renal

Question 1

haemolytic uraemic syndrome causative organism

Answer 1

e. coli 0157:H7

Question 2

HUS triad

Answer 2

AKI
microangiopathic haemolytic anaemia
thrombocytopenia

Question 3

rhabdomyolysis blood results: (5)

Answer 3

raised CK (at least x5 upper limit of normal)
hypocalcaemia (myoglobin binds calcium)
elevated phosphate (released from myocytes)
hyperkalaemia
metabolic acidosis

Question 4

how to differentiate AKI vs CKD (2)

Answer 4

USS - CKD have small kidneys*
hypocalcaemia (due to low vit D)

• exceptions:
• PCKD
• early diabetic nephropathy
• amyloidosis
• HIV associated nephropathy

Question 5

most common cause of death for CKD pts on haemodialysis

Answer 5

IHD

Question 6

stage 1 AKI
i. creatinine
ii. urine production

Answer 6

i. Increase 1.5-1.9x baseline
ii. < 0.5ml/kg/h for >6 consecutive hours

Question 7

stage 2 AKI
i. creatinine
ii. urine production

Answer 7

i. Increase 2.0-2.9x baseline
ii.< 0.5ml/kg/h for >12 consecutive hours

Question 8

stage 3 AKI
i. creatinine
ii. urine production

Answer 8

3 Increase > 3x baseline or >354 µmol/L < 0.3ml/kg/h for > 24h or anuric for 12h

Question 9

most common cause of glomerulonephritis worldwide:

Answer 9

IgA

Question 10

IgA nephropathy associated conditions:

Answer 10

alcoholic cirrhosis
coeliac disease/dermatitis herpetiformis
Henoch-Schonlein purpura

Question 11

IgA nephropathy gold standard ix

Answer 11

renal biopsy

Question 12

IgA vs post streptococcal glomerulonephritis

Answer 12

IgA nephropathy
- 1-2 days post URTI
- usually young males
- macroscopic haematuria

post strp:
- 1-2 weeks post URTI
- proetinuria
- low complement

(but both have hx recent URTI and haematuria)

Question 13

IgA nephropathy mgt

Answer 13

1. conservative
2. ACEi (if persisitent proteinuria or drop in renal function
3. corticosteroids (if no response from ACEi or active disease i.e. falling eGFR)

Question 14

post-strep glomerulopnephritis
features:

Answer 14

recent URTI 1-2 weeks ago
general: headache, malaise
visible haematuria
proteinuria + oedema
hypertension
oliguria

Question 15

post-strep glomerulonephritis bloods:

Answer 15

raised anti-streptolysin O titre
low C3

Question 16

how to calculate anion gap

Answer 16

(Na+ + K+) - (Cl- + HCO-3)

Question 17

normal anion gap

Answer 17

10-18

Question 18

metabolic acidosis with normal anion gap
(hypercholeraemic metabolic acidosis)

Answer 18

gastrointestinal bicarbonate loss:
prolonged diarrhoea: may also result in hypokalaemia
ureterosigmoidostomy
fistula
renal tubular acidosis
drugs: e.g. acetazolamide
ammonium chloride injection
Addison’s disease

Question 19

metabolic acidosis with raised anion gap:

Answer 19

lactate:
- shock
-sepsis
- hypoxia
ketones:
- diabetic ketoacidosis
- alcohol
urate: renal failure
acid poisoning: salicylates, methanol

Question 20

eGFR adjusted dependent on:
MDRD (modification of diet in renal disease)

Answer 20

CAGE

creatinine
age
gender
ethnicity

Question 21

CKD classification based on eGFR

Answer 21

1
Greater than 90 ml/min, with some sign of kidney damage on other tests (if all the kidney tests* are normal, there is no CKD)
2
60-90 ml/min with some sign of kidney damage (if kidney tests* are normal, there is no CKD)
3a
45-59 ml/min, a moderate reduction in kidney function
3b
30-44 ml/min, a moderate reduction in kidney function
4
15-29 ml/min, a severe reduction in kidney function
5
Less than 15 ml/min, established kidney failure - dialysis or a kidney transplant may be needed

Question 22

most common cause of glomerulonephritis in children

Answer 22

minimal change disease

Question 23

causes of minimal change disease

Answer 23

IDIOPATHIC
drugs: NSAIDs, rifampicin
Hodgkin’s lymphoma, thymoma
mono

Question 24

minimal change disease mgt:

Answer 24

PO corticosteroids

Question 25

diabetes insipidus
what is it?

Answer 25

condition characterised by either a decreased secretion of antidiuretic hormone (ADH) from the pituitary (cranial DI) or an insensitivity to antidiuretic hormone (nephrogenic DI).

Question 26

cranial DI causes

Answer 26

idiopathic
post head injury
pituitary surgery
craniopharyngiomas
infiltrative
histiocytosis X
sarcoidosis
DIDMOAD is the association of cranial Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness (also known as Wolfram’s syndrome)
haemochromatosis

Question 27

nephrogenic DI causes

Answer 27

genetic:
more common form affects the vasopression (ADH) receptor
less common form results from a mutation in the gene that encodes the aquaporin 2 channel
electrolytes
hypercalcaemia
hypokalaemia
lithium
lithium desensitizes the kidney’s ability to respond to ADH in the collecting ducts
demeclocycline
tubulo-interstitial disease: obstruction, sickle-cell, pyelonephritis

Question 28

diabetes insipidus ix:

Answer 28

high plasma osmolality, low urine osmolality
a urine osmolality of >700 mOsm/kg excludes diabetes insipidus
water deprivation test

Question 29

diabetes insipidus mgt:

Answer 29

nephrogenic diabetes insipidus:
-thiazides
-low salt/protein diet
central diabetes insipidus can be treated with desmopressin

Question 30

acute interstitial nephritis causes:

Answer 30

drugs: the most common cause, particularly antibiotics
penicillin
rifampicin
NSAIDs
allopurinol
furosemide
systemic disease: SLE, sarcoidosis, and Sjogren’s syndrome
infection: Hanta virus , staphylococci

Question 31

acute interstitial nephritis features:

Answer 31

fever, rash, arthralgia
eosinophilia
mild renal impairment
hypertension

ix:
sterile pyuria
white cell casts

Question 32

iv fluids maintenance requirements:

Answer 32

25-30 ml/kg/day of water
1 mmol/kg/day of potassium, sodium and chloride
50-100 g/day of glucose to limit starvation ketosis

Question 33

renal a. stenosis
most common cause in:
i. <50
ii. >50

Answer 33

i. fibromuscular dysplasia
ii. atherosclerosis