NEPHROLOGY

Question 1

What is seen on EM for Minimal change disease?

Answer 1

Fusion of podocytes
Effacement of foot processes

Question 2

What are the features of minimal change disease?

Answer 2

• Nephrotic syndrome 2ndry to low albumin
• Normotension

Question 3

What is the most common renal manifestation of SLE?

Answer 3

Diffuse profilerative glomerulonephritis

Question 4

What are the findings on renal biopsy in Diffuse proliferative glomerulonephritis?

Answer 4

Wire loop appearance - endothelial and mesangial proliferation
Immune complex deposition

Question 5

What are the findings on EM in diffuse proliferative glomerulonephritis?

Answer 5

Subendothelial immune complex deposits

Question 6

What is the MoA of Tolvaptan?

Answer 6

Vasopressin V2 receptor antagonist
Rx for ADPKD

Question 7

Which chromosome is the ADPKD 1 located on?

Answer 7

Chromosome 16

Question 8

Which chromosome is the ADPKD 2 located on?

Answer 8

Chromosome 4

Question 9

What is the triad of Haemolytic Uraemic Syndrome?

Answer 9

• AKI
• Microangiopathic haemolytic anaemia
• Thrombocytopenia

Question 10

What are the causes of secondary HUS?

Answer 10

• E.coli - most common cause in children
• Pneumococcal infection
• HIV

Question 11

What are the blood film findings in HUS?

Answer 11

• Schistocytes
• Thrombocytopenia
• Anaemia

Question 12

What is the MoA of Eculizumab?

Answer 12

C5 inhibitor monoclonal antibody

Question 13

What medication is given to prevent calcium renal stones?

Answer 13

Thiazide diurectics - Increases Ca reabsorption

Question 14

What medication is given to prevent Oxalate stones?

Answer 14

• Cholestyramine - reduces urinary oxlate excretion
• Pyridoxine

Question 15

What medication is given to prevent uric acid stones?

Answer 15

Allopurinol

Question 16

What is the MoA of MMF?

Answer 16

Blocks purine synthesis –> inhibits proliferation of B and T cells

Question 17

How does alcohol cause polyuria?

Answer 17

ADH suppression in the posterior pituitary –> reduced aquaporin insertion –> reduced water reabsorption

Question 18

What are the features of nephritic syndrome?

Answer 18

• Haematuria
  Proteinuria
  HTN
  Oligouria

Question 19

What are the causes of rapidly progressive glomerulonephritis?

Answer 19

• Goodpasture’s syndrome
• Wegener’s granulomatosis
• SLE

Question 20

What are the findings on renal biopsy in progressive glomerulonephritis?

Answer 20

Crescenteric glomerulonephritis

Question 21

Alports syndrome is due to a defect in which collagen type?

Answer 21

Type 4 - defect resulting in abnormal GBM

Question 22

What is seen on renal biopsy in Alports syndrome?

Answer 22

Splitting of the lamina densa - basket weave appearance

Question 23

What are the features of Alport’s syndrome?

Answer 23

• Microscopic haematuria
• Renal failure
• B/l sensorineural deafness
• lenticonus - protrusion of lens
• retinitis pigmentosa

Question 24

How does Lithium cause nephrogenic diabetes insipidus?

Answer 24

lithium desensitizes the kidney’s ability to respond to ADH in the collecting ducts

Question 25

What is the MoA of Bicalutamide?

Answer 25

Androgen receptor blocker

Question 26

Which antibody mediates hyperacute rejection?

Answer 26

IgG

Question 27

What type of hypersensitivity reaction is Hyperacute rejection?

Answer 27

Type II

Question 28

What are the features of acute graft failure?

Answer 28

* Rising creatine * Pyuria * Proteinuria

Question 29

Which part of the renal tubule is affected in Fanconi syndrome?

Answer 29

Proximal convuluted tubule

Question 30

What is seen on renal biopsy in membranous glomerulonephritis?

Answer 30

* Spike and dome appearance * Thickened basement membrane with subepithelial electron dense deposits

Question 31

Which antibodies cause membranous glomerulonephritis?

Answer 31

Antiphospholipase A2

Question 32

What are the causes of membranous glomerulonephritis?

Answer 32

* Idiopathic: antiphospholipase A2 * Infection: Malaria, syphillis, Hep B * Malignancy: Prostate, Lung, Lymphoma, Leukemia * Drugs: Gold,penicillamine, NSAIDs * SLE, RA

Question 33

What is the management of membranous glomerulonephritis?

