Renal

Question 1

Acute Interstitial Nephritis features

Answer 1

fever, rash, arthralgia
eosinophilia
mild renal impairment
hypertension

white cell casts, sterile pyuria

Question 2

Acute Interstitial Nephritis Causes

Answer 2

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 3

Lithium in AKI

Answer 3

stop due to increased risk of toxicity

Question 4

AKI definition

Answer 4

↑ creatinine > 26µmol/L in 48 hours
↑ creatinine > 50% in 7 days
↓ urine output < 0.5ml/kg/hr for more than 6 hours

Question 5

peritonitis secondary to peritoneal dialysis;
most common cause

Answer 5

staph epidermis

Question 6

peritonitis secondary to peritoneal dialysis; treatment

Answer 6

vancomycin (or teicoplanin) + ceftazidime added to dialysis fluid
OR
vancomycin added to dialysis fluid + ciprofloxacin by mouth

Question 7

feature suggestive CKD over AKI

Answer 7

hypocalcaemia

Question 8

ADPKD Tx to slow progression

Answer 8

Tolvaptan

Question 9

Dialysis disequilibrium syndrome

Answer 9

rare complication of haemodialysis
It is caused by cerebral oedema, but the exact mechanism is unclear

Question 10

ADPKD features

Answer 10

hypertension
recurrent UTIs
flank pain
haematuria
palpable kidneys
renal impairment
renal stones

Question 11

ADPKD extra renal features

Answer 11

liver cysts (70% - the commonest extra-renal manifestation): may cause hepatomegaly

berry aneurysms (8%): rupture can cause subarachnoid haemorrhage

cardiovascular system: mitral valve prolapse, mitral/tricuspid incompetence, aortic root dilation, aortic dissection

cysts in other organs: pancreas, spleen; very rarely: thyroid, oesophagus, ovary

Question 12

diabetes insipidus: plasma/urine osmolality

Answer 12

high plasma osmolality, low urine osmolality

Question 13

why is nephrotic syndrome associated with a hypercoagulable state

Answer 13

due to loss of antithrombin III via the kidneys

Question 14

ADPKD Ix

Answer 14

Abdominal USS

Question 15

Urine dip AKI

Answer 15

Pre-renal- n/a
intrinsic renal (tubules/glomerulus) - protein (maybe blood)
post-renal- blood

Question 16

causes of polyuria

Answer 16

Common (>1 in 10):
diuretics, caffeine & alcohol
diabetes mellitus
lithium
heart failure

less common:
hypercalcaemia
hyperthyroidism
chronic renal failure
primary polydipsia
hypokalaemia
Diabetes insipidus

Question 17

negative fluid balance features

Answer 17

tachycardia
Hypotension
Oliguria
Sunken eyes and reduced skin turgor

Question 18

renal transplant acute graft failure

Answer 18

usually asymptomatic and is picked up by a rising creatinine, pyuria and proteinuria
happens within 6 months

Question 19

HUS triad

Answer 19

acute kidney injury
microangiopathic haemolytic anaemia
thrombocytopenia

Question 20

haematuria and acute urinary retention Tx

Answer 20

bladder irrigation via a 3-way urethral catheter

Question 21

myoglobulinuria causes renal failure by

Answer 21

tubular cell necrosis

Question 22

central DI treatment

Answer 22

desmopressin- vasopressin receptor agonist

Question 23

pre-renal vs renal urinary sodium and urine osmolality

Answer 23

pre-renal: urine osmolality high, urine sodium low
renal: urine osmolality low, urine sodium high

Question 24

AKI after initiation of ACEi

Answer 24

fibromuscular dysplasia in young patients
atherosclerosis of renal arteries in older patients

Question 25

fibromuscular dysplasia MR angiography finsings

Answer 25

string of beads appearance of renal arteries

Question 26

haemolytic uraemic syndrome

Answer 26

AKI MAHA- fragmented red blood cells (schistocystes) Thrombocytopenia (decreased plt)

Question 27

enlarged kidneys on USS

Answer 27

diabetic nephropathy ADPKD amyloidosis HIV-associated nephropathy

Question 28

maintenance fluid rate

Answer 28

30ml/kg/24hour

Question 29

solid organ transplant- most common infection and treatment

Answer 29

CMV ganciclovir

Question 30

hyaline casts seen on urine microscopy

Answer 30

loop diuretics

Question 31

HSP symptoms

Answer 31

palpable purpura over Lower limbs, arthritis/arthralgia, abdominal pain, renal disease

Question 32

nephrotic syndrome triad

Answer 32

proteinuria hypoalbuminaemia oedema

Question 33

nephritic syndrome triad

Answer 33

haematuria hypertension proteinuria oedema

Question 34

causes of nephritic syndrome

Answer 34

renal causes: - membranoproliferative glomerulonephritis - IgA nephropathy - Crescentic/ rapidly progressive nephritis (Goodpastures, ANCA vasculitis) systemic causes: - post-strep glomerulonephritis - hepatitis C - IgA vasculitis

Question 35

causes of nephrotic syndrome

Answer 35

minimal change disease membranous glomerulonephritis focal segmental glomerulosclerosis

Question 36

nephrotic syndrome complications

Answer 36

thromboembolism --> DVT, renal vein thrombosis (sudden drop in renal function) hyperlipidaemia --> ACS, stroke CKD infection hypocalcaemia

Question 37

Salicylate poisoning (aspirin)

Answer 37

- raised anion gap metabolic acidosis--> respiratory alkalosis nausea, vomiting, tinnitus and headache Tx = sodium bicarbonate

Question 38

renal biopsy will show a thickened basement membrane on light microscopy and sub-epithelial spikes on silver staining.

Answer 38

Membranous nephropathy

Question 39

membranous nephropathy causes

Answer 39

primary- anti-phospholipase A2 antibodies malignancy- prostate, lung, lymphoma leukaemia infections- Hep B, malaria, syphylis drugs- gold, penicillamine, NSAIDs AI - SLE< thyroiditis, rheumatoid

Question 40

proteinuric CKD Tx

Answer 40

SGLT-2 inhibitor

Question 41

metabolic acidosis with normal anion gap

Answer 41

Hyperchloraemia Renal tubular acidosis Addison's disease Diarrhoea

Question 42

CKD stages

Answer 42

stage 1- >90 stage 2- 60-90 stage 3a 45-59 stage 3b- 30-44 stage 4- 15-29 stage 5- <15 N.B. only diagnose stage 1 or 2 if supportive evidence to accompany eGFR

Question 43

uraemia

Answer 43

encephalopathy or pericarditis

Question 44

NSAIDs should be stopped in AKI except

Answer 44

aspirin at cardio-protective dose