Nephrology

Question 1

Causes of membraneous GN

Answer 1

Idiopathic
Infections: (Hep B, also Hep C, syphillis)
autoimmune (esp. SLE)
Carcinomas
Drugs (Nsaid, Penicillamine-for RA, wilson, lead toxicity)

Question 2

causes of minimal change disease

Answer 2

idiopathic
NSAID
Hodgkin’s disease and other lymphoproliferative disorders

Question 3

caus3GNes of memebranoproliferative GN

Answer 3

immune complex-mediated: infection(esp. HCV +-cros, IE, HBV, "shunt" nephritis, other chronic infections
SLE
Dryos
sjogren's 
Lymphoma
dysproteinemia
C3 GN

Question 4

Focal segmental glomerulosclerosis

Answer 4

idiopathic(? increased soluble urokinase receptor)
HIV
NSAIDs
Lymphomas
Pamidronate
Heroin
congenital
increased filtration from prior nephron loss
obesity
vesicoureteral reflux
anabolic steroid
genetic

Question 5

Five broad types of abnormalities in bone metabolism associated with Chronic renal failure

Answer 5

hyperparathyorid bone disease, leading to excessive bone resorption and cyst formation
osteoporosis, with decreased bone mineral density
osteomalacia
osteosclerosis
adynamic bone disease, where bone formation as well as bone resorption is impaired

Question 6

Mechanism of renal osteodystrophy

Answer 6

decreased production of 1,25 (OH) D3 by the falling kidney function, cause decreased absorption of calcium and phosphate retention and alteration in free calcium levels by the shifts in the calcium phopshate production. this result in decreased calcium levels and high phosphate levels, and both stimulate parathyorid hormone production -Ca by calcium receptor and po4 by a direct effect on gene induciton
secondary hyperparahtyroidism causes osteitis fibrosis cystica due to increased activity of the osteoclasts. also causes osteosclerosis. long standing secondary hyperparathroidism evolves into tertiary hyper parathyroidism, leading to semi - autonomous hypersecretion of parathyroid hormone. osteomalacia is now rarely seen. adynamic bone disease is now incresing and it seems that oovertreating of hyperparathyroidism may be a factor. (some degree of hyperparathyroidism seems to give progection from adynamic bone disease)

Question 7

Contraindications to renal transplant

Answer 7

absolute
1. Malignant disease (2 years of remission after treatment before tansplant considered)
2. severe ischaemic heart disease
3. active vasculitis or anti-basement membrane disease
4. Occlusive aorto - iliac disease
5. Continuing septis
relative
1. older than 75 years
2. high risk of recurrence in tansplant
3. ureteric or bladder ddisease
4. other co-morbidites

Question 8

Contraindications of renal transplant

Answer 8

Absolute:
1. malignant disease (2 years of remission after treatment before transplant consdiered)
2. severe ischaemic heart disease
3. active vasculitis or anti-basement membrane disease
4. occlusive aorto-iliac disease
5. continuing sepsis
relative
1 older than 75 years
2. high risk of recurrence in transplant
3. ureteric or bladder disease (may need ileal conduit inserted before transplant)
4. other co-morbidites

Question 9

acute rejection of kidney transplant?

Answer 9

pulse intravenous methylprednisolone or monoclonal antibody ( muromonab -CD3)