Renal and electrolytes

Question 1

Goodpasture’s syndrome

• 2 classical associations
• Antibodies associated
• Management

Answer 1

1. Pulmonary haemorrhage and rapidly progressive glomerulonephritis
2. Caused by anti-glomerular basement memberane (anti-GBM) antibodies against type IV collagen
3. Mx
   - Plasma exchange (plasmapharesis)
   - Steroids
   - Cyclophosphamide

Question 2

Management of hypercalcaemia

Answer 2

1. Rehydration with normal saline (usually 3-4L/day)
2. Bisphosphonates may be used after - takes 2-3d to work with max effect being seen at 7d
3. Other options include calcitonin and steroids in sarcoidosis

Question 3

3 organs/areas affected by Wegner’s granulomatosis (granulomatosis with polyangiitis)

Answer 3

Kidney, ENT, respiratory involvement

Kidney: rapidly progressive glomerulonephritis

Question 4

Why are patients with nephrotic syndrome high risk of VTE?

Answer 4

Due to loss of antithrombin III

Question 5

What is the most common histological type of malignant renal cancer?

Answer 5

Clear cell carcinoma

Question 6

Investigation that would help determine whether a patient has pre-renal uraemia or ATN

Answer 6

Urinary sodium - kidneys hold on to sodium to preserve volume

Question 7

Blood gas abnormality when patient takes an OD of aspirin

Answer 7

Metabolic acidosis with high anion gap

Question 8

Most common bacterial cause of haemolytic uraemic syndrome

Answer 8

E. Coli

Question 9

Acid-base balance error in Addison’s disease/adrenal insufficiency

Answer 9

Hyperkalaemic metabolic acidosis