Renal EMQs

Question 1

Pt presents with ARF, fever, night sweats, dysuria & loin pain.

Whats the most approprite Ix?

Answer 1

Urine microscopy- casts and culture

Question 2

Elderly pt. develops ARF 4 days after hip surgery.

Whats the most appropriate Ix?

Answer 2

Urinary Na

Question 3

Pt w/ nocturia, polyuria, hesitancy and developing a gradual rise in serum urea and creatinine.

Most appropriate Ix?

Answer 3

Physical exam and bladder scan

Question 4

What is the likely E- abnormality after MDMA ingestion?

Answer 4

Hyponatraemia

Question 5

What is the likely E- abnormality in a pt with ARF after strenous exercise?

Answer 5

Hypocalcaemia

Question 6

What is the E- abnormality in a pt in the recovery phase of ARF due to rhabdo?

Answer 6

Hypercalcaemia

Question 7

What is th E- abnormality in a pt after the introducion of ACEi in pt wth CHF?

Answer 7

Hyperkalaemia

Question 8

What is the E- abnormality in pt with chronic laxative abuse?

Answer 8

hypokalaemia

Question 9

What condition is assoc. RBC casts?

Answer 9

Glomerulonephritis

Question 10

What condition is assoc. with WBC casts?

Answer 10

Pyelonephritis

Question 11

What condition is assoc. w/ fatty casts?

Answer 11

Nephrotic syndrome

Question 12

What condition is assoc. w/ pigmented casts?

Answer 12

Rhabdomyolysis

Question 13

Biochemical abnormality in athlete doing 1st marathon?

Answer 13

High creatine kinase

Question 14

Biochemical abnormality in pt using ACEi for HTN?

Answer 14

Hyperkalaemia

Question 15

Biochemical abnormality in ecstasy user?

Answer 15

Hyponatraemia

Question 16

Biochemical abnormality in pt with prostatic carcinoma?

Answer 16

Metabolic acidosis

Question 17

Biochemical abnormality in pt having chemo for bulky sarcoma of rt thigh?

Answer 17

Hyperuricaemia

Question 18

What drug combination -> AKI with hyperkalaemia?

Answer 18

Spirinolactone w/ ACEi

Question 19

What drug combination -> KI w/ hypercalcaemia?

Answer 19

Vit D w/ oral Ca

Question 20

What drug combination -> AKI w/ high CK?

Answer 20

Statin & cyclosporin

Question 21

What drug combination -> AKI w/ hyponatraemia?

Answer 21

Loop diuretic & thiazide

Question 22

What histopathological findings occur with rapidly progressive glomerulonephritis?

Answer 22

Crescentic change in the bowman’s space

Question 23

What histopathological findings occur with acute interstitial nephritis?

Answer 23

Eosinophils in the interstitium

Question 24

What histopathological findings occur with acute tubular necrosis?

Answer 24

Mitotic figures in the tbular epithelial nuclei

Question 25

What histopathological findings occur with obstructive uropathy?

Answer 25

Tubular dilatation

Question 26

What test would establish the cause of injury in 24 yo construction worker in an accident. Thighs trapped under rubble for several hours. Has AKI and swollen thigh?

Answer 26

Plasma creatine phosphokinase

Question 27

What test would establish the cause of injury in 39 yo w/ advanced ovarian carcinoma and bulky pelvic and retroperitoneal disease w/ high serum creatinine. Urinary catheter = 75ml in 6 hours w/ macroscopic haematuria?

Answer 27

Renal ultrasound

Question 28

What test would establish the cause of injury in 63yo w/ normal serum creatinine on lisinopril 20mg/day for HTN. 4/52 later serum creatinine 330 and K 5.8?

Answer 28

MRA of renal arteries

Question 29

What test would establish the cause of injury in 41 yo male w/ amoxicillin for chest infection. 2/52 later developed poor appetite and wt loss. Serum creatinine 250?

Answer 29

Mesangial leukocytes & eosinophil infiltration on renal biopsy

Question 30

What's the aetiology of the AKI in 71 yo m w/ permanent ileostromy following pan colectomy for UC w/ recent wt. loss. Oral barium study has ^ stoma output (>3L/day). Creatinine = 220

Answer 30

Pre-renal failure

Question 31

What test would establish the cause of injury in 76 yo F w/ AKI post hip replacement. Tx with normal saline post-op and 240mg gentamicin?

Answer 31

Acute tubular necrosis

Question 32

What test would establish the cause of injury in 55 y.o. after a course of pelvic radiotherapy for advanced cervical cancer. 2/52 developed oliguria w/ haematuria. Serum creatinine 350.

Answer 32

Obstructive uropathy

Question 33

What test would establish the cause of injury in 28 yo w/ AKI w/ haematuria for 2/52 after a sore throat?

Answer 33

Glomerulonephritis

Question 34

Whats the most likely cause of HTN Normal sized kidneys on renal USS

Answer 34

Essential HTN

Question 35

Whats the most likely cause of HTN Asymmetrical kidneys with acute rise in serum creatinine after intro of ACEi?

Answer 35

Bilateral renal artery stenosis

Question 36

Whats the most likely cause of HTN Asymmetrical kidneys with minimal/no change in serum creatinine after ACEi?

Answer 36

unilateral renal artery stenosis

Question 37

Whats the most likely cause of HTN Normal sized kidneys on USS, microaneurysms on fundoscopy?

Answer 37

Diabetic nephropathy

Question 38

What is useful in differentiating renal from pre-renal failure?

Answer 38

Urinary Na

Question 39

What may cause AKI in pt with renal disease?

Answer 39

Coronary angiogram

Question 40

What is safe to perform in Pt. w/ renal impairment to Ix obstruction?

Answer 40

Renal USS

Question 41

What values may be falsely low in pt. with increased muscle mass?

Answer 41

eGFR

Question 42

How does the following cause renal injury? Laxative abuse

Answer 42

Volume depletion

Question 43

How does the following cause renal injury? ACEi

Answer 43

Dilatation of the efferent arteriole

Question 44

How does the following cause renal injury? NSAIDs

Answer 44

Reduces vasodilatory PGs

Question 45

How does the following cause renal injury? Radiocontrast agents

Answer 45

Afferent arteriolar vasoconstricton/ renal iscaemia

Question 46

What drug can cause acute rhabdo?

Answer 46

Statins

Question 47

What requires a dose reduction in Pt. w/ chronic kidney disease?

Answer 47

Gabapentin

Question 48

What may cause post-renal failre by inducing retroperitoneal fibrosis?

Answer 48

Bromocryptin

Question 49

What may cause ureteric calcium stone formation?

Answer 49

Large doses o vit C

Question 50

What can cause frothy urine?

Answer 50

Nephrotic syndrome

Question 51

What can cause cloudy urine?

Answer 51

Acute pyelonephritis

Question 52

What can cause dark urine with red cell casts?

Answer 52

Acute post-strep glomerulonephritis

Question 53

What can cause dark urine with no red cell or red cell casts?

Answer 53

rhabdomyolysis

Question 54

What can cause macroscopic haematuria with no red cell casts?

Answer 54

transitional cell carcinoma of the bladder

Question 55

Pt. presents with ARF, chest symptoms, urine dipstick shows blood+++ and protein+++. Whats the most appropriate Ix?

Answer 55

Renal biopsy