CKD

Question 1

Important causes of CKD are

1
2
3
4
5

Answer 1

diabetes mellitus (35%),
glomerulonephritis (25%),
hypertension (13%)
 polycystic kidney disease (8%), 
reflux nephropathy (8%) and

Question 2

The commonest cause of ESKF in Australia is

_______

Answer 2

diabetes mellitus

Question 3

The commonest cause of nephritis leading to

kidney failure in Australia is _____

Answer 3

IgA nephropathy.

Question 4

T or F

Warmer climates, poorer living conditions and
certain genetic predispositions are associated with
a higher prevalence of kidney failure

Answer 4

T

Question 5

Uraemic symptoms are non-specific and usually are
not recognised until the creatinine clearance is less
than ______

Answer 5

20% of normal

Question 6

______ is characterised by the accumulation of
uraemic toxins and a deficiency of kidney
hormones that cause dysfunction of organs other
than kidneys

Answer 6

CKF

Question 7

CKF

Age is an issue—we lose _____

Answer 7

1% of renal function

per year

Question 8

is defined as a sudden (days to weeks) decrease in
kidney function (azotaemia) with or without oliguria

Answer 8

Acute kidney failure (AKF

Question 9

Classification of AKI

Answer 9

• prerenal (e.g. acute circulatory failure → kidney
hypoperfusion)
• postrenal (e.g. obstruction)
• kidney (intrinsic) (e.g. acute glomerulonephritis)

Question 10

an estimated or measured glomerular filtration
rate (GFR) 1 <60 mL/min/1.73m 2 that is present
for ≥ 3 months with or without evidence of
kidney damage

Answer 10

Chronic kidney disease and failure

Question 11

CKD can also be defined as

evidence of kidney damage with or without
decreased GFR that is present for ≥ 3 months as
evidenced by the following, irrespective of the
underlying cause:

1
2
3
4

Answer 11

— albuminuria
— haematuria after exclusion of urological
causes
— structural abnormalities (e.g. on kidney
imaging tests)
— pathological abnormalities (e.g. renal biopsy)

Question 12

Chronic kidney (or renal) failure (CKF) is defined as
a severe reduction in nephron mass over an extended
period of time, resulting in_____

Answer 12

uraemia

Question 13

Not modifiable risk factors for HPN

Answer 13

Age >60
Family history
Aboriginal or Torres Strait
Islander origin

Question 14

Symptoms from CKF are
rare unless the creatinine clearance is less than ______
of normal and only become common when less than
______ of normal.

Answer 14

20%

10%

Question 15

The common early presenting symptoms of CKD are
generally non-specific and referable to the GIT,
presumably due to the formation of _______in the
upper GIT.

Answer 15

ammonia

Question 16

If a patient presents with symptoms and
has a________ appearance due to a
combination of anaemia and brownish pigmentation,
then CKF should be highly suspected

Answer 16

sallow ‘lemon’ tinge

Question 17

In CKF

Urinalysis should test .

Answer 17

glucose, blood and protein

Question 18

Proteinuria should be confirmed with a 24-hour

urine protein estimation or (preferably) an ______

Answer 18

albumin
creatinine ratio (ACR).

Question 19

Microalbuminuria

Men: ______
Women:______

Answer 19

2. 5–25 mg/mmol

3. 5–35 mg/mmol

Question 20

Macroalbuminuria
Men:_______
Women: _____

Answer 20

> 25 mg/mmol

> 35 mg/mmol

Question 21

The traditional test in identifying and monitoring CKD
is the ________. The normal range is about
40–120 μ mol/L (0.04–0.12 mmol/L)

Answer 21

serum creatinine level

Question 22

T or F,

creatinine is a reliable and insensitive
marker of CKD

Answer 22

F

unreliable

Question 23

Although common in older people, an eGFR ______
is associated with increased risks of adverse clinical
outcomes, especially renal and cardiovascular

Answer 23

<60

Question 24

eGFR = _______

Answer 24

140 – age

Question 25

Drugs that can damage the kidneys include:

• classic nephrotoxic drugs e.g. _____
NSAIDs, COX-2 inhibitors
• ACE inhibitors and AIIR blockers (ARBs)
• aminoglycosides

Answer 25

gentamicin, vancomycin

Question 26

Beware of the ‘triple whammy’
1
2
3

Answer 26

• NSAIDs/COX-2 inhibitors
• ACE inhibitors
• diuretics

Question 27

Increased risk of adverse reaction

• ________:
— vasculitis
— liver dysfunction

• _________
— liver dysfunction
— myopathy
— rhabdomyolysis

• _______: rhabdomyolysis

Answer 27

Allopurinol

Statins:

Gemfibrozil

Question 28

Do not use ____ and _______ together.

