Best of Five MCQs for the European Specialty Examination in Nephrology (Oxford Higher Specialty Training) 0192844164, 9780192844163

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Best of Five MCQs for the European Specialty Examination in Nephrology

Best of Five MCQs for the European Specialty Examination in Nephrology Edited by

Shafi Malik Consultant Transplant Nephrologist, University Hospitals of Coventry and Warwickshire NHS Trust, UK

Great Clarendon Street, Oxford, OX2 6DP, United Kingdom Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries © Oxford University Press 2024 The moral rights of the author have been asserted First Edition published in 2024 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by licence or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this work in any other form and you must impose this same condition on any acquirer Published in the United States of America by Oxford University Press 98 Madison Avenue, New York, NY 006, United States of America British Library Cataloguing in Publication Data Data available Library of Congress Control Number: 2023935576 ISBN 978–​0–​9–​28446–​3 DOI: 0.093/​oso/​97809284463.00.000 Printed and bound by CPI Group (UK) Ltd, Croydon, CR0 4YY Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up-​to-​date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-​pregnant adult who is not breast-​feeding Links to third party websites are provided by Oxford in good faith and for information only. Oxford disclaims any responsibility for the materials contained in any third party website referenced in this work.

PREFACE

In February 2020, the Specialty Certificate in Nephrology and the European Certificate in Nephrology exams were combined into a single exam called the European Specialty Examination in Nephrology. There was a need for a preparatory book that addressed the standards of this new exam and I intended to fulfil that need. Given that this was a Pan European exam, I was keen to have key opinion leaders from Europe and North America to author chapters, in addition to having diversity of authors. Contents of this book mirrors the ESENeph exam blueprint and the question writing style is in keeping with the Royal College of Physicians house style. Questions have detailed answers along with further reading suggestions and at the end of every chapter, there are key take home messages. The intention behind the format of this book is not just to equip candidates with exam focused knowledge but also to upskill them by providing evidence-​based answers and take home messages. My father was a writer and I wanted to follow his footsteps, I have thoroughly enjoyed editing this book and a lot of effort has gone into writing questions. I am thankful to all the authors for their effort, not least my wonderful wife Liza, my kids Roshan and Rihaan while I was putting up with deadlines and my parents for what I am today. Thank you.

CONTENTS

Contributors Abbreviations

ix xi

 Glomerulonephritis, tubulointerstitial nephritis, and vasculitis Questions Answers

 6

2 Acute kidney injury and acute renal replacement therapy Questions

25

Answers

36

3 Disorders of fluid, electrolytes, and acid base Questions

45

Answers

53

4 Chronic kidney disease, haematuria, and proteinuria Questions

59

Answers

77

5 Renal bone disease and renal anemia Questions Answers

95 03

6 Cardiovascular disease, hypertension, and diabetes (Part A) Questions

09

Answers

4

viii

Contents

7 Cardiovascular disease, hypertension, and diabetes (Part B) Questions

27

Answers

35

8 Renal stone disease, urinary tract infection, and obstruction Questions

4

Answers

46

9 Inherited and rarer diseases Questions

5

Answers

60

0 Peritoneal dialysis Questions

67

Answers

75

 Haemodialysis Questions

8

Answers

87

2 Renal transplantation Questions

95

Answers

207

3 Renal disorders in pregnancy Questions

27

Answers

225

4 Nutrition, safe prescribing, and conservative management Questions

233

Answers

24

Index

247

CONTRIBUTORS

Hadeel Ahmed  Specialist Registrar Nephrology, University Hospitals of Leicester NHS Trust, Leicester, UK Julia Arnold  Consultant Nephrologist, Lister Hospital, Stevenage, UK Reem Al-Jayyousi  Associate Professor of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE Jon Barratt  Consultant Nephrologist, University Hospitals of Leicester NHS Trust, Leicester, UK Miriam Berry  Consultant Nephrologist, Queen Elizabeth Hospital, Birmingham, UK Sue Carr  Consultant Nephrologist, University Hospitals of Leicester NHS Trust, Leicester, UK Daniela Viramontes-Hörner  Academic Dietician, University of Nottingham, Royal Derby Hospital Campus, Nottingham, UK Indranil Dasgupta  Consultant Nephrologist, Birmingham Heartlands Hospital, Birmingham, UK Jorge JESÚS-SILVA  Consultant Transplant Nephrologist, University Hospitals of Leicester NHS Trust, Leicester, UK Farid Ghalli  Consultant Nephrologist, University Hospitals Sussex, Brighton, UK Rizwan Hamer  Consultant Nephrologist, University Hospitals of Coventry and Warwickshire NHS Trust, UK Mohammed Awais Hameed  Consultant Nephrologist, Birmingham Heartlands Hospital, Birmingham, UK Katherine Hull  Specialist Registrar Nephrology, University Hospitals of Leicester NHS Trust, Leicester, UK Isma Kazmi  Consultant Nephrologist, St James University Hospital, Leeds, UK Hariharan Iyer  Consultant Nephrologist, London Health Sciences Center, Ontario, Canada Gauri Shankar Jagadesh  Consultant Nephrologist, Queen Elizabeth Hospital, Birmingham, UK Saleh Kaysi  Consultant Nephrologist, Brugmann University Hospital, Belgium Rumeyza Kazancioglu  Professor of Nephrology, Bezmialem Vakif University, Istanbul, Türkiye Kateryna MacConaill  Consultant Nephrologist, University Hospitals of Leicester NHS Trust, Leicester, UK Huda Mahmoud  Consultant Nephrologist, Walsall Manor Healthcare Trust, UK

