1 A patient with chronic kidney disease is least likely to have which of the
following metabolic abnormalities?
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?
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?
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less attentive of late and has become more withdrawn, watching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
)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
B) Hyperkalaemia without ECG changes
D) Cardiogenic pulmonary oedema
E) Chronic kidney disease stage III
Indications for RRT:
- refractory life-threatening hyperkalaemia (ECG changes!)
- 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
- rapidly progressive crescentic glomerulonephritis and alveolar
- Rx: immunosuppression (steroids and cyclophosphamide) +/-
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
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
C) 11-beta hydroxysteroid dehydrogenase deficiency
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.