Renal

Question 1

ANCA +ve vasulitis

Answer 1

ANCA +ve vasulitis
Microscopic polyangitis
Wegener’s granulomatosis
Churg-Strauss angiitis

Question 2

Symptoms of anca vasculitis (+subtype)

Answer 2

ENT +/- resp = Wegener's
 - ENT damage from necrotising granuloma
 - PR3/MPO 70/25%
MPA = no granulomas or URT involvement
 - PR3/MPO 30/60%
CSS = Asthma / Eosinophilia
 - PR3/MPO 5/40%

Question 3

HSP

Answer 3

Small vessel vasculitis
IgA containing immune complexes
Deposition in small vessels of skin/joints/gut/kidney
Childern - purpuric rash + arthralgia + colicky abdo pain

Question 4

Anti-GBM disease (Goodpasture’s)

Answer 4

Auto-Ab against GBM
Associated with pulmonary haemorrhage
- More likely if smoker

Question 5

Treatment of rapidly progressive glomerulonephritis

Answer 5

1. IV methylpred
2. Pulsed IV cyclophosphamide (15mg/kg 2-3 week intervals)
   6 pulses + oral azathioprine if in remission.
   Rituximbab second line

Question 6

Methotraxate + renal

Answer 6

Should be stopped with Cr >170

Predominantly renal excretion - can accumulate

Question 7

Treatment of hyperkalaemia

Answer 7

10ml 10% calcium glucuronate
50ml 50% dextrose + 10 units actarapid
Nebulised salbutamol - 20-30% will not respond. Caution tacky in already cardiac imbalanced pt
If met acidosis + hypovolaemia 250-500 1.26% bicarb
- caution pulmonary oedema . volume overload
Calcium resonium 15g TDS (severe constipation - regular laxatives

Question 8

Acute pulmonary oedema

Answer 8

Nurse upright
High flow O2
Stop IV fluids
Morphine IV 2.5mg + Metoclopramide
Furosemide

Question 9

Indications for emergency dialysis

Answer 9

ECG changes refractory to treatment
Pericarditis (can transform to haemorrhagic pericaridtis)
Encephalopathy
Acidosis causeing circulatory compromise

Question 10

Insensible water loss in normal a pyrexial pt

Answer 10

800ml/day

Question 11

BP targets in hypertension

Answer 11

Usual <140/90
CVD and/or DM <130/80
CKD w/o proteinuria 120-139/<90
CKD + proteinuria (ACR >70) OR DM <130/80

Question 12

Serum creatinine & ACEi

Answer 12

Up to 30% increase in creatinie acceptable, if >, stop
Monitor proteinuria by ACR
Steep rise in Cr following ACEi/ARB = RAS

Question 13

Treating renal artery stenosis

Answer 13

Modify RF

ASTRAL trial showed no benefit of revascularisation in chronic RAS

Question 14

Signs of cholesterol emboli

Answer 14

AKI
Skin Rash - livedo reticularis
Eosinophilia
Labs tests to look for low complement, CK, amylase, CRP

Question 15

Lipid lowering therapy in CKD

Answer 15

SHARP trial
Combination of ezetimibe and low dose simvastatin safe and well tolerated
Clear benefit of lipid lowering therapy over 5 year fu

Question 16

CVD risk + albuminuria

Answer 16

0.4mg/mmol increase = adjusted hazard major CV events + 5.9%

Question 17

Pathological changes in diabetic nephropathy

Answer 17

Renal cell hypertrophy - mesangial cell growth and matrix deposition
Advanced glycation end-products - bind to GBM + vessels, promote free radicals, inflammation, matrix deposition
Glomerular hyperfiltration (glomerular efferent arteriole constriction

Question 18

Target Hb with EPO

Answer 18

Target Hb 10-12
Higher has been associated with CV events / death
Higher cancer progression in some patients

Question 19

Secondary hyperparathyroidism

Answer 19

Recuded calcitirol production kidenys
Accumulation of PO4 due to reduced excretion
Lower serum calcium due to reduced ca absorption from gut and bone
PTH stimulated
Parathyroid hyperplasia
Bone resorption

Question 20

Calciphylaxis

Answer 20

Arteriolar calcification
Thrombotic cutaneous ischaemia
Necrotic ulceration
80% 1 year mortality - sepsis