Chronic renal failure/renal transplant

Question 1

LIF mass differential

Answer 1

Renal transplant
Loaded colon
Diverticular mass
Colorectal carcinoma
Ovarian mass/cyst

Question 2

RIF mass differential

Answer 2

Renal transplant
Appendix mass
Crohn's disease
Caecal carcinoma
Ovarian mass/cyst

Question 3

Bilateral enlarged kidneys differential

Answer 3

APKD
Bilateral hydronephrosis
Amyloidosis

Question 4

Unilateral enlarged kidney differential

Answer 4

Hydronephrosis
RCC
Renal cyst

Question 5

Spleen v kidney o/e?

Answer 5

You can get hand over kidney
Percussion note resonant over kidney
Kidney is ballotable
Spleen has a notch
Spleen moves on respiration

Question 6

Indications for dialysis in CRF

Answer 6

Progressive decline in renal function (CKD 5 GFR<15)
Uraemia (symptomatic)
Renal bone disease
Pericarditis
Volume overload despite fluid restriction and diuretics
Hyperkalaemia (resistant)
Severe metabolic acidosis

Question 7

Aspects renal bone disease

Answer 7

1. Osteomalacia due to vit D deficiency

2. Hyperparathyroidism due to low calcium/high phosphate

Question 8

Haemodialysis complications

Answer 8

Hypotension
Hypovolaemia
Hypokalaemia
Disequilibrium syndrome (cerebral oedema)
Dialysis-related amyloidosis (B2 microglobulin accumulation)

Question 9

Side effects post transplant immunosuppressive therapy

Answer 9

High dose steroids: cushingoid, thin skin, bruising, obesity, muscle wasting in limbs, purple striae

Ciclosporin: gingival hypertrophy