MRCP Part 1 Endocrinology & Renal Medicine 2

Question 1

A patient presents with AKI (creatinine 420 µmol/L, previously 85 µmol/L), oliguria, and urine sediment showing muddy brown casts. What is the most likely cause of AKI?

Accepted Answer

Acute tubular necrosis

Answer

Muddy brown granular casts on urine microscopy are pathognomonic of acute tubular necrosis (ATN), caused by ischaemia or nephrotoxins damaging tubular epithelial cells that are shed and form these casts. Pre-renal AKI shows hyaline casts; GN shows red cell casts; obstruction shows few casts.

Question 2

What is the target blood pressure in a patient with CKD and proteinuria (urine ACR >70 mg/mmol) according to NICE guidelines?

Accepted Answer

<130/80 mmHg

Answer

NICE CKD guidelines recommend a target blood pressure of <130/80 mmHg in patients with CKD who have significant proteinuria (ACR ≥70 mg/mmol) or diabetes. ACE inhibitors or ARBs are first-line for CKD with proteinuria due to their nephroprotective effects.

Question 3

A 25-year-old woman presents with haematuria, bilateral renal cysts on ultrasound, and a family history of renal failure. Genetic testing reveals a PKD1 mutation. What is the diagnosis?

Accepted Answer

Autosomal dominant polycystic kidney disease

Answer

Autosomal dominant polycystic kidney disease (ADPKD) is caused by mutations in PKD1 (chromosome 16, 85% of cases) or PKD2 (chromosome 4). It is the most common inherited kidney disease, presenting with bilateral cysts, haematuria, hypertension, and progressive renal failure.

Question 4

In nephrotic syndrome, which of the following is characteristically NOT seen?

Accepted Answer

Haematuria

Answer

Nephrotic syndrome is characterised by heavy proteinuria (>3.5 g/24h), hypoalbuminaemia, oedema, and hyperlipidaemia/lipiduria. Haematuria is NOT a typical feature of pure nephrotic syndrome (it is more characteristic of nephritic syndrome) though it can occasionally co-exist.

Question 5

A patient with IgA nephropathy presents with visible haematuria 24 hours after an upper respiratory tract infection. What is this phenomenon called?

Accepted Answer

Synpharyngitic haematuria

Answer

Synpharyngitic (or synpharyngeal) haematuria refers to gross haematuria occurring simultaneously with or shortly after (24–72 hours) mucosal infection (typically URTI) in IgA nephropathy. This differs from post-streptococcal GN where haematuria occurs 2–3 weeks after the infection.

MRCP Part 1 Practice Test

MRCP Part 1 Practice Test

MRCP Part 1 Endocrinology & Renal Medicine 2