Renal

Question 1

Causes of HAGMA

Answer 1

C Cyanide, CO
A Alcohols – ethanol
T Toluene
M Methanol, metformin
U Uraemia
D DKA
P Paracetamol, paraldehyde 
I Isoniazid, Iron
L Lactate
E Ethylene glycol
S Salicylates, sepsis

Question 2

Causes of NAGMA

Answer 2

NAGMA - USED CARP
U Ureteric fistula
S Small bowel fistula
E Extra Chloride
D Diarrhoea
C Carbonic anhydrase inhibitors 
A Addison’s
R RTA
P Pancreatic fistula

Question 3

Causes of metabolic alkalosis

Answer 3

C Contraction (dehydration)
L Liquorice (diuretic), laxative abuse
E Endocrine (Conn’s, Cushing’s)
V Vomiting, GI loss (villous adenoma)
E Excess alkali (antacids)
R Renal (Bartter’s), severe K depletion
P Post hypercapnia
D Diuretics

Question 4

Histopathological finding in BK nephropathy

Answer 4

Cytopathic changes (intranuclear basophilic viral inclusions)
Tubulitis
SV40 stain

Question 5

Biopsy finding in minimal change disease

Answer 5

Effacement of podocytes on electron microscopy (minimal change on light microscopy)

Question 6

Biopsy finding in FSGS

Answer 6

Focal areas of sclerosis, suPAR (soluble plasminogen activating receptor)

Question 7

Biopsy finding in Membranous Nephropathy

Answer 7

Thickened basement membrane, anti PLA2R in primary (immune complexes)

Question 8

Biopsy finding in IgA Nephropathy

Answer 8

Mesangial deposits that stain for IgA

Question 9

Biopsy finding in Lupus Nephritis

Answer 9

Mild mesangial proliferation through to cresenteric GN, wire loops, subendothelial

Question 10

Biopsy finding in post streptococcal GN

Answer 10

Subepithelial hump like deposits, hypercellularity of mesangial and endothelial cells, subendothelial deposits of IgG, IgM, C3, C4, C5-9

Question 11

Biopsy finding in pauci-immune GN

Answer 11

Crescents, segmental necrotising GN, granulomas in GPA, none in MPA or EGPA

Question 12

Biopsy finding in cryoglobulinaemia

Answer 12

Mixed cryoglobulinaemia: immune complex mediated inflammatory disease
Mostly MPGN: endocapillary proliferation, subendothelial and intraluminal CGs, Ig, complement, granular dense subendothelial deposits with ‘fingerprint’ like appearance

Question 13

Biopsy finding in anti GBM

Answer 13

Crescentic, non-proliferative GN, linear IgG glomerular basement membrane staining

Question 14

Biopsy finding in AIN

Answer 14

Interstitial oedema, marked interstitial infiltrate (predominantly T cells and monocytes), tubulitis
Eosinophilia

Question 15

Features of Renal Tubular Acidosis Type 1

Answer 15

Impaired ability to excrete H+ in distal convoluted tubule
urine pH >5.5
renal calculi
hyperchloraemic acidosis
low-normal serum potassium
plasma bicarbonate <15

Question 16

Features of Renal Tubular Acidosis Type 2

Answer 16

Impaired ability to absorb HCO3 in proximal tubule
urine pH <5.5
no renal calculi
hyperchloraemic acidosis
low-normal serum potassium
plasma bicarbonate usually >15

Question 17

Features of Renal Tubular Acidosis Type 4

Answer 17

Decreased secretion of aldosterone or decreased effect
urine pH <5.5
no renal calculi
hyperchloraemic acidosis
high serum potassium
plasma bicarbonate usually >15

