Nephrology

Question 1

Fever, rash, eosinophilia, renal impairment, HTN

White cell casts

Answer 1

Acute interstitial nephritis

Question 2

Vitamin def - CKD vs AKI

Answer 2

CKD = hypocal (reduced Vit D)

Question 3

Drugs to stop in AKI

Answer 3

As may worsen AKI; NSAIDs, Aminoglycosides, ACEi, ARBs, Diuretics

Due to risk of Tox; Metformin, Lithium, Digoxin

Question 4

Pre-renal Uraemia vs ATN

Answer 4

Pre-Renal - Kidneys hold on to sodium - Urine Na <20 good response to fluid challenge

ATN - Urine Na >40

Question 5

AKI staging

Answer 5

1 - inc Cr 1.5-1.9 or > 26.5. UO < 0.5ml/kg/hr for > 6hr

2 - 2-2.9, UO < 0.5 12 hr

3 - > 3, Cr > 350, UO < 0.3ml/kg for > 24hr

Question 6

ADPKD ft and asso

Answer 6

Ft; HTN, recurrent UTI, flank pain, haematuria, palpable kidneys

Extra-renal manif; liver cysts, berry aneurisms

Question 7

Child; microscopic haematuria, progressive renal F, bilat deafness

Answer 7

Alport syndrome - Abnormal GBM

typical Q - failing renal transplant - presence of anti-GMB abs

Question 8

Raised Anion Gap metab aci

Answer 8

= gap > 14

Lactic aci, excess ketones, renal failure (raised urate)

Question 9

Normal anion gan metab aci (8-14)

Answer 9

GI bicarb loss (diarrhoea)
RTN
Addisons

Question 10

Dietary advice CKD

Answer 10

Low prot/Phos/Na/Ke

Question 11

GFR and CKD staging

Answer 11

1 - eGFR > 90 but signs of damage
2- 60-90 but signs
3a - 45-59
3b - 30-44
4 - 15-29
5 - <15

Question 12

Child - AKI, MAHA, Thrombocytopenia

Answer 12

HUS - Shiga EColi (O157:H7)
Supportive Tx

Question 13

Child, recent infection - palpable purpuric rash/oedema over buttocs and extensor surfaces, abdo pain, polyarthritis, haematuria

Answer 13

HSP

Tx - supportive, self-limiting condiiton

Question 14

Macroscopic haematuria in kid 1-2 days after URTI

Answer 14

IgA Nephropathy

Tx - supportive -> ACEi -> SteroidsC

Question 15

Causes of peritonitis in Peritoneal dialysis

Answer 15

Coag-neg Staph Epidermidis (or Staph A)
Tx - Van/teicoplanin + Ceftizidime

Question 16

Visible heameaturia, proteinuria/oedema, TN, oliguria, recnt URTI

Answer 16

Post-strep Glomeruloneph
Dev 1-2 W following URTI

Blood - raised anti-streptolysin O titre
renal biopsy - immunofluorescence = ‘starry sky’

Question 17

Immunosupp regime in renal transplant

Answer 17

initial: ciclosporin/tacrolimus with a monoclonal antibody

maintenance: ciclosporin/tacrolimus with MMF or sirolimus

Question 18

AKI with v high creatinine, Raised CK, hypocal, hyperphos, hyperkal, metab acidosis, myoglobbinuria

Answer 18

Rhabdomyolysis

Question 19

SEs Spiro

Answer 19

Hyperkal, gynaecomastia

Question 20

Most common cause of nephrotic syndro in adults

Answer 20

Focal segmented glomerulonephritis

Bloods - hyperlipidaemia