|
Minimal change glomerulonephritis
Minimal change glomerulonephritis nearly always presents as nephrotic syndrome, accounting for 75% of cases in children and 25% in adults
Causes
drugs: NSAIDs, gold
Hodgkin's lymphoma
thymoma
Features
nephrotic syndrome
hypertension
highly selective proteinuria
renal biopsy: electron microscopy shows fusion of podocytes
Management
majority of cases (80%) are steroid responsive
cyclophosphamide is the next step for steroid resistant cases
good prognosis
4 3-What is the best way to differentiate between acute and chronic renal failure?
|
|
A.
|
24 hr creatinine
|
|
|
|
B.
|
Urinary albumin
|
|
|
|
C.
|
Serum creatinine
|
|
|
|
D.
|
Renal ultrasound
|
|
.
|
Serum urea
|
Small kidneys is (usually) a sign of chronic renal failure
|
Acute vs. chronic renal failure
Best way to differentiate is renal ultrasound - most patients with CRF have bilateral small kidneys
Exceptions
autosomal dominant polycystic kidney disease
diabetic nephropathy
amyloidosis
Other features suggesting CRF rather than ARF
hypocalcaemia (due to lack of vitamin D)
4 4-Which one of the following features is least likely to be seen in Henoch-Schonlein purpura?
|
A.
|
Abdominal pain
|
|
B.
|
Renal failure
|
|
C.
|
Polyarthritis
|
|
D.
|
Thrombocytopenia
|
|
E.
|
Purpuric rash over buttocks
|
Henoch-Schonlein purpura
Henoch-Schonlein purpura (HSP) is an IgA mediated small vessel vasculitis. There is a degree of overlap with IgA nephropathy (Berger's disease). HSP is usually seen in children following an infection
Features
palpable purpuric rash (with localized oedema) over buttocks and extensor surfaces of arms and legs
abdominal pain
polyarthritis
features of IgA nephropathy may occur e.g. haematuria, renal failure
4 5-Which of the following factors would suggest that a patient has established acute tubular necrosis rather than pre-renal uraemia?
|
A.
|
Urine sodium = 10 mmol/L
|
|
B.
|
Fractional urea excretion = 20%
|
|
C.
|
Increase in urine output following fluid challenge
|
|
D.
|
Specific gravity = 1025
|
|
E.
|
Fractional sodium excretion = 1.5%
|
ATN or prerenal uraemia? In prerenal uraemia think of the kidneys holding on to sodium to preserve volume
|
ARF: ATN vs. prerenal uraemia
Prerenal uraemia - kidneys hold on to sodium to preserve volume
|
Pre-renal uraemia
|
Acute tubular necrosis
|
|
Urine sodium
|
< 20 mmol/L
|
> 30 mmol/L
|
|
Fractional sodium excretion*
|
< 1%
|
> 1%
|
|
Fractional urea excretion**
|
< 35%
|
>35%
|
|
Urine:plasma osmolality
|
> 1.5
|
< 1.1
|
|
Urine:plasma urea
|
> 10:1
|
< 8:1
|
|
Specific gravity
|
> 1020
|
< 1010
|
|
Urine
|
'bland' sediment
|
brown granular casts
|
Response to fluid challenge
|
Yes
|
No
|
*fractional sodium excretion = (urine sodium/plasma sodium) / (urine creatinine/plasma creatinine) x 100
**fractional urea excretion = (urine urea /blood urea ) / (urine creatinine/plasma creatinine) x 100
4 6-Each one of the following is seen in renal osteodystrophy, except:
|
A.
|
Osteitis fibrosa cystica
|
|
B.
|
Primary hyperparathyroidism
|
|
C.
|
High phosphate
|
|
D.
|
Low calcium
|
|
E.
|
Low vitamin D
|
Chronic kidney disease: bone disease
Basic problems in chronic kidney disease
low vitamin D (1-alpha hydroxylation normally occurs in the kidneys)
high phosphate
low calcium: due to lack of vitamin D, high phosphate
secondary hyperparathyroidism: due to low calcium, high phosphate and low vitamin D
Several clinical manifestations may result: Osteitis fibrosa cystica
aka hyperparathyroid bone disease
Adynamic
may be due to over treatment with vitamin D
Osteomalacia
Osteosclerosis Osteoporosis
26-year-old man with loin pain and haematuria is found to have autosomal dominant polycystic kidney disease. A defect in which one of the following genes is likely to be responsible?
|
A.
|
Fibrillin-2 gene
|
|
B.
|
Polycystin gene
|
|
C.
|
Fibrillin-1 gene
|
|
D.
|
Von Hippel-Lindau gene
|
|
E.
|
PKD1 gene
|
Most cases of autosomal dominant polycystic kidney disease (ADPKD) are due to a mutation in the PKD1 gene. The PKD1 gene encodes for a polycystin-1, a large cell- surface glycoprotein of unknown function
ADPKD
Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited cause of kidney disease, affecting 1 in 1,000 Caucasians. Two disease loci have been identified, PKD1 and PKD2, which code for polycystin-1 and polycystin-2 respectively
ADPKD type 1
|
ADPKD type 2
|
85% of cases
|
15% of cases
|
Chromosome 16
|
Chromosome 4
|
Ultrasound diagnostic criteria (in patients with positive family history)
two cysts, unilateral or bilateral, if aged < 30 years
two cysts in both kidneys if aged 30-59 years
four cysts in both kidneys if aged > 60 years
What is the most likely outcome following the diagnosis of minimal change nephropathy in a 20-year-old male?
|
A.
|
Chronic renal impairment requiring renal replacement therapy
|
|
B.
|
Persistent proteinuria
|
|
C.
|
Full recovery
|
|
D.
|
Chronic renal impairment not requiring renal replacement therapy
|
|
E.
|
Relapsing-remitting course
|
Minimal change glomerulonephritis
Minimal change glomerulonephritis nearly always presents as nephrotic syndrome, accounting for 75% of cases in children and 25% in adults
Causes
drugs: NSAIDs, gold
Hodgkin's lymphoma
thymoma
Features
nephrotic syndrome
hypertension
highly selective proteinuria
renal biopsy: electron microscopy shows fusion of podocytes
majority of cases (80%) are steroid responsive
cyclophosphamide is the next step for steroid resistant cases
good prognosis
4 9-Each one of the following is a cause of sterile pyuria, except:
|
A.
|
Renal stones
|
|
B.
|
Acute glomerulonephritis
|
|
C.
|
Renal TB
|
|
D.
|
Bladder/renal cell cancer
|
|
E.
|
Appendicitis
|
Sterile pyuria
Causes
partially treated UTI
renal TB
appendicitis
bladder/renal cell cancer
calculi
adult polycystic kidney disease
5 0-Which of the following types of renal stones are said to have a semi-opaque appearance on x-ray?
|
A.
|
Calcium oxalate
|
|
B.
|
Cystine stones
|
|
C.
|
Urate stones
|
|
D.
|
Xanthine stones
|
|
|
Renal stones on x-ray
cystine stones: semi-opaque
urate + xanthine stones: radio-lucent
|
Do'stlaringiz bilan baham: |
