Renal

Question 1

Diagnostic test of choice for patients with unexplained haematuria?

Answer 1

CT urography

• allows characterisation of renal tumours and cysts

Question 1

Initial imaging choice for suspected renal artery fibromuscular dysplasia?

Answer 1

CT angiography

Question 2

best 1st line imaging for kidney stones?

Answer 2

US KUB

Question 3

most effective treatment to facilitate the passage of uric acid stones?

Answer 3

urinary alkalinization with potassium citrate

Question 4

when should erythropoietin stimulating agents be used in patients with CKD?

Answer 4

only if Hb <11

• above this, avoid due to increased risk of serious cardiovascular events and stroke

Question 5

isomorphic erythrocytes vs dysmorphic erythrocytes?

Answer 5

dysmorphic erythrocytes (particularly acanthocytes), suggest a glomerular origin

isomorphic erythrocytes suggest a nonglomerular origin of blood

Question 6

leokocyte casts suggestive of?

Answer 6

acute interstitial nephritis, infections

Question 7

erythrocyte casts suggestive of?

Answer 7

glomerulonephritis

Question 8

granular casts suggestive of?

Answer 8

acute tubular necrosis

Question 9

gold standard imaging for diagnosis of kidney stones?

Answer 9

non contrast helical CT

Question 10

indications for kidney biopsy?

Answer 10

• glomerular haematuria
• severely increased albuminuria
• kidney disease of unclear cause
• kidney transplant dysfunction or monitoring

Question 11

initial treatment of primary focal segmental glomerulosclerosis?

Answer 11

high dose glucocorticoids

Question 12

1st line management of primary membranous nephropathy?

Answer 12

conservative mx

• to allow for spontaneous remission in ~30%
  (otherwise need to initiate immunosuppression)

Question 13

tx of minimal change glomerulopathy?

Answer 13

glucocorticoids

Question 14

tx of anti-GBM disease?

Answer 14

pulse glucocorticoids followed by oral prednisolone, and cyclophosphamide

Question 15

treatment of ANCA-associated glomerulonephritis with concomitant pulmonary alveolar haemorrhage?

Answer 15

plasmapheresis

Question 16

What medication delays decline in kidney function in adults at risk for rapidly progressive ADPCKD?

Answer 16

Tolvaptan

Question 17

What are some kidney manifestations of tuberous sclerosis

Answer 17

renal angiomyolipomas, renal cell carcinomas, kidney cysts

Question 18

what genotype confers increased risk of CKD in black patients?

Answer 18

High risk APOL1 genotype

Question 19

management of hepatorenal syndrome?

Answer 19

• discontinue diuretics
• restrict sodium
• vasoconstrictors + albumin infusion

Question 20

1st line therapy of chronic hypertension in pregnancy?

Answer 20

methyldopa, labetalol

Question 21

management of acute onset severe hypertension of preeclampsia?

Answer 21

IV labetalol/ hydralazine
or
oral short acting nifedipine

Question 22

what should you screen for in newly diagnosed membranous nephropathy PLA2R negative?

Answer 22

cancer screening

Question 23

cysts in ESRF?

Answer 23

screen for malignant transformation with yearly US KUB
- ESRF = increased risk of renal cell carcinoma

Question 24

what to give CKD patients with GERD?

Answer 24

famotidine

• avoid PPIs e.g. omeprazole which may contribute to the progression of CKD

Question 25

for chronic hypertension in pregnancy, what is the level above which you would treat?

Answer 25

only treat if SBP >/=160 or DBP >/=110 if there is no end organ damage to avoid overtreatment of hypertension and associated foetal risk

Question 26

tx of symptomatic hypermagnesaemia?

Answer 26

iv calcium gluconate

Question 27

how to calculate urine anion gap?

Answer 27

urine anion gap = urine sodium + K - urine chloride

*if there is acidosis, then normal function of kidneys is to excrete more acid in urine and urine anion gap should be negative (as more chloride being excreted)

Question 28

primary therapeutic intervention in most patients with renal artery stenosis?

Answer 28

medical management
including correction of modifiable CVRF

Question 29

primary therapeutic intervention in most patients with renal artery stenosis?

Answer 29

medical management
including correction of modifiable CVRF

Question 30

in patients with hypophophataemia, what do you expect fractional excretion of phosphorous to be?

Answer 30

<5%

• if >5%, suggests proximal renal tubular phosphate dysfunction

Question 31

most common cause of nephrotic syndrome in Black patients?

Answer 31

Focal segmental glomerulosclerosis

Question 32

what shape are struvite crystals in the urine?

Answer 32

characteristic coffin lid appearance

Question 33

which organisms causes raised urine pH?

Answer 33

proteus, klebsiella, pseudomonas infections

Question 34

1st line treatment of lithium-induced nephrogenic diabetes insipidus?

Answer 34

amiloride
- blocks epithelial sodium channels in the collecting tubule and prevents the uptake of lithium by these cells

Question 35

treatment of salicylate toxicity?

Answer 35

IV sodium bicarbonate
- increases urinary elimination of salicylate

Question 36

IV ferric carboxymaltose can cause this electrolyte derangement?

Answer 36

hypophosphataemia via renal phosphate wasting

Question 37

what substances will not test positive on urine dipstick but are measure in urinary albumin concentration?

Answer 37

monoclonal Ig/ light chains, myoglobin, haemoglobulin

Question 38

prophylactic management in patients with recurrent calcium oxalate kidney stones?

Answer 38

thiazide diuretics
- decrease Ca2+ excretion

Question 39

how can IV acyclovir affect kidneys and cause AKI?

Answer 39

intratubular obstruction from acyclovir crystal precipitation

• prevention and tx: IV fluids

Question 40

what potassium binders can be used to treat hyperK in CKD?

Answer 40

patiromer, sodium zirconium cyclosilicate

Question 41

can you use MMF in pregnancy?

Answer 41

no - teratogenic