A 44-year-old man is referred to the renal team. He has a long history of chronic sinusitis and was investigated last year for haemoptysis but no cause was found. A number of recent urine dipstick tests has shown persistent microscopic haematuria.
Given the likely diagnosis, what findings would be expected on renal biopsy?
Correct Answer C:
Wegener's granulomatosis:
Wegener's granulomatosis is an autoimmune condition associated with a necrotizing granulomatous vasculitis, affecting both the upper and lower respiratory tract as well as the kidneys.
Features:
Investigations:
Management:
A 62-year-old man is reviewed in the renal clinic. He has been referred as his creatinine level increased from 90 to 173 μmol/l after the introduction of ramipril. This had been started in an attempt to control his blood pressure. An ultrasound abdomen is reported as follows: Both kidneys are small with the right measuring 5.8 cm and the left 5.6 cm Normal liver, pancreas, spleen and bladder outline What is the most appropriate next line investigation?
Correct Answer E:
Renal vascular disease:
Renal vascular disease is most commonly due to atherosclerosis (> 95% of patients). It is associated with risk factors such as smoking and hypertension that cause atheroma elsewhere in the body. It may present as hypertension, chronic renal failure or 'flash' pulmonary oedema. In younger patients however fibromuscular dysplasia (FMD) needs to be considered. FMD is more common in young women and characteristically has a 'string of beads' appearance on angiography. Patients respond well to balloon angioplasty.
Investigation:
Each one of the following is associated with papillary necrosis, except:
Correct Answer D:
Papillary necrosis:
Causes:
Which one of the following types of glomerulonephritis is most characteristically associated with streptococcal infection in children?
Correct Answer B:
Diffuse proliferative glomerulonephritis, causes:
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 70-year-old man has been admitted with abdominal pain. The surgeons wish to perform a contrast-enhanced CT but are concerned because he has chronic kidney disease stage 3. Other than ensuring adequate hydration, which one of the following can reduce the risk of contrast-induced nephropathy?
Nephrotoxicity due to contrast media:
Contrast media nephrotoxicity may be defined as a 25% increase in creatinine occurring within 3 days of the intravascular administration of contrast media.
Risk factors include:
Prevention:
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