Renal

Question 1

KDIGO definition of AKI

Answer 1

• Increase in Cr by >26.5 umol/L within 48 hours OR
• Increase in Cr by ≥1.5 times baseline which is known/presumed to have occurred within prior 7 days OR
• Urine volume <0.5ml/kg/hr for 6 hours

Question 2

KDIGO AKI stages

Answer 2

Question 3

What molecule is implicated in pathogenesis of FSGS?

Answer 3

suPAR - serum soluble urokinase-type plasminogen activator receptor

Circulating suPAR activates podocyte ß3 integrin causing foot process effacement, proteinuria

Immature myeloid cells produce suPAR

Question 4

Adverse effects of SGLTI2i?

Answer 4

(1) Euglycaemic DKA
- Risk factors: intercurrent illness, fasting, post-op

(2) Glycosuria
- Increased UTI, topical candidiasis

Question 5

Biggest risk factor for CKD + others?

Answer 5

Age

Question 6

Most common eGFR equation?

Answer 6

CKD-EPI
Includes gender, age, ethnicity

Question 7

CKD stages?

Answer 7

Question 8

BP aims in CKD?

Answer 8

○ Aim BP ≤140/90 without albuminuria
○ Aim BP ≤130/80 with albuminuria

Use ACEi/ARB as first line

Question 9

Aim of anaemia management in CKD?

Answer 9

Optimise iron stores (IV preferable)
Target Hb 100-115 (studies show higher target worse outcomes)
Avoid PRBC - avoid sensitisation
Target ferritin 300-500, t-sat 20-30%
EPO with caution
New potential Mx: HIF compounds

Question 10

MoA cinacalcet?

Answer 10

Modulates CaSR in parathyroid glands - increases sensitivity to circulating Ca thereby inhibiting PTH release

Question 11

What markers go up first in CKD-MDB?

Answer 11

FGF-23 and PTH
Around eGFR 45

Question 12

What happens in CKD-MBD (Ca, PO4, PTH, FGF-23 and Vit D)?

Answer 12

Low Ca2+
High PO4
High PTH
High FGF-23
Low 1,25-Vit D

Question 13

How does FGF-23 decrease calcitriol?

Answer 13

Suppresses activity of 1-alpha-hydroxylase (conerts 25-hydroxyvitamin D to calcitriol)
[[ PO4 retention also decreases 1-alpha-hydroxylase ]]

Stimulates 24-hydroxylase which converts calcitriol to inactive metabolites in proximal tubule

Question 14

What secretes FGF-23?

Answer 14

Secreted by osteoblasts and osteoclasts in response to calcitriol, increased PO4, PTH and calcium

Question 15

What is role of klotho?

Answer 15

Expressed in cell surface membranes of prox. and distal renal tubules

Required for FGF-23 receptor activation

Question 16

What markers predict poor CV outcomes in CKD-MBD patients?

Answer 16

Elevated FGF-23, low serum albumin

Question 17

Which T-helper subset most implicated in glomerulonephritis?

Answer 17

TH17
Differentiate in presence of TFFß, IL-6 and IL-17
IL-17 and IL-21 then recruit other inflammatory cells

Question 18

Management of BK nephropathy?

Answer 18

Occurs post renal transplant

Management is reduction in immunosuppression
- Withdrawal of MMF/tacrolimus
- Replacement of tacrolimus by cyclosporin
- Overall reduction of immunosuppression