Nephrology

Question 1

Causes of selective proteinuria

Answer 1

1. minimal change nephrotic $
2. Congenital nephrotic $

Question 2

grades of proteinuria

Answer 2

1. ≥150-500 mg/24 hrs urine → mild proteinuria
   2- > 500 & < 2000 → moderate
   3- ≥ 2000 mg → heavy or massive

Question 3

definition of proteinuria

Answer 3

protein in urine ≥ 150 mg/ 24h urine
( > 40 mg/m2/h )

Question 4

Normal spot urine for protein/creatinine ratio

Answer 4

<0.2mg/mg in children >2 y old
<0.5mg/mg in those 6 ~24 months old

Question 5

The most common cause of persistent proteinuria in school-age children and adolescents

Answer 5

orthostatic proteinuria

occurs in up to 60 % of children with persistent proteinuria
No renal dysfunction whatsoever

Question 6

causes of Glomerular proteinuria

Answer 6

1. Nephrotic syndrome
2. Alport syndrome
3. collagen diseases / vasculitis (HSP - SLE)
4. DM
5. Tumors (Lymphoma - solid tumors)
6. Toxins (Mercury)
7. infections (GABHS - HBV- HCV - IMN)

Question 7

causes of tubulointerstitial proteinuria

Answer 7

1. ATN (Aminoglycosides - NSAID - Radiocontrast)
2. **Acute tubulointerstitial nephritis **(NSAID - Penicillin - cephalosporin)
3. PKD
4. Proximal RTA (Fanconi)
   5.Pyelonephritis
5. Toxins (Lead - copper - Mercury)

Question 8

why does hyperlipidemia occur in nephrotic $

Answer 8

الالبيومين بيقع كتير في البول فالكبد هيحصله اوفر اكتيفيتي فا هيطلع كل منتجاته بزيادة ومن ضمنها الالبيومين والكوليستيرول
فالكزليستيرول هيعلى جامد + ان الكبد مش هيعرف يكسره عشان الكلية بتوقع ال lipoprotein lipase

Question 9

criteria of nephrotic syndrome

Answer 9

1. Heavy selective proteinuria > 40 mg/m2/hour.
2. Hypoproteinemia.
3. Generalized edema.
   +/- Hyperlipidemia.

Question 10

main ccc of nephrotic $

Answer 10

1. ↑ risk of infections
2. hypercoagulability
3. S/E of drugs (HTN & polycythemia dt steroids)
4. Hypovolemic shock

Question 11

most common cause of nephrotic $ in childhood

Answer 11

idiopathic

complete remission following CS therapy

Question 12

indications of genetic testing

Answer 12

1. steroid resistant idiopathic nephrotic $
2. children < 1 year
3. FH pf proteinuria
4. Extrarenal symptoms

Question 13

indications of kidney biopsy

Answer 13

1. Children > 12 years
2. steroid resistant

Question 14

most common cause of nephrotic syndrome in children

Answer 14

minimal change nephrotic syndrome

> 70% between 1 and 8 years , M: F = 2 : 1

Question 15

how to differentiate between different types of edema

Answer 15

1. Renal → Eyelid, extremities then generalized
2. Cardiac → LL then ascites then generalized
3. Hepatic → Ascites then generalized

Question 16

what are common organisms in infections dt nephrotic syndrome

Answer 16

1. Gram -ve eg. E-coli
2. Capsulated eg. pneumococci,

Question 17

most common infection following nephrotic syndrome

Answer 17

Peritonitis

then akin infections & UTI

Question 18

why is there increased risk of infections in nephrotic $

Answer 18

1. Loss of IgG and opsonins in urine
2. Used of steroid
3. Edema and ascites

Question 19

why is there hypercoagulable state in nephrotic $

Answer 19

a) Hemoconcentration (due to edema and ascites + using diuretics).
b) Loss of protein C and S in urine.
c) Decreased fibrinolytic functions.
d) Increased platelets aggregation and thrombocytosis.
e) Precipitated cholesterol on vessel wall.

Question 20

type of proteinuria in nephrotic $

Answer 20

heavy selective

Question 21

DD of minimal change nephrotic $

Answer 21

1. Congenital nephrotic $
2. FSGS
3. Membranous glomerulonephritis
4. membranoproliferative glomerulonephritis
5. secondary dt systemic disease (DM / SLE)

Question 22

Alternatives to steroids in nephrotic $

Answer 22

1. Cyclophosphamide (Endoxan).
2. Calcineurin inhibitors.
   a. Cyclosporine A (Sandimmune)
   b. Tacrolimus (Prograf)
3. Mycophenolate mofetil (Cellcept).
4. Levamisole
5. Rituximab

Question 23

What is the leading cause of acute kidney injury in a nephrotic patient?

