Renal

Question 1

What are clinical signs of adequate RRT?

Answer 1

Volume status (pulse, bp, jvp, chest, oedema)
Asterixis (metabolic encephalopathy)
Excoriation marks
RR (resp compensation for metabolic acidosis)
Pericardial rub (uraemia pericarditis)

Question 2

What are complications of HD?

Answer 2

Removal of fluid too quickly +/- too much
- hypotension, cramps, headache
Bacteriaemia if through tunnelled line
Bleeding from heparin
Dialysis related amyloidosis
Fistula problems
Dialysis disequilibrium syndrome

Question 3

What are complications of PD?

Answer 3

Bacterial peritonitis
Catheter exit site infections
Kinking of tube due to constipation
Peritoneal sclerosis
Pleuroperitoneal leak due to diaphragmatic defect

Question 4

What complications can occur with a fistula?

Answer 4

Aneurysm or pseudo aneurysm
Thrombosis (no thrill or bruit)
Steal syndrome
Stenosis (consider a fistula gram)

Question 5

What are the manifestations of renal osteodystrophy?

Answer 5

Osteitis fibrosa
- increased bone turnover due to secondary hyperparathyroidism, bone cysts occur

Adynamic bone disease (bone turnover reduced)

Osteomalacia

Question 6

What is the definition of nephrotic syndrome?

Answer 6

Hypoalbuminaemia
Heavy proteinuria (>3G/24hrs)
Oedema

Question 7

What is the differential for nephrotic syndrome

Answer 7

Minimal change (idiopathic, assoc with DM, IgA nephropathy, HIV, paraneoplastic

FSGS (idiopathic, hiv, obesity, NSAIDs)

Membranous (infection; hep B/C, malaria, autoimmune; SLE, RA,
Paraneoplastic, drugs)

Mesangiocapillary GN

Question 8

What are the complications of NS

Answer 8

Oedema (salt, diuretics)
HTN
Hypercholesterolaemia 
Thrombosis
Infection

Question 9

What are the clinical features of PCKD

Answer 9

FHx + diffuse cysts + enlarged kidneys
Asymptomatic or
Infection/stones/HTN or pain from cysts
Maybe hepatomegaly from cysts

Question 10

What are extra renal manifestations of PCKD

Answer 10

Associated with MV prolapse, AR
Intracranial aneursyms
Liver cysts

Question 11

How do you manage PCKD

Answer 11

Manage HTN and address CV RFs
Screen for intracranial aneursyms if high risk
Consider tolvaptan (vasopressin receptor 2  antagonist)

Question 12

What diseases cause bilateral renal cysts

Answer 12

PCKD
Multiple simple cysts
VHL syndrome
Tuberous sclerosis

Question 13

What are the absolute CIs to kidney donation

Answer 13

Diabetes
Uncontrolled HTN or evidence of end organ damage
Active Ca
Unable to consent
Acute symptomatic infection

Question 14

How do you assess acute allograft dysfunction

Answer 14

Calcineurin levels
MSU
FBC
Signs of HUS
USS, urine cytology
Renal biopsy

Question 15

What are the causes of allograft dysfunction

Answer 15

Volume depletion
Rejection
Calcineurin toxicity
Ureteric problem
Post 4 weeks: infection: CMV, BK
PTLD, lymphoma

Question 16

What are SEs of steroids

Answer 16

Osteoporosis
Skin thinning
Obesity
Diabetes
AVN
Adrenal insufficiency
Psychosis and insomnia

Question 17

What are mTOR inhibitors

Answer 17

Rapamycin and everolimus, inhibit T and B cell activation

Question 18

What are SEs of mTOR inhibitors

Answer 18

Hyperlipidaemia
Impaired wound healing
Mouth ulcers
tMA

Question 19

What are the SEs of mycophenolate?

Answer 19

Myelosuppression and diarrhoea

Question 20

What are SEs of CNIs

Answer 20

Nephrotoxic, diabetes, HUS, HTN
Cyclosporine: hirsuitism, gum hyperplasia
Tacrolimus: tremor, transient hair loss