Renal

Question 1

In renal transplant which HLA antigen is most important to match

Answer 1

DR > B > A

Question 2

Worldwide most common cause of hepatocellular carcinoma

Answer 2

Chronic Hep Be

Chronic hepatitis C in Europe)

Question 3

Risk factors for hepatocellular carcinoma

Answer 3

Hep b or c, alcohol, haemochromatosis, primary biliary cirrhosis, male sex, aflatoxin, diabetes/metabolic syndrome,

Question 4

8 year old child presents with swelling around eyes and limbs, tiredness and weight gain. GP does urine dip. What is most likely underlying diagnosis

Answer 4

Minimal change disease (triad of proteinuria, hypoalbuminemia, and oedema).. most common cause of nephrotic syndrome in children. Mostly idiopathic

Question 5

Alports syndrome is caused by a defect in….

Answer 5

Type IV collagen

4lports

Question 6

Alports syndrome is what inheritance

Answer 6

X linked dominant in ,85%. Rarely autosomal recessive

Question 7

Classic presentation of nephritic syndrome

Answer 7

Hypertension and haematuria with AKI.

e.g. rapidly progressive glomerulonephritis,IgA nephropathy (after URTI), Alports

Question 8

AKI -distinguish between pre renal uraemia and acute tubular necrosis

Answer 8

Prerenal uraemia - kidneys hold on to sodium to preserve volume… So low urinary sodium (<20)
Fractional sodium excretion <1%

In prerenal, anything related to excretion is low (urine sodium, low fractional sodium and urea excretion,) any real is high (urine: creat , urine plasma osmo)

Question 9

Features of leptospirosis

Answer 9

Rat urine…Sewage workers, farmers, vets, abattoir,

Fever, renal failure, jaundice, subconjunctival haemorrhage

Treat with high dose benzylpenicillin

Question 10

Isolated hyperbilirubinaemia with and without bilirubinuria

Answer 10

Gilbert’s if no bilirubinuria
Rotor or dublin-Johnson syndromes if there is bilirubinuria… Because it’s conjugated.

All autosomal recessive

Question 11

Renal tubular acidosis 1 Vs 2 Vs 3 anion gap

Answer 11

Metabolic acidosis with normal anion gap

… Low bicarb causes hypochloraemia

Question 12

Complications of RTA 1

Answer 12

Hypokalemia, nephrocalcinosis and renal stones

Question 13

Complications of RTA2

Answer 13

Hypokalemia, osteomalacia

Question 14

Complications of RTA4

Answer 14

HYPERkalaemia

(Caused by hypoaldosteronism) so loop diuretics etc

Question 15

Complications of RTA4

Answer 15

HYPERkalaemia

(Caused by hypoaldosteronism) so loop diuretics etc

Question 16

What causes increased risk of DVT in CKD

Answer 16

Acquired antithrombin III deficiency… Small protein so easily lost throuhh the nephron

Question 17

hypertension, kidney injury, proteinuria and haematuria point towards a nephritic picture of kidney insult. In SLE what is most common histological pattern seen?

Answer 17

most common histological pattern seen in lupus nephritis is diffuse proliferative glomerulonephritis

Question 18

55yr old with persistent proteinuria, BG of multiple myeloma

Renal biopsy shows Congo red stain shows apple-green birefringence under polarised light

Answer 18

Amyloidosis biopsy findings - Congo red stain shows apple-green birefringence under polarised light

Question 19

Starry sky microscopy renal biopsy

Answer 19

Acute post-streptococcal glomerulonephritis

Also starry sky microscopy in Burkitt’s lymphoma

Question 20

Nephrotoxicity due to contrast can be prevented by…

Answer 20

IV NaCl 1ml/kg/hr for 12 hr pre and post

Occurs 2-5 days after administration

Question 21

Food to avoid in CKD because of hyperkalemia

Answer 21

Banana oranges kiwi avocado spinach tomato

🍌 🍊 🥝 🥑 🍅

Question 22

minimal change glomerulonephritis is made. What is the most appropriate initial treatment to reduce proteinuria?

Answer 22

Prednisolone

majority of cases (80%) are steroid-responsive

Question 23

Female 55, smoker, poorly controlled hypertension.. develops flash pulmonary oedema. What do you expect renal USS to show?

