Renal

Question 1

Glomerular BM collagen

Answer 1

TIV

Question 2

Immunofluorescence pattern glomerular disease

Answer 2

granular - immune complexes
linear - auto antibodies against GBM

Question 3

Post strep glomerulonephritis

Answer 3

acute proliferative glomerulonephritis
1-4 weeks post infection (nephritic)
TIII hypersensitivity
pyogenic exotoxin B
inc anti strep AB, dec C3
malaise, fever, haematuria, periorbital oedema
95% kids recover

Question 4

Post staph glomerulonephritis AB

Answer 4

IgA (rather than IgM)

Question 5

Rapidly progressive GN

Answer 5

severe oliguria and signs nephritic
T1 anti GBM ABs e.g. goodpastures
T2 immune complex e.g. post infective
T3 pauci immune, anca
Tx steroids and cytotoxic
can be fatal

Question 6

Morphology rapidly progressive GN

Answer 6

crescents - proliferative parietal epitelium bowmans capsule with monocytes an macrophages
fibrin strands between layers in crescents
ruptures in GBM

Question 7

Diagnostic criteria nephrotic

Answer 7

massive proteinurea (3.5g/d)
Hypoalbuminaemia
Oedema
Hyperlipidaemia and lipiduria

Question 8

Membranous nephropathy

Answer 8

nephrotic
accumulation Ig causing thickening glomerular capillary wall
75% primary
secondary - gold, penicillamine, captopril
doesn’t respond steroids

Question 9

Minimal change disease

Answer 9

most frequent nephrotic in children
age 2-6
benign
responsive to steroids
massive proteinuria, no HTN

Question 10

Focal segmental glomerulosclerosis

Answer 10

most frequent nephrotic in adults
primary or secondary
minimally responsive to steroids
20% develop renal failure in 2y

Question 11

Membranoproliferative glomerulonehritis

Answer 11

nephrotic and nephritic
GBM thickened tram track like
T1 IgG and complement
T2 alternate complement (dense deposit disease)
poor prognosis 50% ERF

Question 12

IgA nephropathy (bergers)

Answer 12

most common glomerulonephritis
IgA deposits in mesangial cells and recurrent haematuria
renal failure over 20y

Question 13

Allport syndrome

Answer 13

hereditory nephritis
genes encoding TIV collagen
haematuria and slowly progressive proteinuria

Question 14

ATN

Answer 14

causes 50% ARF hospitalised pateints
ischaemic or toxic injury
Ischaemia - PCT and LOH
cast deposition - DCT
toxic 95% recovery, shock related - 50% mort

Question 15

ATN clinical course

Answer 15

initiation phase - 36h, initial insult, slight dec UO
maintenance phase - inc K, metabolic acidosis, oliguria, Na and H2O overload
recovery phase - dec K and Na, massive diuresis

Question 16

Morphology tubointerstitial nephritis

Answer 16

acute - interstitial oedema, leukocytes
chronic - interstitial fbrosis, mononuclear leukocytes, tubular atrophy

Question 17

Signs tubointerstitial nephritis

Answer 17

no nephritic or nephrotic
defects tubular function with salt wasting and metabolic acidosis

Question 18

% UTI gram -ve

Answer 18

85%

Question 19

Cause viral pyelonephritis

Answer 19

polyomavirus (mainly post kidney transplant)

Question 20

Complications pyelonephritis

Answer 20

papillary necrosis (DM, sickle, obstructive)
pyonephrosis (with almost complete obstruction)
perinephric abscess

Question 21

Causes chronnic pyelonephritis

Answer 21

reflux - most common
obstruction

Question 22

Drug induced nephritis

Answer 22

15d post exposure
fever, eosinophilia, rash
TIV reaction
50% inc creatinine, oliguria

Question 23

Malignant nephrosclerosis

Answer 23

assoc HTN malig
fibrinoid necrosis arterioles and hyperplastic arteriolitis (onion skinning)
5y survival 75%, normal renal function 50%

Question 24

Renal artery stenosis

Answer 24

70% due to atheroma origin renal art
other fibromuscular dysplasia age 30-40

Question 25

Calcium oxalate and phosphate stones

Answer 25

70%
55% have normal blood calcium
radioopaque
furosemide, aetazolamide, antacids, glucocorticoids, crohns

Question 26

Magnesium ammonium phosphate stones

Answer 26

15-20%
struvite, staghorn
urea splitting bacteria (proteus)
inc pH urine

Question 27

Uric acid stones

Answer 27

5-10%
50% idiopathic
acidic urine
radiolucent

Question 28

Cysteine stones

Answer 28

1-2%
form in acidic urine
genetic defect reabsorption AAs

Question 30

Urine in hepatorenalsyndrome

Answer 30

Hyperosmolar
Low in sodium
No proteins

Question 31

Type of hypersensitivity post strep

Answer 31

Rheumatic fever - II
Glomerulonephritis - III

Question 32

Triad tubulointerstitial nephritis

Answer 32

15d post exposure
Rash, fever, eosinophilia

Question 33

Renal problem associated HIV

Answer 33

FSGS

Question 34

Buffer urine chronic acidosis

Answer 34

Ammonia
(Normally phosphate predominant)