Nephrology

Question 1

Clinical presentaion - granulomatosis with polyangiitis

Answer 1

Upper respiratory tract: epistaxis, sinusitis, nasal crusting
Lower respiratory tract: dyspnoea, haemoptysis
Glomerulonephritis
Saddle-shape nose deformity

Question 2

Clinical presentation - goodpasture’s syndrome

Answer 2

Haemoptysis
Systemically unwell: fever, nausea
Glomerulonephritis

Question 3

Fts of Henoch-Schonlein purpura

Answer 3

• children, following an infection
• palpable purpuric rash (+localized oedema) over buttocks and extensor surfaces of arms and legs
• abdo pain
• polyarthritis
• +/- IgA nephropathy = haematuria, renal failure

Question 4

Main cause of nephrotic syndrome in children

Answer 4

minimal change disease

Question 5

Fts of minimal change disease

Answer 5

• nephrotic syndrome
• normotension
• highly selective proteinuria (only intermediate-sized proteins - albumin, transferrin)
• renal biopsy = normal on light microscopy; electron microsscopy shows fusion of podocytes and effacement of foot processes

Question 6

Prognosis for minimal change disease (roughly)

Answer 6

1/3 1x episode only
1/3 infrequent relapses
1/3 frequent relapses, stop before adulthood

Question 7

Mx of minimal change disease

Answer 7

oral corticosteroids

if resistant: cyclophosphamide

Question 8

Main causes of minimal change disease

Answer 8

most (80-90%) idiopathic
drugs: NSAIDs, rifampicin
Hodgkin’s lymphoma, thymoma
infectious mononucleosis