Pathologies

Question 1

1. Define Acute Kidney Injury
2. Identify the characteristics of each of the three stages of AKI
3. What are the main risk factors for AKI?
4. Identify 6 triggers of AKI
5. Name the 5 drugs that are essential to contraindicate

Answer 1

1. An abrupt decrease in renal function characterised by an rise in serum creatinine and/or decrease in Urine output
2. STAGE 1- 1.5-1.9 fold increase in Serum creatinine
   STAGE 2- 2-2.9 fold increase in Serum creatinine
   STAGE 3- 3 or more fold increase in Serum creatinine or on dialysis
3. Diabetes, liver disease, heart failure, old age, Chronic kidney disease, peripheral vascular disease, previous AKI
4. Hypotension, hypovolaemia, contrast studies, deteriorating NEWS score, sepsis, surgery
5. Metformin, NSAIDs, ACEI, ARBs, Gentamicin

Question 2

1. Name the three classifications of the causes of AKI
2. What are the main causes of pre-renal AKI?
3. What are the main causes of renal AKI?
4. What would urinalysis find?
5. What are the three main causes of post-renal AKI?
6. Name three symptoms that point to a renal cause

Answer 2

1. Pre-renal, renal and post renal
2. Haemorrhage, infection, dehydration
3. Acute tubular Necrosis, Glomerulonephritis, Vasculitis, interstitial nephritis
4. Haemoprotenuria
5. Tumours obstructing ureter, kidney stones, prostate enlargement
6. Rash, joint pain, weight loss

Question 3

1. What are the most important drug considerations for the treatment of AKI?
2. How should we approach treatment?

Answer 3

1. Stop nephrotoxins and anti-hypertensives, ensure drug dosages are appropriate for patient’s renal function,
2. Fluid resuscitation with crystalloid, stop high risk medicines, treat underlying cause, if sepsis antibiotics but NOT GENTAMICIN

Question 4

1. Define chronic kidney disease
2. What is the worldwide prevalence?
3. How is it staged?
4. When is it diagnosed?
5. What stages do not count as CKD in the absence of markers of kidney damage?

Answer 4

1. Reduction in Kidney function and/or kidney damage that lasts beyond three months
2. 10-15%
3. according to GFR (with prefix G1-5) and ACR levels (with prefix A1-3)
4. Markers of kidney damage e.g. ACR greater than 3mg/mmol and/or eGFR below 60ml/kg/min
5. G1-A1 and G2-A1

Question 5

1. Identify some of the main causes of CKD

2. Identify some of the main complications of CKD

Answer 5

1. Hypertension, diabetes mellitus, CVD, obesity with metabolic syndrome, vasculitis, SLE, glomerular disease, multiple myeloma, history of AKI, Obstructive uropathy, Nephrotoxic drugs
2. AKI, CVD, Hypertension,/dyslipidaemia, renal anaemia, renal mineral and bone disease, malnutrition, malignancy, ESRD, peripheral neuropathy/myopathy

Question 6

1. What general measures are taken in the measurement of CKD
2. Treatment of CKD-MBD?
3. Treatment of Renal anaemia?

Answer 6

1. Treat any underlying modifiable cause e.g. CVD, hypertension, diabetes, autoimmune conditions, obstruction.
   Avoid nephrotoxic drugs,
   Address CVD risk factors (smoking cessation, weight loss, exercise)
   Arrange follow-up
   Primary CVD prevention- Atorvostatin
2. Dietary restriction of phosphate, gut phosphate binders e.g. sevelamer, lanthanum, calcium acetate, calcium carbonate, aluminum
   Fluid/salt/K+ restriction,
   Vit D analogues e.g. alfacalcidol
3. ESAs (erythropoiesis-stimulating agents)

Question 7

1. Define Dysproteinaemia

Answer 7

1. Overproduction of immunoglobulin by clonal expansion of cells from a B cell lineage
   2.