Kidney Disease

Question 1

List classic clinical features of kidney disease

Answer 1

Loin pain
Haematuria
Dysuria
Proteinuria (frothy)
Oligouria
Asymptomatic

Question 2

The kidney is involved in excretion of urea. What happens if this is impaired?

Answer 2

Uraemia (urea over 40 before manifests)

Can lead to pericarditis, encephalopathy, neuropathy etc.

Question 3

The kidney is involved in fluid balance. What happens if this is impaired?

Answer 3

Fluid retention (oedema)

Question 4

The kidney is involved in electrolyte balance. What happens if K becomes too high?

Answer 4

Hyperkalaemia can cause arrhythmias

Question 5

The kidney is involved in acid-base balance. What is the classic breathing sign of an acidotic patient?

Answer 5

Metabolic acidosis leads to Kussmaul’s respiration

Question 6

Which class of drug has to be closely monitored and can potentially cause renal failure?

Answer 6

ACE inhibitors/ARBs

Question 7

What are the effects of NSAID on the kidney?

Answer 7

Allergic reaction
Reduce GFR (inhibit prostaglandin production)

Question 8

Which antibiotics can insult to the kidney?

Answer 8

Gentamicin
Trimethoprim
Penicillins

Question 9

What might radiology contrast cause within the kidney?

Answer 9

Contrast nephropathy

Question 10

What does specific gravity in urinalysis tell us?

Answer 10

Urine concentration

Question 11

Define heavy proteinuria

Answer 11

1-3g of protein in the urine per day

Question 12

Define acute kidney injury

Answer 12

Decline in GFR over hours/days/weeks with/without oliguria in a patient with normal or impaired renal function

Question 13

How much urine a day is classed as oliguria?

Answer 13

Less than 400ml a day

Question 14

Which equation is used to provide estimated GFR (eGFR)

Answer 14

MDRD4 equation

Encompasses serum creatinine, age, sex and race

Question 15

eGFR overestimates GFR if high muscle mass. True/False?

Answer 15

False

eGFR overestimates GFR is muscle mass is low, and underestimates GFR if muscle mass is high

Question 16

Define stage 1 CKD

Answer 16

Normal GFR (over 90)
Evidence of kidney damage

Question 17

Define stage 2 CKD

Answer 17

GFR 60-90

Evidence of kidney damage

Question 18

Define stage 3 CKD

Answer 18

GFR 30-60

Question 19

Define stage 4 (severe) CKD

Answer 19

GFR 15-30

Question 20

Define stage 5 CKD (renal failure)

Answer 20

GFR less than 15

Question 21

Patients with proteinuria are more likely to progress to CKD. True/False?

Answer 21

True

More proteinuria = faster progression

Question 22

List common causes of chronic kidney disease

Answer 22

Diabetes (commonest)
Hypertension
Chronic glomerulonephritis
Reflux nephropathy
Polycystic kidneys

Question 23

Symptoms due to reduced GFR don’t occur until late. True/False?

Answer 23

True

GFR less than 20 usually

Question 24

List methods of slowing progression of CKD

Answer 24

Reduce proteinuria + control BP - ACE inhibitors, spironolactone

Question 25

What is the initial danger of ACE inhibitors for kidney disease?

Answer 25

Cause initial fall in GFR which leads to hyperkalaemia | i.e. short term pain, long term gain

Question 26

How does anaemia arise in CKD?

Answer 26

Erythropoietin production declines in CKD

Question 27

How is anaemia in CKD rectified?

Answer 27

IV iron | Erythropoietin injection

Question 28

How does bone disease arise in CKD?

Answer 28

Impaired vitamin D hydroxylation in damaged kidney

Question 29

How is bone disease in CKD rectified?

Answer 29

Alfacalcidol (active vitamin D) | Phosphate intake

Question 30

If initial CKD therapy is unsuccessful, what are the treatment options for renal failure?

Answer 30

Haemodialysis Peritoneal dialysis Transplant Conservative/palliative management

Question 31

What is the best form of access for dialysis?

Answer 31

Arteriovenous fistula (AVF)

Question 32

Acute kidney injury is defined using creatinine and urine output. Define acute kidney injury

Answer 32

Increase in creatinine greater than 26.4 micomol//L, or by 50% Reduction in urine output

Question 33

How is acute kidney injury classified due t cause?

Answer 33

Pre-renal (functional) Renal (structural) Post-renal (obstruction)

Question 34

List pre-renal causes of acute kidney injury

Answer 34

Hypovolaemia (haemorrhage) Hypotension (shock) Hypoperfusion (NSAID, ACEI)

Question 35

Pre-renal AKI is reversible. True/False?

Answer 35

True

Question 36

Outline the pathophysiology of AKI due to volume depletion

Answer 36

Decreased effective intravascular volume causes increased ADH and aldosterone release, causing salt and water retention, leading to oliguria and AKI

Question 37

What is the commonest form of AKI in hospital?

Answer 37

Acute tubular necrosis due to decreased renal perfusion

Question 38

Outline treatment for AKI

Answer 38

Treat cause/factors 0.9% saline Antibiotic if sepsis

Question 39

What is the main vascular cause of AKI?

Answer 39

Vasculitis

Question 40

What is the main glomerular cause of renal AKI?

Answer 40

Glomerulonephritis

Question 41

List tubular causes of AKI

Answer 41

Ischaemia Antibiotics Contrast nephropathy Rhabdomyolysis

Question 42

Dark urine in AKI may be a sign of what?

Answer 42

Rhabdomyolysis (myoglobin in urine)

Question 43

List initial investigations for AKI

Answer 43

``` U+Es FBC, coagulation Urinalysis Ultrasound Antibodies ```

Question 44

What are the indications for renal biopsy?

Answer 44

Rapidly progressive glomerulonephritis +ve antibodies Not improving

Question 45

List life-threatening complications of AKI

Answer 45

``` Hyperkalaemia Pulmonary oedema Acidosis Uraemic pericardial effusion Severe uraemia ```

Question 46

Trimethoprim can cause AKI. True/False?

Answer 46

True

Question 47

List the main causes of post-renal AKI

Answer 47

Obstruction from stones/cancer Stricture Extrinsic pressure

Question 48

Outline management of post-renal AKI

Answer 48

Catheter Nephrostomy Refer to urology

Question 49

How is hyperkalaemia complicating AKI treated?

Answer 49

Calcium gluconate | Insulin