Kidneys

Question 1

indications of dialysis

Answer 1

AEIOU (indications of dialysis)

Acidamia (metabolic acidosis)
Electrolyte abnormality (Na, K, Ca)
Intoxication (SLIME – salicylates, lithium, isopropanol, Mg-containing laxatives, ethylene glcol)
Overload of fluid not expected to respond to treatment with diuretics
Uraemia complications (eg. pericarditis, encephalopathy, or GI bleeding)

Question 2

criteria for acute kidney injury

Answer 2

RIFLE criteria (criteria for acute kidney injury)

Risk: GFR decrease >25%, serum creatinine increased 1.5 times or urine production of 50%, doubling of creatinine or urine production 75%, tripling of creatinine or creatinine >355 μmol/l (with a rise of >44) (>4 mg/dl) OR urine output below 0.3 ml/kg/hr for 24 hours
Loss: persistent AKI or complete loss of kidney function for more than 4 weeks
End-stage renal disease: need for renal replacement therapy (RRT) for more than 3 months

Question 3

systemic diseases with glomerular involvement

Answer 3

SWf HD GAME (systemic diseases with glomerular involvement)

Systemic lupus erythematosus
Wegener’s granulomatosus

Henoch-Schonlein purpura
Diabetes mellitus

Goodpasture’s syndrome
Amyloidosis
Microscopic polyangitis/polyarteritis
Bacterial Endocarditis

Question 4

glomerular syndromes

Answer 4

NN-RCI “think Simcity” (glomerular syndromes)

Nephritic (PHARAOH – variable proteinuria, haematuria, azotaemia ↑Cr, Ur, RBC casts, oliguria, HTN)
Nephrotic (LEAP – lipids increased, lipiduria, edema [hypoalbuminaemia], azotaemia, proteinuria > 3.5g/d)

Rapidly progressing glomerulonephritis (PAN – proteinuria, acute renal failure, acute nephritis)
Chronic renal failure
Isolated urinary abnormality

Question 5

causes of high anion gap metabolic acidosis

Answer 5

LTKR “left total knee replacement” (causes of high anion gap metabolic acidosis)

Lactate
Toxins (CSP MICE – cyanide, salicylates, paraldehyde, methanol, iron, CO, ethylene glycol “anti-freeze”)
Ketones (alcoholic ketoacidosis, diabetic ketoacidosis)
Renal failure (+ uraemia)

Question 6

non-anion gap acidosis

Answer 6

ACCRUED (non-anion gap acidosis)

Acid infusion, aldosterone inhibitor
Compensation for respiratory alkalosis
Carbonic anhydrase inhibitor (acetazolamide)
Renal tubular acidosis
Ureteral diversion
Extra alimentation or hyperalimentation, pancreatic fistua
Diarrhoea

Question 7

Detection of acute renal failure (ARF)

Answer 7

Detection of acute renal failure (ARF)  
Mnemonic: ACUte  
A  	Acute presentation over hours or days  
C  	Creatinine rises  
U 	Urea rises (±oliguria <400 ml/24 h)

Question 8

Causes of acute renal failure (ARF)

Answer 8

Causes of acute renal failure (ARF)  
Mnemonic: ACUte  
A  	ATN/Acute GN  
C  	Circulatory dysfunction (i.e. shock – hypovolaemia, sepsis, cardiogenic)  
U  	Urinary outflow obstruction

Question 9

Clinical presentation of chronic renal failure

Answer 9

Clinical presentation of chronic renal failure  
Mnemonic: RESIN & 8 Pʼs  
R  	Retinopathy  
E  	Excoriations (scratch marks)  
S  	Skin is yellow  
I  	Increased blood pressure  
N  	Nails are brown  
P  	Pallor  
P  	Purpura and bruises  
P  	Pericarditis and cardiomegaly  
P  	Pleural effusions  
P  	Pulmonary oedema  
P  	Peripheral oedema  
P  	Proximal myopathy  
P  	Peripheral neuropathy

Question 10

Complications of dialysis

Answer 10

Complications of dialysis  
Mnemonic: CHAIR  
C  	Cardiovascular disease  
H  	Hypertension  
A  	Anaemia  
I  	Infections  
R 	Renal bone disease