Dr Hill's tutorial

Question 1

How many hours do patients do haemodialysis a week?

Answer 1

4hr x 3 = 12 hours a week… in comparison to the 24 hr filtering a day that functioning kidneys have

Question 1

Differentials for kidney failure other than diabetes and hypertension, by age

Answer 1

Young person:
Alport’s syndrome
IgA nephropathy
Drug toxicity

Older person:
Myeloma

Question 2

How does IgA nephropathy present?

Answer 2

Haematuria
Proteinuria not so much
1-3 days after an URTI but not necessarily

Question 3

How long does dialysis actually extended your life for if you are diabetic?

Answer 3

Five years

Question 4

How long does a living donor kidney transplant last for?

Answer 4

10 to 15 years

Question 5

What infections do patients who are on kidney transplant immunosuppression get?

Answer 5

EBV
PCP pneumonias
Thrush
Latent opportunistic infections like shingles

Question 6

Which immunosuppressants are used in renal failure?

Answer 6

Tacrolimus
Ciclosporin
Mycophenolate mofetil

+ monoclonal antibodies

Question 7

How do ciclosporin and tacrolimus work?

Answer 7

They inhibit calcineurin, which is a phosphatase (phosphate remover) involved in T cell activation

Question 8

Give some side effects of tacrolimus and ciclosporin

Answer 8

Hypertension
Hyperglycemia
Renal failure
Malignancy

Tacrolimus can also caused hyperlipidemia (tacos and cheese)

Therefore these patients need to be regularly monitored for CVD

Question 9

How does mycophenolate mofetil work?

Answer 9

Inhibits T and B cell proliferation

Question 10

What do you need to ensure if a patient is on MMF?

Answer 10

That they are well vaccinated
That they receive antibiotics if unwell

Question 11

What diseases are associated with IgA nephropathy?

Answer 11

Certain lung conditions like broncholitis and sarcoidosis

Question 12

IgA nephropathy treatment

Answer 12

Steroids - prednisolone
Cyclophosphamide
Rituximab

Note - IgA nephropathy is a spectrum, you can get it with vasculitis

Question 13

Polycystic kidney disease - genetics

Answer 13

PKD 1 gene - on chromosome 16
PKD 2 gene - chromosome 4

Question 14

Who gest PKD 1 gene polycystic kidney disease?

Answer 14

Middle aged people

Question 15

Who gest PKD 2 gene polycystic kidney disease? How do they present?

Answer 15

Presents with renal failure - people in their 70s

Question 16

Management of PKD

Answer 16

Tolvaptan - a vasopressin inhibitor. Interferes with cyclic AMP in tubular cells and presents cyst formation

Question 17

Does tolvaptan actually do anything about berry aneurysms?

Answer 17

Nope, doesn’t decrease the risk

Question 18

What are the stages of CKD

Answer 18

5 stages (goes down by 15 each time)

Stage 1 - over 75
Stage 2 - 60-75
Stage 3a - 45-60
Stage 3b - 30-45
Stage 4 - 15-30
Stage 5 - under 15

5d = dialysis
5t = transplant

Question 19

When does someone have dialysis or transplant

Answer 19

When they are at stage 5 CKD