MLA Nephrology

Question 1

How can you differentiate between acute and chronic kidney injury?

Answer 1

• Look at previous U&E injury
• Suspect CKD if the kidneys are small on ultrasound anaemia, low calcium, high PO4
• Definite CKD if creatinine high and eGFR is low

Can be acute on chronic too

Question 2

What causes isolated high urea?

Answer 2

Upper GI bleed, blood is broken down into urea

Or overproduction or urea or dehydration

Question 3

What is creatinine?

Answer 3

Waste product of digesting protein

It doesn’t cause any damage if it accumulates

Question 4

How can you differentiate between the causes of AKI?

Answer 4

Pre-renal: lying and standing BP (hypovolaemia/ sepsis)
Renal: blood in urine (damage)
Post-renal: Ultrasound KUB (obstruction)

Question 5

What are the indications for dialysis?

Answer 5

• Pulmonary oedema
• Severe acidosis
• Symptomatic uraemia
• Hyperkalaemia

(Patient won’t be responding to treatment)

Question 6

How is CKD managed?

Answer 6

ACE/ARB/SGLTi drugs decrease progression
BP control
Treat underlying cause

Main cause of death is cardiovascular death to prevent that: stop smoking, diet

Manage complications like electrolyte abnormalities and anaemia

Question 7

What is anasarca?

Answer 7

Generalised oedema
- Ascites with pulmonary oedema with peripheral oedema

Question 8

What are the complications are correcting hyponatraemia too quickly?

Answer 8

Central pontine demyelination causing speech dysfunction, reduced motor function, and altered mental state which may become permanent