Nephrology

Question 1

When to refer to a specialist regarding eGFR

Answer 1

if eGFR falls below 30 or

progressively by > 15 in a year

Question 2

Factors which may affect eGFRn result

Answer 2

pregnancy
muscle mass (e.g. amputees, body-builders)
eating red meat 12 hours prior to the sample being taken

Question 3

eGFR variables

Answer 3

CAGE - Creatinine, Age, Gender, Ethnicity

Question 4

Drugs causing proteinuria

Answer 4

Gold, penicillamine

Question 5

minimal change glomerulonephritis

Answer 5

1st line - prednisolone

2nd cyclophosphamide

Question 6

anti hypertensive choice in CKD

Answer 6

If the urinary albumin:creatinine ratio (ACR) is 30 or more offer an ACE inhibitor as first line treatment. If the ACR is less than 30 then treat them according to current NICE’s guidance on hypertension

Question 7

Wilms’ nephroblastoma

Answer 7

Wilms’ nephroblastoma is one of the most common childhood malignancies. It typically presents in children under 5 years of age, with a median age of 3 years old.

Features
abdominal mass (most common presenting feature)
flank pain
painless haematuria
other features: anorexia, fever
unilateral in 95% of cases
metastases are found in 20% of patients (most commonly lung)

Question 8

Sevelamer

Answer 8

non calcium based phosphate binder

used in high phosphate

Question 9

Minimal change disease prognosis

Answer 9

Prognosis is overall good, although relapse is common. Roughly:
1/3 have just one episode
1/3 have infrequent relapses
1/3 have frequent relapses which stop before adulthood

Question 10

Henoch-Schonlein purpura

Answer 10

SCAR
Skin rash on extensor surface
Colicky abdominal pain
Arthralgia, poly
Renal failure

Question 11

renal artery stenosis

Answer 11

20% increase in serum creatinine when started on an ACE-i