AKI and CKD module

Question 1

What are the causes of ARF?

Answer 1

Pre-renal
Intrinsic renal
Post-renal

Question 2

What can cause pre-renal AKI?

Answer 2

Reduced renal perfusion: major haemorrhage, hypovolemia due to severe diarrhoea or vomiting, reduced renal perfusion in sepsis and hypotension due to cardiac causes such as MI

Question 3

What can pre-renal AKI lead to?

Answer 3

Acute tubular necrosis

Question 4

What can cause intrinsic renal AKI?

Answer 4

ATN
Acute glomerulonephritis
Acute interstitial nephritis
Rhabdo myloysis

Question 5

What can cause post-renal AKI?

Answer 5

Obstruction of the urinary tract

2 kidneys must be obstructed to cause ARF so the obstruction must be at the level of the bladder or urethra

Question 6

What are common complications of ARF?

Answer 6

Hyperkalemia
Metabolic acidosis
Fluid overload

Question 7

What can an ultrasound of the kidneys show?

Answer 7

Obstruction
Check size of kidneys - CKD will show small, shrunken kidneys
Cysts

Question 8

What is the treatment of hyperkalemia?

Answer 8

10ml calcium gluconate 10%
10 units actrapid insulin with 50ml 50% dextrose
2.5mg salbutamol neb

Question 9

What is needed to class someone as having CKD if they fall into stage 1 or 2?

Answer 9

Structural kidney damage: proteinuria or abnormalities on scanning

Question 10

When will people start to notice symptoms with a low GFR?

Answer 10

When it reaches 20ml/min

Question 11

How is CKD managed in GP?

Answer 11

Urinalysis: proteinuira for progression of CKD
Haematuria = renal disease or lesion of lower urinary tract
If proteinuria present, send for protein:creatinine ratio - 100mg/mmol is equivalent to Ig per day

Question 12

What is nephrotic syndrome?

Answer 12

Heavy proteinuria >3g day
Hypoalbuminaemia
Oedema
Hyperlipidaemia

Question 13

What are the causes of nephrotic syndrome?

Answer 13

Primary glomerulonephritis 
Minimal change nephropathy
Membranous nephropathy 
Diabetes
SLE
Malignancy
Chronic infections
Drugs: gold, penicillamine

Question 14

How will minimal change and membranous nephropathy present?

Answer 14

Nephrotic syndrome with normal renal function and BP

Question 15

What tests need to be carried out before a renal biopsy is performed?

Answer 15

Blood count and coag screen - moderate or severe thrombocytopenia and coag defects are CI to biopsy but can be corrected
Renal ultrasound: check that 2 kidneys are present, size and position

Question 16

What are the contraindications to renal biopsy?

Answer 16

Thrombocytopenia
Coag defects
Small kidneys - increased bleeding, biopsy inconclusive
Uncontrolled hypertension - bleeding 
Untreated UTI 
Single kidney

Question 17

What is the treatment for minimal change nephropathy?

Answer 17

Prednisolone 40-60 mg daily

PPI to protect against peptic ulcer

Question 18

What are the investigations in nephrotic syndrome?

Answer 18

BP
Urinalysis: if positive for protein
Quantify protein:creatinine ratio
Blood sample to check U&Es and serum albumin

Question 19

What is the presentation of IgA nephropathy?

Answer 19

Episodes of macroscopic haematuria associated with an URTI

Question 20

How is IgA nephropathy diagnosed?

Answer 20

Renal biopsy

Question 21

What drug should be prescribed to control BP in someone with proteinuria?

Answer 21

ACEi: reduced BP and reduces protein excretion, slowing the progression of kidney disease

Question 22

What is the outcome for IgA nephropathy?

Answer 22

25% will have progressively declining renal function and will require dialysis or transplantation
Heavy proteinuria and scarring are associated with a higher risk of progression

Question 23

What are the options for renal replacement therapy?

Answer 23

Haemodialysis
Peritoneal dialysis
Pre-emptive transplantation

Question 24

What does proteinuria with haematuria suggest?

Answer 24

Kidneys are the source of blood