Nephrology

Question 1

What is the anion gap formula?

Answer 1

(Na+K)-(Cl+HCO3)

Question 2

What is a common cause of HUS?

Answer 2

E coli 0157:H7

Question 3

What can happen if you use 0.9% Sodium Chloride in large volumes?

Answer 3

risk of hyperchloraemic metabolic acidosis

Question 4

Dietary advice of CKD patients?

Answer 4

Low protein
Low phosphate
Low sodium
Low potassium

Question 5

What cancer risk is increased due to renal transplant?

Answer 5

Squamous cell cancer of the skin

Question 5

What are some causes of a raised anion gap?

Answer 5

1) lactate:
2) ketones:
3) urate: renal failure
4) acid poisoning: salicylates, methanol

Question 6

What acid-base balance does vomiting result in?

Answer 6

Hypochloraemic, hypokalaemia metabolic alkalosis

Question 7

What acid-base balance does diarrhoea result in?

Answer 7

hyperchloraemic metabolic acidosis

Question 8

Daily glucose requirement in fluids?

Answer 8

50-100g/day

Question 9

What is the treatment of IgA nephropathy?

Answer 9

1) minimal proteinuria or isolated haematuria with normal GFR then nothing
2) If persistent proteinuria or slightly reduced GFR-> ACEi
3) If active disease not responding to ACEi-> immunosuppression with corticosteroids

Question 10

What is the most common causative organism of peritonitis in patients of Continuous Ambulatory Peritoneal Dialysis (CAPD)?

Answer 10

Staphylococcus epidermidis

Question 11

What is the management of peritonitis due to CAPD?

Answer 11

1) vancomycin (or teicoplanin) + ceftazidime added to dialysis fluid
2) OR vancomycin added to dialysis fluid + ciprofloxacin by mouth

Question 12

What do kidneys look like on the ultrasound of someone with chronic kidney disease?

Answer 12

Bilateral small kidneys

Question 13

What are the variables included in Modification of Diet in Renal Disease Equation

Answer 13

eGFR variables -
(CAGE)
Creatinine
Age
Gender
Ethnicity

Question 14

What is a hyperacute transplant rejection normally due to?

Answer 14

Hyperacute transplant rejection is caused by pre-existing antibodies against ABO or HLA antigens

Question 15

What is the treatment of PCKD?

Answer 15

Tolvaptan
If:
- CKD 2, 3
Rapidly progressing disease

Question 15

When should ACE inhibitors be stopped in CKD?

Answer 15

1) decrease in eGFR of up to 25%
2) a rise in creatinine of up to 30%

Question 16

What are the key features of HUS?

Answer 16

1) AKI
2) Microangiopathic haemolytic anaemia
3) Thrombocytopenia

NOTE: think child following diarrhoeal illness (E. coli)

Question 17

What are the causes of cranial diabetes insipidus?

Answer 17

1) idiopathic
2) post head injury
3) pituitary surgery
3) craniopharyngiomas
4) infiltrative (histiocytosis X or
sarcoidosis)
5) haemochromatosis
6) DIDMOAD is the association of cranial Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness (also known as Wolfram’s syndrome)

Question 18

What are the causes of nephrogenic diabetes insipidus?

Answer 18

1) genetic:
2)electrolytes (hypercalcaemia or
hypokalaemia)
3)lithium
4) demeclocycline
5) tubulo-interstitial disease: obstruction, sickle-cell, pyelonephritis

Question 19

What is the management of diabetes insipidus?

Answer 19

nephrogenic:
- thiazides
- low salt/protein diet
Central:
desmopressin

Question 20

What is the management of HUS?

Answer 20

treatment is supportive e.g. Fluids, blood transfusion and dialysis if required

Question 21

What is the management of rhabdomyolysis?

Answer 21

1) IV fluids to maintain good urine output
2) urinary alkalinization is sometimes used

Question 22

What are some causes of raised lactate anion gap?

Answer 22

• shock
• sepsis
• hypoxia
• metormin

Question 23

What are some causes of raised ketone anion gap?

Answer 23

• DKA
• Alcohol

Question 24

What are some causes of acid poisoning raised anion gap?

Answer 24

methanol or salicylate

Question 25

What are causes of urate raised anion gap?

Answer 25

renal failure