Nephrology

Painless hematuria, continuing viral illness few days ago, no edema,

urine BL +++, protein +
(nephrotic – IGA nephropathy– HSP- fabricated – uti – alport $ )

6 year old boy.. 24 hr after appendectomy develop rash shown in pic

sole of foot ..history of abdominal pain .. healthyappendex.. plt=140 ,
wbc6 = normal .. most appropriate investigation?
-blood culture
- BM aspiration
- Renal Biopsy
- clotting study
- urine analysis and microscopy >>hsp
‫ سؤالمكررمنامتحاناتقديمة‬.. ‫االجابةفيهااختالفكبيييير‬
Immediate managment??
- pain relief
- iv fluids
- anti spasmodic
- anti viral
-antibiotics

Neonate female 6 month old vomiting ,tetany , blpr 82/55 low NA , low K
(barter– cf – pyloric stenosis – renal a stenosis – primary
hypoaldosteronism)

EMQS ( proteinuria )
FSGN
Iga nephropathy
Minimal change
Post strepto
Post infectious GN
HSP
SlE
Alport

A) 8 years with pain in knee..ankles..abd pain.. throat infection.. non

blanching rash ,+ protein and blood in urine
>>> HSP

B) visual defect...deafness.. repeatedhaematuria,+protein in urine

>>>alport

C) 14 year with high Bp..low albumin.. protein urea ..

microscopicheamaturea ... ECG show LVH... -ve PANCA..C ANCA
..normal complement and Immuniglobines
>>>FSGNs
child with nephrotic syndrome and oedema and ascites what
to do ?it mentioned its newly diagnosed
Prednisolone 60 mg + penicillin v for pneumococcal
prophlaxis (1st presentation only)

HSP case with normal everythings urine dip stick clear what
to do ?
Monitor blood pr for 6 month
previous fit child with conjunctivitis,cough , polyuria
,polydipsia intermittent vomiting and increased urea and
createnin ,lhigh calcium I think ,high ALK p,low phosphate (?)
Sarcoidosis

a child 3 years girl ,with vomiting ,fever , with UTI , WBC in urine 10,
mixed organism in urine they asked what to do next , ?
I think I select clean catch specimen *
bag of urine not sure
but some select SPA
start trimethoprim

2 years old with long history of constipation, vomiting, and height less
than 9th centile, weight less than 2nd centile. PH = (acidosis)
I wrote renal tubular acidosis *
Pyloric stenosis
Barter syndrome
Chloride losing diarrhea

senario nephrotc syndrome repeated Q.

i think scenario bloody urine diarrhea for few days then developed oliguria and petcheal rash
Hepatomegaly tip spleen labs showed low platelets increased RFT
what to do
.stool c/s
.blood film
.ASO
.bone marrow

Child known CF presented with vomiting labs showed Na 108 K 2.3. Bicarb 37 what is your
diagnosis
.Pseudobarter
.Nephronenic DI
.Pyloric stenosis
.CAH
.SIADH

picture of HSP ... WHAT is the most serious complication;

-acute renal failure
-git hamorrahge
- cns complication
pt with history of recent URTI came with hematuria, high creatinine .... C3 C4 normal ... ASOT
200 BP NORMAL.. DIAGNOSIS
-IGA nephropathy
-acute GN

Dmsa scan not like this exactly function 60:40 lt is lower position than rt (lt less uptake)

- Scarring
- Malposition and reduced uptake

female cf with vomiting after each meal and abd distension metabolic alkalosis
-Psuedobartter
-hypertrophied pyloric stenosis

Severe nephrotic scenario with frequent relapse given steroid and still not improved next
step
-tacrolimus
-infliximab
-cyclophosamide

Recurrent uti with hypertension (renal artery stenosis history) investigation next step?
-DMSA
- renogram
- mag 3
- doppler u/s

pt went to FRANCE develop profuse diarrhea before 2 days of admission(didn't tell bloody),
skin rash, low plt ,high urea & creatinine ( HUS SENARIO ) ASKED about investigation :
- blood film for fragmented cells

pt with low na, low k, cl normal, serum metabolic acidosis .....urine (glu +,amino acid +, ph 5)
-fanconi
-barter
-distal tubular acidosis
-cystenosis

A child with decreased sodium, decreased k, metabolic acidosis, glucose +,

protein + :
-Cystinosis
-glactoscemia
A picture of MCUG of 5 months showing reflux and hydronephrosis, pt have uti
,pt febrile, what to do next( it was similar to this picture but unilat):
-DMSA
-MAG3
-cystoscopy

A case with puffy eyelids, history of urti, FH of dilYaSIS can't close jeans,
protein ++++, blood +++, hypertensive, high RFT: 3 questions:
* Next step::
-fluid restriction and follow up UOP
-nifedipine
-referral for urgent nephrology outpatient

* What aids your diagnosis?

-Complement level
-u/s abdomen

* We gave her nifedipine, BP got higher180/100, subconjunctival hge, ttt?

