Copy of Nephrology Module 1

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

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

What is the most likely cause for his infection?

Which of the following factor is responsible for causing insulin deficiency in New Onset Diabetes Mellitus After Transplant (NODAT)?

A 40 year old man has an abdominal CT performed to investigate his abdominal pain. The CT reveals bilateral renal cysts, 2 on the left and 3 on the right (various sizes 1-4cm). His father was diagnosed with the same in his late 30’s.

What is the most likely diagnosis?

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

A 30 year old male patient has a generalized tonic-clonic seizure one week post renal transplantation. On examination, he is confused and drowsy with a blood pressure of 160/100.

Which of the following drug is most likely to be responsible for his deterioration?

Which of the following patient group is most likely to benefit from renovascularization strategy following the diagnosis of renal artery stenosis?

A 70-year-old man from Wellington is referred for investigation of proteinuria and impaired renal function. He has generalized osteoarthritis and developed chronic osteomyelitis of the right tibia after a fracture at the age of 20.

His only medication is indomethacin. Physical examination is unremarkable. Blood pressure is 122/66 mmHg. Urinalysis reveals 4+ proteinuria and 1+ glycosuria.

The following investigation results are obtained:

• serum creatinine 0.25 mmol/L [0.06-0.12]
• urine protein 2.90 g/day [<0.15]
• serum albumin 35 g/L [35 – 50]
• urine microscopy red blood cells 107-108 /mL [erythrocyte morphology suggests red cells are of glomerular origin]
• blood glucose: random 6.1 mmol/L [3.5 -7.8], 2 hrs after 75 g oral glucose 8.1 mmol/L [<7.8], haemoglobin A1C 6.2% [<6.0%]

Renal ultrasound normal renal size and morphology.

Which of the following is the most likely diagnosis?

Rapamycin (Sirolimus) can most likely cause the following side effect:

Which type of glomerulonephritis is less likely to recur post transplant and cause graft failure?

A 16-year-old teenager is taken to see the GP by his mother. For the past two days he has had a sore throat associated with blood in his urine. There is no significant past medical history. The GP suspects glomerulonephritis and refers the patient to hospital.

What would the renal biopsy show?

A 72 year old man from Wellington is being seen in the ED resus unit and appears to be in severe septic shock with fever, tachycardia and hypotension. His blood pressure has dropped to 75/60mmHg. You decide to commence fluid resuscitation on this man.

Which of the following fluid should you avoid?

What is the haemoglobin range that should be targeted in patients with chronic renal failure who are not yet on dialysis?

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

A 32-year-old Caucasian 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 0.9 mg/dL 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 is less likely to 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 NOT specific to lupus nephritis?

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: