Nephrology Module 1

A 25 year old man who underwent a kidney transplant three weeks ago is noted to have an acute rise in serum creatinine. A renal biopsy shows acute cellular rejection.

Which immune cell population is the primary mediator of cellular rejection?

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?

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?

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 generalised 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 one of the following is the most likely diagnosis?

Rapamycin (Sirolimus) is most likely to cause which of the following side effect?

Which of the following type of glomerulonephritis is least 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 a renal biopsy most likely show?

What Haemoglobin range should be targeted in patients with chronic renal failure, not on dialysis?

Which one of the following is NOT a poor prognostic indicator for proliferative lupus nephritis?

In patients with end stage renal failure, which of the following intervention is least helpful in preserving their residual renal function (RRF)?

Which of the following is NOT a feature of 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: