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Nephrology

Fluid, electrolyte and acid-base homeostasis |Investigation of renal disease |The differential diagnosis and management of proteinuria, haematuria, oliguria, polyuria | renal biopsy | Renal disease: Glomerulonephritis |Nephrotic and nephritic syndromes|
Diabetic nephropathy | Analgesic nephropathy | Hypertensive renal disease and renovascular disease | Inherited renal disease, e.g. polycystic kidney disease, Alport's disease |Reflux nephropathy | Tubulo-interstitial diseases of the kidney (including acute and chronic interstitial nephritis) |Urinary infections, nephrolithiasis and obstructive nephropathy |Renal stone disease|Obstructive nephropathy | Acute and chronic renal failure |Dialysis | Renal transplantation

 

  • Fluid, electrolyte and acid-base homeostasis:
    • Recognition of under-hydration and over-hydration, causes, consequences and treatment
    • Electrolyte disorders associated with altered sodium, potassium, acid-base and water homeostasis; appropriate treatment of these disorders.

    exam questions

    2003 paper two question 21

    2005 paper two question 76 urgent treatment of hyperkalcaemia (k > 7 with ecg changes tented T waves, prolonged QT interval, bradycardia ) is IV Calcium gluconate

    references

    Current Concepts: Hypokalemia
    Gennari F. J. N Engl J Med 1998; 339:451-458, Aug 13, 1998. Review Articles

  • Investigation of renal disease:
    • Biochemical tests of renal functions; urinalysis and urine microscopy serological testing; appropriate use of renal imaging techniques

exam questions

references

Core curriculum in nephrology Imaging
O'Neill WC and Baumgarten DA
American Journal of Kidney Diseases, Vol 42, No 3 (September), 2003: pp601-604

The differential diagnosis and management of proteinuria, haematuria, oliguria, polyuria

Renal Biopsy

    • Indications and requirements for, and complications of, renal biopsy
    • Knowledge of the typical renal biopsy appearance of common renal disorders.
  • Renal disease:
    • Glomerulonephritis: primary and secondary, the immunopathogenisis of the major glomerulopathies (with and without association with systemic disease), treatment options including role and complications of immunosuppression

    Exam Questions

    2003 paper two question 87 Renal involvement in SLE and indications for treatment

    2005 paper one question 5 In a patient with IgA nephropathy who has a serum creatinine in the normal range, the best predictor of developing end-stage renal failure is level of proteinuria.

    2005 paper two question 75 Management of stable Wegener’s granulomatosis following flare with 18/12 treatment with cyclophosphomide - is cycstoscopy to monitor for complications of cyclophosphomide treatment (cycstitis, bladder ca)

     

    References

    Glomerulonephritis
    SJ Chadban, RC Atkins
    The Lancet - Vol. 365, Issue 9473, 21 May 2005 , Pages 1797-1806

    Glomerulonephritis
    Hricik DE, Chung-Park M, Sedor JR
    N Engl J Med 339:888, September 24, 1998 Review Article

    Alport’s Syndrome, Goodpasture’s syndrome and Type IV Collagen
    Hudson BG, Tryggvason K, Sundaramoorthy M, Neilson EG
    NEJM 348: 2543, June 19, 2003 Review Article

    • Nephrotic and nephritic syndromes: aetiology, complications and management
      v Diabetic nephropathy: incidence, stages, microalbuminuria, management-early and late
    • Analgesic nephropathy: aetiology, incidence, clinical manifestations, and treatment.
    • Hypertensive renal disease and renovascular disease: incidence, natural history, diagnosis, and management (including pharmacological and non pharmacological treatment of hypertension)

    exam questions

    2002 paper two question 62 monitoring renal function with the use of ACEI

    2004 paper one question 17 A rise in creatinine after the initiation of antihypertensive treatment for chronic hypertension is primarily due to a shift in autoregulatory response

    2004 paper one question 53 Endothelial cell pathology on renal biopsy is most characteristic of Pre-eclampsia

    2004 paper two question 90 unilateral renal artery stenosis

    references

    Practice Monitoring renal function in hypertension
    Una Martin and Jamie J Coleman
    BMJ 2006; 333: 896-899.

