Fatigue (I Feel Tired)

Question 1

How are acute, subacute and chronic fatigue defined?

Answer 1

Acute = fatigue lasting one month or less
Subacute = fatigue lasting between one and six months
Chronic = fatigue lasting over six months

Question 2

What can cause proteinuria on a urine dipstick (7)?

Answer 2

-Pregnancy
-Abnormally high BP
-Chronic Kidney Disease
-Urinary Tract Infection
-Nephrotic/nephritic syndrome
-Fever
-After physical exercise

Question 3

How is Chronic Kidney Disease (CKD) defined?

Answer 3

Abnormalities of kidney function or structure present for more than 3 months, with implications for health.

Question 4

What does a decreased MCV reflect?

Answer 4

A defect in cellular haemoglobin synthesis.

Question 5

What can cause microcytic hypochromic anaemia? (2)

Answer 5

Iron deficiency
Thalassaemia

Question 6

How is ‘accelerated progression of Chronic Kidney Disease (CKD)’ defined? (2)

Answer 6

-A sustained decrease in GFR of 25% or more and a change in GFR category within 12 months
OR
-A sustained decrease in GFR of 15 ml/min/1.73 m2 per year

Question 7

How is Chronic Kidney Disease (CKD) diagnosed? (2)

Answer 7

-Any patient with markers of kidney damage present for more than 3 months
OR
-Patient with eGFR < 60ml/min/1.73m² on at least 2 occasions, separated by a period of at least 90 days (with or without markers of kidney damage).

Question 8

What factors is Chronic Kidney Disease (CKD) classification based on? (3)

Answer 8

CGA:
-Cause
-GFR category (G1-G5)
-Albuminuria category (A1-A3)

Question 9

When should ACE inhibitors/ARBs be stopped in a patient with poor renal function?

Answer 9

Renal function needs to be checked 7-10 days following commencement and if there is a decline >25%, you should stop these medications.

Question 10

What four patient variables are used in the Kidney Failure Risk Equation?

Answer 10

-Age
-Gender
-eGFR
-Albumin:creatinine ratio

Question 11

What does the Kidney Failure Risk Equation calculate?

Answer 11

Estimated risk of end stage renal disease requiring dialysis or transplantation over the next 2 or 5 years.

Question 12

Name two ACE inhibitors.

Answer 12

Ramipril
Lisinopril

Question 13

Name three angiotensin receptor blockers (ARBs).

Answer 13

Candesartan
Irbesartan
Losartan

Question 14

What is Aranesp?

Answer 14

A re-engineered form of erythropoietin, given for symptomatic anaemia associated with chronic renal failure, chronic kidney disease or chemotherapy (helps the body increase RBC production).

Question 15

What are the advantages of commencing a Chronic Kidney Disease (CKD) patient on bicarbonate (if indicated)?

Answer 15

Correcting acidosis delays CKD progression, improves erythropoietin response, protects the bones and controls hyperkalaemia.

Question 16

What is calcium acetate?

Answer 16

A calcium-containing phosphate binder used to treat hyperphosphataemia and hypercalciuria; used in end-stage renal disease (ESRD) to limit phosphate rise, improve calcium levels and thereby inhibit PTH.

Question 17

Name two glucagon-like receptor 1 agonists (GLP1).

Answer 17

Semaglutide
Dulaglutide

Question 18

How should metformin be given in patients with renal impairment? (2)

Answer 18

The dose of metformin should be reviewed if the eGFR is below 45 ml/minute/1.73m2, and stopped if the eGFR is below 30 ml/minute/1.73m2.

Question 19

What is the primary approach for treating secondary hyperparathyroidism?

Answer 19

Inhibition of parathyroid hormone (PTH); this can be achieved by giving active and inactive vitamin D (this may cause increased phosphate absorption, which can be managed with a phosphate binder such as calcium acetate).

Question 20

What is Alfacalcidol?

Answer 20

A vitamin D analogue used to treat vitamin D deficiency and hypocalcaemia.

Question 21

What is sodium zirconium?

Answer 21

A potassium chelating agent, used only to control hyperkalaemia.

Question 22

How can ACE inhibitors/angiotensin receptor blockers delay progression of kidney disease?

Answer 22

They dilate the efferent arteriole, lowering intraglomerular pressure and preventing loss of protein, protecting the kidney in the long term.

Question 23

How can SGLT2 inhibitors be used to delay progression of kidney disease?

Answer 23

SGLT2 inhibitors can lower intraglomerular pressure by constricting the afferent arteriole and limiting the blood flow to the glomeruli.

Question 24

What effect of intraglomerular pressure lowering medications on GFR do we need to worry about?

Answer 24

Anything over a 25% drop in glomerular filtration rate (GFR) from baseline; this indicates we should stop intraglomerular pressure lowering medications.

Question 25

What are the indications for starting urgent haemodialysis in a Chronic Kidney Disease (CKD) patient? (5)

Answer 25

Treatment Resistant:
-Fluid overload
-Hyperkalaemia
-Uraemia
-Metabolic acidosis
-Other more relative indications (such as uncontrollable anaemia or hyperphosphatemia)

Question 26

What is meant by Renal Replacement Therapy (RRT)?

Answer 26

Either transplantation or dialysis; there are two types of the latter - haemodialysis and peritoneal dialysis.

Question 27

What is involved in haemodialysis?

Answer 27

Blood is filtered outside of the body using a dialysis machine.

Question 28

What is involved in peritoneal dialysis?

Answer 28

Patient’s abdominal peritoneal lining is used to filter the blood; a catheter is inserted into the abdomen (via surgery) and dialysis fluid is placed into the abdomen; excess waste and water pass from the blood into this fluid, and after a few hours the fluid is drained out.

Question 29

Which vessels are generally anastomosed to the blood supply of a transplanted kidney?

Answer 29

External iliac vessels

Question 30

Why is arteriovenous fistula mapping undergone prior to starting dialysis?

Answer 30

Arteriovenous fistulas are the preferred initial access point for dialysis fistula creation compared to prosthetic grafts or haemodialysis catheters.

Question 31

When is dialysis fistula creation performed?

Answer 31

In patients suffering from end-stage renal disease (ESRD) who require permanent vascular access for haemodialysis.