Kidney Disorders

Question 1

define polycystic kidney disease (PKD)

Answer 1

an autosomal dominant disease characterised by cystic dilation of renal tubular epithelium

Question 2

causes of PKD

Answer 2

PKD1 mutation (polycystin-1) on chromosome 16 (85%)
PKD2 mutation (polycystin-2) on chromosome 4

Question 3

risk factors of PKD

Answer 3

FH of PKD
FH of intracranial aneurysm
PMH of hypertension

Question 4

clinical features of PKD

Answer 4

flank/suprapubic and lower back pain
bilateral kidney enlargement
polyuria, dysuria and urinary urgency

Question 5

external manifestation features of PKD

Answer 5

intracranial berry aneurysm
mitral valve prolapse
colonic diverticular
extrarenal cysts

Question 6

investigations of PKD

Answer 6

urine dip + M,C&S
bloods (FBC, U+E, CRP and lipids)
renal US
CT abdomen and pelvic

Question 7

common investigation findings in PKD

Answer 7

proteinuria + haematuria ⬆️ urea, creatinine and cholesterol in bloods
⬇️ eGFR
bilateral cysts and kidney enlargement on imaging

Question 8

medical management of PKD

Answer 8

vasopressin receptor antagonist (tolvaptan)
ACE inhibitor or ARB (ramipril or losartan)
paracetamol

Question 9

conservative management of PKD

Answer 9

regular monitoring of bloods and cyst progression

avoiding contact sport

Question 10

define nephrotic syndrome

Answer 10

a clinical syndrome characterised by a triad of:

• proteinuria (>3g/day)
• hypoalbuminaemia
• oedema

Question 11

pathophysiology of nephrotic syndrome

Answer 11

arise secondary to increased permeability of serum protein through a damaged basement membrane in renal glomerulus

Question 12

causes of nephrotic syndrome

Answer 12

systemic (DM, SLE)
minimal change disease
drugs (gold or penicillamine)

Question 13

clinical features of nephrotic

Answer 13

weight gain
loss of appetite
nausea + vomiting
frothy urine

Question 14

signs of nephrotic syndrome

Answer 14

periorbital + peripheral oedema

mild hypertension

Question 15

investigations of nephrotic syndrome

Answer 15

bloods (FBC, U+Es, RFTs, LFTs, autoatnibodies, serum cholesterol, glucose)
urine dipstick
renal US + biopsy

Question 16

management of nephrotic syndrome

Answer 16

high dose steroids
anticoagulants
diuretics
ACE inhibitors

Question 17

complications of nephrotic syndrome

Answer 17

infection
venous thromboembolism
hyperlipidaemia

Question 18

define chronic kidney disease (CKD)

Answer 18

a gradual irreversible decline in kidney function defined by either a decreased GFR or kidney damage markers

Question 19

describe the requirements of a CKD diagnosis

Answer 19

decreased GFR (<60) for >3mnths
histological or structural kidney abnormalities
electrolye abnormalities
albuminuria

Question 20

risk factors of CKD

Answer 20

CVD 
proteinuria
AKI 
hypertension 
diabetes 
smoking 
chronic NSAID use

Question 21

clinical features of advanced CKD

Answer 21

weight loss/anorexia 
nausea + vomiting 
fatigue and weakness 
pruritus 
muscle cramps
dyspnoea

Question 22

signs of CKD

Answer 22

skin pigmentation
pallor
peripheral oedema
pleural effusion

Question 23

investigations of CKD

Answer 23

bloods (FBC, U+Es, creatinine, serology autoantibodies)
urine dipstick
ECG
renal US + biopsy

Question 24

define stage I of CKD

Answer 24

> 90ml/min GFR with demonstratable kidney damage

Question 25

define stage II of CKD

Answer 25

60-89ml/min GFR with demonstrable kidney damage, proteinuria or raised albumin/creatinine

Question 26

define stage III of CKD

Answer 26

30-59ml/min GFR

Question 27

define stage IV of CKD

Answer 27

15-30ml/min GFR

Question 28

define stage V of CKD

Answer 28

< 15ml/min GFR

Question 29

complications of CKD

Answer 29

CVD 
renal osteodystrophy
fluid (oedema)
hypertension 
electrolyte disturbance 
anaemia 
leg restlessness 
sensory neuropathy

Question 30

management of anaemia in CKD

Answer 30

subcutaneous erythropoietin injections

Question 31

management of oedema in CKD

Answer 31

reduce fluid and salt intake

diuretics (e.g. furosemide)

Question 32

management of hypocalcaemia and hypophosphataemia in CKD

Answer 32

restrict dietary potassium

prescribe sevelamer and alfacalcidol

Question 33

additional management of CKD

Answer 33

stop nephrotoxic drugs
start antihypertensives
refer for parathryoidectomy if PTH >28mmol/L