1High-yield associations
| Finding or trigger | Classic association | The exam point |
|---|---|---|
| Haemoptysis and AKI, linear IgG on biopsy | Anti-GBM disease | Plasma exchange, cyclophosphamide and steroids; if also ANCA positive, maintain as for vasculitis. |
| Nephrotic syndrome, anti-PLA2R antibodies | Primary membranous nephropathy | Titre guides treatment and relapse; it does not exclude secondary causes (CARI 2025). |
| Visible haematuria 1 to 2 days after a sore throat | IgA nephropathy | Complement normal. Post-streptococcal GN follows 1 to 3 weeks after a throat infection, with low C3. |
| Persistently low C3 with normal C4 | C3 glomerulopathy | TGA product information (revised September 2026) lists iptacopan for C3G; the PBS lists it for PNH only. |
| Hyperkalaemia, normal anion gap acidosis, diabetes | Type 4 RTA (hyporeninaemic hypoaldosteronism) | Review culprit drugs; diet and diuretic. PBS lists patiromer for chronic hyperkalaemia. |
| Flash pulmonary oedema, AKI after an ACE inhibitor | Bilateral renal artery stenosis | Expect a small eGFR fall; stop if it exceeds 25% within 2 weeks (KHA 2024). |
| AKI with rash and eosinophilia, on a PPI | Acute interstitial nephritis | Stop the drug; sterile pyuria, white cell casts; steroids if recovery is slow. |
| AKI, hypercalcaemia, anaemia, bland dipstick | Myeloma cast nephropathy | Dipstick misses light chains: urgent serum free light chains and electrophoresis. |
| Haematuria, sensorineural deafness, anterior lenticonus | Alport syndrome (COL4A3 to COL4A5) | ACE inhibitor early. Genetic testing for monogenic disease is accessible in Australia (CARI 2025). |
| ADPKD with a family history of subarachnoid haemorrhage | Intracranial aneurysm | Screen only for that history, a high-risk job, major surgery or anxiety (CARI 2026). |
| Hypokalaemic alkalosis, low urine calcium, low serum magnesium | Gitelman syndrome | Normal BP; mimics thiazide use. Bartter syndrome has high urine calcium. |
2Australia-only high-yield (won't be in UK or US banks)
Kidney Health Check (Kidney Health Australia CKD handbook, 2024). Blood pressure, urine ACR and eGFR: yearly with diabetes or hypertension and in First Nations adults from 18; every 2 years with cardiovascular disease, a family history of kidney failure, obesity or smoking. 1 in 10 Australians and 1 in 5 First Nations adults have signs of CKD.
CKD care (KHA 2024; KDIGO 2024). ACE inhibitor or ARB at maximum tolerated dose, then an SGLT2 inhibitor (KHA: not started below eGFR 25; KDIGO: from 20), then finerenone in type 2 diabetes. BP under 130/80. Refer at eGFR under 30, persistent uACR 30 mg/mmol or more, or a sustained 25% fall within 12 months.
PBS (October 2026). Dapagliflozin (items 13106T, 15257B) and empagliflozin (14092Q, 15253T) are listed for chronic kidney disease; finerenone for CKD with type 2 diabetes only; patiromer for chronic hyperkalaemia. Sevelamer, lanthanum and sucroferric oxyhydroxide: initiation through the Highly Specialised Drugs program, maintenance on the General Schedule. Cinacalcet for secondary hyperparathyroidism.
ADPKD (KDIGO 2025; CARI commentary 2026). PBS lists tolvaptan, Authority Required, initial and continuing. CARI notes the PBS criteria exclude imaging, and Mayo class MRI has no MBS item. Liver tests monthly for 18 months, then quarterly. SGLT2 inhibitors are not currently recommended in ADPKD.
Glomerular disease (CARI 2025; TGA and PBS, October 2026). Dapagliflozin is standard care in IgA nephropathy. Sparsentan and targeted-release budesonide have no TGA product information or PBS listing found. Belimumab's TGA indications include lupus nephritis, but it was not found in the PBS medicine index; voclosporin has neither. PBS lists avacopan for ANCA vasculitis induction.
Kidney failure (ANZDATA 2026; TSANZ guidelines 2026). Diabetic kidney disease caused 37% of new dialysis starts in 2025 (interim tables); 47% on kidney replacement therapy have a transplant. Deceased donor listing needs dialysis and significant benefit; the 80% five-year survival rule ended in 2018. The Organ and Tissue Authority funds TSANZ's national eligibility and allocation rules. See Physify's Renal Transplantation course.
3Sample questions (Physify format)
1. A 52 year old man has a Kidney Health Check because he smokes and has a BMI of 33. He is not Aboriginal or Torres Strait Islander and has no diabetes, hypertension or cardiovascular disease. His blood pressure, eGFR and urine ACR are normal. Under the 2024 Kidney Health Australia handbook, when should the check be repeated?
- A. In 12 months
- B. In 2 years
- C. In 5 years, with his cardiovascular risk assessment
- D. Once more at age 60, then stop
- E. Not at all, as his results were normal
Answer: B
B. Correct. Obesity and smoking each call for a Kidney Health Check every 2 years (KHA 2024).
A. Yearly checks are for diabetes, hypertension and First Nations adults from 18.
C. The handbook has no five-yearly interval for these risk factors.
D. A once-off check applies when age 60 or over is the only indication.
E. A normal result does not remove his risk factors, so checks continue.
2. A 38 year old woman with ADPKD has an eGFR of 58 mL/min/1.73m², falling by 6 mL/min/1.73m² a year for three years. Her BP is 118/76 on ramipril and her urine ACR is 4 mg/mmol. She has no family history of aneurysm or subarachnoid haemorrhage, no high-risk occupation, no planned surgery, no anxiety about aneurysm and is not planning pregnancy. What is the most appropriate next step?
- A. Start dapagliflozin to slow her eGFR decline
- B. Start tolvaptan, with monthly liver tests
- C. Add finerenone to her ramipril
- D. Arrange MR angiography to screen for an intracranial aneurysm
- E. Advise 4 litres of fluid a day and no caffeine
Answer: B
B. Correct. eGFR 25 or more with rapid decline (3 or more a year) meets KDIGO 2025; PBS lists tolvaptan for ADPKD. Liver tests monthly for 18 months, then quarterly (CARI 2026).
A. CARI does not currently recommend SGLT2 inhibitors in ADPKD, as the trials excluded it.
C. Finerenone's CKD indication requires type 2 diabetes, which she does not have.
D. None of CARI's screening triggers is present, so screening is not routine.
E. CARI advises fluid tailored to the person and climate; moderate caffeine is acceptable.
3. A 45 year old man has biopsy-proven IgA nephropathy. On maximum-dose perindopril his proteinuria is 1.4 g/day, eGFR 52 mL/min/1.73m² and BP 124/78. Which addition is most appropriate under Australian guidance and access in October 2026?
- A. Dapagliflozin 10 mg daily
- B. Sparsentan in place of perindopril
- C. Targeted-release budesonide capsules
- D. Iptacopan 200 mg twice daily
- E. Candesartan added to perindopril
Answer: A
A. Correct. CARI 2025 calls dapagliflozin standard care in IgA nephropathy, and the PBS lists it for chronic kidney disease.
B. Sparsentan has no TGA product information and was not found in the PBS medicine index.
C. No targeted-release budesonide product was found in the TGA or PBS listings.
D. Iptacopan's TGA indications are PNH and C3 glomerulopathy; the PBS lists PNH only.
E. Combining an ACE inhibitor and an ARB is not recommended (KHA 2024).