Answer 28

statins and gemfibrozil

Question 29

• \_\_\_\_\_\_\_: interstitial nephritis
• \_\_\_\_\_\_: bleeding
• \_\_\_\_\_: GIT bleeding
• Omeprazole and related agents: interstitial
nephritis

Answer 29

Beta lactams
LMW heparin
Aspirin/NSAID

Question 30

What drug?

Confusion, encephalopathy

Answer 30

Aciclovir

Question 31

What drug?

Steven Johnson syndrome

Answer 31

Cotrimoxazole

Question 32

Peripheral neuropathy

Answer 32

Flagyl (long term)

Question 33

Seizures

Answer 33

Penicillin (high dose IV)
Quinalones:
• ciprofloxacin
• norfloxacin

Question 34

Prolonged hypoglycaemia

Answer 34

Sulfonylureas

Question 35

Nausea, bradycardia

Answer 35

Digoxin

Question 36

Ventricular tachycardia (Mg
required before conversion

Answer 36

Sotalol

Question 37

Confusion, acute brain syndrome

Answer 37

Codeine

Question 38

Liver dysfunction

Bone marrow depression

Answer 38

Methotrexate

Question 39

Tremor—confusion

Thyroid dysfunction

Answer 39

Lithium

Question 40

none of the antihypertensive
agents is specifically contraindicated but those
eliminated mainly by the kidney ________ should be given in lower dosage.

Answer 40

e.g. ACE

inhibitors, atenolol, sotalol)

Question 41

ACE inhibitors should not be
used in the presence of __________;

________ are effective in
larger doses.

Answer 41

kidney artery stenosis

loop diuretics (e.g. frusemide)

Question 42

The first-line agents are ACEIs or
ARBs, which should not be used together. They
should be ceased if the creatinine levels exceed
_______above baseline or if the serum K exceeds
________ (despite dose reduction

Answer 42

30%

6 mmol/L

Question 43

Diuretics have a vital role in the patient with _____

Answer 43

diastolic

heart failure

Question 44

Mx of Anemia in CKF

Anaemia

• Exclude _____ and _______

• Give iron for iron deficiency and also
_____especially for Hb <100 g/L
initiated in a renal unit.

• Avoid transfusions where possible

Answer 44

chronic infection and iron deficiency.

erythropoietin

Question 45

Hyperphosphataemia control in CKF

• Balanced nutrition to reduce dietary phosphate
______ restriction
• __________tablets (to bind phosphate

Answer 45

• Protein

Calcium carbonate

Question 46

Hot to Tx Hyper K

• Low potassium diet
• Cease ACEI/ARB/spironolactone (if applicable)
1
2
3
4
5

Answer 46

• Nebulised salbutamol
• IV insulin and dextrose
• IV calcium gluconate
• Oral resonium A
• Then dialysis

Question 47

About
two-thirds of patients receive haemodialysis and
about_________ are on continuous ambulatory peritoneal
dialysis and automated overnight peritoneal dialysis
(nocturnal dialysis).

Answer 47

22%

Question 48

In HD

The preferred access is via an _______ usually
between the radial artery and a cephalic vein.

Answer 48

AV fistula

Question 49

_______ is the treatment of choice for
kidney failure except where contraindicated, such as
with active malignancy or tuberculosis and perhaps
the elderly.

Answer 49

Transplantation

Question 50

Rejection and infection are
problems, occurring especially in the first 6 months.
As a rule, never stop the_____

Answer 50

immunosuppressants

Question 51

The commonest
causes of CKF in children include 
1
2
3

Answer 51

chronic glomerulonephritis, obstructive

nephropathy and reflux nephropathy.

Question 52

Dialysis and transplantation are normally considered

for children over _______ of age with end-stage CKF

Answer 52

2 years