Nephrology

Question 1

What are the causes of minimal change disease?

Answer 1

Idiopathic - majority of cases
10-20% a cause is demonstrated:
NSAIDs
Rifampicin
Thymoma
Hodgkin's lymphoma
Mono

Question 2

What is the prognosis of minimal change disease?

Answer 2

1/3rd = 1 episode only
1/3rd = infrequent episodes
1/3rd = frequent relapses which stop by childhood

Question 3

How is minimal change disease managed?

Answer 3

80% = steroid-responsive –> cyclophosphamide = the next step for steroid-resistant cases

Question 4

How does IgA nephropathy classically present?

Answer 4

It classically presents as macroscopic haematuria in young people following an upper respiratory tract infection

Question 5

How does post-strep glomerulonephritis present?

Answer 5

While this would also produce a nephritic syndrome, it is more likely in younger patients and occurs 7-14 days after upper respiratory tract infection

Question 6

How is Goodpasture’s syndrome diagnosed?

Answer 6

Presence of anti-glomerular basement membrane antibodies

Question 7

In what condition is immune complex deposition seen?

Answer 7

IgA nephropathy

Question 8

In what condition is splitting of the basement membrane seen?

Answer 8

Alport’s syndrome - abnormality in type IV collagen

Question 9

In what condition is wire looping of capillaries seen?

Answer 9

Diffuse membranous glomerulonephritis

Question 10

What is the role of the PCT?

Answer 10

Sodium resorption

Question 11

Which type of testicular cancer is a raised AFP associated with?

Answer 11

Seminoma

Question 12

What is IgA nephropathy also known as?

Answer 12

Berger’s disease

Question 13

When should ESWL be used to treat renal calculi

Answer 13

Asymptomatic calculi, <1.5cm, with normal renal anatomy

Question 14

How should large staghorn calculi be treated (in normally functioning kidneys)?

Answer 14

Percutaneous nephrolithotomy

Question 15

When should nephrectomy be performed?

Answer 15

When the kidney is functioning at <10% and is symptomatic

Question 16

What should be used if ESWL fails?

Answer 16

Flexible ureterorenoscopy with holmium laser

Question 17

How do cystine calculi usually present?

Answer 17

Ground glass appearance

Recurrent

Question 18

How should cystine calculi be treated?

Answer 18

Alkaline diuresis

Question 19

How does acute interstitial nephritis present?

Answer 19

Eosinophillia, arthralgia, fever - commonly caused by NSAIDS

Question 20

What condition is PSC associated with?

Answer 20

IBD, esp. UC

Question 21

What may complicate PSC?

Answer 21

Cholangiocarcinoma

Question 22

Which type of germ cell tumour responds well to chemo?

Answer 22

Seminomas

Question 23

What is the most common nephrotic syndrome seen in children?

Answer 23

Minimal change disease

Question 24

A renal biopsy fluoresces bright green under polarized light after Congo red staining - what is the diagnosis?

Answer 24

Renal amyloidosis

Question 25

What is the most sensitive test for identifying a colovesical fistula?

Answer 25

CT abdo/pelvis

Question 26

What is the commonest type of renal stone?

Answer 26

Calcium oxalate

Question 27

When there are abnormalities of the urinary tract, what are the most common causative organisms?

Answer 27

1. Pseudomonas aerguinosa | 2. Staph epidermis

Question 28

How may urethral injuries be classified?

Answer 28

Anterior or posterior

Question 29

What is an anterior urethral injury?

Answer 29

Injuries distal to the membranous urethra - most commonly related to blunt trauma to the perineum, e.g. straddle injuries - may present many years later as a stricture

Question 30

What is a posterior urethral injury?

Answer 30

In the membranous or prostatic urethra - most commonly related to major blunt trauma - e.g. RTAs and falls - and are commonly associated with pelvic fractures

Question 31

What is haemolytic uraemic syndrome?

Answer 31

1. Acute renal failure 2. Microangiopathic haemolytic anaemia 3. Thrombocytopenia

Question 32

What is the most common cause of acute renal failure in children?

Answer 32

Haemolytic uraemic syndrome

Question 33

What are >90% of cases of HUS secondary to?

Answer 33

Infection

Question 34

What is the classical presenting feature of HUS?

Answer 34

Profuse diarrhoea that turns bloody in 1-3 days | There is often fever, abdominal pain and vomiting

Question 35

What type of UTI might cause green/blue urine?

Answer 35

Pseudomonas UTI

Question 36

How do you differentiate with ATN and hypovolaemia?

Answer 36

``` ATN = raised urinary sodium Hypovolaemia = very low urinary sodium ```

Question 37

What are the non-cystic presentations of adult polycystic kidney disease?

Answer 37

1. Mitral valve prolapse 2. Intracranial berry aneurysms 3. Colonic diverticula 4. Renal cell carcinoma

Question 38

How long a course of Abx is given if catheterised?

Answer 38

7 days

Question 39

How long of a course of Abx is given if pregnant?

Answer 39

7 days

Question 40

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

Answer 40

Focal Segmental Glomerulosclerosis

Question 41

What procedure should be offered to symptomatic men with BPH with a prostate volume <30g

Answer 41

TUIP - transurethral incision of the prostate

Question 42

When should open prostatectomy be offered?

Answer 42

As an alternative to TURP, TUVP or HoLEP, and only when prostate volume >80g

Question 43

What should be offered to men with prostate cancer whom wish to retain their sexual function?

Answer 43

Bicalutamide - with the trade offs of gynaecomastia and reduced survival