A 65-year-old man with a history of hypertension is reviewed. As part of routine blood tests to monitor his renal function whilst taking ramipril the following blood tests are received:
What stage of chronic kidney disease does this patient have?
Correct Answer A: CKD: only diagnose stages 1 & 2 if supporting evidence to accompany eGFR.
Chronic kidney disease is only diagnosed in this situation if supporting tests such as urinalysis or renal ultrasound are abnormal.
Chronic kidney disease: eGFR and classification: Serum creatinine may not provide an accurate estimate of renal function due to differences in muscle. For this reason formulas were develop to help estimate the glomerular filtration rate (estimated GFR or eGFR). The most commonly used formula is the Modification of Diet in Renal .
Disease (MDRD) equation, which uses the following variables:
Factors which may affect the result:
CKD may be classified according to GFR:
*i.e. normal U&Es and no proteinuria
Which of the following factors would suggest that a patient has established acute tubular necrosis rather than pre-renal uraemia?
Correct Answer E: ATN or prerenal uraemia? In prerenal uraemia think of the kidneys holding on to sodium to preserve volume.
Acute renal failure: acute tubular necrosis vs. Prerenal uraemia:
Prerenal uraemia - kidneys hold on to sodium to preserve volume:
*Fractional sodium excretion = (urine sodium/plasma sodium) / (urine creatinine/plasma creatinine) x 100
**Fractional urea excretion = (urine urea /blood urea ) / (urine creatinine/plasma creatinine) x 100
A 20-year-old man presents with facial and ankle swelling. This has slowly been developing over the past week. During the review of systems he describes passing 'frothy' urine. A urine dipstick shows protein +++.
What is the most likely cause of this presentation?
Correct Answer A: Nephrotic syndrome in children / young adults - minimal change glomerulonephritis.
Minimal change glomerulonephritis nearly always presents as nephrotic syndrome, accounting for 75% of cases in children and 25% in adults. The majority of cases are idiopathic and respond well to steroids.
Membranous glomerulonephritis would be unusual in a 20-year-old.
Minimal change glomerulonephritis:
Minimal change glomerulonephritis nearly always presents as nephrotic syndrome, accounting for 75% of cases in children and 25% in adults.
The majority of cases are idiopathic, but in around 10-20% a cause is found:
Features:
Management:
Prognosis is overall good, although relapse is common. Roughly:
*Only intermediate-sized proteins such as albumin and transferrin leak through the glomerulus.
Which one of the fllowing is least associated with focal segmental glomerulosclerosis?
Correct Answer D:
Focal segmental glomerulosclerosis:
Focal segmental glomerulosclerosis is cause of nephrotic syndrome and chronic kidney disease. It generally presents in young adults.
Causes:
Focal segmental glomerulosclerosis is noted for having a high recurrence rate in renal transplants.
Fanconi syndrome is associated with each one of the following, except:
Correct Answer A:
Fanconi syndrome:
Fanconi syndrome describes a generalized disorder of renal tubular transport resulting in:
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