Nephrology

Question 1

HIV associated nephropathy features?

Answer 1

1. Enlarged kidneys
2. Raised urea and creatinine
3. Nephrotic syndrome (FSGS)
4. Normotension

Question 2

CKD with large kidneys?

Answer 2

A - amyloidosis, ADPKD
D - diabetes
H - hydronephrosis, HIV associated nephropathy

Question 3

Abiraterone acetate MOA

Answer 3

MOA - blocks cytochrome P450 17 alpha hydroxylase -> blocks synthesis of testosterone from adrenal, testes and prostate

Used in castrate/hormone +/- docetaxel resistant prostate CA

Question 4

Causes of membranous GN?

Answer 4

Primary - anti-phospholipase A2 antibodies (anti-PLAR)

Secondary
Malignancy such as solid tumours (lung, colon, breast, kidney)
Infections: hepatitis B or C, HIB, malaria, syphilis, schistosomiasis
Autoimmune diseases: SLE, sarcoidosis, IBD
Drugs: NSAID’s, captopril, gold, penicillamine, lithium, clopidogrel

Question 5

Complications of nephrotic syndrome?

Answer 5

1. Hypoalbuminemia
2. Fluid overload
3. Loss of ATIII -> DVT, PE, renal vein thromboses
4. Loss of immunoglobulins
5. Hyperlipidemia (increased cholesterol, triglycerides, LDL)

Question 6

Complications of plasma exchange

Answer 6

1. Hypocalcemia
2. Metabolic alkalosis
3. Loss of systemic medications
4. Loss of immunoglobulins
5. Loss of coagulation factor

Question 7

Normal anion gap metabolic acidosis

Answer 7

FUSED CARS
F - fistula (biliary, pancreatic)
U- ureterosigmoidostomy
S- saline administration
E- endocrine (Addison’s ds, hyper PTH)
D- diarrhea
C- carbonic anhydrase inhibitor i.e. acetazolamide
A- ammonium chloride
R- renal tubular acidosis
S- spironolactone

Question 8

Most common cause of genetic nephrogenic DI?

Answer 8

Mutation in the vasopressin receptor (arginine vasopressin 2 receptor - AVPR2 gene on Chromosome Xq28)

Question 9

MOA of finasteride

Answer 9

5 alpha reductase inhibitor
SE: gynecomastia, ejaculation disorders

Question 10

3 organisms associated with staghorn calculi

Answer 10

1) Proteus mirabilis
2) Klebsiella
3) Pseudomonas
All having urease that breaks down urea -> ammonia, thus causing alkalinisation of urine

Question 11

Most common form of SLE nephropathy

Answer 11

Diffuse proliferative glomerulonephritis

Question 12

WHO classification of lupus nephritis

Answer 12

Stage I: normal kidneys
Stage 2: mesangial GN
Stage 3: focal segmental proliferative
Stage 4: diffuse proliferative
Stage 5: membranous GN
Stage 6: sclerosing GN

Question 13

Cystinuria vs cystinosis

Answer 13

Both are autosomal recessive
Cystinuria - defect in the protein transporting cysteine, ornithine, lysine, arginine (COLA)
-> high cystine in the urine => recurrent renal stones (semi-opaque)
Mx: hydration, penicillamine

Cystinosis - abnormal accumulation of cystine in the cells
=> multisystem ds, i.e eyes, brain, kidneys, thyroid, diabetes
=> Fanconi syndrome -> RTA
common in children!