Approches

Question 1

Abdo pain and vomiting in PD

Answer 1

DDx:
EPS
chronic infection
malignancy

Hx: Onset, pain character, associated symptoms (fever, diarrhea), weight loss
P/E: peritoneal sign, abdo mass, LN
Ix:
- WCC, RLFT
- PDF x cell count, C/ST, AFB, Fungal, Cytology
- CT abdo

EPS Tx

• drip and suck
• TPN
• stop PD, to HD
• steroid and tamoxifen
• surgery as last resort

Question 2

hypoK acidosis

Answer 2

DDx
dRTA: Sjogren, SLE, drug (amphoB, NSAID), hyperCa, post obstructive, MCKD
pRTA: MM, drug (acetazolamine, gentamycin, TDF), heavy metal, PNH, Vit D deficiency
GI causes

Hx: onset and severity of symptoms, associated symptoms (arthritis, rash, sicca, bone pain, V/D), drug, FMHx, occupation

P/E rheumat signs, LN

Ix:

• RLFT, VBG, AG, CaPO4, Urate, autoimmune, SPE
• Urine K, Cr, AG/OG, pH, glucose
• USG kidney

Tx:
stop offending drug
treat underlying causes
dRTA: K citrate
pRTA: K citrate +/- thiazide +/- spirolactone

ddx p and dRTA:

• urine pH
• glucouria, hypoPO4, hypoUrate, aminaciduria

Question 3

hypoK alkalosis

Answer 3

ddx:
aldosteronism, mimicks (AME, GRA, Liddle), drug (diuretics), hypovolemia, bartter, gitelmann, GI

Hx:
onset and severity of symptoms, polyuria, HT, D/V, associated symptoms, drug, FHx

P/E: fluid status, HT

Ix:

• RFT, CaPO4, Mg, VBG, renin and aldo
• urine x K, Cr, Ca, Cl

bartter vs gitelman

• earlier onset
• hypocalciuria in gitelman (<0.2 mmol/mmol)

AME vs Liddle vs aldosteronism

• low aldo and renin vs high aldo and low renin
• genetic test

Tx:
Stop drug
- gitelman / bartter: Na, Mg, K supp +/- NSAID if bartter
- AME: spirolactone / amiloride
- Liddle: amiloride

Question 4

post transplant AKI causes

Answer 4

ddx:
hypoVol, rejection, infection (bacterial, BK, CMV), drug (CNI), ATN, vascular (TRAS, RVT), urological

Hx: D/V, fever, dysuria, GI, drug compliance
P/E: fluid status, graft tenderness, renal bruit
Ix:
- CBC, RLFT, CaPO4, Ab screening, drug level, pp65, BK PCR
- urine R/M, C/ST, uPCR
- USG doppler
- Renal biopsy
- TK drainage if any

Tx:
Rejection: TCMR / ABMR, maintenance drug
Infection: BK / CMV, maintenance drug

Question 5

hyperCa in PD

Answer 5

high PTH: hyperparathyroidism
low PTH:
- malignancy
- infection: TB
- adynamic bone disease
- endocrine: hyperthyroidism, acromegaly, pheochromocytoma
- Drug: Ca, Vit D, PO4 binder

Hx: associated symptoms, constituitional symptoms, fever, bone pain, heat intolerance, HT, flush, drug history,
P/E LN, thyroid status
Ix: PTH, RFT, CAPO4, Vit D, TFT

Tx:
adynamic bone disease: stop Ca, Vit D, Cinacalcet, alusorb
IPD + IVF