    Renal Dsyfunction Complicating the Treatment of Hypertension
    Palmer BF
    NEJM 347: 1256, October 17, 2002 Review Article

     

    • Inherited renal disease, e.g. polycystic kidney disease, Alport's disease: genetics, diagnosis/screening, and complications

    exam questions

    2004 paper one question 37 In patients with autosomal dominant polycystic kidney disease (PKD) due to a mutation in the PKD1 gene, Non-clonal expansion of tubular epithelial cell types best accounts for the formation of renal cysts?

    references

    Autosomal dominant polycystic kidney disease • REVIEW ARTICLE The Lancet, Volume 369, Issue 9569, 14 April 2007-20 April 2007, Pages 1287-1301
    Vicente E Torres, Peter C Harris and Yves Pirson

    Alport’s Syndrome, Goodpasture’s syndrome and Type IV Collagen
    Hudson BG, Tryggvason K, Sundaramoorthy M, Neilson EG
    NEJM 348: 2543, June 19, 2003 Review Article

    • Reflux nephropathy: aetiology, clinical manifestations, and therapy
    • Tubulo-interstitial diseases of the kidney (including acute and chronic interstitial nephritis): aetiology, clinical manifestations, and therapy.
  • Urinary infections, nephrolithiasis and obstructive nephropathy:
    • Urinary tract infections: clinical manifestations, microbiology, diagnosis, investigation, management (including pyelonephritis, cystitis, prostatitis, and recurrent urinary tract infections)

    Exam Questions

    2005 paper two question 93 - enterococcal UTI and antibiotic resistance

    References

    • Renal stone disease: incidence, aetiology, clinical manifestations, prevention, drug therapy, urological principles

    Exam Questions

    2002 paper two question 9 Renal Colic in HIV infected man repeated 2003 paper two question 66

    References

    Management of kidney stones
    Nicole L Miller and James E Lingeman
    BMJ 2007; 334: 468-472

    Kidney Stones
    Malvinder S Parmar
    BMJ Volume 328, 12 June 2004 pp 1420-4

    • Obstructive nephropathy: diagnosis and management including indications for emergency nephrostomy; knowledge and understanding of acute urinary retention.
  • Acute and chronic renal failure:
    • Definition, differentiation between 'prerenal', 'renal' and 'postrenal' causes of acute renal failure; knowledge of common causes of acute and chronic renal failure; knowledge of symptoms and signs of uraemia; assessment of severity; non dialytic therapy including principles of managing calcium phosphate balance
    • Effect of common drugs on renal function and principles of dose modification of drugs in renal failure.

    Exam Questions

    2003 paper one question 69 Mechanism of acute renal impairment with the use of ACEI

    2005 paper one question 42 the most effective therapy for hyperphosphataemia associated with chronic renal failure is Oral phosphate binders

    References

    Preventing nephropathy Induced by Contrast Medium
    Barrett BJ; Parfrey PS
    NEJM 354:4 January 26, 2006 PP 379-386

    Chronic kidney disease
    Prabir Kumar Mitra, Peter R W Tasker, and M S Ell
    BMJ 2007; 334: 1273.

    Renal Dsyfunction Complicating the Treatment of Hypertension
    Palmer BF
    NEJM 347: 1256, October 17, 2002 Review Article

  • Dialysis:
    • Understanding modalities available in acute and chronic renal failure; indications for acute and chronic renal replacement therapy; recognising problems with dialysis patients, e.g. nutritional support. This includes choosing between CAPD and haemodialysis (HD)
    • Long-term complications of CAPD and HD: dialysis amyloid; loss of peritoneal membrane function; indications for and implications of surgical parathyroidectomy
    • Principles of Tenckhoff catheter insertion, complications: peritonitis, and exit-site infections, AV-fistula, infected dialysis cannulae.

     

    Exam Questions

    2004 paper two question 74 In dialysis dependent patients Hyperphosphataemia is most indicative of risk for future cardiovascular disease

    2005 paper two question 13 Clinical indicators for dialysis

    2005 paper two question 31 ESRD and haemodialysis general suppression of immune system due to ureamia. If initial attempts at hep b immunisation are inadequate appropriate to Immunise with up to 3 further doses of hepatitis B vaccine

    2005 paper two question 96 indications for urgent versus elective haemodialsys in ARF

    References

  • Renal transplantation:
    • Choosing/screening potential recipients, donors
    • Immunosuppresive regimens, side effects (short- and long-term)
    • Basic principles of diagnosis and management of cellular and vascular rejection
    • Common post-transplantation problems: CMV infections, treatment, prophylaxis, UTI, pyelonephritis, lymphocoele
    • Investigations of late graft dysfunction.

Exam Questions

2002 paper two question 7 cyclosporin toxicity

2002 paper two question 78 Complications of renal transplant

2003 paper one question 29 Loss of renal function following renal transplant

2003 paper two question 56 Side effects of tacrolimus in renal transplant

2004 paper one question 63 Macrophage infiltration occurs in cellular rejection and is the main feature

References

Renal Transplantation
Suthanthiran M, Strom TB
NEJM  Volume 331: 365-376 August 11, 1994 Number 6

Immunosuppressive Drugs for Kidney Transplantation
Halloran PF
NEJM 351: 2715, December 23, 2004