Renal

Question 1

Interstitial nephritis is most commonly caused by

Answer 1

Nephrotoxic drugs

Question 2

5 nephrotoxic drugs

Answer 2

Hyperkalaemia-causing

1. ACEi/ARBs
2. NSAIDs
3. Digoxin

Hypernatraemia-causing
4. Lithium

Other
5. Ionising CT scan contrast

Question 3

Where do carbonic anhydrase inhibitors act?

Answer 3

Proximal convoluted tubule

Question 4

MOA of carbonic anhydrase inhibitors at the proximal convoluted tubule

Answer 4

Prevent NaHCO3 reabsorption to reduce Na reabsorption

Question 5

Where do osmotic diuretics act?

Answer 5

Proximal convoluted tubule and thick descending limb

Question 6

MOA of osmotic diuretics at the proximal convoluted tubule/thick descending loop

Answer 6

Prevent water reabsorption by increasing solute concentration - decrease blood pressure by reducing volume

Question 7

Loop diuretics act at the

Answer 7

Thick ascending limb

Question 8

MOA of loop diuretics at the thick ascending limb

Answer 8

Prevent cation and Cl- reabsorption leading to volume loss and renin release

Question 9

What do furosemide/bumetanide/loop diuretics promote the release of?

Answer 9

Renin from thick ascending limb

Question 10

Where do thiazide diuretics act?

Answer 10

Distal convoluted tubule

Question 11

MOA of thiazide diuretics at the distal convoluted tubule

Answer 11

Promote excretion of K by inhibiting Na excretion. Reduce Ca but increase Mg. Increase urea absorption leading to raised uric acid.

Question 12

Where do potassium sparing diuretics act?

Answer 12

Collecting duct

Question 13

Amiloride and triamterene inhibit excretion of what cation?

Answer 13

K

Question 14

MOA of spironolactone

Answer 14

Inhibit aldosterone binding to aldosterone receptor, preventing Na/K pump mRNA translation and thus loss of K

Question 15

5 questions/areas to rule out in someone with haematuria

Answer 15

1. Infection: Ask about associated LUTI or UUTI symptoms
2. Recent trauma/surgery
3. Drug history - Anticoagulants, NSAIDs, furosemide, rifamycin, methyl-dopa, cephalosporins.
4. Smoking history
5. Foreign travel - schistosomiasis

Question 16

What 3 points define an AKI?

Answer 16

1. Increase in creat > 25 mmol/l in 48 hours
2. Increase in creat > 50% in 7 days
3. < 0.5 ml/kg/hour urine output for > 6 hours

Question 17

Main cause of pre-renal AKI and what findings are seen on bloods?

Answer 17

Renal hypo perfusion

Normal creat, high urea

Question 18

Renal AKI findings on bloods and diagnostic tool

Answer 18

Raised creat and raised urea

Biopsy of kidneys

Question 19

Acute tubular necrosis causes what electrolyte imbalance?

Answer 19

Hypercalcaemia

Question 20

Post-renal AKI is caused by

Answer 20

Outflow obstructions

Question 21

Most common electrolyte imbalance with an AKI

Answer 21

Hyperkalaemia

Question 22

CKD is defined as

Answer 22

Impaired renal function for > 3 months with 2 eGFR tests reporting declining renal function < 60 ml/min +/- A score > 3 mg/mol

Question 23

2 congenital causes of CKD

Answer 23

Polycystic kidney disease and Alport’s syndrome

Question 24

Pruritus, anaemia, anorexia and muscle cramps are signs of

Answer 24

CKD

Question 25

CKD 3 causes what 3 electrolyte/hormonal imbalances

Answer 25

Hypocalcaemia, hyperphosphataemia, increased PTH

Question 26

The A score measures

Answer 26

Albumin:Creatinine ratio (proteinuria)

Question 27

3 findings on a spinal x-ray in someone with CKD

Answer 27

1. Osteosclerosis at vertebrae ends 2. Osteomalacia 3. Osteoporosis 'Rugger jersey'

Question 28

Stage 2 CKD is

Answer 28

Mild: eGFR 60-89

Question 29

Stage 3a CKD is

Answer 29

Moderate: eGFR 45-59

Question 30

Stage 3b CKD is

Answer 30

Moderate: 30-44

Question 31

Severe CKD is

Answer 31

Stage 4: 15-29

Question 32

Rhabdomyolysis releases what 4?

Answer 32

Myoglobinuria Potassium Phosphate CK

Question 33

5 RF for rhabdomyolysis

Answer 33

Extreme exercise, fall with a long lie, MDMA/ecstasy, crush injuries, seizures

Question 34

Dark coke-coloured urine is a sign of

Answer 34

Rhabdomyolysis

Question 35

What causes the AKI in rhabdomyolysis and how can it be managed?

Answer 35

Myoglobinurea - sodium bicarbonate

Question 36

4 signs/symptoms of nephritic syndrome

Answer 36

Haematuria Oliguria Proteinuria Fluid retention

Question 37

IgA Nephropathy/Berger's affects where and who?

Answer 37

Mesangial cells | Young adults 24-48 hours post URTI

Question 38

Membranous glomerulonephritis affects where and what is it triggered by?

Answer 38

Basement membrane | Hepatitis B/malaria/SLE

Question 39

Goodpasture Syndrome affects where and causes what 2 symptoms?

Answer 39

Basement membrane in kidney and lungs | AKI and haemoptysis

Question 40

Nephrotic syndrome presents with what 5 signs/symptoms

Answer 40

1. Proteinuria/hypalbuminaemia 2. Oedema 3. Hypercholesterolaemia 4. Hypertension 5. Hyper-coagulopathy

Question 41

Red cast cells are seen in

Answer 41

Nephritic syndrome

Question 42

Most common glomerulonephrosis in children

Answer 42

Minimal change disease

Question 43

Hyaline casts in the urine suggest

Answer 43

Loss of albumin

Question 44

Frothy urine and oedema in a child can be a sign of

Answer 44

Minimal change disease

Question 45

Complication of glomerulonephrosis

Answer 45

Thrombosis

Question 46

Autosomal dominant PKD presents in

Answer 46

Adulthood

Question 47

Autosomal recessive PKD presents in

Answer 47

Neonates/antenatal scans

Question 48

Vasculitis that is triggered by URTI/gastroenteritis in children?

Answer 48

HSP - IgA

Question 49

HSP presents with what 3?

Answer 49

Rash, polyarteritis, haematuria

Question 50

Churg-Strauss presents with what 2?

Answer 50

Severe asthma and eosinophilia

Question 51

Wegener's/granulomatosis with polyangiitis presents with what 3?

Answer 51

1. Crusty nasal secretions 2. Epistaxis 3. Perforated nasal septum - saddle shaped

Question 52

Signs/symptoms of Kawasaki Disease (name 3)

Answer 52

1. Strawberry tongue 2. Red fingers/toes 3. Fever

Question 53

What antibodies are commonly seen in vasculitis?

Answer 53

ANCA - Anti-neutrophil cytoplasmic antibodies

Question 54

P-ANCA/MPO is seen in

Answer 54

Churg Strauss and Microscopic Polyangiitis

Question 55

C-ANCA/PR3 is seen in

Answer 55

Wegener's

Question 56

Flank pain, weight loss and haematuria are signs of

Answer 56

RCC

Question 57

Common complication of CKD/RCC

Answer 57

Anaemia

Question 58

Wilms tumour is

Answer 58

A nephroblastoma of the kidney