Nephrology

Question 1

Complications of Nephrotic Syndrome

Answer 1

• increased risk of thromboembolism related to loss of antithrombin III and plasminogen in the urine
• deep vein thrombosis, pulmonary embolism
• renal vein thrombosis, resulting in a sudden deterioration in renal function
• hyperlipidaemia
• increasing risk of acute coronary syndrome, stroke etc
• chronic kidney disease
• increased risk of infection due to urinary immunoglobulin loss
• hypocalcaemia (vitamin D and binding protein lost in urine)

Question 2

Haematuria in patient of Coeliac disease

Answer 2

IgA Nephropathy
- other associated conditions include Recent URTI, Alcoholic cirrhosis, Dermatitis herpetiformis, henoch-Schonlein Purpura

Question 3

Markers for poor prognosis in IgA Nephropathy

Answer 3

• Male gender, proteinuria (especially > 2 g/day), hypertension, smoking, hyperlipidaemia, ACE genotype DD

Question 4

Investigation for diagnosis of idiopathic membranous Glomerulonephritis

Answer 4

Anti-Phospholipase A2

Question 5

Most common cause of Peritonitis secondary to Peritoneal dialysis

Answer 5

Coagulase Negative Staphylococcus Epidermidis

Question 6

Cardiac Anomaly a/w ADPKD

Answer 6

Mitral Valve Prolapse

Question 7

Eculizumab

Answer 7

Anti-C5 Monoclonal antibody used for Adult typical HUS

Question 8

Causes of Membranous Glomrulonephritis

Answer 8

• idiopathic: due to anti-phospholipase A2 antibodies
• infections: hepatitis B, malaria, syphilis
  malignancy (in 5-20%): prostate, lung, lymphoma, - leukaemia
• drugs: gold, penicillamine, NSAIDs
• autoimmune diseases: systemic lupus erythematosus (class V disease), thyroiditis, rheumatoid

Question 9

Fanconi Syndrome

Answer 9

Reabsorptive defect in PCT where there is increased excretion of nearly all amino acids, glucose, bicarbonate and phosphate

Question 10

which type of nephropathy is commonly associated with HIV

Answer 10

Focal Segmental Glomerulosclerosis

Question 11

Disorders associated with glomerulonephritis and low serum complement levels

Answer 11

• post-streptococcal glomerulonephritis
• subacute bacterial endocarditis
• systemic lupus erythematosus
• mesangiocapillary glomerulonephritis

Question 12

Wilm’s Tumour Associations

Answer 12

• Beckwith-Wiedemann syndrome
• as part of WAGR syndrome with Aniridia, Genitourinary malformations, mental Retardation
• hemihypertrophy
• around one-third of cases are associated with a - loss-of-function mutation in the WT1 gene on chromosome 11

Question 13

Causes of Nephrogenic DI

Answer 13

• genetic:
  more common form affects the vasopression (ADH) receptor
  less common form results from a mutation in the gene that encodes the aquaporin 2 channel
• electrolytes
  hypercalcaemia
  hypokalaemia
• lithium
  lithium desensitizes the kidney’s ability to respond to ADH in the collecting ducts
• demeclocycline
• tubulo-interstitial disease: obstruction, sickle-cell, pyelonephritis

Question 14

Causes of Cranial DI

Answer 14

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

Question 15

Causes for Diffuse Proliferative Glomerulonephritis

Answer 15

• SLE
• Post-streptococcal Glomerulonephritis

Question 16

Renal Biopsy Finding in Goodpasture Syndrome

Answer 16

linear IgG deposits along the basement membrane

Question 17

Causes of Acute Interstitial Nephritis

Answer 17

• drugs: the most common cause, particularly Antibiotics: penicillin, rifampicin
  NSAIDs
  allopurinol
  furosemide
• systemic disease: SLE, sarcoidosis, and Sjogren’s syndrome
• infection: Hanta virus , staphylococci

Question 18

Renal biopsy in Alport syndrome (X-linked Dominant)

Answer 18

• Electron microscopy: characteristic finding is of the longitudinal splitting of the lamina densa of the glomerular basement membrane, resulting in a ‘basket-weave’ appearance