Nephro

Question 1

Clinical presentation of ADPKD

Answer 1

• HTN
• Gross haematuria
• Flank pain
• Fluid overload
• UTI

Question 2

Associated conditions of ADPKD

Answer 2

ABBCCCCD
Aneurysm (berry’s)
Blood pressure (HTN)
Chronic renal failure, Cancer, Cysts, Cardiac (mitral valve prolapse)
Diverticular disease

Question 3

Complications of ADPKD

Answer 3

Renal
- (acute) UTI, Pyelonephritis, Haematuria, Cyst rupture, Haemorrhage, Pain, Renal failure
- (chronic) Renal failure, pain, renal calculi, RCC

Extra-renal
- (abdominal) liver + spleen + pancreas + ovaries cysts, diverticular disease
- (cardiac) mitral valve prolapse
- (neuro) Berry’s aneurysm, SAH

Systemic
- HTN
- Anaemia
- Polycythemia
- Malnutrition

Question 4

Investigations required for ADPKD

Answer 4

Biochemical
- FBC: note Hb
- UECr: note eGFR
- Electrolytes: Ca, Mg, PO4
- Uric acid
- Urinalysis

Imaging
- Renal US
- MR Angiography (brain) - for Berry’s aneurysm
- Barium enema - for colonic diverticular

Question 5

Ultrasound diagnostic criteria for ADPKD

Answer 5

<30y: 2 cysts bilateral / unilateral
30-59y: >2 cysts bilateral
>60y: >4 cysts bilateral

Question 6

Management of ADPKD

Answer 6

Non-pharm
- education, screen family, avoid nephrotoxic medications, genetic counselling

pharm
- monitor UECr
- control BP: give anti-hypertensives eg ACE-I, ARB
- treat chronic RF: renal replacement therapy
- treat complication

surgical
- renal transplant
- nephrectomy
- AVF creation for haemodialysis
- cyst drainage
- cystectomy

Question 7

Diagnostic criteria for Chronic Kidney Disease (CKD)

Answer 7

Any 1 of the following for >3mo:
- impaired eGFR <60ml/1.73m2
- Proteinuria
- imaging abnormality e.g. ADPKD, hydronephrosis
- biopsy abnormality e.g. nephrotic / nephritic syndrome

Question 8

Causes of CKD

Answer 8

Pre-renal
- congestive cardiac failure
- liver cirrhosis
- renal artery disease

Renal
- glomerular disease: FSGS, nephrotic syndrome, GN, diabetic nephropathy

Tubulointerstitial disease
- interstitial nephritis
- chronic pyelonephritis
- multiple myeloma
- chronic irate nephropathy
- inherited: PKD, renal tubular acidosis

Post-renal
- untreated obstructive uropathy
- reflux nephropathy

Question 9

Clinical presentation of CKD

Answer 9

reduced GFR + increased albuminuria:
- oedema, HTN, frothy urine, oliguria

complications of advanced CKD:
- fatigue, LOW, LOA, AMS
- anaemia, hypoglycemia
- pruritus

Question 10

Investigations for CKD

Answer 10

Biochemical
- FBC, UECr, RP, PTH, Vit D, albumin, fasting lipids (for HLD)
- hepatitis screening
- autoimmune markers

Urine
- urine dipstick
- UFEME
- urine PCR

Imaging
- US kidney, bladder, prostate
- Doppler US –> note renal artery stenosis
- CXR (if pulmonary congestion is suggested)

Biopsy
- note tubulointerstitial fibrosis, FSGS, atrophy

Question 11

Complications of CKD

Answer 11

ABCDEFGU
Anaemia, Acidosis
Bone health
Cholesterol, CVS risk
Drugs, Diet, Dialysis prep
Electrolytes
Fluid overload
Glucose
Uremia, Uric acid

Question 12

Indications for dialysis

Answer 12

Acute (AEIOU)
Acidosis
Electrolyte derangement
Intoxication
Overload
Uremia

Stage 5 CKD aka ESRF

Question 13

Complications of haemodialysis

Answer 13

• infection –> septicaemia –> septic shock
• thrombosis
• stenosis
• intradialytic hypotension
• hypoglycaemia
• deranged electrolytes uncorrected

Question 14

Complications of peritoneal dialysis

Answer 14

• infection (peritonitis)
• hyperglycemia
• R pleural effusion
• catheter outflow failure, pericatether leak
• abdo wall hernia
• intestinal perforation

Question 15

Why peritoneal dialysis over haemodialysis?

Answer 15

• renal function preserved in PD
• risk of fluid overload reduced in PD
• more freedom of fluid & diet intake
• vascular sites preserved (KIV future use)

Question 16

Why haemodialysis over peritoneal dialysis?

Answer 16

• filtration more precisely controlled in HD
• reduced technique failure
• lower risk of infection
• no daily laxatives required unlike in PD
• greater patient compliance