DHA Nephrology Exam 2023
For those planning to exam DHA Nephrology specialist..
3500 MCQs
Updated
Enough to pass exam
Questions Samples :
Question 1
A 54-year-old woman with a history membranous glomerulonephritis secondary to systemic lupus erythematous
is admitted to hospital. Her previous stable renal function has deteriorated rapidly. The following blood tests were obtained:
Na+ 139 mmol/l
K+ 5.8 mmol/l
Urea 44 mmol/l
Creatinine 867 μmol/l
Albumin 17 g/l
ESR 49 mm/hr
Urinary protein 14 g/24 hours
Urine dipstick protein +++
blood ++
What has likely caused the sudden deterioration in renal function?
A. Exacerbation of SLE
B. Renal vein thrombosis **
C. Bilateral hydronephrosis
D. Acute interstitial nephritis
E. Analgesic nephropathy
Nephrotic syndrome predisposes to thrombotic episodes, possibly due to loss of antithrombin III.
These commonly occur in the renal veins and may be bilateral. Common symptoms include loin pain and
haematuria.
A greater rise in the ESR would be expected if the renal failure was due to an exacerbation of SLE.
Nephrotic syndrome: complications
Complications
increased risk of infection due to urinary immunoglobulin loss
increased risk of thromboembolism related to loss of antithrombin III and plasminogen in the urine
hyperlipidaemia
hypocalcaemia (vitamin D and binding protein lost in urine)
acute renal failure
Question 2
A 25-year-old man has a renal biopsy due to worsening renal function. This reveals linear IgG deposits along the basement membrane. What is the most likely diagnosis?
A. Systemic lupus erythematous
B. IgA nephropathy
C. Minimal change disease
D. Post-streptococcal glomerulonephritis
E. Goodpasture’s syndrome **
Goodpasture’s syndrome
IgG deposits on renal biopsy
anti-GBM antibodies
These changes are characteristic of Goodpasture’s syndrome.
Goodpasture’s syndrome
Goodpasture’s syndrome is rare condition associated with both pulmonary haemorrhage and rapidly progressive
glomerulonephritis. It is caused by anti-glomerular basement membrane (anti-GBM) antibodies against type IV collagen.
Goodpasture’s syndrome is more common in men (sex ratio 2:1) and has a bimodal age distribution (peaks in 20-30 and 60-70 age bracket). It is associated with HLA DR2.
Features
pulmonary haemorrhage
followed by rapidly progressive glomerulonephritis
Factors which increase likelihood of pulmonary haemorrhage
smoking
lower respiratory tract infection
pulmonary oedema
inhalation of hydrocarbons
young males
Investigations
renal biopsy: linear IgG deposits along basement membrane
raised transfer factor secondary to pulmonary haemorrhages
Management
plasma exchange
steroids
cyclophosphamide
Question 3
A 65-year-old female with a 20 year history of rheumatoid arthritis is referred to the acute medical unit with bilateral leg oedema. The following results are obtained:
Urea 11.2 mmol/l
Creatinine 205 μmol/l
Albumin 26 g/l
Bilirubin 12 mmol/l
ALP 120 IU/l
Urine protein 6.2 g/24 hours
Which investigation is most likely to lead to the correct diagnosis?
A. CT abdomen
B. Plasma magnesium
C. Intravenous urogram
D. Rectal biopsy **
E. Renal angiogram
This rather odd question fooled most candidates when it appeared. The chronic inflammatory process (rheumatoid) predisposes to amyloidosis which in turn can cause nephrotic syndrome.
Rectal biopsy is an (infrequent) test done to look for amyloidosis.
