Which one of the following types of glomerulonephritis is most characteristically associated with Goodpasture's syndrome?
Correct Answer D:
Rapidly progressive glomerulonephritis, causes:
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.
Glomerulonephritides Knowing a few key facts is the best way to approach the difficult subject of glomerulonephritis:
Membranous glomerulonephritis:
IgA nephropathy - aka Berger's disease, mesangioproliferative GN:
Diffuse proliferative glomerulonephritis:
Minimal change disease:
Focal segmental glomerulosclerosis:
Rapidly progressive glomerulonephritis - aka crescentic glomerulonephritis:
Mesangiocapillary glomerulonephritis (membranoproliferative):
A patient with type 1 diabetes mellitus is reviewed in the nephrology outpatient clinic. He is known to have stage 1 diabetic nephropathy.
Which of the following best describes his degree of renal involvement?
Correct Answer B: For the purposes of the MRCP, increase in the glomerular filtration rate (GFR) is most characteristic of stage 1 diabetic nephropathy. It is however known that elevation of the GFR usually persists into stage 2.
Diabetic nephropathy: stages:
Diabetic nephropathy may be classified as occurring in five stages*:
Stage 1:
Stage 2 (silent or latent phase):
Stage 3 (incipient nephropathy):
Stage 4 (overt nephropathy):
Stage 5:
The timeline given here is for type 1 diabetics. Patients with type 2 diabetes mellitus (T2DM) progress through similar stages but in a different timescale - some T2DM patients may progress quickly to the later stages.
A 13-year-old girl develops purpura on her lower limbs and buttocks associated with microscopic haematuria. A diagnosis of Henoch-Schonlein purpura is made. Her urea and electrolytes show mild renal impairment that is still present 4 weeks later, although she does not require any specific therapy.
What is the most likely renal outcome?
Henoch-Schonlein purpura:
Henoch-Schonlein purpura (HSP) is an IgA mediated small vessel vasculitis. There is a degree of overlap with IgA nephropathy (Berger's disease). HSP is usually seen in children following an infection.
Features:
Treatment:
Prognosis:
A 47-year-old woman presents with loin pain and haematuria. Urine dipstick demonstrates:
An x-ray demonstrates a stag-horn calculus in the left renal pelvis.
What is the most likely composition of the renal stone?
Correct Answer C:
Stag-horn calculi:
Renal stones: imaging:
The table below summarizes the appearance of different types of renal stone on x-ray:
*stag-horn calculi involve the renal pelvis and extend into at least 2 calyces. They develop in alkaline urine and are composed of struvite (ammonium magnesium phosphate, triple phosphate).
Ureaplasma urealyticum and Proteus infections predispose to their formation.
A 34-year-old man presents to the Emergency Department with abdominal pain. This started earlier on in the day and is getting progressively worse. The pain is located on his left flank and radiates down into his groin. He has had not had a similar pain before and is normally fit and well. Examination reveals a man who is flushed and sweaty but is otherwise unremarkable.
What is the most suitable initial management?
Correct Answer B: This man may need to be referred acutely to the surgeons for pain relief and investigations to exclude obstruction. It would not be suitable to start bendroflumethiazide in the initial phase of the first episode. An immediate abdominal ultrasound is not necessary as neither his age nor symptoms point to a diagnosis of abdominal aneurysm.
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.
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