GUM

Question 1

Define chronic kidney disease

Answer 1

Abnormal kidney structure or function for more than 3 months which has implications on health

Question 2

In what 2 ways is CKD classified?

Answer 2

GFR and albumin:creatinine ratio

Question 3

Causes of CKD

Answer 3

Diabetes 
Hypertension
Glomerulonephritis
Long term NSAID use
Heart failure

Question 4

Symptoms of CKD

Answer 4

People may be asymptomatic.
Fluid overload eg SOB, oedema 
Anorexia 
Nausea and vomiting 
Pruritus
Fatigue

Question 5

Management of CKD

Answer 5

Consider referral to nephrology

ACEI/ARB especially if diabetic or uncontrolled hypertension
Improve diabetic control
Manage symptoms e.g, loop diuretics for oedema

Question 6

Definition of AKI

Answer 6

Sudden decline in renal function leading to an ability to excrete waste products and regulate fluid and electrolytes.

Question 7

Pre-renal causes of AKI

Answer 7

Hypovolaemia e.g. haemorrhage, sepsis
Shock
MI
Thrombus
Renal artery stenosis
Antihypertensive drugs

Question 8

Renal causes of AKI

Answer 8

Drugs
Vasculitis
Glomerulonephritis
Acute tubular necrosis
Interstitial nephritis

Question 9

Drugs causing AKI

Answer 9

Aminoglycocides e.g. gentamicin
Diuretics
ACEi/ARB
NSAIDs
IV contrast
Chemotherapy

Question 10

Post-renal causes of AKI

Answer 10

Post-operative
Neurogenic bladder e.g. cauda equina, MS
Renal stones
Enlarged prostate
Urethral stricture
Urinary tract tumours and malignancy

Question 11

Complications of AKI

Answer 11

Chronic renal impairment
Prolonged hospital stay
Hyperkalaemia
Pulmonary oedema
Acidaemia
Pericarditis
Uraemic encephalopathy

Question 12

Management of AKI

Answer 12

Treat underlying cause
e.g.
Fluids for hypovolaemia
Review medication

Treat emergencies!

Question 13

Name some emergency complications of AKI and how to treat them

Answer 13

Pulmonary oedema - frusemide / loop diuretics

Hyperkalaemia - IV calcium gluconate, insulin and dextrose, salbutamol nebulisers

Acidosis - sodium bicarbonate

Question 14

Stages of AKI

Answer 14

Stage 1:
Creatinine - rise of 26 in 48h, or 1.5-1.9x baseline
Urine - <0.5ml/kg/h for >6h

Stage 2:
Creatinine - Rise 2-2.9x baseline
Urine - <0.5ml/kg/h for >12h

Stage 3:
Creatinine - Rise >3x baseline, rise of >354, or renal replacement therapy being needed
Urine - <0.3ml/kg/h for 24h, or anuria for 12h

Question 15

Strategies for preventing AKIs

Answer 15

Withhold/stop unnecessary medication
Encourage hydration
Identify those at risk e.g. elderly, polypharmacy, single kidney

Question 16

Features of prostatism

Answer 16

Voiding/obstructive:

• weak/intermittent flow
• hesitancy
• incomplete emptying
• terminal dribbling

Storage/Irritative:

• Urgency
• Frequency
• Incontinence
• Nocturia

Question 17

Findings on digital rectal exam in BPH and prostate cancer

Answer 17

BPH - enlarged prostate, smooth, firm but not hard, well-defined midline sulcus

Prostate cancer - enlarged, nodular, hard, sulcus not palpable

Question 18

What is the scoring system used to determine impact on life in prostatism

Answer 18

IPSS - international prostate symptom score

Question 19

Lifestyle advise for prostatism?

Answer 19

Reduce caffeine
Reduce alcohol
Limit fluids, especially before bed

Question 20

Pharmacological management of prostatism

Answer 20

Alpha blocker e.g. tamsulosin
5a-reductase inhibitor e.g. finasteride
Anticholingeric e.g. oxybutynin, tolteridine