Renal

Question 1

Cranial causes of DI

Answer 1

Idiopathic
Head injury
Pituitary surgery
Histiocytosis X
Craniopharyngiomas
DIDMOAD

Question 2

Nephrogenic DI causes

Answer 2

Genetic - ADH receptor mutation (AQP mutation)
Electrolytes - hypercalcaemia, hypokalaemia
Drugs - demeclocycline, LITHIUM
Tubulointerstitial disease - obstruction, sickle cell, pyelonephritis

Question 3

DI Ix

Answer 3

High plasma osmolality (concentrated)
Low urine osmolality (dilute)
Urine osmolality >700 excludes DI
Water deprivation test

Question 4

ADPKD genes

Answer 4

PKD1>2 (ch16 vs 4)

One is more common and presents earlier with renal failure

Question 5

ADPKD USS criteria in those with pos FHX

Answer 5

Two cysts ( uni or bilateral) if <30
Two cysts in both kidneys if 30-59
Four cysts in both kidneys if >60

Question 6

ACR sample collection rules

Answer 6

First pass morning sample

If 3-70 repeat, if >70 no need to repeat

Question 7

Referral to a nephrologist

Answer 7

ACR >70 (unless known diabetic and already appropriately treated)
ACR >30 + persistent haematuria after UTI excluded (2/3 show >1+)
Consider if ACR 3-29 plus persistent haematuria and other RFs - declining eGFR, cardiovascular disease

Question 8

HTN in CKD
First line
GFR <45

Answer 8

ACEi - esp good in proteinuric renal disease diabetic

At this point furosemide is useful, added benefit of lowering serum K

Question 9

ACEi acceptable Cr and GfR changes

Answer 9

GFR decrease 25%

Cr rise 30%

Question 10

Bladder TCC RFs

Answer 10

Smoking
Aniline dyes
Rubber manufacture
Cyclophosphamide

Question 11

Bladder SqCC RFs

Answer 11

Schistosomiasis
Calmette-Guerin (BCG Rx)
Smoking

Question 12

Goodpastures/anti GBM biopsy

Answer 12

Linear IgG deposition
Against type IV collagen
HLA DR2 associated

Question 13

Anti GBM Mx

Answer 13

Plasmapheresis
Steroids
Cyclo

Question 14

Alports mutation
Inheritance
Demographics

Answer 14

Type IV collagen
X linked dominant
More severe in males

Question 15

Alports features

Answer 15

Microscopic haematuria 
Progressive renal failure 
Bilateral sensorineural deafness 
Lenticonus - protrusion of lens surface into anterior chamber 
Retinitis pigmentosa

Question 16

Alports bx results

Answer 16

Renal Bx result- splitting of lamina densa on EM

Question 17

Features of Diabetic nephroptathy

Answer 17

Thickened GBM
Mesangial expansion
Kimmelstein-Wilson nodules 
Disruption of podocytes 
(Glycation of basement membrane of efferent arteriole -> glomerular pressure -> dilation of afferent arteriole -> further inc in pressure -> hyperfiltrarion ( inc in GFR)

Question 18

Diabetic nephropathy stage 1

Answer 18

Hyperfiltration (inc GFR)

May be reversible

Question 19

Diabetic nephropathy stage 2

Silent /latent

Answer 19

GFR remains elevated , not yet developed microalbiminuria

Question 20

Stage 3 diabetic nephropathy

Incipient

Answer 20

Microalbuminuria 30-300 mg/day, dipstick neg

Question 21

Diabetic nephropathy stage 4
Overt nephropathy
Histology

Answer 21

Persistent proteinuria - albumin excretion >300mg/day, dipstick pos
HTN
Likely present
Histology - diffuse glomerulisclerosis and focal (Kimmelstein Wilson)

Question 22

Stage 5 diabetic nephropathy

Answer 22

ESRF - GFR < 10

Needs RRT

Question 23

Renal stones - calcium oxalate
Freq
Radiolucency

Answer 23

40%

Opaque

Question 24

Renal stones - mixed calcium oxalate, phos
Freq
Radiolucency

Answer 24

25%

Opaque

Question 25

Renal stones - triple phosphate
Freq
Radiolucency

Answer 25

10%

Opaque

Question 26

Renal stones - calcium phosphate
10%
Radiolucency

Answer 26

10%

Opaque

Question 27

Renal stones- urate stones
Freq
Radiolucency

Answer 27

5-10%

Radiolucent

Question 28

Renal stones - cystine
Freq
Radiolucency

Answer 28

1%

Semi opaque, ground glass

Question 29

Renal stones - xanthine
Freq
Radiolucency

Answer 29

<1%

Radiolucent