Renal

Question 1

Proteinuria in the elderly - Ix/conditions to consider? (3)

Answer 1

○ Urine MCS -?chronic UTI
○ SPEP/UPEP - myeloma
○ Renal USS - ?obstruction

Question 2

AKI aetiology - history questions (5)

Recommendation for f/u (1)

Answer 2

○ Symptoms of acute illness (V/D/infection)
○ Systemic symptoms - ?rash ?arthralgia –> systemic vasculitis/rheum cause
○ Meds - NSAIDs, PPIs, Abx, IV contrast
○ Flank pain (?kidney stones)
○ Obstructive LUTS ?prostatic hypertrophy)

Increased risk of AKI - offer kidney health check yearly for 3 years

Question 3

Scenarios in which eGFR may be unreliable (8)

Answer 3

AKI
Dialysis
Recent cooked meat/exceptional dietary intake
Extremes of body size
Conditions of skeletal muscle/paraplegia/amputees/high muscle mass
Kids <18 y.o
Medications
Pregnancy (use creatinine in pregnancy instead)

Question 4

CKD - when to refer to specialist? (4)

Answer 4

eGFR <30
Persistent significant albuminuria
Sustained decrease in eGFR (≥25% in 12 months)
Multi-drug resistant hypertension

Question 5

CKD and Hyperlipidaemia - what to do?

Answer 5

§ If >50 y.o and any stage of CKD, start statin or statin/ezetimibe combo (irrespective of lipid levels)
§ If <50 y.o and any stage of CKD, statin IF one or more CVS risk factors

Question 6

Pruritis in CKD Rx options (5)

Answer 6

moisturisers
evening primrose oil
topical capsaicin
avoid detergents/soaps
Consider gabapentin or Derm referral for UVB