Rheumatoid drugs such as gold may cause nephrotic syndrome but none of the other options point to this as an
answer
Amyloidosis:
types
AL amyloid
L for immunoglobulin Light chain fragment
due to myeloma, Waldenstrom’s, MGUS
features include: cardiac and neurological involvement, macroglossia, periorbital eccymoses AA amyloid
A for precursor serum amyloid A protein, an acute phase reactant
seen in chronic infection/inflammation
e.g. TB, bronchiectasis, rheumatoid arthritis
features: renal involvement most common feature
Beta-2 microglobulin amyloidosis
precursor protein is beta-2 microglobulin, part of the major histocompatibility complex
associated with patients on renal dialysis
Question 4
Which one of the following types of glomerulonephritis is most characteristically associated with partial lipodystrophy?
A. Minimal change disease
B. Diffuse proliferative glomerulonephritis
C. Mesangiocapillary glomerulonephritis **
D. Membranous glomerulonephritis
E. Rapidly progressive glomerulonephritis
Mesangiocapillary glomerulonephritis (membranoproliferative)
type 1: cryoglobulinaemia, hepatitis C
type 2: partial lipodystrophy
Type 2 mesangiocapillary glomerulonephritis is associated with partial lipodystrophy. Type 1 is seen in association with hepatitis C and cryoglobulinaemia Mesangiocapillary glomerulonephritis is sometimes referred to as membranoproliferative glomerulonephritis
Glomerulonephritides
Knowing a few key facts is the best way to approach the difficult subject of glomerulonephritis:
Membranous glomerulonephritis
presentation: proteinuria / nephrotic syndrome / chronic kidney disease
cause: infections, rheumatoid drugs, malignancy
1/3 resolve, 1/3 respond to cytotoxics, 1/3 develop chronic kidney disease IgA nephropathy – aka Berger’s disease, mesangioproliferative GN
typically young adult with haematuria following an URTI
Diffuse proliferative glomerulonephritis
classical post-streptococcal glomerulonephritis in child
presents as nephritic syndrome / acute kidney injury
most common form of renal disease in SLE
Minimal change disease
typically a child with nephrotic syndrome (accounts for 80%)
causes: Hodgkin’s, NSAIDs
good response to steroids
Focal segmental glomerulosclerosis
may be idiopathic or secondary to HIV, heroin
presentation: proteinuria / nephrotic syndrome / chronic kidney disease
Rapidly progressive glomerulonephritis – aka crescentic glomerulonephritis
rapid onset, often presenting as acute kidney injury
causes include Goodpasture’s, ANCA positive vasculitis
Mesangiocapillary glomerulonephritis (membranoproliferative)
type 1: cryoglobulinaemia, hepatitis C
type 2: partial lipodystrophy
Question 5
A 67-year-old woman presents for review due to ankle swelling. She has a history of rheumatoid arthritis which was diagnosed when she was 24 years old and a 8 year history of type 2 diabetes mellitus. Her current medication includes metformin and methotrexate. On examination she has bilateral pitting lower limb oedema. A 24 hour urine collection is reported as follows:
24 hr urinary protein 4.8g
What is the most likely cause of her leg oedema?
A. Diabetic nephropathy
B. Nephrotic syndrome secondary to methotrexate
C. Dilated cardiomyopathy secondary to methotrexate
D. Amyloidosis **
E. Protein-losing enteropathy secondary to metformin
This patient has developed nephrotic syndrome secondary to amyloidosis, a recognised complication of inflammatory conditions such as rheumatoid arthritis. Methotrexate is not a common cause of nephritic syndrome. Diabetic nephropathy often presents as nephrotic syndrome but typically develops at least 15 years after onset.
Nephrotic syndrome:
causes
Primary glomerulonephritis accounts for around 80% of cases
minimal change glomerulonephritis (causes 80% in children, 30% in adults)
membranous glomerulonephritis
focal segmental glomerulosclerosis
membranoproliferative glomerulonephritis
Systemic disease (about 20%)
diabetes mellitus
systemic lupus erythematosus
amyloidosis
Drugs
gold (sodium aurothiomalate), penicillamine
Others
congenital
neoplasia: carcinoma, lymphoma, leukaemia, myeloma
infection: bacterial endocarditis, hepatitis B, malaria
Younis younis –
Wounderful
Dr Ubaid –
Wounderful
Hamad ahmed –
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