Answer 23

Asymmetric kidneys -fibromuscular dysplasia

The most common cause for renal vasc disease after renal artery stenosis 2nd atherosclerosis (90%)

Question 24

Man with hypertension and smoker who develops flash pulmonary oedema after starting on ACEi

Answer 24

Renal artery stenosis (fibromuscular dysplasia is 90% women)

Question 25

causes of renal papillary necrosis mnemonic

Answer 25

``` POSTCARDS: Pyelonephritis, Obstruction of the urogenital tract, Sickle cell disease, TB, Cirrhosis of the liver, Analgesia/alcohol abuse, Renal vein thrombosis, Diabetes mellitus, Systemic vasculitis. ```

Question 26

what type of renal stones does Proteus mirabilis infection precipitate

Answer 26

struvite kidney stones

Question 27

When does contrast induced nephropathy occur?

Answer 27

2-5 days after administration Give 0.9% sodium chloride at a rate of 1 mL/kg/hour for 12 hours pre- and post-

Question 28

Most common renal abnormality in Turner's syndrome

Answer 28

horseshoe kidney

Question 29

Patient with CKD on haemodialysis..what are they most likely to die from?

Answer 29

Ischaemic heart disease account for 50% of the mortality in patients receiving dialysis

Question 30

what are the features of autosomal-dominant polycystic kidney disease (ADPKD) ?

Answer 30

Englarged kidneys so well-circ palpable mass in left and right flank Renal stones, recurrent UTIs, Hypertension symps may include constant abdominal pain and early satiety Most common (70%) extra-renal manifestation of hepatic cysts (can cause hepatomegaly)

Question 31

What is the most common extra-renal manifestation of auto dom polycystic kidney disease ADPKD?

Answer 31

70% have hepatic cysts, which can cause hepatomegaly

Question 32

Incidence of contrast induced nephropathy without any risk factors Vs renal function impairment

Answer 32

7% generally 25% if impaired 60% Cr>400 100% t2dm and Cr>400

Question 33

Patient newly taking lithium, protein: creatinine ratio 450, albumin 22 (low). Most likely nephropathy

Answer 33

Minimal changes is most likely lithium-induced nephropathy | Also most common cause of nephrotic syndrome in children

Question 34

Which nephropathy is associated with malignancy of bronchus or bowel

Answer 34

Membraneous

Question 35

How long does it take for an AV fistula to be functional

Answer 35

6 to 8 weeks post-surgery to allow full maturation to take place, where the fistula can withstand a dialysis flow rate of 500ml/min

Question 36

Young boy, 2 days post lrti gets haematuria. Diagnosis and renal biopsy?

Answer 36

IgA nephropathy histology: mesangial hypercellularity, positive immunofluorescence for IgA & C3 Post strep is 1-2 weeks not days and less likely to have macro haematuria

Question 37

Young patient, AKI after ACEi starting

Answer 37

Fibromuscular dysplasia

Question 38

renal angiomyolipomas (haemorrhagic) are strongly linked to...

Answer 38

1/10 have TS | Most patients with TS have it bilat

Question 39

Patient presents with 4/7 bloody diarrhoea, AKI and platelets 91. No neuro signs Organism?

Answer 39

E coli is the classic cause of HUS Neuro signs would point towards ttp

Question 40

Which are nephritic and which are nephrotic

Answer 40

nephRItic - Rapidly progressive, IgA Proliferative are mixed The rest are nephrotic

Question 41

Which glomerulonephritis is most assx with goodpastures

Answer 41

Rapidly progressive (think like pulmonary haemorrhages) Crescentic histology

Question 42

Prognosis of Minimal Change disease

Answer 42

Likely full recover but 2/3 have later relapses

Question 43

Diffuse macpap rash, Sterile pyuria, white cell casts, eosinophilia

Answer 43

Acute interstitial nephritis | Commonly secondary to abx

Question 44

Glomerulonephritis with Spike and dome appearance on electron microscope and anti phospholipase A2 antibodies

Answer 44

Membraneous glomerulonephritis

Question 45

anti phospholipase A2 antibodies , facial swelling, proteinuria

Answer 45

Membraneous glomerulonephritis

Question 46

Which glomerulonephritis is assx with post strep

Answer 46

Diffuse proliferative (same as SLE)

Question 47

What is thin basement membrane disease

Answer 47

Inherited collagen type 4 defect. Up to 5% of population Persistent microscopic haematuria with all other normal results

Question 48

Sudden deterioration in renal function in patient with nephrotic syndrome

Answer 48

Renal vein thrombosis. Especially occurs in membraneous glom Predisposed to thrombotic events due to loss of antithrombin iii

Question 49

eGFR variables

Answer 49

Creatinine Age Gender Ethnicity May be affected by pregnancy, muscle mass, red meat but they're not included

Question 50

Most common cause of peritonitis secondary to peritoneal dialysis

Answer 50

Staph epidermis (coag neg) Can also be staph A

Question 51

What are the 4 stages of diabetic nephropathy

Answer 51

1 hyperfiltration 2 silent/latent 3 microalbuminaemia 4 proteinuria

Question 52

What cancer is someone who is on long-term immunosuppressants for organ transplant at risk of

Answer 52

Skin cancer, particularly Squamous cell carcinoma