Renal

Question 1

Which presents with nephritic syndrome - IgA nephropathy or membranous glomerulonephritis

Answer 1

Ig A

Note: membranous GN more likely to present with nephrotic syndrome

Question 2

In a pt with ESRD and anaemia on oral Fe supplementation with transferin sats > 20% and ferritin > 100 what is the next step in mgmt ?

Answer 2

EPO

Not IV Fe replacement

Question 3

Typical presentation of acute interstitial nephritis

Answer 3

Typical clinical features include:

Renal failure with fever
Arthralgia
Eosinophilia
Eosinophiluria

Question 4

Blood pressure in Liddle syndrome and Bartter syndrome

Answer 4

Liddle - elevated BP

Bartter - normal BP

Question 5

Renin and aldosterone in Liddle syndrome?

Answer 5

Low

Note: higher in Bartter and Gitelman

Question 6

Lab value to distinguish Gitelman from Bartter?

Answer 6

Mg - v low in Gitelman and normal/mild dec in Bartter

Question 7

What is the main clinical feature that differentiates RTA type 1 (distal) from type 2 (proximal)

Answer 7

Nephrolithiasis is present in type 1

Note: type 1 is due to failure of acidification of urine at the collecting ducts and hence urine pH is persistently alkaline and favours the precipitation of Ca phos leading to stone formation
type 2 is due to a failure of bicarb reabs but urine can still be acidified by the collecting ducts

Question 8

Complement levels are low in IgA nephropathy T/F

Answer 8

F - they are normal

Contrast to post strep GN where C3 is low and C4 can be slightly low too

Question 9

Type 1 RTA is associated with what drugs?

Answer 9

Li
Amphotericin B

Cisplatin
Toluene

Question 10

Which RTA is associated with Fanconi syndrome?

Answer 10

Type 2

Question 11

Which RTA is assoc with SLE or sickle cell disease?

Answer 11

Type 4

Question 12

Which RTA is assoc with RA and Sjogren’s?

Answer 12

Type 1

Question 13

Which RTA has hyperK?

Answer 13

Type 4

Note: type 2 and 1 have hypoK

Question 14

Lab abnormalities in Bartter syndrome?

Answer 14

Metabolic hypokalaemic alkalosis
Hypercalciuria

Increased renin and aldosterone

Note: normal Mg, normal BP

Question 15

Patients with Bartter syndrome are hypertensive T/F

Answer 15

F - normotensive

Question 16

Membranous GN is assoc with

Answer 16

Malignancy
Medications: penicillamine, GOLD, captopril, and heavy metals (mercury and cadmium)
Autoimmune disease: SLE, thyroid, Rheumatoid arthritis
Hepatitis B
Odd infections - like syphilis, leprosy, HIV, schistosomiasis, malaria
Sickle cell disease

Note: Elderly patients, male more than female. Immune complex deposition with IgG and C3. Nephrotic syndrome is the main presentation

Question 17

Patients with chronic kidney disease who have proteinuria equivalent to ACR ≥70 mg/mmol should have their blood pressure controlled to the target range ____

Answer 17

120-129/<80 mmHg

Note: same target range should be used in patients with diabetes.

Question 18

5 yr mortality of renal artery stenosis

Answer 18

80%

Question 19

Patients with APKD should undergo routine screening for cerebral aneurysms T/F

Answer 19

F

Note: only high risk patients should undergo screening. Indications for screening:
-previous rupture of aneurysm
-concerning neurological symptoms (for example, severe headache)
-positive family history of haemorrhagic stroke or aneurysm.

Question 20

Finding on renal biopsy in post strep GN?

Answer 20

Wire loop lesion

Note: A wire-loop lesion is a capillary loop with immune complex deposition circumferential around the loop. They may also be seen in lupus nephritis.

Question 21

Which is associated with ADPKD AS or MVP?

Answer 21

MVP present in 20% pts with ADPKD

Note: AS is not associated in ADPKD