Question 18

Causes of Renal Tubular Acidosis Type 1

Answer 18

SLE, Sjogrens, Nephrocalcinosis (primary hyperPTH), amphotericin B, obstructive

Question 19

Causes of Renal Tubular Acidosis Type 2

Answer 19

Multiple myeloma, acetazolamide, Fanconi syndrome, vitamin D deficiency

Question 20

Causes of Renal Tubular Acidosis Type 4

Answer 20

Aldosterone deficiency (primary, secondary), aldosterone resistance, drugs: NSAIDs, ACEI, ARB, spironolactone, trimethoprim

Question 21

Clinical utility of anti PLA2R

Answer 21

Sensitivity 78% Specificity 99% for primary Membranous Nephropathy

Question 22

Thrombospodin domain 7A (THDS7A)

Answer 22

Found in 2 - 5% of patients with primary membranous nephropathy

Question 23

NPHS2 - podocin

Answer 23

Familial FSGS

no response to steroids

Question 24

NPHS1 - nephrin

Answer 24

Congenital nephrotic syndrome

Question 25

Secondary causes of FSGS

Answer 25

``` Obesity Heroin abuse HIV (African American) Malignancy Loss of renal mass ```

Question 26

Is there a role for immunosuppression in IgA nephropathy

Answer 26

No. | Stop IgAN study - no change in progression

Question 27

Secondary causes of membranoproliferative GN

Answer 27

``` Hepatitis C +/- mixed cryoglobulinaemia SLE Hepatitis B SBE Malaria Thrombotic microangiopathies ```

Question 28

Defect in TTP

Answer 28

Deficiency in ADAMTS13 (metalloproteinase)

Question 29

Diagnostic criteria for autosomal dominant polycystic kidney disease

Answer 29

Ultrasound criteria for diagnosis (uptodate) Age 15 - 29: >/= 3 cysts, unilateral or bilateral Age 30 - 39: >/= 3 cysts, unilateral or bilateral Age 40 - 59: >/= 2 cysts in each kidney Age >60: >/= 4 cysts in each kidney

Question 30

Genetic defect in PCKD

Answer 30

PKD 1 - polycystin 1 on chromosome 16 - more cysts - earlier age - earlier ESRD (median at age 50s) PKD 2 - polycystin 2 on chromosome 4 - more indolent - later ESRD (median at age 70s)

Question 31

Urine Na level in pre-renal disease

Answer 31

Urine Na < 20 mmol/L

Question 32

Cyclosporin | MOA and SE

Answer 32

Calcineurin inhibitor inhibits IL-2 generation Nephrotoxic, diabetes, hyperlipidaemia, aHUS, hirsutism, gum hyperplasia

Question 33

Tacrolimus | MOA and SE

Answer 33

``` Calcineurin inhibitor inhibits IL-2 generation Binds to FK-BP More hyperglycaemia Neurotoxicity, aHUS, alopecia ```

Question 34

Mycophenolate | MOA and SE

Answer 34

Reversible inhibitor of inositol monophosphate dehydrogenase in purine synthesis (G1 arrest) Myelosupression, higher risk of CMV, teratogenic, diarrhoea

Question 35

Azathioprine | MOA and SE

Answer 35

``` Purine analogue Safe in pregnancy Bone marrow suppression Skin malignancy Increased MCV ```

Question 36

Prednsiolone | MOA and SE

Answer 36

Inhibits genes that code for cytokines - IL1, IL2, TNF gamma, etc Hyperglycaemia, AVN, osteoporosis, Cushing's

Question 37

Sirolimus/Everolimus | MOA and SE

Answer 37

mTOR inhibitors | Hyperlipidaemia, affects healing, non-nephrotoxic, anti-malignancy, causes oedema

Question 38

Basiliximab | MOA and SE

Answer 38

``` Anti IL2 (CD25) - lowers rates of rejection Safe, can cause hypersensitivity ```

Question 39

ATG (anti-thymocyte globulin) | MOA and SE

Answer 39

Polyclonal anti-lymphocyte globulin Increased risk of infection/malignancy serum sickness, leukopenia, hypotension, fevers