nephrology

Question 1

what are the functions of the kidney ?

Answer 1

waste handling
water handling
salt balance
acid/base control
endocrine - RBC, BP, Vit D

Question 2

what is nephrotic syndrome ?

Answer 2

proteinuria - 3+
hypoalbuminaemia
oedema

Question 3

what are typical features of nephrotic syndrome ?

Answer 3

age 2-5
normal BP
resolving microscopic haematuria
normal renal function

Question 4

how do you treat nephrotic syndrome ?

Answer 4

prednisolone 8 weeks

side effects - check varicella status, pneumococcal vaccination

Question 5

what causes steroid resistant nephrotic syndrome ?

Answer 5

acquired - focal segmental glomerulosclerosis FSGS - podocyte loss, inflammation

congenital - infants

Question 6

what causes macroscopic haematuria ?

Answer 6

GN, post infective GN
IGA

UTI
trauma
stones

Question 7

what causes microscopic haematuria ?

Answer 7

GN, post infection GN
IGA

UTI
trauma
stones

Question 8

what is nephritic syndrome ?

Answer 8

haematuria
proteinuria
reduced GFR - oliguria, fluid overload, hypertension, worsening renal failure

Question 9

what causes glomerulonephritis ?

Answer 9

post infective
HSP/ IgA nephropathy
membranoproliferative GN
Lupus nephritis
ANCA positive vasculitis

Question 10

what is the usual causative organism of post-infective GN ?

Answer 10

group A strep
beta haemolytic

throat 7-10 days
skin 2-4 weeks

Question 11

how is post infective strep diagnosed ?

Answer 11

bacterial culture
positive ASOT
low C3 normalises

self-limiting

Question 12

how do you treat post-infective GN ?

Answer 12

antibiotics
support renal function
diuretics if overload/ hypertension

Question 13

when is IgA nephropathy seen ?

Answer 13

1-2 days after URTI
usually older children/adults
most common glomerulonephritis

Question 14

what are clinical signs of IgA nephropathy ?

Answer 14

recurrent macroscopic/ +/- microscopic haematuria

varying degree of proteinuria

Question 15

how do you treat IgA nephropathy ?

Answer 15

mild - ACEi
moderate to severe - immunosuppression

outcomes variable 25% ESRF by 10 yrs

Question 16

what are features of Henoch Schonlein purpura IgA related vasculitis ?

Answer 16

mandatory palpable purpura

1 of;
abdominal pain
renal involvement
arthritis or arthralgia
biopsy - IgA deposition

Question 17

how do you treat IgA vasculitis ?

Answer 17

symptomatic
glucocorticoids may help with GI involvement
immunosuppression
long term hypertension and proteinuria screening

Question 18

how do you manage AKI ?

Answer 18

3Ms
monitor - urine output, PEWs, BP, weight
maintain - good hydration
minimise - drugs

Question 19

what are different intrinsic renal problems and what causes them ?

Answer 19

glomerular disease - HUS, GN
tubular injury - acute tubular necrosis - hypoperfusion, drugs
interstitial nephritis - NSAIDs, autoimmune

Question 20

what is haemolytic-uraemic syndrome ?

Answer 20

typical post diarrhoea
E.coli

pneumococcal infection
drugs

Question 21

what is the triad of haemolytic-uraemic syndrome ?

Answer 21

microangiopathic haemolytic anaemia
thrombocytopenia
AKI

Question 22

what are the grades of vesico-ureteric reflux ?

Answer 22

1 - ureter only
2 - ureter, pelvis, calyces
3- dilatation ureter
4 - moderate dilatation of ureter
5 - gross dilatation

Question 23

what factors affect progression of CKD ?

Answer 23

late referral
hypertension
proteinuria
high intake of protein, phosphate, salt
bone health
acidosis
recurrent UTIs

Question 24

what is Potter’s sequence ?

Answer 24

decreased amniotic fluid
pulmonary hypoplasia
fetal compression
bilateral renal agenesis
AR polycycstic kidney disease

Question 25

what is Alport syndrome ?

Answer 25

glomerular basement membrane disease
collagen 4 abnormalities
X linked dominant inheritance

Question 26

what is the presentation of Alport syndrome ?

Answer 26

heamaturia
proteinuria
hypertension
rena failure in early adult life
deafness
eye changes - lenticonous, macular changes