renal investigations + findings

Question 1

Nodular glomerulosclerosis (Kimmelstein- Wilson lesions)

Answer 1

Diabetic nephropathy

Question 2

management of diabetic nephropathy?

Answer 2

• tight glycemic control
• ACEI/ ARB (aim for BP <130/80)
• statins

Question 3

investigations chronic pyelonephritis?

Answer 3

• micturating cystography
• renal USS
• CT urogram

may all be useful

Question 4

most common cause of chronic pyelonephritis?

Answer 4

• reflux nephropathy
• vesico ureteric reflex (genetic disposition) usually presenting in childhood with recurrent infection but often asymptomatic

Question 5

investigations renal artery stenosis?

Answer 5

1st= MR angiography or CT angiography

Duplex USS (difficult in obese patients)

-renin: aldosterone (both high)

Question 6

renal artery stenosis treatment

Answer 6

• ACEI (contraindicated in bilateral disease)
• statin
• antiplatelets

surgical angioplasty +/- stent in severe cases

Question 7

string bean appearance on angiography

Answer 7

fibromuscular dysplasia

Question 8

string bean appearance on angiography

-what treatment?

Answer 8

-this is fibromuscular dysplasia (rare cause of renal artery stenosis)

treatment= surgical stenting

Question 9

diabetic nephropathy on USS

Answer 9

bilaterally enlarged kidneys

Question 10

what type of glomerulonephritis causes haematuria

Answer 10

nephritic syndrome

-mesangial cell damage/ endothelial (vasculitis) is proliferative leading to haematuria

Question 11

what type of glomerulonephritis causes proteinuria?

Answer 11

• nephrotic syndrome

- prodocyte damage (non priliferative atrophy) causes proteinuria

Question 12

nephrotic syndrome presentation?

Answer 12

• proteinuria (>3g/day)
• hypo albuminaemia (<30g/l)
• eodema

Question 13

nephritic syndrome presentation?

Answer 13

• oliguria
• haematura (red cell casts in urine)
• hypertension
• some proteinuria/ fluid retention

Question 14

light microscopy shows mesengial cell proliferation + immunofluorescence shows IgA and C3 deposits

Answer 14

IgA nephropathy

Question 15

podocyte fusion and foot process effacement?

Answer 15

minimal change

Question 16

minimal change treatment

Answer 16

1st- steroids

cyclophophamide= if steroid resistant

Question 17

IgA nephropathy treatment?

Answer 17

ACEI/ ARB

Question 18

minimal change- nephritic or nephrotic?

Answer 18

nephrotic

Question 19

FSGS- nephritic or nephrotic

Answer 19

nephrotic

Question 20

light microscopy= focal/ segmental sclerosis + hyalinosis

electron microscopy= effacement of foot processes

immunofluorescence= minimal Ig/ complement deposition

Answer 20

focal segmental glomerulosclerosis

Question 21

focal segmental glomerulosclerosis treatment

Answer 21

steroids +/- immunosuppression

Question 22

membranous nephropathy- nephritic or nephrotic

Answer 22

nephrotic

Question 23

electron microscopy= thick BM with sub epithelial electron complex depositions (spike and dome appearance)

Answer 23

-membranous nephropathy

Question 24

treatment- membranous nephropathy

Answer 24

• ACEI/ ARBs
• immunosuppression (steroids + cyclophosphamide +/- B cell monoclonal antibodies)

1/3rd spontaneously resolve, 1/3rd respond to immunosuppression, 1/3 rd end stage renal failure

Question 25

patient just started amoxicillin, presents with fever, rash, arthralgia, elevated creatinine urine test: - raised eosinophils - white cell casts - sterile pyuria

Answer 25

acute interstitial nephritis

Question 26

urinary ACR >30mg/mmol + hypertension treatment?

Answer 26

ACIE (ramipril)

Question 27

what formula is used to help estimate GFR?

Answer 27

Modification of Diet in Renal Disease Equation (MDRD): - serum creatinine - age - gender - ethnicity used as serum creatinine may not provide an accurate estimate of renal function due to differences in muscle mass

Question 28

- nephritic | - rapid decline in renal function + glomerular epitherlial crescent formation on biopsy

Answer 28

-rapidly progressive glomerulonephritis

Question 29

treatment- radpidly progressive glomerulonephritis

Answer 29

-immunosuppression (steroids + cyclophosphamide + azathioprine) +/- plasma + temporary RRT

Question 30

congo red staining | -apple green birefringence under polarised light

Answer 30

amyloidosis

Question 31

longitudinal splitting of lamina densa seen on electron microscopy (characterised by basket weave appearance) - microscopic haematuria - progressive renal failure - bilateral sensorineural deafness - ocular manifestations - proteinuria

Answer 31

Alport's syndrome (X linked dominant defect in type IV collagen)

Question 32

indications for dyalisis?

Answer 32

AEIOU - Acidosis (PH <7.15) - Electrolyte abnormalities (K > 7 or resistant to treatment) - Intoxication (overdose of certain meds) - Oedema (severe and unresponsive pulmonary oedema) - Uraemia > 40 (seizures, loss of conscioussness)

Question 33

causes of interstitial nephritis?

Answer 33

``` Drugs: (Not All Pills Fuck Renals) NSAIDS Allopurinol Penicillin Furesomide Rifampicin ``` Infection: -TB Systemic: -sarcoidosis

Question 34

causes of tubular injury?

Answer 34

- iscaemia (prolonged renal hypoperfusion) - drugs (gentamycin) - contrast - rhabdomyolysis

Question 35

treatment- hyperkalaemia?

Answer 35

- ECG + IV access - 10 ml 10% calcium gluconate (protect myocardium) - insulin actrapid 10 units + 50ml 50% dextrose or nebuliser salbutamol (short term shift)

Question 36

hyperkalaemia- ECG findings

Answer 36

- tall tented T waves - small p waves - wide QRS

Question 37

hypokalaemia- ECG findings

Answer 37

- U waves - small or absent T waves - prolonged PR interval - ST depression

Question 38

findings of acute tubular necrosis

Answer 38

- AKI - muddy brown casts in urine - high urine sodium + low urine sodium (with poor response to fluid challenge)

Question 39

findings in rhabdomyolysis?

Answer 39

- AKI - disproportionall raised creatinine - raised CK - metabolic acidosis - hyperkalaemia - high phosphate - low calcium - myoglobinuria Patient often has had a fall or been immobile for hours + is associated with statins

Question 40

rhabdomyolysis treatment?

Answer 40

IV fluids +/- urinary alkalinisation

Question 41

Drugs that should be stopped/avoided in AKI

Answer 41

- ARB - Diuretics - Trimethoprin (co trimoxazole) - Contrast - Gentamycin - NSAIDs - ACEI Avoid Drugs That Can Give Nasty AKIs

Question 42

ascites treatment

Answer 42

spironolactone