CKD questions

Question 1

how does CKD cause susceptibility to fractures

Answer 1

secondary hyperparathyroidism
decreased renal excretion of phosphate results in phyerphosphataemia, which leads to claium phosphate precipitation in body tissues and subsequent hypocalcaemia
also there is a decrease in renal hydroxylation of vit D, resulting in impaired intestinal calcium absorbtion due to low calcitriol

Question 2

chronically low calcium increases excretion of

Answer 2

parathyroid hormone in order to raise serum calcium by stimulating osteoclast actvitiy

Question 3

what does elevated PTH do

Answer 3

increases bone turnover and decreases bone mineralization
predisposing patients to fractures

Question 4

clinical appearance of acute interstitial nephritis

Answer 4

most commonly drug induced
more likely to result in tubular epithelial cell casts or white cell casts

Question 5

clinical appearance of acute tubular necrosis

Answer 5

ATN can be secondary to ischaemia or toxins
most common cause of aki in a hospitalised patient
muddy brown granular casts to appear in the urine

Question 5

define AKI

Answer 5

increase in serum creatinine >26.5 within 48 hours
increase in serum creatinine to 1.5 times baseline within 7 days
OR
<0.5 ml/kg/hr for 6 hours

Question 6

pre-renal causes of AKI

Answer 6

hypovolaemia eg. acute haemorrhage, diarrhoea
low effective circulating volume eg. heart failure, sepsis
alterations in renal vascular auto regulation eg. NSAIDs, ACEI

Question 7

renal causes of AKI

Answer 7

vascular eg. vasculitis, haemolytic uraemic syndrome, thrombotic thrombocytopaenic purpura, atheroembolic disease
glomerular disease eg. nephrotic/nephritic
tubular eg. acute tubular necrosis
intertsitium eg. acute interstitial nephritis

Question 8

post renal causes of AKI

Answer 8

prostatic disease
neurogenic bladder

Question 9

standard investigations of AKI

Answer 9

FBC, EUC,
urinalysis and urine microscopy

Question 10

abnormal protienuria/haematuria with fragmented red blood cells

Answer 10

glomerulonephrtis

Question 11

aterile pyuria indicates

Answer 11

acute interstitial nephritis

Question 12

pigmented granular casts/tubular epithelial casts indicates

Answer 12

acute tubular necrosis

Question 13

response to fluid repletion is used to indicate

Answer 13

pre-renal AKI versus acute tubular necrosis
if sufficient fluid is given to reverse the signs of volume depletion, creatinine should return to baseline in 72 hours

Question 14

muddy brown granular casts and pathogneumonic for

Answer 14

acute tubular necrosis

Question 15

what investigation should be done urgently for the patient with hyperkalaemia

Answer 15

ECG