Nephrology

Question 1

Investigations when assessing glomerulonephritis

Answer 1

Blood- FBC, U&Es, LFT, CRP, immunoglobulins, electrophoresis, complement- C3 and C4, autoantibodies- ANA, ANCA, anti-dsDNA, anti-GBM, blood culture, hepatitis serology, ASOT (for strep)
Urine- MC&S, Bence Jones proteins, RBC casts, A:CR, P:CR
Imaging- CXR, renal ultrasound
Renal biopsy- required for diagnosis

Question 2

Nephritic causes of glomerulonephritis

Answer 2

IgA nephropathy
Henoch-Schonlein purpura 
Post- streptococcal 
Anti-GBM disease
Rapidly progressive GN

Question 3

What is Berger’s disease?

Answer 3

IgA nephropathy

Question 4

Clinical picture of IgA nephropathy

Answer 4

Mesangial deposition of IgA complexes 
Occurs around 12-72 hours after infection- usually URTI
Young men classically
Macroscopic haematuria 
Associated with HSP and coeliac

Question 5

Features of Henoch-Schonlein purpura

Answer 5

Small vessel vasculitis 
Palpable pruritic rash
IgA nephropathy and deposition in skin, joints and gut 
Abdominal pain
Polyarthritis

Question 6

Treatment of IgA nephropathy

Answer 6

Supportive- fluids and analgesia
ACE-i/ ARB to reduce the proteinuria and protect the renal function
Corticosteroids if persistent

Question 7

Diagnosis of IgA nephropathy

Answer 7

Renal biopsy showing IgA deposition in the mesangium

Question 8

Clinical features of post- streptococcal glomerulonephritis

Answer 8

1-2 weeks after streptococcal infection
Evidence of streptococcal infection- low C3 complement levels, raised ASOT and anti-DNAase B
Immune complex formation and inflammation in the glomerulus

Question 9

Treatment for post-streptococcal GN

Answer 9

Supportive

Abx to clear the streptococcus

Question 10

Auto-antibodies in anti-GBM disease

Answer 10

Type IV collagen

Question 11

Presentation of anti-GBM disease

Answer 11

Renal disease- oliguria/ anuria, haematuria, AKI, renal failure
Lung disease- pulmonary haemorrhage, SOB, haemoptysis

Question 12

Treatment for anti-GBM disease

Answer 12

Plasma exchange
Corticosteroids
Cyclophosphamide

Question 13

Causes of rapidly progressive GN

Answer 13

Small vessel/ ANCA vasculitis
Lupus nephritis
Anti-GBM antibodies

Question 14

Primary aetiology of nephrotic syndrome

Answer 14

Minimal change disease, membranous nephropathy, focal segmental glomerulosclerosis, membranoproliferative GN

Question 15

Secondary aetiology of nephrotic syndrome

Answer 15

DM
Lupus nephritis 
Myeloma 
Amyloid
Pre-eclampsia

Question 16

Proteinuria results from

Answer 16

Podocyte pathology

Question 17

Management of nephrotic syndrome

Answer 17

Reduce oedema- fluid and salt restriction, diuresis with loop diuretics
Renal biopsy and then treatment of underlying cause
Biopsy avoided in children unless no response to steroids (not minimal change disease in this case)
Reduce proteinuria- ACE-i/ARB
Heparin/ warfarin

Question 18

Treatment for minimal change disease

Answer 18

Prednisolone 1mg/kg

Question 19

Drugs associated with minimal change disease

Answer 19

Lithium

NSAIDs

Question 20

Commonest glomerulonephritis seen on renal biopsy

Answer 20

Focal segmental glomerulosclerosis FSGS

Question 21

Secondary causes of FSGS

Answer 21

HIV
Heroin
Lithium
Lymphoma
Any cause of decreased kidney mass or number of nephrons- other glomerulonephitides

Question 22

Treatment of FSGS

Answer 22

ACE-i/ARB and blood pressure control in all

Corticosteroids in primary disease

Question 23

Presentation of lupus nephritis

Answer 23

Rash
Photosensitivity
Ulcers
Arthritis
Serositis
CNS effects
Cytopenias 
Renal disease- nephropathy is common

Question 24

Triad in haemolytic uraemic syndrome

Answer 24

Haemolytic anaemia
Low platelets
AKI with haematuria/proteinuria

Question 25

Classical secondary cause of haemolytic uraemic syndrome

Answer 25

Shiga toxin producing Escherichia coli 0157:H7