What is the most likely outcome following the diagnosis of minimal change nephropathy in a 10-yearold male?
Correct Answer C: As 1/3 of patients have infrequent relapses and 1/3 of patients have frequent relapses a majority (2/3) will have later recurrent episodes. It is important however to stress to patients that generally speaking the longer term prognosis in minimal change glomerulonephritis is good.
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 following statements regarding minimal change glomerulonephritis is incorrect?
Correct Answer D: Hypertension and haematuria are rare in minimal change glomerulonephritis.
A 65-year-old man presents to the Emergency Department with lethargy and leg swelling. Initial bloods show the following:
Which one of his regular medications is most important to stop straight away?
Correct Answer A: NSAIDs such as ibuprofen can significantly worsen renal impairment and must be avoided in patients with acute kidney injury or chronic kidney disease.
Prescribing in patients with renal failure:
Questions regarding which drugs to avoid in renal failure are common.
Drugs to avoid in renal failure:
Drugs likely to accumulate in chronic kidney disease - need dose adjustment:
Drugs relatively safe - can sometimes use normal dose depending on the degree of chronic kidney disease:
A 67-year-old with chronic kidney disease stage 4 and metastatic prostate cancer presents as his pain is not controlled with co-codamol.
Which one of the following opioids is most appropriate to use given his impaired renal function?
Correct Answer A: Alfentanil, buprenorphine and fentanyl are the preferred opioids in patients with chronic kidney disease.
Palliative care prescribing: pain:
NICE guidelines:
In 2012 NICE published guidelines on the use of opioids in palliative care. Selected points are listed below. Please see the link for more details.
Starting treatment:
SIGN guidelines:
SIGN issued guidance on the control of pain in adults with cancer in 2008. Selected points:
Other points:
When increasing the dose of opioids the next dose should be increased by 30-50%.
Opioid side-effects:
Which one of the following statements is true regarding autosomal recessive polycystic kidney disease?
Correct Answer E:
ARPKD:
Autosomal recessive polycystic kidney disease (ARPKD) is much less common than autosomal dominant disease (ADPKD). It is due to a defect in a gene located on chromosome 6.
Diagnosis may be made on prenatal ultrasound or in early infancy with abdominal masses and renal failure. End stage renal failure develops in childhood. Patients also typically have liver involvement, for example portal and inter-lobular fibrosis.
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