Nephrology

Question 1

Glomerulonephritis

Answer 1

Renal biopsies show any changes of glomerulonephritis along with renal scarring from longstanding hypertension or urinary tract infections

Question 2

Nephrogenic Diabetes Insipidus

Answer 2

V2 ADH mutation is usually X linked recessive.
Nephrogenic DI related to vasopressin-2 receptor mutation is X linked. This fits best with only male members of the family being affected by the condition. Nephrogenic DI may also occur as a sporadic condition or be autosomal recessive, although drugs are the commonest precipitants.

Autosomal recessive nephrogenic DI is related to mutations in the aquaporin-2 gene,

Question 3

Nephrotic Syndrome

Answer 3

The triad of proteinuria, hypoalbuminaemia and oedema typifies the nephrotic syndrome.

The minimum threshold for proteinuria which is defined as ‘nephrotic’ is 300 mg/mmol.

Question 4

Symptomatic Nephrotic syndrome caused by membranous nephropathy

Answer 4

Immunosuppression in the form of alternating steroids and cyclophosphamide is indicated in those patients with symptomatic nephrotic syndrome caused by membranous nephropathy

Question 5

ADPKD

Answer 5

Abdominal ultrasound has a sensitivity approaching 100% for autosomal dominant polycystic kidney disease (ADPKD) patients above 20 years of age.

Question 6

Rhabdomyolysis

Answer 6

The biochemical features of rhabdomyolysis are raised creatine kinase, hypocalcaemia (especially early after injury), hyperkalaemia and acute kidney injury.

Question 7

Phosphate excretion in dialysis

Answer 7

Dialysis is able to remove about 2700 mg of phosphate per week in a patient who is anuric. This is half of the normal kidney’s ability.

Question 8

Staghorn calculus ( Struvite)

Answer 8

Ammonium magnesium phosphate
- Associated with proteus infections.
- Urease inhibitors + Abx

Question 9

Renal stones

Answer 9

• Cystine stones- cystinuria
• Oxalate stones- Short Bowel syndrome
• Calcium phosphate stones- Renal tubular acidosis
• Urate stones- Gout
• Struvite stones- Proteus

Question 10

Minimal change disease

Answer 10

Features
- nephrotic syndrome
- normotension - hypertension is rare
- highly selective proteinuria

-Renal biopsy
normal glomeruli on light microscopy.
electron microscopy shows fusion of podocytes and effacement of foot processes

Management
- oral corticosteroids: majority of cases (80%) are steroid-responsive
- cyclophosphamide is the next step for steroid-resistant cases