Renal

Question 1

Most common type of glomerulonephritis
Usually 20+60s peak
IgG + complement deposits on basement membrane

Answer 1

Membranous gN

Question 2

diffuse proliferative GN
<30 usually
1-3 weeks after strep infection
Nephritic syndrome develops
Usually fully recover

which one

Answer 2

Post streptococcal GN

Question 3

Most common cause of primary glomerulonephritis
GN following sore throat (1-2days following)
Peak 20
IgA deposits + glomerular mesangial proliferation

dx?

Answer 3

IgA nephropathy:
(Berger’s disease)

Question 4

GN + Pulmonary haemorrhage
(Acute kidney failure + haemoptysis + proteinuria)

dx

Answer 4

Goodpastures
Anti-GBM antibodies attack glomerulus + pulmonary basement membranes

Question 5

Nephrotic syndrome - most common in children vs adults

Answer 5

Most common cause is minimal change disease in children = steorids

Most common cause is focal segmental glomerulosclerosis in adults

Question 6

Acute = Presents AKI + HTN
Hypersensitivity reaction to drugs (NSAID/ABx)/ infection usually
Might also have rash/ fever/ eosinophilia
Eosinophilic casts can be seen

diagnosis

Answer 6

interstitial nephritis

Question 7

Most common cause of AKI
7-21 days recovery
Due to ischaemia/toxins
Muddy brown casts

Answer 7

Acute tubular necrosis

Question 8

Screening for PCKD

Answer 8

US

Question 9

Pt presents with anaemia, low platelet count, AKI 5 days after diarrhoea - dx and mx

Answer 9

Haemolytic Uraemic syndrome

Thrombosis in small blood vessels from shiga toxin (e.coli 0157 or shigella - Abx or anti-motility can increase risk HUS with these)

Medical emergency -Anti-HTN, blood transfusions, dialysis

Question 10

Nephrotoxic drugs

Answer 10

NSAIDs, Anti-HTN (ACEi)

Question 11

Treating complications in CKD

Answer 11

Sodium bicarb - met acidosis
Iron + erythropoietin
Vit D - bone disease
Transplant

Question 12

Acute dialysis indications

Answer 12

AEIOU
Acidosis, Electrolyte abnormalities ( ↑K), Intoxication, Oedema (pulm), Uraemia symptoms (seizures)

Question 13

Hyperacute rejection vs acute graft failure vs chronic graft failure

Answer 13

Hyperacute rejection (mins- hours) = due to pre-existing Abs against ABO or HLA antigens. T2 Hs. no tx possible - remove the graft

Acute graft failure <6m = usually asmyp with rising creatinine, pyuria and protienuria

Chronic graft failure >6m

Question 14

Crush injury then…
Myoglobinuria - red-brown urine
U&Es = ↑ K (as phosphate released), AKI
↑ CK
SUspect in crush injury etc

dx, mx

Answer 14

rhabdomyolysis - skeletal muscle breakdown
IV Fluids, Na bicarb, poss mannitol…
Treat high potassium

Question 15

Medications that can cause hyperkalaemia

Answer 15

Aldosterone antag, ACEi, ARBs, NSAIDs, K+ supp

Question 16

Hyperkalaemia ECG signs

Answer 16

Tall tented T waves, flattening/absence P waves, Broad QRS Complexes

Question 17

Tx hyperkalaemia

Answer 17

k</6 = diet + stop meds
K>/6 + ECG changes = urgent Tx
K>6.5 regardless ECG changes = urgent Tx

Insulin + dextrosie = drive carbs to cells to take K+ too
Calcium gluconate = stabilise cardiac membrane and ↓ arrhythmia risk

Also:
Neb salbutamol (temp drive K to cells)
IV F to increase urine output
PO Calcium resonium which works slow to drive K to stools
Sodium bicarb
Dialysis

Question 18

Overdose - what type… and mx
Raised anion gap metabolic acidosis
N&V, tinnitus, headache. In more severe - hyperventilation and 2ry resp alkalosis which over 24hrs can progress to met acidosis and hypokalaemia.

Answer 18

Salicylate poisoning
IV sodium bicarb

Question 19

Primary vs secondary aldosteronism

Answer 19

Primary and secondary aldosteronism can be differentiated by looking at renin levels. If renin is high then a secondary cause is more likely like renal artery stenosis.

Question 20

Intermittent hypertensive episodes with paroxysmal palpitations, sweating, tremors or anxiety

likely diagnosis

Answer 20

Pheochromocytoma