Nephr

Question 1

How does acute kidney transplant rejection present? What do you do next?

Answer 1

less than 6 months but not hyperacute
Pain localised to transplant
reducing function
white cells raised

need to biopsy the kidney and increase steroids to try and prevent

Question 2

What is the management for goodpastures

Answer 2

steroids
plasma exchange
cyclophosphamide

Question 3

What are the stages of AKI?

Answer 3

1,2,3

1 - Creatinine 1.5-1.9x baseline
2 - Creatineine 2x baseline
3 - Creatineine 3x baseline OR 354

Question 4

How should renal stones be investigated

Answer 4

ultrasound - 50% found and 90% are correctly diagnosed
easy to identify hydronephrosis

non contrast CT to confirm

Question 5

What is the treatment for renal stones?

Answer 5

Immediate analgesia - strong diclofenac
alpha blockers such as tamsulosin

size of the stone - >5mm need management intervention

uretoretinoscopy - distal or larger or failed SWL/ preg
sound wave lithotripsy - smaller
percutaneous nephrolithotomy - staghorn

Question 6

What is the cut off for treating hyperkalaeima?

Answer 6

k+ 6.5
OR
Ecg changes

Question 7

what causes the purpuric rash in HSP

Answer 7

small vessel vasculitis

not thrombocytopenia

Question 8

difference between ATN and AIN

Answer 8

ATN - muddy brown casts - is damage related usually from drugs

AIN - hypersensitivity mediated with high IgE. present wtith AKI

Question 9

When monitoring ACEi use what is the cutoff for stopping?

Answer 9

30 percent rise in creatine

25% fall in egfr

Question 10

What is the rate that fluids should be given as maintenance?

Answer 10

30ml/kg/day

encourage oral intake where possible

Question 11

What are the complications of haemodialysis?

Answer 11

most people die from IHD - events are common

Question 12

How quickly can you replace potassium

Answer 12

20mmol per hour

Question 13

severe vs mild hypokalaemia?

Answer 13

2.5-3.5 mild

less than 2.5 or symptomatic - leg cramps, weakness palpitations

Question 14

crescenteric glomerulonephritis causes

Answer 14

goodpastures
wegeners(c anca)
SLE

Question 15

Why do you need a nephrostomy tube

Answer 15

hydronephrosis

Question 16

Why is an anion gap important?

Answer 16

to differentiate sources of metabolic acidosis

Question 17

What causes a raised anion gap

Answer 17

increased production of or reduced excretion of fixed acids such as 
lactic acid - sepsis/tissue ischemia
urate(renal failure)
ketones(DKA)
drugs(salicylates

Question 18

causes of an acidosis with normal anion gap?

Answer 18

accumulation of H+ or loss of bicarb
addisons
diarrhoea
renal tubular acidosis

Question 19

potentiol complications of AV fistulas

Answer 19

thrombosis
infection
stenosis
steal syndrome

Question 20

polyuria polydipsia dehydration normal high sodium

Answer 20

diabetes insipidus

nephrogenic - lithium, hypercalcaemia, hypokalaemia

Question 21

how do you investigate HUS

Answer 21

bloods: thrombocytopenia Haemolytic anaemia
film - red cell fragments
U and E renal failure
stool culture