Answer 33

* ACE i * Steroids

Question 34

What causes high plasma aldosterone/renin ratio?

Answer 34

Renal artery stenosis

Question 35

What causes low plasma aldosterone/renin ratio?

Answer 35

Liddle's syndrome (L for Low)

Question 36

What causes high aldosterone and low renin ratio?

Answer 36

Primary hyperaldosteronism

Question 37

What causes raised PSA levels?

Answer 37

* BPH * Prostatitis/UTI * Ejaculation * Vigrous exercise * Urinary retention * Instrumentation of the urinary tract

Question 38

What are the features of Goodpasture's syndrome (Anti - GBM disease)?

Answer 38

* Pulmonary haemorrhage * Rapidly progressive glomerulonephritis

Question 39

What causes anti-GBM disease?

Answer 39

anti-GBM antibodies against Type IV collagen

Question 40

Which HLA is associated with Goodpastures?

Answer 40

HLA DR 2

Question 41

What are the renal biopsy findings in anti-GBM disease?

Answer 41

Linear IgG deposits along the basement membrane **(remember Gs) **

Question 42

What is the management of anti-GBM disease?

Answer 42

* plasma exchange * steroids * cyclophosphamide

Question 43

What are the causes of normal anion gap acidosis?

Answer 43

FUSEDCARS * Fistula * Ureterogastric conduit * Saline * Endocrine (Addison's, hyper PTH) * Diarrhoea * Carbonic anhydrase inhibitors * Ammonium chloride * Renal tubular acidosis * Spironolactone

Question 44

How does IgA nephropathy (Berger's disease) present?

Answer 44

Macroscopic haematuria post URTI 1-2 days post infection

Question 45

What is seen on renal histology in IgA nephropathy?

Answer 45

Mesangial hypercellularity Positive immunofluorescence for IgA and C3

Question 46

What are staghorn (struvite) stones composed of?

Answer 46

Magnesium ammonium phosphate

Question 47

What is the mode of inheritance in Alport's syndrome?

Answer 47

X-linked dominant

Question 48

What is the MoA of Tamsulosin?

Answer 48

Alpha - 1 antagonist - decreases smooth muscle tone

Question 49

What is the MoA of Finasteride?

Answer 49

5 - alpha reductase inhibitor - blocks conversion of testosterone to DHT

Question 50

What are the complications of nephrotic syndrome?

Answer 50

* VTE - due to loss of antithrombin III * Hyperlipidaemia - increased risk of CVE, ACS * CKD * Hypocalcaemia due to loss of Vit D in urine

Question 51

What cardiac abnormality is associated with ADPKD?

Answer 51

Mitral valve prolapse Aortic root dilation Aortic dissection

Question 52

What is the common cause of nephrotic syndrome in young adults?

Answer 52

Focal segmental glomerulosclerosis

Question 53

What are the causes of focal segmental glomerulosclerosis?

Answer 53

* Idiopathic * IgA nephropathy * HIV * Alports syndrome * Sickle cell

Question 54

What are the findings of FSG on renal biopsy?

Answer 54

Effacement of foot processes

Question 55

What is the management of HIV-associated nephropathy?

Answer 55

Antiretroviral therapy

Question 56

What is the management of renal stones?

Answer 56

* 5-10mm - shockwave lithotripsy * 10-20 - shockwave lithotripsy / ureteroscopy * >20mm percutaneous nephrolithotomy

Question 57

What type of stones are semi-opaque on Xray?

Answer 57

Cysteine stones

Question 58

Which stones are radio-lucent?

Answer 58

Urate and xanthine stones

Question 59

What are the features of Acute Interstitial nephritis?

Answer 59

Fever, rash, arthralgia Eosinophilia Mild renal impairment HTN

Question 60

What is seen on urine microscopy in Acute interstitial nephritis?

Answer 60

Sterile pyuria White cell casts

Question 61

Which drugs commonly cause Acute Interstitial nephritis?

Answer 61

Penicillin Rifampicin Antibiotics Furosemide NSAIDs Allopurinol

Question 62

Which systemic diseases cause Acute Interstitial nephritis?

Answer 62

SLE Sarcoidosis Sjogren's

Question 63

What is reabsorbed in the PCT?

Answer 63

Sodium, glucose and amino acids