Renal 3

Question 1

+ve ANCA - how to confirm it?

Answer 1

Positive Indirect Immunofluorescence (IIF) - sensitive
Use leucocytes

MUST then confirm with ELISA - specific
Use purified antigen

Question 2

SLE pathogenesis?

Answer 2

Autoantibodies against chromatin/DNA

Defect in self clearance of immune complex, persistence of apoptotic cell debris

Question 3

Indications for renal biopsy? 4Rs

Answer 3

Rising Proteinuria > 0.5 g/day
Rising serum creatinine ( all other cause excluded)
RBC dysmorphic
Renal ANCA positive

Question 4

What specific staining specific for SLE in direct immunofluorescence?

Answer 4

C1q staining

Question 5

Commonest cause of secondary HTN?

Answer 5

Primary aldosteronism

Question 6

4 types of familial hyperaldosteronism - differences?

Answer 6

Type I - GRA = glucocorticoid remediable
Type II - Familial history but no genetic mutation (largest group)
Type III - KCNJ5 mutation (massive adrenal adenoma)
Type IV = CACNA mutation

Question 7

What is specific sign for renovascular HTN?

Answer 7

Abdominal bruit lateralize to one side

Question 8

Commonest cause of Cushing syndrome?

Answer 8

Exogenous steroids

Pituitary gland Cushing disease

Question 9

Urine anion gap positive in?

Answer 9

Healthy individuals and RTA Type I

Everything else is negative

Question 10

aldosterone acts where?

Answer 10

Collecting duct

• Absorb NA
• Excrete K
• indirectly excrete H via alpha-intercalated cells

Question 11

How is ammonia derived in kidney?

Answer 11

Breakdown of GLUTAMINE in PCT

Hyperkalemia decreases glutamine breakdown

Question 12

Hypokalemia causes what?

Answer 12

Augments alpha-intercalated cells - H-Katpase to secrete for Hydrogen and reabsorb potassium

Question 13

Why Gitelman has low Mg?

Answer 13

Downregulates Mg absorption Channel - TRMP6 = high urinary Mg loss

Question 14

Role of Citrate in RTA Type 1?

Answer 14

Citrate binds to Calcium and keeps it soluble
In RTA 1 - Citrate is reabsorbed

So no citrate, calcium + alkaline urine traps calcium = calcium stones

Question 15

MESNA is use for what?

Answer 15

Prevent hemorrhagic cystitis

Question 16

MPO P anca has more?

Answer 16

poorer survival - more fibrosis of kidney

Silica exposure

Question 17

Having positive for both P and C-anca means?

Answer 17

Coccaine use

Levamisole ( anti-helmintic drug)

Question 18

Thin basement membrane clinical features?

Pathogenesis?

Answer 18

persistent microscopic hematuria only ( has family hx as well)
Everything else negative
Biopsy shows thin basement membrane

Mutation of COL4A3/4

Question 19

Commonest and prevalent CKD-MBD disease?

Answer 19

Adynamic bone disease (ADB)

Question 20

Difference between ADB and Osteitis fibrosa cystica?

Answer 20

ADB - reduced osteoblast/clasts + no osteoid accumulation on bone

• Low PTH - resistance to it/suppression
• hypercalcemia

OF - increased bone turnovers then increased bone formation and resorption

Question 21

Antibody-mediated rejection is due to activation of what complement pathway?

Answer 21

Classical pathway

Question 22

Treatment for ADB?

Answer 22

Non-calcium-containing phosphate binders
Aim PTH 2x higher than usual baseline

Calcimetic - helps the PTH and Calcium but doesn’t alter BMD/bone turnover

Low calcium in dialysate for dialysis patients

NO Calcitriol or Vitamin D( non-dialysis) - increases PTH and worsens ADB

Question 23

What drug and condition a/w calciphylaxis?

Answer 23

Warfarin

vitamin K deficiency