Nephrology

Question 1

what is diagnostic of goodpasture syndrome

Answer 1

linear pattern of IgG deposition against glomerular basement membrane

Question 2

Goodpasture syndrome triad

Answer 2

acute glomerulonephritis
pulmonary alveolar haemorrhage
circulating anti GBM antibodies

Question 3

nephronophthisis

Answer 3

AR
causes medullary cystic kidney disease (small kidneys b/l on US)
leading cause childhood ESRD
presents with polyuria and polydipsia

Question 4

When is renal biopsy indicated in HSP

Answer 4

proteinuria - UPCR >200, increasing trend >4/52 after diagnosis
nephrotic syndrome - low alb, oedema and heavy proteinuria
nephritic syndrome - HTN, haematuria, rapidly deteriorating renal function
HTN
Macroscopic haemturia with proteinuria

Question 5

Cystinosis

Answer 5

AR
failure to thrive
recurrent vomiting
metabolic acidosis
hypo K
dehydration

Question 6

grade of VUR

Answer 6

I: urine tracks into ureter non dilation
II: urine tracks into renal pelvis, no dilation
III: mild-moderate dilatation of ureter only
IV: ureteral tortuosity, with pelvicalyceal dilatation
V: gross dilatation and ureteral tortuosity with blunted fornices

Question 7

nephrotic syndrome triad

Answer 7

oedema
proteinuria
hypoalbuminaemia

Question 8

most common type nephrotic syndrome

Answer 8

primary idopathic (90%)
of this 85-90% minimal change disease, carries best prognosis
10-15% focal segmental glomerulosclerosis 10-15%

Question 9

management of nephrotic syndrome

Answer 9

steroids - pred minimum 16 weeks
penicillin prophylaxis
PPI

Question 9

when is nephrotic syndrome classes as steroid resistant

Answer 9

doesn’t respond to 28days of treatment with prednisolone

all steroid resistant require biopsy

Question 10

distal renal tubular acidosis type I vs type IV

Answer 10

I:
reduced H excretion in distal tubule
urine ph >5.5 - can never acidify
nephrocalcinosis
plasma hCO3 <10
low-normal plasma K
high urine ca/cr ratio

IV:
impaired aldosterone action causing reduced H and NH3 excretion
urine Ph >5.5
plasma HCO3 >15
high plasma K
normal urine ca/cr ratio

Question 11

signs pre renal failure over ATN

Answer 11

return of renal function to baseline within 24-72 hrs after fluids
urinary na concentration <20

Question 12

HSP - histology

Answer 12

small vessel vasculitis - skin, GI, kidneys and joints
deposits of IgA in mesangium

Question 13

AD polycystic kidney disease

Answer 13

multiple renal cysts
commonest inherited nephropathy
PKD1 on chromosome 16