Renal

Question 1

what is acute intermittent porphyria
presentation triad
drug that can precipitate an attack

Answer 1

deficiency of one of the enzymes needed to synthesise haem
abdominal, neurologic and psychiatric sx (urine fluoresces a bright red colour on standing.)
nitrofurantoin

Question 2

In a patient with suspected anaemia of chronic disease secondary to CKD, what should be checked prior to starting EPO and if low what should be done

Answer 2

iron status
correct iron deficiency before starting any erythropoietin stimulating agent

Question 3

which drugs may have to be stopped in AKI due to increased risk of toxicity (but not bc they worsen aki)

Answer 3

metformin
digoxin
lithium

Question 4

aki criteria

Answer 4

urine output less than 0.5ml/kg for more than 6 hours
serum creatine >26micromol/L increase over 48hrs
serum creatinine increase by 1.5x within 7 days

Question 5

aki staging creatinine

Answer 5

creatinine
stage 1 - 1.5-2x
stage 2 - 2-3 x
stage 3 >3

Question 6

differentiating between pre renal and renal (ATN)

Answer 6

urea:creatinine ratio higher in pre renal
ATN has a high urine sodium
pre renal is concentrated urine, renal is diluted as can’t reabsorb water

Question 7

indications for renal replacement therapy (haemofiltration)

Answer 7

Acidosis (aki with refractory metabolic acidosis)
Electrolytes - resistant hyperkalaemia
Intoxication - drug overdoses that’s led to non improving aki
Overload - pulmonary oedema resistant to tx
Uraemia - pericarditis or encephalopathy

Question 8

Haemolytic uraemia syndrome - who, triad, presentation, organism causing, rx, complication and its presentation

Answer 8

occurs in kids

haemolytic anaemia
thrombocytopenia
AKI

Abdo pain and bloody diarrhoea
E coli

rx - supportive. don’t give abx.

complication - TTP - pentad inc neurological sx and fever

Question 9

CKD criteria

Answer 9

eGFR less than 60 for more than 3 months
urine ACR >3 for more than 3 months

Question 10

causes of anaemia in ckd x3

Answer 10

anaemia of chronic disease
reduced epo
uraemia - can suppress bone marrow

Question 11

GO OVER OSMOLALITY - DONT KNOW IT

if serum osmolality high
if serum osmolality low but urine osmolality low
if serum osmolality low but urine osmolality high

if urine osmolality low

Answer 11

• glucose or given lots of fluids
• ## losing sodium and water eg

Question 12

what needs to be checked in hyoponatraemia

Answer 12

serum and urine osmolality
and volume status

Question 13

causes of hyponatreamia

Answer 13

hypervolaemic - HF, LF, RF
euvolaemic - SIADH (euvolameia and low serum osmolality)
hypovolaemic - thiazides diuretics, addisons, D+v

Question 14

which nsaid is okay to continue in AKI

Answer 14

aspirin

Question 15

what anti coags can you use in AKI/CKD

Answer 15

warfarin
DOACs are CI if creatine clearance is lower than 15ml/min

Question 16

osmolality in DI

Answer 16

high plasma, low urine

Question 17

nephrotic vs nephritic features and causes

Answer 17

nephrotic - oedema, hypoalbuminaemia and proteinuria
Minimal change disease, membranous, focal segmental and diabetic

nephritic - htn, haematuria, oliguria
IgA nephropathy, post strep, alport, rapidly progressingr

Question 18

rx of:
nephrotic

Answer 18

anti coags
can give steroids or immunosuppressants depending on the cause
supportive

Question 19

ix for glomerulonephritis

Answer 19

Urine dip, u&e, renal biopsy, MSU, anti - streptolyisin O for post strep.

Question 20

compare IgA nephropathy and post strep GN

Answer 20

poststrep - 2 weeks post infection
IgA - few days post infection

Question 21

ck level in rhabdo

Answer 21

> 10000

Question 22

Rx of overhydration

Answer 22

noradrenaline

Question 23

analgesic used in renal colic

Answer 23

diclofenac

Question 24

peritoneal vs haemodialysis

Answer 24

peritoneal - less need to come to hospital, need to be able to manage complex equipment at home by themselves, more suitable for younger patients. But risk of peritonitis and encapsulating peritoneal sclerosis

Haemodialysis - regular hospital trips but supported by staff, need a fistula creating, infection, clotted lines

Question 25

most common organism causing peritonitis in peritoneal dialysis

Answer 25

staph epidermidis. Staph aureus is also a more common cause