Nephrology

Question 1

Pathophysiology and renal histology of Anti-GBM disease.

Answer 1

Type 2 immune response of IgG against alpha 3 subunit of type 4 collagen. Linear deposits of IgG on immunoflorescence.

Question 2

Pathophysiology and renal histology of Lupus Nephritis.

Answer 2

Type 3 immune complex formation (anti-DNA) deposition. Full house deposition in mesangium and subendothelial layer.

Question 3

Pathophysiology and renal histology of ANCA Vasculitis.

Answer 3

Autoantibodies against neutrophil granule proteins. Pauci-immune crescentic glomerulonephritis.

Question 4

Pathophysiology and renal histology of Membranous glomerulonephritis.

Answer 4

Type 3 immune complex deposition disease. Subepithelial dense deposits in electron microscopy and spikes on silver staining.

Question 5

Pathophysiology and renal histology of IgA vasculitis.

Answer 5

Type 3 IgA immune complex mediated disease. Globular IgA deposits in the mesangium.

Question 6

Pathophysiology and renal histology of FSGS.

Answer 6

Injury to podocytes through permeability factors. Segmental sclerosis seen on renal biopsy.

Question 7

Contraindications to renal biopsy.

Answer 7

Small hyperechoic kidneys (less than 9 cm), which are generally indicative of chronic irreversible disease

Solitary native kidney

Multiple, bilateral cysts or a renal tumor

Uncorrectable bleeding diathesis

Severe hypertension, which cannot be controlled with antihypertensive medications

Hydronephrosis

Active renal or perirenal infection

Anatomic abnormalities of the kidney which may increase risk (see above)

Skin infection over the biopsy site

An uncooperative patient

Question 8

Absolute contraindications to renal transplant.

Answer 8

Active infections.

Active malignancy.

Active substance abuse.

Reversible renal failure.

Uncontrolled psychiatric disease.

Documented active and ongoing treatment nonadherence.

significantly shortened life expectancy.

Question 9

Relative contraindications to renal transplant.

Answer 9

Significant sun damage 
Significant vascular disease 
History of non adherence
Malnutrition 
Oxalosis
Potential for recurrent kidney disease

Question 10

What is meltzers triad and what does it indicate?

Answer 10

Triad of palpable purpura, arthralgia and myalgia indicating cryoglobulinaemic vasculitis.

Question 11

Describe Liddles Syndrome

Answer 11

Autosomal dominant condition of increased sodium reabsorption and potassium excretion. ClassicL triad of hypertension hypokalaemia and metabolic acidosis. Low renin and aldosterone are seen.

Question 12

Alport Syndrome Summary

Answer 12

X linked disorder characterised by defect in alpha 5 chain of type 4 collagen.

Question 13

What are the most common causes of hypokalaemic periodic paralysis?

Answer 13

Autosomal dominant condition resulting from mutations in sodium and calcium channels

Question 14

What is a chloride responsive metabolic alkalosis? And what causes it?

Answer 14

Urine chloride <20

Gastric losses

Question 15

CMV prophylaxis agent post high risk renal transplant?

Answer 15

Valganciclovir

Question 16

What are the indications for stenting in bilateral renal artery stenosis?

Answer 16

Medical therapy failure
Flash pulmonary oedema
Progressive renal failure
Short duration of hypertension prior to diagnosis

Question 17

Does aminoglycoside induced kidney injury result in oliguric or non-oliguric kidney injury?

Answer 17

Non-oliguric

Question 18

Does AIN result in oliguric or non-oliguric kidney injury? I

Answer 18

Non oliguric

Question 19

Empiric therapy for peritoneal dialysis associated peritonitis?

Answer 19

Gentamicin IP
Cephazolin IP or Vancomycin IP (if MRSA colonised)

Add Metronidazole PO/IV of concern re diverticula disease

Question 20

What are the indications for catheter removal with peritoneal dialysis associated peritonitis?

Answer 20

Refractory disease (>4 days)
Relapsing disease
Refractory exit site infection
Fungal peritonitis

Question 21

A patient has polymicrobial peritonitis associated with peritoneal dialysis. What are the next steps in management?

Answer 21

Add metronidazole to empiric therapy

Surgical referral ?intra-abdominal pathology (ischaemic bone or diverticulitis)

Question 22

What are the five features of HIV associated nephrotic syndrome?

Answer 22

Massive proteinuria 
Normal or large kidneys 
FSGS
Elevated urea and creatinine 
Normotension