A patient develops mesangiocapillary glomerulonephritis secondary to partial lipodystrophy.
Which type of complement is likely to be low?
Correct Answer A:
Mesangiocapillary glomerulonephritis (membranoproliferative):
Mesangiocapillary glomerulonephritis: Overview:
Type 1:
Type 2 - 'dense deposit disease':
Type 3:
Management:
A 45-year-old woman with type 1 diabetes mellitus is reviewed in the diabetes clinic. Three months ago her blood tests were as followed:
At the time she was started on lisinopril to treat both the hypertension and act as a reno-protective agent. Lisinopril had been titrated up to treatment dose. Her current bloods are as follows:
Of the following options, what is the most appropriate course of action?
Correct Answer D: The small change in both the creatinine and eGFR are acceptable and below the threshold where ACE inhibitors should be stopped.
Chronic kidney disease: hypertension:
The majority of patients with chronic kidney disease (CKD) will require more than two drugs to treat hypertension.
ACE inhibitors are first line and are particularly helpful in proteinuric renal disease (e.g. diabetic nephropathy). As these drugs tend to reduce filtration pressure a small fall in glomerular filtration pressure (GFR) and rise in creatinine can be expected. NICE suggest that a decrease in eGFR of up to 25% or a rise in creatinine of up to 30% is acceptable, although any rise should prompt careful monitoring and exclusion of other causes (e.g. NSAIDs). A rise greater than this may indicate underlying renovascular disease.
Furosemide is useful as a anti-hypertensive in patients with CKD, particularly when the GFR falls to below 45 ml/min*. It has the added benefit of lowering serum potassium. High doses are usually required. If the patient becomes at risk of dehydration (e.g. Gastroenteritis) then consideration should be given to temporarily stopping the drug.
*The NKF K/DOQI guidelines suggest a lower cut-off of less than 30 ml/min.
Which one of the following may be useful in the prevention of oxalate renal stones?
Correct Answer D:
Renal stones: management: Acute management of renal colic Diclofenac 75 mg by intramuscular injection is the analgesia of choice for renal colic*. A second dose can be given after 30 minutes if necessary.
Prevention of renal stones:
Calcium stones:
Oxalate stones:
Uric acid stones:
*PR diclofenac is an alternative
A 10-year-old boy is admitted to hospital with diarrhoea and lethargy. There is a known local outbreak of E coli 0157:H7 and his initial bloods show evidence of acute renal failure.
Given the likely diagnosis, which one of the following investigation results would be expected?
Correct Answer C: Serum haptoglobins (which bind haemoglobin) and the platelet count are decreased in haemolytic uraemic syndrome.
Haemolytic uraemic syndrome: Haemolytic uraemic syndrome is generally seen in young children and produces a triad of:
Causes:
Investigations:
Which one of the following is not a risk factor for the development of calcium oxalate and calcium phosphate renal stones?
Correct Answer A: Bendroflumethiazide may help prevent the formation of calcium based renal stones. It may however theoretically increase the risk of urate based stones.
Renal stones: risk factors:
Risk factors:
Risk factors for urate stones:
Drug causes:
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