Renal

Question 1

Define hyperkalaemia

Answer 1

Elevated serum potassium >5.5mM

Question 2

What are the stages of hyperkalaemia?

Answer 2

Mild: 5.5-6.0mM
Moderate: 6.1-6.9mM
Severe: >7mM

Question 3

Give causes of hyperkalaemia

Answer 3

Excess intake (potassium supplements, massive blood transfusions)

Release from intracellular fluid (rhabdomyolysis, burns, crush injury, tumour lysis syndrome)

Inadequate excretion (renal impairment, medications - ACEi, ARBs, NSAIDs, K sparing diuretics)

Pseudohyperkalaemia (haemolysis during venepuncture)

Question 4

How can hyperkalaemia present?

Answer 4

Asymptomatic
N&V
Diarrhoea
Hypotonia
Muscle weakness
Hyporeflexia
Paraesthesia 
Cardiac arrhythmias

Question 5

What are the classical changes seen on an ECG which are indicative of hyperkalamia?

Answer 5

Flattened P waves
Tall tented T waves
Wide QRS - becoming sinusoidal

Question 6

What are the three components of the management of hyperkalaemia?

Answer 6

Myocardial protection
Drive potassium into ICF
Potassium elimination

Question 7

What drugs are used to protect the myocardium during hyperkalaemia?

Answer 7

Calcium gluconate/chloride (10ml of 10% by slow IV injection)

Question 8

What can be used to drive potassium into the ICF?

Answer 8

Salbutamol 5mg nebs
Insulin-dextrose infusion
Sodium bicarbonate

Question 9

How can potassium be eliminated?

Answer 9

Calcium resonium

Question 10

When should RRT be considered in a patient with hyperkalaemia?

Answer 10

Serum potassium >6.5mM and refractory to medical management

Question 11

What are the complications of hyperkalaemia?

Answer 11

Cardiac arrhythmias - VF

Cardiac arrest

Question 12

Define nephritis

Answer 12

Inflammation of the kidneys

Question 13

What are the features of nephritic syndrome?

Answer 13

Haematuria
Oliguria
Proteinuria (<3g per 24 hours)
Fluid retention

Question 14

What criteria must be fulfilled before a patient can be said they have nephrotic syndrome?

Answer 14

Peripheral oedema
Proteinuria >3g in 24 hours
Serum album <30g per litre
Hypercholesteraemia

Question 15

Define interstitial nephritis

Answer 15

Inflammation of the space between the cells and tubules

Question 16

What are the two types of interstitial nephritis?

Answer 16

Acute interstitial nephritis

Chronic interstitial nephritis

Question 17

Define glomerulosclerosis

Answer 17

Describes the pathological process of scarring of the tissue in the glomerulus

Question 18

What can cause glomerulosclerosis?

Answer 18

Any type of glomerulonephritis
Obstructive uropathy
Focal segmental glomerulosclerosis

Question 19

How can most types of glomerulonephritis be treated?

Answer 19

Immunosuppression

Blood pressure control using ACEi/ARBs

Question 20

How might a patient present with nephrotic syndrome?

Answer 20

Oedema

Frothy urine

Question 21

What does nephrotic syndrome predispose a patient too?

Answer 21

Thrombosis
Hypertension
High cholesterol

Question 22

What is the most common cause of nephrotic syndrome In children?

Answer 22

Minimal change disease

Question 23

Describe minimal change disease

Answer 23

Usually idiopathic

Treated successfully with steroids

Question 24

What is the most common cause of nephrotic syndrome in adults?

Answer 24

Focal segmental glomerulonephritis

Question 25

What is the most common cause of primary GN?

Answer 25

IgA nephropathy

Question 26

What is the peak age of presentation of IgA nephropathy?

Answer 26

20s

Question 27

What is the classical histology appearance of IgA nephropathy?

Answer 27

IgA deposits and glomerular mesangiall proliferation

Question 28

What is the most common type of glomerulonephritis overall?

Answer 28

Membranous glomerulonephritis

Question 29

When are the peaks in membranous glomerulonephritis?

Answer 29

20s and 60s

Question 30

What does histology show in membranous glomerulonephritis?

Answer 30

IgG and complement deposits on the basement membrane

Question 31

What are the causes of membranous glomerulonephritis?

Answer 31

Idiopathic 70% | Secondary to malignancy, rheumatoid disorders and drugs

Question 32

Describe post streptococcal glomerulonephritis

Answer 32

Patients are generally <30 years 1-3 weeks after a streptococcal infection Develop a nephritic syndrome Usually make a full recovery

Question 33

Describe Goodpasture's syndrome

Answer 33

Anti-GBM attack the glomerulus and pulmonary basement membrane Glomerulonephritis + pulmonary haemorrhage

Question 34

What histology is suggestive of rapidly progressive glomerulonephritis?

Answer 34

Crescentic glomerulonephritis

Question 35

What can rapidly progressive glomerulonephritis present secondary too?

Answer 35

Goodpasture's syndrome | Granulomatosis with polyangiitis

Question 36

What is the most common cause of glomerular pathology and chronic kidney disease in the UK?

Answer 36

Diabetic nephropathy

Question 37

In patients with diabetes, how should they be regularly screened to detect diabetic nephropathy?

Answer 37

ACR + U&Es

Question 38

How should a patient with diabetic nephropathy be managed?

Answer 38

Optomise blood sugar control | Optomise BP - using ACEi

Question 39

What drug should be started in all patients with diabetic nephropathy regardless of their BP?

Answer 39

ACEi

Question 40

How does acute interstitial nephritis present?

Answer 40

AKI | HTN

Question 41

What can cause acute interstitial nephritis?

Answer 41

Hypersensitivity reaction to drugs/infection

Question 42

What features may be associated with acute interstitial nephritis?

Answer 42

AKI +... Rash Fever Eosphilia

Question 43

How can acute interstitial nephritis be managed?

Answer 43

Treat the underlying cause | Steroids - reduce inflammation, improve recovery

Question 44

How does chronic interstitial nephritis present?

Answer 44

Chronic kidney disease

Question 45

What are potential causes of chronic interstitial nephritis?

Answer 45

Autoimmune Infectious Iatrogenic Granulomatous disease