GP_GU

Question 1

Name 5 key functions of the kidneys

Answer 1

1. Vit D metabolism
2. Blood volume/ fluid balance
3. Makes EPO
4. Waste/ toxin/ drug excretion
5. Acid-base regulation

Question 2

What bloods tests can be ordered to assess kidney function

Answer 2

1. eGFR
2. Creatinine
3. U&Es
4. Other biochemistry: bicarb, albumin, Ca, alkphos, PTH, phosphate?

Question 3

What makes up U&Es?

Answer 3

1. Sodium
2. Potassium
3. Urea
4. Creatinine
5. eGFR?

Question 4

What urine tests can be done to assess kidney function?

Answer 4

1. Albumin: creatinine ratio

2. Urinalysis for proteinuria & haematuria

Question 5

Which patients are at risk of CKD and need their renal function monitored regularly? (Name 5 risk factors/diseases)

Answer 5

1. High blood pressure
2. Diabetes
3. AKI
4. CVS disease i.e. coronary heart disease, HF
5. Other conditions that effects kidneys i.e. kidney stones, SLE
6. Patients on long term steroids
7. Hx of AKI
8. Old age (>50)
9. Fhx of CKD

Question 6

What are the DAMN drugs?

Answer 6

Key drugs that can cause AKI:

1. Diuretics
2. Ace inhibitors
3. Metformin
4. NSAIDS

Question 7

Give 5 causes of CKD

Answer 7

Vascular: Htn
Infection: Strep glomerulonephritis
Trauma
Autoimmune: SLE
Metabolic: Diabetes, hypercalcaemia
Iatrogenic: DAMN drugs - NSAIDs, ace-i
Neoplasms
Congenital: Alports, PCOS

Question 8

Give 4 symptoms of CKD

Answer 8

• NB early stages are usually asymptomatic
  1. Swollen ankles, hands, feet
  2. Puffy face
  3. SOB
  4. Tiredness
  5. Weight loss and poor appetite
  6. Muscle cramps

Question 9

Give 4 signs of CKD

Answer 9

1. Pallor
2. Htn
3. Peripheral oedema
4. Pleural effusion
5. Proteinuria
6. Haematuria

Question 10

Define CKD stage 1

Answer 10

A normal eGFR ( >90ml/min), but other tests have detected signs of kidney damage

Question 11

Define CKD stage 2

Answer 11

A slightly reduced eGFR (60-89ml/min), with other signs of kidney damage

Question 12

Define CKD stage 3a

Answer 12

eGFR of 45-59ml/min

Question 13

Define CKD stage 3b

Answer 13

eGFR of 30-44ml/min

Question 14

Define CKD stage 4

Answer 14

eGFR of 15-29ml/min

Question 15

Define CKD stage 5

Answer 15

eGFR below 15ml/min

Question 16

4 principles of managing CKD

Answer 16

1. Lifestyle advice
2. Treat cause
3. Manage complications
4. Consider renal replacement therapy if disease is severe

Question 17

List 5 lifestyle advice that can be given to patients with CKD

Answer 17

1. Stop smoking
2. Lose weight/ exercise regularly
3. Eat a balances and healthy diet
4. Moderate alcohol intake
5. Regulate salt intake
6. Avoid NSAIDs i.e. ibuprofen

Question 18

List 5 complications of CKD

Answer 18

1. Anaemia
2. Coagulopathy
3. Htn leading to LV hypertrophy, HF
4. Fluid overload leaning to pulmonary oedema
5. Secondary hyperparathyroidism: bone pain and fractures
6. Calcium phosphate loading
7. Hyperkalaemia
8. Acidosis

Question 19

What drugs an be used to control Htn in CKD?

Answer 19

Ace-i/ARB or Ca channel blockers

Question 20

What are the BP targets for patients with:

1. CKD
2. CKD and diabetes

Answer 20

1. < 140/90mmHg

2. <130/80mmHg

Question 21

If acutely fluid overloaded what medication can be given in CKD?

Answer 21

Loop diuretic

Question 22

What medication can be given in patient with CKD has metabolic acidosis?

Answer 22

Oral bicarbonate supplements

Question 23

What 3 options make up renal replacement therapy?

Answer 23

1. Haemodialysis
2. Peritoneal dialysis
3. Kidney transplant