Misc

Question 1

ix that show evidence of kidney damage

Answer 1

uricaidaemia
u+e distrubances
proteinuria (1st sign)
imaging
histology

Question 2

variables included in eGFR calculation

Answer 2

age gender creatinine ethnicity

Question 3

factors that affect egfr result

Answer 3

pregnancy, eating red meat in past 24 hr

Question 4

stage 1, 2, 3a, 3b, 4, 5 egfr

Answer 4

> 90, >60 >45, >30 >15, =<15

Question 5

complications of CKD

Answer 5

CVS risk
bone problems
fluid overload
HTN
electrolyte disturbance
anaemia
leg restlessness
sensory neuropathy

Question 6

rx diabetic nephropathy

Answer 6

HTN and diabetic control

Question 7

how to measure proteinuria

Answer 7

now use the al: cr ratio

used to be 3.5g/day

Question 8

ACEi are both good and bad for the kidneys. why are they good?

Answer 8

Antihypertensive effect is reno-protective and prevents CKD worsening ∴ used in CKD management

Efferent arteriole vasodilation causes reduced filtration pressure which reduces proteinuria ∴ ACEi are used to treat asymptomatic proteinuria. Prolonged proteinuria can cause a lot of damage to kidneys

Question 9

how to treat asymptomatic proteinuria

Answer 9

acei

Question 10

ACEi are both good and bad for the kidneys. why are they bad?

Answer 10

efferent arteriole vasodilation (causing decreased glomerular pressure) can cause AKI, especially if hypovolaemic
this is reversible after ACEi withdrawal.
stop ACEi in anyone with AKI

Question 11

who are at particular risk of AKI when on ACEi

Answer 11

renal artery stenosis
HF
hypovolaemia
these pts can also expect the greatest benefit from ACEi so ACEis should not be withheld in these pts but doses carefully titrated with monitoring of renal function and potassium levels.

Question 12

what is acute tubular necrosis and what is it caused by

Answer 12

death of tubule epithelial cells

low BP -> hypoperfusion
nephrotoxics incl

presents with AKI (one of most common causes). tubule cells replace themselves so pts usually recover

Question 13

what is cardiorenal syndrome

Answer 13

disorders of the heart and kidneys whereby dysfunction in one may induce dysfunction of the other

Question 14

what diseases cause pulmonary renal syndrome (respiratory failure involving bleeding in the lungs + kidney failure)

Answer 14

ANCA +ve vasculitis (incl Wegener’s, Churg-Strauss)

Anti glomerular basement membrane disease (Goodpasture’s)

Question 15

what is Goodpasture syndrome (aka anti-GBM disease)

Answer 15

autoimmune - antibodies attack basement membrane in lungs and kidneys.
life-threatening.
AKI, SOB, haemoptysis, nosebleeds
cavitating lung lesions

Question 16

how is anti-GBM disease treated

Answer 16

steroids

plasma exchange