Kidney diseas

Question 1

Nephrotic syndrome

Answer 1

‘Leaky kidneys’ which allows filtration of large molecules

Triad of signs:

• Proteinuria
• Oedema
• Low blood albumin

Low blood albumin reduces osmotic pressure and causes salt and water to leak into tissues= oedema.

Low osmotic pressure= activation of RAAS= more fluid retention

Increased clotting tendency due to lack of antithrombin III

Hyperlipidaemia- due to increased hepatic protein synthesis

Question 2

Clinical features of nephrotic syndrome

Answer 2

Oedema

Proteinuria- more than 3g/day

Low serum albumin

High cholesterol

Question 3

Nephritic syndrome

Answer 3

Inflamed kidneys

Characterised by:

• Microscopic Haematuria
• Proteinuria- with okay levels of serum albumin
• Hypertension due to fluid retention
• Reduced urine output

Question 4

Acute kidney injury

Answer 4

Rapid decline in excretory kidney function

Causes:

• Acute tubular necrosis
• Reactions of contrast
• Certain drugs
• Rhabdomyolysis- break down of damaged skeletal muscle
• Interstitial nephritis
• Obstruction

Question 5

AKI stage I

Answer 5

Serum creatinine criteria:

• Increase of 26micromol/L within 48 hours
• 1.5-1.9x baseline

Urine volume criteria:
- <0.5ml/kg/h for 6-12 hours

Question 6

AKI stage II

Answer 6

Serum creatinine criteria:
- 2.0-2.9x baseline

Urine volume criteria:
- <0.5ml/kg/h for 12 hours

Question 7

AKI stage III

Answer 7

Serum creatinine criteria:

• Increase above 354micromol/L within 48 hours
• > 3x baseline
• Patients <18, decrease of eGRF<35ml/min per 1.73m3

Urine volume criteria:

• <0.3ml/kg/h for 24 hours
• Anuria for 12 hours

Question 8

AKIN and RIFLE limitations for diagnosing AKI

Answer 8

Assumes we know Creatinine baseline

Assumes urinary output is measured

Assumes creatinine kinetics are the same across different stages of CKD

Question 9

Indications for renal replacement therapy

Answer 9

Uncontrollable:

• Fluid overload
• Metabolic acidosis
• Hyperkalaemia

Uremic pericarditis/ encephalopathy

Poisoning

Question 10

Chronic kidney disease signs

Answer 10

Nocturia+ Poluria

Oedema

Acidaemia

Anaemia

Hypocalcaemia/ hyperphosphatemia

Question 11

Multi-system disease that may involve kidney

Answer 11

Small vessel vasculitis

HIV

Sarcoidosis

Myeloma

Systemic lupus erythematosus

Question 12

Autosomal dominant polycystic disease

Answer 12

Disease inherited in autosomal dominant fashion.

Abnormal tubular structure and growth of multiple cysts.

Question 13

Diagnosis of CKD

Answer 13

Proteinuria

Reduced GFR

• 3 eGFR<60
• Over a period not less than 60 days.
• Progressive decline