x

CONTRIBUTORS

Noor Mahmoud  Pharmacist, Black Country Partnership Trust, UK Shafi Malik  Consultant Transplant Nephrologist, University Hospitals of Coventry and Warwickshire NHS Trust, UK Valentin Maisons  Specialist Nephrologist, University Hospital of Tours, Tours, France Safak Mirioglu  Nephrology Fellow Bezmialem Vakif University, Istanbul, Türkiye Shingai Pepereke  Specialist Registrar Nephrology, University Hospitals of Leicester NHS Trust, Leicester, UK Javeria Peracha  West Midlands Specialist Registrar Nephrology Alexandra Riding  Consultant Nephrologist, Royal Free London NHS Foundation Trust, UK Steve Riley  Consultant Nephrologist, University Hospital of Wales, Cardiff, UK Dwarak Sampathkumar  Consultant Nephrologist, Meenakshi Hospital, Thanjavur, India Haresh Selvaskandan  Specialist Registrar Nephrology, University Hospitals of Leicester NHS Trust, Leicester, UK Murugan Sivalingam  Consultant Nephrologist, Sundaram Medical Foundation, Chennai, India

ABBREVIATIONS

AA

aristolochic acid

AAN

aristolochic acid nephropathy

AAV

ANCA-​associated vasculitis

AD

autosomal dominant

ADPKD autosomal dominant polycystic kidney disease AG

anion gap

AHS

allopurinol hypersensitivity syndrome

aHUS

atypical haemolytic uraemic syndrome

AIN

acute interstitial nephritis

AKI

acute kidney injury

AML angiomyolipoma APD

automated peritoneal dialysis

ANCA

Antineutrophilic cytoplasmic antibody

AVS

adrenal vein sampling

BAFF

B-​cell activating factor

BMI

body mass index

BUN

blood urea nitrogen

C3GN

C3 glomerulonephritis

CAPD

continuous ambulatory peritoneal dialysis

CCPD

continuous cyclic peritoneal dialysis

CRRT

continuous renal replacement therapy

CKDu

chronic kidney disease of unknown aetiology

CRP

C-reactive protein

DAD

directed altruistic donor

DDS

dialysis disequilibrium syndrome

DI

diabetes insipidus

DRA

dialysis-​related amyloidosis

DRESS

drug rash with eosinophilia and systemic symptoms

EF

ejection fraction

eGFR

estimated glomerular filtration rate

EGPA

eosinophilic granulomatosis with polyangiitis

xii

Abbreviations

EPS

encapsulating peritoneal sclerosis

ERT

recombinant enzyme replacement therapy

ESA

erythropoietin-​stimulating agent

ESRD

end-stage renal disease

ESI

exit site infection

ESR

erythrocyte sedimentation rate

FSGS

focal segmental glomerulosclerosis

FUN

fluid urea nitrogen

GBM

glomerular basement membrane

GLA

γ-​linolenic acid

GN glomerulonephritis GP

general practitioner

GPA

granulomatosis with polyangiitis

HD haemodialysis IAP

intra-​abdominal pressure

IgAN

IgA nephropathy

IP intraperitoneal ISN/​RPS International Society of Nephrology/​Renal Pathology Society KDIGO Kidney Disease: Improving Global Outcomes LAC

levamisole-​adulterated cocaine

LAMP

lysosome-​associated membrane protein

MAHA

microangiopathic haemolytic anaemia

MBD

mineral bone disease

MCKD

medullary cystic kidney disease

MMF

mycophenolate mofetil

MN

membranous nephropathy

MPGN

membranoproliferative glomerulonephritis

MRSA

methicillin-​resistant Staphylococcus aureus

MSK

medullary sponge kidney

NSTEMI non-​ST elevation myocardial infarction OAT

organic anion transporter

PAC

plasma aldosterone concentration

PCNL

percutaneous nephrolithotomy

PD

peritoneal dialysis

PEG

polyethylene glycol

PET

pre-​eclampsia

PGA

pyroglutamic metabolic acidosis

PIGN

post-​infectious glomerulonephritis

PLA2R

phospholipase A2 receptor

Abbreviations

PTE

post-​transplant erythrocytosis

PTH

parathyroid hormone

PTHrP

parathyroid hormone-​related peptide

RAS

renin–​angiotensin system

RRF

residual renal function

RRT

renal replacement therapy

RVT

renal vein thrombosis

SCAR

severe cutaneous adverse reaction

SJS

Stevens–​Johnson syndrome

SLE

systemic lupus erythematosus

Sosm

serum osmolality

SPK

simultaneous pancreas–​kidney

SUN

serum urea nitrogen

TBMN

thin basement membrane nephropathy

TEN

toxic epidermal necrolysis

TIN

tubulointerstitial nephritis

TINU

tubulointerstitial nephritis and uveitis syndrome

TLS

tumour lysis syndrome

TMA

thrombotic microangiopathy

TRAS

transplant renal artery stenosis

TSC

tuberous sclerosis complex

UF ultrafiltration VEGF

vascular endothelial growth factor

VTE

venothromboembolic event

xiii

chapter



GLOMERULONEPHRITIS, TUBULOINTERSTITIAL NEPHRITIS, AND VASCULITIS QUESTIONS

. A 54-​year-​old man is referred from the ENT clinic. He presented with recurrent ear infections. He had five courses of antibiotics over the previous 0 months for recurrent ear pain, discharge, and difficulty hearing. On questioning, he reports being more breathless on exertion and to have lost 5 kg in weight over the last few months. On examination, he appeared lethargic and pale. His pulse was 92 beats/​min and regular; his BP was 42/​75 mmHg and his oxygen saturation was 96% on room air. His chest was clear on auscultation. Investigations: c-​ANCA serum CRP white cell count

positive (negative at :20) 79 mg/​L (