 59
moderate renal impariment (U&E, protein)

anaemia, early bone disease

Question 12

CKD Stage 4

Answer 12

GFR 15 - 29
severe renal impariment (U&E, protein)

fatigue, swelling, nausea, vomiting

Question 13

CKD Stage 5

Answer 13

GFR < 15
renal failure

dialysis or transplant required

Question 14

Nephrotic Syndrome

What are the key features?

Answer 14

heavy proteinuria (likely to be > 3g/d)
odema
low albumin
high cholesterol

NB. must involve a glomerular lesion in order for protein to get out of the kidney

Question 15

Nephrotic Syndrome

Causes

Answer 15

Systemic:

• DM
• SLE
• Amyloid
• Myeloma
• HIV, hepatitis

Renal:

• Minimal Change disease (progressing to Focal Segmental Glomerulosclerosis
• Membranous GN
• Vasculitidies

Question 16

Nephritic Syndrome

What are the key features?

Answer 16

heavy haematuria (micro or macro) and red cell casts

proteinuria
hypertension
oliguria (<300ml/day)

Question 17

Nephritic Syndrome

Causes

Answer 17

Renal:

• post-strep GN
• IgA nephropathy
• rapidly progressive GN
• membranoproliferative GN

Vasculidities

• Goodpasture’s
• MPA
• Churg Strauss
• HSP

Question 18

Acute Tubular Necrosis

Causes

Answer 18

1. ) TOXIC
   - Hb, myoglobin
   - drugs - aminoglycosides, cisplatin, ethylene glycol (antifreeze)
2. ) ISCHAEMIA
   - hypoperfusion
   - renal artery stenosis
   - renal artery embolism

Question 19

Acute Interstitial Nephritis

Causes

Answer 19

• pyelonephritis
• allergic reaction to meds:
  - penicillin, cephalexin, rifampicin
  - NSAIDs
  - sulfa drugs
  - quinolones
  - diuretics
  - allopurinol
  - phenytoin

Question 20

Nephrotoxic Drugs

Answer 20

Meds which interfere with autoregulation: ACEi, ARBs, ciclosporin, NSAIDs, tacrolimus

Antibiotics: aminoglycosides, sulfonamides, amphotericin B, foscarnet, quinolones (cipro, levo), rifampicin, tetracycline, IV acyclovir, pentamidine, vancomycin

Chemo: cisplatin, methotrexate, mitomycin, cyclosporine, ifosphamide, zolendronate

Heavy metals: mercury, lead, arsenic, bismuth, lithium

Statins

chronic stimulant laxatives (volume depletion)

Radiographic Contrast

Chinese herbals containing aristocholic acid
Cocaine, Heroin, Methamphetamine, Methadone

Cimetidine
Fenofibrate (Tricor)
Trimethoprim