Back up copy of Nephrology Module 1

Which of the following factors is most responsible for causing insulin deficiency in Post-Transplant Diabetes Mellitus (PTDM, formerly NODAT)?

An 18-year-old man had a renal transplant from his mother six months ago. Both donor and recipient were CMV negative. He develops an intercurrent illness with fever and non-specific aches and pains. There has been no documented acute rejection.

On examination, temperature is 38.8°C, blood pressure 105/60 mmHg; he is well perfused and otherwise well. His pharynx is slightly inflamed but no pus is visible. Blood tests show stable renal function and normal white cell count.

What is the most likely cause of his infection?

In renal transplant patients, what is the main cause of death with a functioning graft?

Which patient group is most likely to benefit from revascularization following diagnosis of atherosclerotic renal artery stenosis?

Rapamycin (Sirolimus) most commonly causes which side effect?

Which glomerulonephritis is least likely to recur post-transplant and cause graft failure?

A 16-year-old presents to the GP with a two-day sore throat associated with visible haematuria, no significant past history. The GP suspects glomerulonephritis.

What would renal biopsy most likely show?

What haemoglobin range should be targeted in ESA-treated non-dialysis CKD patients?

Which of the following intervention would be most helpful in preventing contrast induced nephropathy?

A 32-year-old woman presents to the rheumatology clinic with a 6-month history of joint pain, malar rash, and fatigue. She was recently diagnosed with Systemic Lupus Erythematosus (SLE) based on clinical features and positive serologies, including antinuclear antibodies (ANA) and anti-double-stranded DNA (anti-dsDNA). Given the systemic nature of her symptoms, a renal function assessment was initiated to evaluate for possible lupus nephritis.

Her laboratory tests reveal normal renal function with a serum creatinine of 90 micromol/L and no proteinuria or active urinary sediment on urinalysis. Despite her SLE diagnosis, her renal assessment does not indicate lupus nephritis at this time.

Considering this information, which of the following factor has the least impact on her future prognosis, especially in the context of proliferative lupus nephritis?

The following interventions are all useful in preserving the residual renal function in patients with end stage renal failure, except?

Which of the following feature is less specific to lupus nephritis relative to SLE without renal involvement?

A patient has been diagnosed with lupus nephritis and has >50% glomeruli involved.

Which stage of lupus nephritis is this?

Which one of the following is NOT a consistent histological feature of proliferative lupus nephritis?

Which one of the following is NOT beneficial in the treatment of lupus nephritis?

Which of the following is least likely to occur with cyclophophamide toxicity?

Mycophenolate mofetil is least likely to cause which of the following side effect?

What is the drug of choice for refractory, relapsing lupus nephritis?

Which of the following intervention is least likely to be beneficial in pauci immune rapidly progressive glomerulonephritis?

When do most patients with Type 1 diabetes develop microalbuminuria?

The presence of overt nephropathy in Type 1 diabetes mellitus is commonly associated with following complication:

What is the biochemical definition of macroalbuminuria in diabetic nephropathy in men [Mainly the Albumin Creatinine Ratio (ACR) and Albumin Excretion Rate(AER)]?

Which of the following intervention is less likely to slow the progression of diabetic nephropathy?

Which of the following medication has been proven to slow the progression of diabetic nephropathy in both Type 1 and Type 2 DM.

The use of ACE inhibitors/ARBs in diabetic patients who are normoalbuminuric and normotensive are protective against which complication?

A 42-year-old woman is six weeks post-renal transplant for focal segmental glomerulosclerosis. Following the procedure, she was discharged on a combination of tacrolimus, mycophenolate, and prednisone.

She now presents with five day history of feeling generally unwell with anorexia, fatigue and arthralgia. On examination her sclera are jaundiced and she has widespread lymphadenopathy with hepatomegaly.

Which of the following infection is she most likely to have?

Which of the following is the main site of potassium reabsorption in the nephron?

A 16 year old teenager with severe bronchiolitis obliterans presents to the Emergency Department with increasing exercise intolerance over the previous week.

A capillary blood gas shows the following picture:

• pH 7.29 [7.35 – 7.45]
• pCO2 97 mmHg [36 – 44 mmHg]
• Bicarbonate (HCO3-) 45 mmol/L [21 – 30 mmol/L]
• Base excess +18 mmol/L [-3 – +3 mmol/L]

This result is most consistent with the following acid/base balance:

Which of the following molecule is primarily reabsorbed in the proximal tubule of the nephron?

A 68-year-old woman with a background of postmenopausal osteoporosis (T-score −3.2 at the femoral neck) presents to her general practitioner with a 6-week history of progressive fatigue, generalised muscle weakness, and bone pain. She received her second annual infusion of zoledronic acid (Aclasta) 5 mg approximately 8 weeks ago. She has no history of diabetes, myeloma, or prior renal disease. Her regular medications include cholecalciferol and a calcium supplement. She denies vomiting, diarrhoea, or diuretic use.

Physical examination reveals proximal muscle weakness but is otherwise unremarkable.

Investigations reveal:

Which of the following findings most strongly supports the underlying diagnosis?