Qs

Question 1

which condition are angiomyolipomas associated with?

Answer 1

tuberous sclerosis
-> ash leaf spots, white patch of hair, angiofibromas (freckles)

TS also assoc with polycystic kidney

Question 2

why does anaemia occur in ESRD?

Answer 2

healthy kidneys produce erythropoeitin which is the hormone that stimulates production of RBC

reduced erythropoeitin -> reduced RBCs -> anaemia

Question 3

recurrent UTIs, asymtomatic microscopic haematurea, tenderness at costovertebral angle, abdo xray = multiple pre-calyceal calcifications affecting both kidneys, “bunch of grapes” appearance

Answer 3

medullary sponge kidney

benign, mx = increase oral fluid intake

Question 4

which type of collagen is affected in alports syndrome?

Answer 4

type IV - important for integrity of basement membrane

haematuria, hearing loss, lens dislocation

Question 5

pathophysio of renal bone disease

Answer 5

high serum phosphate (not being secreted)
low active vit d (kidneys metabolise vit D)
low calcium due to low vit D (needed for absorption)

high PTH (reacting to low serum Ca + high serum phosphate)
--> secondary hyperparathyroidism

Question 6

why does osteomalacia + ostero sclerosis occure in CKD?

Answer 6

osteomalacia = increased bone turnover without adequate Ca

osteosclerosis = osteoblasts increase to match osteoclasts but low Ca means not properly minerlised

Question 7

where specifically does furosemide act?

Answer 7

Na-K-Cl cotransporter

Question 8

which type of glomerular nephritis is associated with heroin use?

Answer 8

focal segmental

also HIV, obesity

Question 9

foot process fusion

Answer 9

minimal change

Question 10

Which electrolyte disturbance is most characteristically caused by chronic kidney disease?

Answer 10

hypocalcaemia

Question 11

ECG changes in hyperkalaemia

Answer 11

PR prolongation
Tented T waves
widening QRS

–> T wave flattening then sine waves

Question 12

why is insulin involved in the treatment of hyperkalaemia?

Answer 12

insulin cause potassium to shift to the intrecellular space therby reducing serum concentration

Question 13

high uraemia and saddling of ST segments on ECG

Answer 13

uraemia pericarditis

indication for dialysis

Question 14

A 25- year-old man with crescentic IgA presents to the low clearance renal clinic. His latest eGFR is 20mls/min. He asks which renal replacement therapy offers him the best outcomes in terms of mortality.

Answer 14

live donor renal transplant

then brain dead then cardiac dead

Question 15

which glomerulonephritis can be secondary to malignancy?

Answer 15

membranous nephropathy

70% are idiopathic but can be secondary to malignancy, rheumatoid disorders, drugs (NSAIDs)

Question 16

is membranous glomerulonephritis nephrotic or nephritic

Answer 16

nephrOtic

Question 17

histology of membranous glomerulonephritis

Answer 17

IgG + complement deposits on basement membrane

Question 18

A 24- year-old worman with a renal transplant present to the renal clinic with a 24 hour history of dysuria and frequency. A urinary tract infection is suspected.
Which antibiotic should be avoided given the patient’s history?

Answer 18

Trimethoprim

• has the potential for nephrotoxicity with the immunosupressants ciclosporin and Tacrolimus as well as an increased risk of haematological toxicity with azathioprine.
• Serum creatinine may rise due to competition for renal secretion.
• Hyperkalaemia is common in CKD 5 and transplant patients. Patients with renal transplants should avoid all potentially nephrotoxic substances where possible.