-labetolol IV
-increase nefidipine

A baby born at 32 weeks, nephrocalcinosis, ↑ calcium/ creatinine ratio, no

family history of similar condition?
-idiopathic hypercalciuria
-Barter
-wiliam syndrome

Scenario of male pt with hematuria and FH of deafness in second degree relative ask about
diagnose, history of viral inf last 3day
1/alport syndrome
2/IgA nephropathy

EMQ
HUS
pre renal failure
hsp
neuroblatoma
wilms
duge induce nephritis

scenario about 5yrs old farmer sun (live in farm) who develop non bloody diarrhea with
oliguria then and renal failure blood film normal urine show trace of protein and blood
= pre renal failure
Frank hematuria 2month history of intermittent fever and irritability, parent feel increase
abd girth = wilms

Macroscopic hematuria painless, 3attaks ass with infection in 2 occasions = HUS

Case of hsp what is accurate for follow up

1/if no renal failure follow at least for 6 months (guideline)
2/no protein urea and hematuria no need to follow up
3/if persistent microscopic hematuria do biopsy

Hematuria, HTN, c3 andc4 normal, history of second degree relative with deafness
!/alport syndrom
!!/IgA nephropthy
!!!/ PSCGN

Pt. with hypertension you need to start ACE Inhibitor, what advice to give to parent
1/urea and creatine after 2day
2/LFT before treatment

Pt. with u&e result with urine electrolyte glucose urea (was clear scenario of fanconi
syndrome)

heamaturia -1 brother sister had renal failure and the

mother➔ adult polycystic kidney disease

Joint pain then abdominal pain then rash on the back of LL+
Blood results anemia low platelet and normal WBC➔
HSP vs SLE

renàl failure with hearing loss -alport syndrome

Fever, after exercise and protinuria+=➔ stationary

ptnuria
infant 2 month on ACE drugs asking for 2 side effects
**Renal and… first dose hypotension

HSP how to follow up…you need to know each follow up

by weeks like BP and proteinuria to answer this question
3 monthes infant with morning eye puffiness, loose stool
anemia Hgb 9 , wbc 5-6 no availabile differential Urine analysis :
proteinurea Hypoalbuminemia…………… OPTIONS
Congenital nephrotoc syndrome ????,
schwachman diamond syndrome ??

GIRL WITH long scenario has past history of rash joint problem
and renal problem ,,,SLE(CORRECT) ,, TB?/

child with menegioccocal sepsis and low urine output, low Na,
high urine Na, urine and serum osmolality were given, what of
the findings support renal than pre renal causes of low UOP?

- Serum Na

- Urine Na

Urine/plasma creatinine ratio

Urin plasma urea

case history with lab values all going with fanconi syndrome

2 cases of hemolytic uremic syndrome . . One was atypical with neurological signs. .
Guess askes about investigation and answer was blood film

a case of puv . . Most appropriate urgent action . . Mcug vs electrolytes . . I went for
mcug. . Other went for electrolytes for fear of renal failure

a case of hematuria. . F/h of deafness in uncle. . IgA level normal. . I went for alport
syndrome . . . Others went for berger disease

Case of proteinuria. . Ask about investigating . . Spot for ptn/creatine ratio

long case scenario with lab.. Met alkalosis. . Answer was barter syndrome

picture with rash on feet. .Acute abdominal pain went for operation . . Then
developed a rash on sole of leg . . Answer HSP
Girl develope nausea vomiting and profuse Diarrhea investigation anaemia,
thrombocytopenia, high urea and creatinine Dx?
HUS (heamlytic ureamic syndrome)
Dignostic invistigations 2 option
a_blood culture
b_stool culture (EColi_ 0157)
c_urine culture
d_blood film (schistocytes due to microangiopathic heamolysis)

Pt 9 y with diarrhea bloody and vomiting urine blood and protein inv Hb 9 , platelet
low , urea 40 what 3 inv to confirm diagnosis :
A. Peripheral blood film
B. Creatinine clearance
C. Reticulocyte count
D. Stool culture

Pt with truncus arteriosus waiting surgery cardiology team put him on diuretics he
present with O above 95 % and high lactic acid with low PH what is the explanation
for high lacic acide :
1. Chronic diuretic use
2. prolong poor perfusion to the kidney
3. Lung perfusion is more than systemic

Pt with history compatible with HSP ask what investigation for follow up

Pt prescribed enalapril ( ACE inhibitor ) whate advice to give parent :

A. Chech urine in fortnight
B. Check creatinine clearance two days later

Anuria , high urea&creatinin – DD DIC,& HUS & Renal vein thrombosis

there was a child with haematuria and HTN..management? labetalol, fluid retriction → This
is a big scenario as I remember for a child with APGN, hematuria, hypertension, and raised
renal function tests; the questions are three, what is the next option? → Follow-up in the
nephrology clinic; what will confirm the diagnosis → serum C3; the patient started beta
blocker therapy but developed severe hypertension what u will give → Labetalol

A child with ALL on treatment..2 things u will worry about..options were high K, high
phosphate, high uric acid → high uric acid (tumor lysis syndrome)

a child with hyperkalemia..2 steps of management.

a data question asked diff between pre and post renal failure.
8yrs old Asian child with nephrotic syndrome. edema and ascites. Choose 2 management
options
Prednisolone60mg/m2 alternate day
Prednisolone 60mg/m2 od
Frusemide 1mg/kg od
Cyclosporin. .

Scenarios related to DI RTA 3 to 4questions.

Picture of 4months? MCUG with markedly dilated system .What next to test
DMSA
Ivp
MAG scan

Q@ protienuria (EMQ)
Alport syndrome

Q@ protienuria (EMQ)
Transient proteriuria

Q@ protienuria (EMQ)
Adpkd.

child with joint pain with non-thrombocytopenic purpura

-HSP
-EBV
-SLE(cause thrombocytopenia)