Pre-re(n)ading

Question 1

What are the functions of the kidney?

Answer 1

Electrolyte homeostasis
Waste product excretion
Hormone - EPO, vitamin D,
Acid base balance
Water and salt production
Drug clearance

Question 1

ewew

Question 2

Which cells of the kidney deal with electrolytes?

Answer 2

Tubular cells - in proximal and distal tubular cells

Question 3

Which electrolyte is most deranged in CKD?

Answer 3

Potassium

Question 4

What ECG changes do you get with hyperkalemia

Answer 4

Tented T waves
Broadened QRS (more than 3 squares)

Question 5

Hyperkalemia management (rapid fire)

Answer 5

Calcium gluconate
Dextrose
Insulin

Question 6

How would you manage patient with hyperkalemia (fully)

Answer 6

This is a medical emergency, ask for senior help

A to E - assess for cardiac changes/compromise
Do a 12 lead ECG - repeat to ensure it’s not spurious
Repeat Us and Es and request CK if rhabdomyolysis
Review/stop any drugs contributing
Call for senior help

10 ml 10 % calcium gluconate
10 percent 100ml dextrose
10U rapid insulin (you only give a tiny amount of insulin)
(check these values)

(note this runs for 3 hours)

Keep taking bloods every 30-40mins / VBGs to check

Question 7

Causes of hyperkalemia

Answer 7

Kidneys not filtering out potassium (due to drugs or kidney injury).
- ACE inhibitors
- Spironolactone
- Potassium sparing diuretics

Too much being taken in (
- chocolate
- tomatoes
- bananas

Too much being released from the cells
- tumour lysis syndrome
-rhabdomylosis

Question 7

What else can be done to lower the potassium?

Answer 7

1. Salbutamol - beta adrenergic receptor
2. If the pt has renal failure or acidosis:
   Give bicarbonate as this neutralised
3. Calcium resonium (potassium exchange) - in anuric hyperkalemia
4. Zerconium - blocks potassium ion exchange in large bowel and prevents potassium reabsorption

Question 9

How would you assess waste product

Answer 9

Urea and creatinine

Uremia - a condition where there is a problem with waste

Question 10

What is urea? How is it made? When can you not rely on urea to interpret kidney function? What happens in dehydration

Answer 10

Urea - break down of proteins and break down of nitrogenous waste in liver

No liver - therefore no urea production - therefore you can’t use urea to interpret

dehydration = urea goes up more than creatinine

Question 11

What is creatinine

Answer 11

Something made at a steady state by the muscles

Anything influences muscle bulk will influence creatinine

Question 12

How do we calculate eGFR?

Answer 12

Creatinine can be used to create eGFR.

MDR equation for eGFR

Cockroft-Gault equation - also takes weight into

Question 13

Why do we measure creatinine for eGFR?

Answer 13

It’s cheapest to measure

Question 14

What can we used to measure eGFR more accurately?

Answer 14

Nuclear labelled EDTA

Previously it used to be inulin clearance

Question 15

What is a newer way of interpreting kidney function?

Answer 15

Cystatin C

Question 16

When can you start dialysis?

Answer 16

It always depends on

Someone with a generally lower creatinine would present with symptoms of uremia much earlier than someone with a large muscle bulk.

For example someone with a smaller muscle bulk
Urea of 20
Creatinine of 300

Note -

Question 17

What drives EPO production?

Answer 17

Hypoxia inducing factor induces erythropoetin production gene

Question 18

What can we give to E

Question 19

What’s the enzyme that creates vit D

Answer 19

1 alpha hydroxylase

Answer 20

Calcium reabsorption

Question 21

Problems of low calcium

Answer 21

Muscle contractility issues - esp in heart

Spasms, muscle cramps, seizures, parasthesias, seizures

Question 22

What happens in kidney failure when vit D can’t get hydroxylated?

Answer 22

Low calcium, high PTH, resorb

Answer 23

Osteomalacia

Answer 24

alpha hydroxylated vitamin D hormone

Question 25

High PTH and high calcium

Answer 25

Primary or tertiary - you end up with tertiary because the body is constantly

Question 26

How much do you normally pee?

Answer 26

500ml - 1L

Question 27

How much urine does the body filter per minute?

Answer 27

100ml/minute = 0.1L/minute
6000ml/hour=6L/hr

Yet we don’t pass this because you end up concentrating the urine, thanks to the Loop of Henle, so you don’t pee out as much.

Question 28

Name two nephrotoxic drugs which must be stopped?

Answer 28

Gentamycin
Amicacin

Question 29

A to E of RENAL MED

Answer 29

A - anaemia - give EPO