Nephrology

Question 1

What does the ureteric bud form?

Answer 1

Renal pelvis, infundiublae, calyces and collecting ducts

Question 2

What does the metenephric mesenchyme form?

Answer 2

Glomerulus, PCT, DCT, Loop of hence

Question 3

In a drowning incident with hypoxia which areas of the kidney will be affected the most?

Answer 3

Loop of henle, PCT

Question 4

What conditions can cause neonatal onset of fanconi syndrome?

Answer 4

Tyrosinaemia, Galactosemia, Mitochondrial disease

Question 5

How do you test for cystinosis?

Answer 5

Elevated cystine levels in WBC and corneal deposits seen by ophthalmology

Question 6

Treatment for corneal deposits in Cystinosis?

Answer 6

Cysteamine (mercaptamine)

Question 7

Which part of the nephron does acetazolamide work?

Answer 7

PCT

Question 8

Which part of the nephron does amiloride work?

Answer 8

CD

Question 9

Which part of the nephron does chlorothiazide work?

Answer 9

DCT

Question 10

Which part of the nephron does spironolactone work?

Answer 10

CD

Question 11

What channel does amiloride work on?

Answer 11

ENAC on the Collecting duct

Question 12

What electrolyte disturbance does Gitelman Syndrome cause?

Answer 12

Hypokalaemia, hypomagnesaemia, Alkalosis, Hypocalciuria

Question 13

What electrolyte disturbance does Bartter syndrome cause?

Answer 13

Polyuria, hypochloraemia, hypokalaemia, alkalosis, hypercalciuria - nephrocalcinosis

Question 14

Equation for Fraction of excreted Na+?

Answer 14

(Urine Na x Plasma Cr)/(Urine Cr x Plasma Na) x 100
Pre-renal <1%
Renal >2%

Question 15

What is the gene for genetically x-linked diabetes insipidus?

Answer 15

AVPR2 gene coding for the ADH receptor

Question 16

Treatment of nephrogenic DI?

Answer 16

Low solute diet
Water
Diuretics - tricks kidney to reabsorb at the PCT

Question 17

What is Liddle Syndrome?

Answer 17

Gain in function of the aldosterone system causing increased Na and excretion of K+ with resulting hypertension.
Treatment low salt diet and amiloride

Question 18

How long can nephritis develop after HSP condition?

Answer 18

3 months

Question 19

What does split thickened glomerular basement membrane with basket weave appearance indicate on histology renal biopsy?

Answer 19

Alport syndrome

Question 20

What is the gene and inheritance for Alport syndrome?

Answer 20

COL4A5 - X linked 80%. Encodes for Type IV collagen which makes up the framework of the basement membrane.
Can be AD and AR - less severe forms

Question 21

What are the extra-renal features of alport syndrome?

Answer 21

Anterior lenticonus, hearing loss, macular abnormalities

Question 22

What is linear IgG staining pathognomonic for on renal biopsy?

Answer 22

Anti-GDM

Question 23

Definition of nephrotic syndrome?

Answer 23

Nephrotic range proteinuria and hypoalbuminaemia or oedema where serum albumin can’t be measured.

Question 24

What is nephrotic range

Answer 24

> 40mg/m2/hr (>1000mg/m2/day)
Urine protein to creatinine ratio >200mg/mmol

Question 25

Which autoantibody is associated with idiopathic membranous nephropathy?

Answer 25

PLA2R- Targets the M type phospholipase A2 receptor (surface of podocyte cell membranes)

Question 26

What is the gene mutation in Gitelman syndrome?

Answer 26

SLA12A3 (NCCT) - Autosomal recessive

Question 27

What test can measure GFR in the hospital?

Answer 27

Plasma disappearance of radio-isotope study - Cr-EDTA

Question 28

What is the Schwartz equation for eGFR

Answer 28

eGFR = 36.5 x height (cm) = serum creatinine (umol/L)

Question 29

What can overestimate your creatinine clearance?

Answer 29

Low muscle mass Tubular secretion of creatinine (eg.nephrotic syndrome/CKD)

Question 30

What gene and inheritance is related to nephropnopthisis?

Answer 30

NPHP - Autosomal recessive Nephrocystin gene

Question 31

What is the classical presentation of nephropnopthisis?

Answer 31

Polyuria Polydipsia Enuresis Bland urine Disproportionate anaemia for degree of CKD Short stature Small kidneys with poor CM differentiation Extra-renal manifestations - Retinitis pigmentosa, visual and developmental delay, cerebellar abnormalities, obesity, polydactyly

Question 32

What is the most common organism involved in spontaneous peritonitis in a nephrotic patient?

Answer 32

Strep. Pneumoniae

Question 33

What electrolyte disturbance can Tacrolimus cause?

Answer 33

hypomagnesaemia, hyperkalaemia

Question 34

Best study modality to look for ectopic ureters or duplex collecting system?

Answer 34

IVU

Question 35

What is the treatment for children on PD who present with suspected peritonitis?

Answer 35

Cefazolin and Ceftazidime (need to cover for gram negative and gram positive organisms until culture returns) If MRSA known vancomycin and ceftazidime

Question 36

What is the gene mutation for congenital nephrotic syndrome?

Answer 36

NPHS1 and NPHS2