Nephrology

Question 1

Why does nephrotic syndrome lead to a hypercoagulable state?

Answer 1

Loss of antithrombin III in the kidneys (causing antithrombin III deficiency) + plasminogen

Question 2

What can you see bartter’s and gittelman’s syndrome like?

Answer 2

Bartter’s mimics loop diuretics (acts on NKCC2 channel)

Gittelmann’s syndrome acts like thiazide diuretics (acts on ENaC channels)

Question 3

What is the metabolic disturbance in bartter’s syndrome?

Answer 3

metabolic alkalosis

Hypokalaemia

Question 4

What type of stone do proteus bacteria cause?

Answer 4

Struvite stones (staghorn) which form in alkaline urine (proteus produces ammonia)

Question 5

give two causes of renal artery stenosis

Answer 5

Atherosclerosis

Fibromuscular dysplasia

Question 6

What is seen in fibromuscular dysplasia on MR angiography?

Answer 6

String of beads

Question 7

What does a normal water deprivation test show?

Answer 7

Increase in urine osmolality

Question 8

What drug not to prescribe with statins + why?

Answer 8

Clarithromycin

Risk of rhabdomyolysis

Question 9

What is the commonest/most severe form of renal disease in SLE?

Answer 9

Diffuse proliferative glomerulonephritis

Question 10

What is the commonest cause of glomerulonephritis worldwide?

Answer 10

Berger’s disease (IgA nephropathy)

Question 11

How to differentiate IgA nephropathy from post strep glomerulonephritis?

Answer 11

IgA: develops 1-2 days after URTI; macroscopic hameturia

post-streptococcal GN: 1-2 weeks after URTI, proteinuria = predominant

Question 12

Common presentation of IgA nephropathy?

Answer 12

young male, with recurrent macroscopic haematuria

Question 13

Management of IgA nephropathy?

Answer 13

If isolated haematuria (+ no or minimal proteinuria) –> no Tx; just f/u

Persistent proteinuria –> ACE inhibitor

If falling eGFR –> immunosuppression

Question 14

causes of metabolic alkalosis

Answer 14

Cushing's syndrome
diuretics
primary hyperaldosteronism
liquorice
Bartter's syndrome
hypokalaemia
carbenoxolone
vomiting / aspiration

Question 15

Causes of metabolic acidosis

Answer 15

acetazolamide
Addison's disease
renal tubular acidosis
diarrhoea
ammonium chloride injection
fistula
ureterosigmoidostomy

Question 16

What are the broad causes of renal AKI

Answer 16

Glomerulonephritis

Tubulointerstitial disease (Acute interstitial nephritis
Acute tubular necrosis
Light chain cast nephropathy
Nephrotoxic anticancer agents
Tumour infiltration (RCC)
Tumour lysis syndrome)

Vascular

Question 17

What are the two broad cause of acute tubular necrosis?

Answer 17

(1) Ischaemia (shock, sepsis)

2) nephrotoxins (aminoglycosides, myoglobin [rhabdo], radiocontrast agents, lead

Question 18

What is the appearance of diffuse proliferative glomerulonephritis on light microscopy?

Answer 18

Wire loop appearance

Question 19

Commonest glomerulonephritis caused by SLE?

Answer 19

diffuse proliferative glomerulonephritis

Question 20

What might be seen on renal USS on unilateral Renal artery stenosis?

Answer 20

Small kidney on affected side

Question 21

In renal transplant what is Acute rejection within?

Answer 21

Within 6 months

Question 22

Eye complication in VHL?

Answer 22

Retinal haemorrhages (may present as sudden loss eyesight - if vitreous haemorrhage)