Nephrology indications CC

Question 1

Indications of IV calcium in treatment of hypocalcemia

Answer 1

• symptomatic patients (carpopedal spasm, tetany, seizures)
• patients with a prolonged QT interval
• serum corrected calcium ≤7.5 mg/dL (1.9 mmol/L)

Question 2

Indications of dialysis in hypercalcemia

Answer 2

• serum calcium levels greater than 18 mg/dL (4.5 mmol/L) with:
  ** neurologic symptoms or
  ** acute kidney injury

Question 3

Methanol and ethylene glycol toxicity, dialysis indications

Answer 3

• Metabolic acidosis, regardless of drug level
• Elevated serum methanol or ethylene glycol levels (more than 50 mg/dL; or methanol 15.6 mmol/L, ethylene glycol 8.1 mmol/L), unless arterial pH is above 7.3
• Evidence of end-organ damage (eg, visual changes, renal failure)

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Question 4

Renal indications for plasmapheresis

Answer 4

• TTP/HUS
• ANCA-associated rapidly progressive glomerulonephritis if associated with pulmonary hemorrhage or dialysis dependent patients
• Anti-glomerular basement membrane disease (Goodpasture’s syndrome)
• Catastrophic antiphospholipid syndrome (APS)
• kidney transplant: FSGS recurrence or Acute Antibody-mediated rejection in kidney transplant
• Myeloma cast nephropathy

Question 5

Continuous renal replacement (CRRT, or CRT)

Answer 5

• The modality of choice for hypotensive, hemodynamically unstable pt needing RRT

Effective for fluid removal

Question 6

Indications for urgent dialysis

Answer 6

• Acid-base disturbances: Specifically, persistent metabolic acidosis (pH <7.1) refractory to conventional therapy.
• Electrolyte disorders: Mainly hyperkalemia with serum potassium concentration >6.5 mEq/L or rapidly rising potassium levels resistant to medical therapy; occasionally hypercalcemia or complications from tumor lysis syndrome.
• Specific drug and toxin intoxications that are dialyzable
• Fluid overload or congestive heart failure that is refractory to diuretics.
• Uremic symptoms such as pericarditis, neuropathy, an otherwise unexplained decline in mental status, or bleeding.

Question 7

Indications of urinary catheter use in hospitalized patients

Answer 7

• Management of immobilized patients
• Management of patients with neurogenic bladder
• Hourly urine output measurement in critically ill patients
• Management of urinary retention,
• Hematuria associated with clots,
• Open wounds of the sacrum or perineum with associated urinary incontinence,
• Surgery of the genitourinary tract and associated structures,
• End-of-life care
• Management of patients with persistent urinary incontinence after conservative, behavioral, pharmacologic, and surgical measures have failed.

Question 8

Indications for nephrology services for patients with chronic kidney disease

Answer 8

• Acute kidney injury
• GFR <30 ml/min/1.73 m2
• Persistent albuminuria (ACR > 300 mg/g)
• Urinary red cell casts
• CKD plus hypertension despite treatment with four agents
• Persistent potassium abnormalities
• Recurrent or extensive nephrolithiasis
• Hereditary kidney disease
• Progressive CKD (rapid decline of more than 5 ml/min/1.73 m2 per year)

MCQs

Question 9

Contraindications for peritoneal dialysis in the ICU setting

Answer 9

Absolute contraindications:

• Abdominal adhesions,
• The lack of trained staff;
• Uncorrected mechanical defects that prevent dialysis (such as hernias) or increase the risk of infection

Relative contraindications:

• intra-abdominal sepsis,
• wound infections,
• PD catheter leaks,
• malnutrition,
• inflammatory or ischaemic colitis
• newly placed foreign bodies in the abdomen

MCQs