CKD

Question 1

Method of cannulating deeper fistula

Answer 1

Buttonhole ( track is created with created with repetiive cannulation - sharp then blunt needle cannulation)

This method, known as the “buttonhole” technique, has the advantage of reducing pain, unsuccessful attempts, bleeding, hematoma, and aneurysm formation. Prolonged bleeding with this technique generally does not occur in the absence of miscannulation, but studies have reported a higher incidence of infections. The primary cause of infections seems to be poor cannulation technique. Despite the risk of infection, ease of buttonhole cannulation makes it a preferred technique for self-cannulation, which is this patient’s ultimate goal.

as distinct from Rope ladder technique (sites rotated and sharp needle use)

Buttonhole is not use for AV graft

Question 2

Protection against further thrombosis

Answer 2

A prospective, randomized, double-blind, parallel group trial examined the efficacy of dipyridamole and/or aspirin in decreasing the rate of thrombosis in polytetrafluoroethylene grafts. Neither drug therapy improved patency in patients with previous thrombosis of an existing graft, but thrombosis rates were significantly reduced in new AV grafts in patients who had received dipyridamole.

Question 3

Hepcidin role

Answer 3

Hepcidin induces degradation of ferroportin - a protein responsible for the transport of iron out of enterocytes

Question 4

What is Fabry Disease

Answer 4

A prospective, randomized, double-blind, parallel group trial examined the efficacy of dipyridamole and/or aspirin in decreasing the rate of thrombosis in polytetrafluoroethylene grafts. Neither drug therapy improved patency in patients with previous thrombosis of an existing graft, but thrombosis rates were significantly reduced in new AV grafts in patients who had received dipyridamole.

• Angiokeratomas.

Diagnosis is usually established by demonstrating an α-galactosidase A activity level in leukocytes of <25–30% of standard control in patients with suspected disease. In heterozygote female patients, genetic analysis is more accurate because enzymatic activity is unreliable due to random X inactivation. Kidney biopsy can also be used for diagnosis. Findings include vacuolization of glomerular epithelial cells, and a classic appearance on electron microscopy of enlarged lysosomes filled with lamellated membrane structures. Skin biopsy of the angiokeratomas is not likely to be diagnostic.

Enzyme replacement therapy (ERT) with α-galactosidase A is indicated to prevent disease progression. Guidelines suggest initiation of treatment for all patients with Fabry who have CKD, significant proteinuria, or an abnormal kidney biops

Question 5

Above what dialysate bicarbonate level is there increased mortality

Answer 5

38

Question 6

Safe antibiotic in pregnancy

Answer 6

amoxicillin pr cefpodoxime or fosfomycin

Avoid nitro in CKD + first trimester
Avoid trimethoprim in first or last trimester. May be safe in mid pregnancy

Question 7

Relapsing peritonitis

v

Repeat peritonitis

v

Recurrent peritonitis

Answer 7

relapsing = 2nd episode with same organism within 4 weeks of completion of antibiotics for initial episode

Repeat is same organism > 4 weeks after

Recurrent is different organism within 4 weeks of stopping abx

Question 8

What % of female carriers for alports reach ESRD by 40?

Answer 8

12%

Question 9

Polyuria years after stopping lithium use - what medication do you use?

Answer 9

Thiazide- chlorthalidone

Question 10

Positive Hep B surface antigen but negative core antibody in a dialysis patient -

Answer 10

Most likely recently vaccinated ( with recombinant Hep B surface antigen) - normally within 2 weeks

Question 11

Drain pain on automated PD

Answer 11

First step= Tidal mode of peritoneal dialysis
Typically start with 85% and then titrate this
—> Next try continuous ambulatory PD ( as gravity drainage may be less prone to provoke drain pain)