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Renal SBAs
1 A patient with chronic kidney disease is least likely to have which of the
following metabolic abnormalities?...
)E Von Hippel–Lindau syndrome
Alport’s disease is an inherited disease of the kidney affecting production
of type IV colla...
- Rx: immunosuppression (steroids and cyclophosphamide) +/-
plasma exchange
8 A 71 year old male with chronic kidney disea...
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Renal SBAs for 3rd years (with answers)

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Renal SBAs for 3rd years (with answers)

  1. 1. Renal SBAs 1 A patient with chronic kidney disease is least likely to have which of the following metabolic abnormalities? A) Acidosis B) Hyperkalaemia C) Hyperphosphataemia D) Uraemia E) Hypoparathyroidism In renal disease there is low calcium, low levels of Vitamin D and high levels of phosphate. This leads to increased secretion of parathyroid hormone – hyperparathyroidism. 2 A patient presents with a K+ of 6.7mmol/L. ECG shows peaked T waves and absence of P waves. Which of the following is most appropriate in the initial management of this patient? A) Furosemide B) Dietary restriction of K+ and amino acids C) Insulin and dextrose D) Calcium chloride and insulin and dextrose E) Calcium resonium In hyperkalaemia where worrying ECG features are present, patients should be given insulin and dextrose to lower K+ acutely, and calcium chloride to protect the myocardium. 3 Which of the following is not routinely considered as part of a renal screen in the investigation of new-onset renal failure? A) Complement B) Renal ultrasound. C) Caeruloplasmin and serum copper D) Anti-neutrophil cytoplasmic antibodies E) Bence–Jones protein Caeruloplasmin and serum copper are useful in investigation of liver disease of unknown aetiology and are sensitive predictors of Wilson’s disease, but are not useful in investigating renal failure. 4 A 15-year-old boy is referred to the renal clinic by his GP with a history of worsening haematuria. His mother has been worried recently that he has been taking illicit drugs as he has been finding it more difficult to cope at school and has been falling behind in his schoolwork. He also seems to be less attentive of late and has become more withdrawn, watching television on his own with the volume up loud. Which of the following conditions fits most closely with the clinical history? )A Alport’s syndrome )B Anderson–Fabry disease )C Goodpasture’s syndrome )D Wegener’s granulomatosis
  2. 2. )E Von Hippel–Lindau syndrome Alport’s disease is an inherited disease of the kidney affecting production of type IV collagen. The clinical progression is one of asymptomatic haematuria and eye disorders (lenticonus). 5 A 30-year-old man presents to hospital complaining that his urine has been very dark recently. He recently has taken a few days off work with a very sore throat and coryzal symptoms. Urine dipstick in hospital returns highly positive for blood and protein. He is admitted for supportive management and is scheduled for a renal biopsy, which shows mesangial proliferation with a positive immunofluorescence pattern. What is the most likely diagnosis? A) IgA nephropathy B) Post-streptococcal glomerulonephritis C) Rapidly progressive glomerulonephritis D) Membranous glomerulonephritis E) Henoch-Schoenlein purpura The usual presenation of IgA nephropathy is with haematuria, usually following an upper respiratory tract infection. Mesangial deposition of IgA and C3 seen on immunofluorescence is pathognomonic of IgA nephropathy. 6 Which one of the following is an indication for renal replacement therapy (RRT)? A) Pericarditis B) Hyperkalaemia without ECG changes C) Anaemia D) Cardiogenic pulmonary oedema E) Chronic kidney disease stage III Indications for RRT: - refractory life-threatening hyperkalaemia (ECG changes!) - acidosis - hypervolaemic pulmonary oedema - uraemic pericarditis and encephalopathy - CKD stage V 7 Which of the following diseases do antibodies against type IV collagen in the glomerular basement membrane cause? A) Wegeners granulomatosis B) Alport’s syndrome C) Goodpasture’s syndrome D) Henoch-Schoenlein purpura E) Scleroderma renal crisis Goodpasture’s syndrome: - rapidly progressive crescentic glomerulonephritis and alveolar haemorrhage
  3. 3. - Rx: immunosuppression (steroids and cyclophosphamide) +/- plasma exchange 8 A 71 year old male with chronic kidney disease develops an acutely hot, tender MCP joint on her left hand. What is the most likely diagnosis? A) Rheumatoid arthritis B) Reiter’s syndrome C) Gout D) Pseudogout E) Renal bone osteodystrophy Patients with CKD have an impaired excretion of urate from the DCT and a higher incidence of gout. 9 Which one of the following causes of chronic kidney disease is most associated with a normal haemoglobin concentration? A) – Goodpasture’s syndrome B) – Hepatitis C C) – Hypertension D) – Polycystic kidney disease E) – Diabetes mellitus Most causes of CKD usually result in anaemia due to decreased EPO production. In polycystic kidney disease there is an increase in EPO however, resulting in a normal or polycythaemic picture. 10 A 35 year old lady with IBS is found to be hypertensive and hypokalaemic following routine bloods for abdominal pain. She takes only food supplements as medication. What is the most likely cause? A) Cushing’s disease B) Peppermint C) 11-beta hydroxysteroid dehydrogenase deficiency D) Liquorice E) Conn’s syndrome Liquorice inhibits 11-beta hydroxysteroid dehydrogenase, which is responsible for inactivating cortisol at the mineralocorticoid receptor. Hence liquorice consumption may lead to apparent mineralocorticoid excess by allowing cortisol to persistently activate the mineralocorticoid receptor. Liquorice is sometimes recommended for IBS. Conn’s, Cushing’s, Liddle’s, and 11-beta hydroxysteroid dehydrogenase deficiency also cause hypertension and hypokalaemia.

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