Answer 23

hypovolemia

Question 24

definition of hematuria

Answer 24

presence of ≥ 5 RBC per HPF in a 10 ml freshly voided and centrifuged sample

Question 25

what are clinical presentations of glomerular disorders

Answer 25

1. Asymptomatic proteinuria 2. nephrotic syndrome 3. Recurrent hematuria 4. Acute glomerulonephritis 5. rapidly progressive GN 6. Acute RF 7. chronic RF

Question 26

age of presentation of Alport syndrome

Answer 26

5 ~ 20 years ## Footnote renal impairment in 20 ~ 30 years in men

Question 27

diagnosis of IgA nephropathy

Answer 27

predominant IgA deposits in kidney biopsy using immunohistochemical staining (Not serum IgA) ## Footnote M/C in 2nd or 3rd decades M>F

Question 28

Recurrent gross hematuria syndrome:

Answer 28

1. IgA nephropathy 2. Alport syndrome 3.benign familial hematuria

Question 29

enumerate causes of Glomerular hematuria:

Answer 29

1. PSCGN 2. recurrent gross hematuria syndrome 3. MPGN (HUS - SLE) 4. MGN (HSP) 5. Thin BM disease

Question 30

the interval between infection and appearance of hematuria in IgA nephropathy

Answer 30

1 - 2 days ## Footnote compared to 1 - 2 weeks in Poststrept.

Question 31

nephritogenic strain of Group A strept. pyogenes

Answer 31

1. pharyngeal infective 12 2. skin infective 49

Question 32

type of GN in post streptococcal

Answer 32

diffuse proliferative

Question 33

oliguria parameters

Answer 33

1. infants → < 1 ml/kg/hr 2. children → < 0.5 ml/kg//hr 3. Adults → < 400 ml / d Anuria → < 1 ml/kg/day

Question 34

complications of PSCGN

Answer 34

1. HF 2. RF 3. HTN encephalopathy

Question 35

indications for renal biopsy in PSGN

Answer 35

1. Persistently low C3 beyond 8 weeks 2. Persistent heavy proteinuria after 6 months 3. **Atypical presentation:** nephrotic syndrome, severe acute renal failure with estimated *GFR <30ml/min/1.73m2* 4. **Atypical course:** failure of renal functions to improve after initial improvement during the acute phase which usually last no more than 2 weeks

Question 36

M/C cause of ARF

Answer 36

Pre Renal

Question 37

patient has post infectious GN , Hematuria , puffines,.... presented with Tachycardia, what is the first line investigation

Answer 37

Electrolytes

Question 38

patient with CKD for many years, encountered a trauma, then presented with shoulder/ clavicular pain, what is the investigation

Answer 38

PTH

Question 39

second most common cause of FUO in pediatrics

Answer 39

UTI ## Footnote first is Ottitis media

Question 40

Causes of ARF in the newborn

Answer 40

1. Renal Agenesis / dysgenesis 2. NEC 3. RDS + any other causes

Question 41

complications of AKI

Answer 41

1. Volume overload → HF / PE 2. hyperkalemia → Arrythmia 3. GIT bleeding 4. Seizures, coma or behavioral changes

Question 42

significance of Na level in urine analysis

Answer 42

< 30mEq/L pre renal > 30mEq/L renal > 70mEq/L tubular dysfunction

Question 43

when to suspect irreversible renal failure

Answer 43

no diuresis within 2 hours after giving diuretics

Question 44

Treatment of hyperkalemia in ARF

Answer 44

1. IV Ca gluconate 2. NAHCO3 3. K exchange resin 4. in severe cases → Insulin + glucose regimen 5. Dialysis

Question 45

indications of dialysis

Answer 45

1. persistent hyperkalemia 2. Volume overload + refractory pulmonary edema or hypertension 3. Refractory metabolic acidosis 4. Anuria 5. BUN > 100 ~ 150 mg/dl

Question 46

classify stages of CKD according to GFR

Answer 46

**1 → > 90 ml/min/1.73m3** (damage + normal / high GFR) **2 → 89 ~60** (mild decrease) **3 → 59 ~ 30** **4 → 29 ~ 15** **5 → < 15 / dialysis** (kidney failure)

Question 47

what is the mechanism of Renal osteodystrophy in CKD

Answer 47

1. Hypocalcemia & hyperphosphatemia will lead to hyperparathyroidism. 2. Metabolic acidosis will lead to bone resorption. 3. Deficient activation of vitamin D. (α-1 OH)

Question 48

what is the mechanism of Growth retardation in CKD

Answer 48

1. Renal Osteodystrophy 2. ↓ Protein-calorie intake 3. Growth hormone resistance 4. Anemia 5. Metabolic acidosis

Question 49

what is the mechanism of Anemia in CKD

Answer 49

1. Decreased erythropoietin production 2. Bleeding 3. inadequate iron & folate intake. 4. Low grade hemolysis. 5. Aluminum, lead intoxication

Question 50

M/C risk factor for UTI

Answer 50

primary VUR

Question 51

M/S ccc of recurrent UTI

Answer 51

renal scarring

Question 52

regarding cystitis

Answer 52

no fever - no renal insufficiency

Question 53

criteria for diagnosing UTI

Answer 53

1. presence of pyuria 2. 50 000 CFU/ml of a single organism in an appropriately collected specimen of urine

Question 54

indications of VCUG

Answer 54

1. Abnormal US 2. recurrent UTI

Question 55

Acute management of pyelonephritis

Answer 55

Oral antibiotics for 7–10 days. If oral antibiotics cannot be used, use intravenous (IV) antibiotics for 2–4 days followed by oral antibiotics for a total duration of 10 days

Question 56

Acute management of Cystitis

Answer 56

Oral antibiotics for 3 days. If the child is still unwell after 24–48 hours they should be reassessed.