Renal

Question 1

What 2 factors can you look at to diagnose AKI?

Answer 1

1) Urine output

2) Creatinine

Question 2

How many AKI grades are there?

Answer 2

3

Question 3

Give the creatinine criteria for each AKI grade

Answer 3

1) Rise of >26 umol/L or 1-1.9x baseline

2) Rise of 2.0-2.9x baseline creatine

3)
- > 3.0x baseline creatine or
- > 353.6 umol/L or
-initiation of renal replacement therapy or
- decrease of eGFR to < 35 mL/min

Question 4

Give the urine output criteria for each AKI grade

Answer 4

1) <0.5 ml/kg/hr for 6 hours

2) <0.5 ml/kg/hr for 12 hours

3) <0.3 ml/kg/hr for >24h or anuria for 12h

Question 5

What should you ALWAYS ask for when interpreting investigations?

Answer 5

Previous investigations to compare

Question 6

What is the earliest clinical marker of a developing AKI?

Answer 6

Urine output

Question 7

Why is creatinine a good marker of renal function?

Answer 7

As it is almost 100% filtered by kidney

Question 8

What renal function changes are acceptable after starting an ACEi?

Answer 8

A rise in the creatinine and potassium may be expected after starting ACE inhibitors.

Acceptable changes are an increase in serum creatinine, up to 30%* from baseline and an increase in potassium up to 5.5 mmol/l*.

Question 9

What rise in serum creatinine is acceptable after starting ACEi?

Answer 9

Up to 30% from baseline

Question 10

What rise in serum potassium is acceptable after starting ACEi?

Answer 10

Up to 5.5 mmol/l

Question 11

What is the most common group of causes of AKI?

Answer 11

Pre-renal e.g. 2ary to dehydration or sepsis

Question 12

ECG signs of hyperkalaemia?

Answer 12

1) tall, tented T waves

2) flattened P waves

3) broad bizarre QRS

Question 13

Emergency management of hyperkalaemia?

Answer 13

1) IV calcium gluconate 10%

2) Salbutamol 5mg nebulised

3) Insulin dextrose infusion

4) Dialysis/haemofiltration if not responding

Question 14

How long should Abx be prescribed for in women >65?

Answer 14

3 days (also send a urine culture)

Question 15

Next steps in suspected UTI if associated with visible or non-visible haematuria?

Answer 15

Send an MSU for all women with a suspected UTI if associated with visible or non-visible haematuria

Question 16

Why are patients with nephrotic syndrome at an increased risk of VTE?

Answer 16

Due to loss of antithrombin III

Question 17

What testicular volume indicates onset of puberty?

Answer 17

> 4ml

Question 18

What is the treatment for acromegaly?

Answer 18

Ocreotide

Question 19

How can the SAAG gradient be calculated?

Answer 19

Serum albumin - ascitic albumin = SAAG gradient

Question 20

What does a high SAAG indicate (i.e. >11 g/L)?

Answer 20

Low levels of protein in ascitic fluid e.g. portal HTN, RHF

Question 21

What cause of nephrotic syndrome is frequently associated with malignancy?

Answer 21

Membranous nephropathy

Question 22

What is SAAG used to determine?

Answer 22

Whether ascites has been caused by portal HTN or not.

Question 23

What is Budd Chiari syndrome?

Answer 23

Hepatic vein thrombosis

Can lead to portal HTN

Question 24

How can rhabdomyolysis cause AKI?

Answer 24

Due to acute tubular necrosis –> myoglobin is nephrotoxic.

Question 25

What condition typically presents with haemoptysis + AKI/proteinuria/haematuria?

Answer 25

Anti-GBM disease (Goodpasture's)

Question 26

What is the most likely outcome following the diagnosis of minimal change nephropathy in a 10-year-old male?

Answer 26

Full recovery but with later recurrent episode

Question 27

What condition should you consider in a young female patients who develop AKI after the initiation of an ACE inhibitor?

Answer 27

Fibromuscular dysplasia

Question 28

What can be seen in urine in AIN?

Answer 28

White cell casts & eosinophils

Question 29

Why is nephrotic syndrome associated with a hypercoaguable state?

Answer 29

Due to loss of antithrombin III in the kidneys

Question 30

How can hypothyroidism affect sodium?

Answer 30

Severe hypothyroidism can result in SIADH. This dilutes blood conc of Na+ (euvolaemic hyponatraemia).

Question 31

What is the most common cause of AKI?

Answer 31

Acute tubular necrosis (intrarenal AKI)

Question 32

Give some causes of ATN

Answer 32

1) Ischaemia (e.g. from pre-renal cause) 2) Nephrotoxins: - aminoglycosides - myoglobin (from rhabdo) - uric acid (tumour lysis syndrome) - IV contrast - ethylene glycol

Question 33

How do penicillins vs aminoglycosides cause AKI?

Answer 33

Penicillin - AIN Aminoglycosides - ATN

Question 34

What is typically seen in urine in ATN?

Answer 34

Muddy brown casts

Question 35

What are the 3 key causes of intrarenal AKI?

Answer 35

1) ATN 2) AIN 3) Glomerulonephritis

Question 36

What are some causes of AIN?

Answer 36

Drugs - penicillins, NSAIDs, diuretics

Question 37

Features of AIN?

Answer 37

- AKI features - eosinophilia - fever - rash creates an allergic picture

Question 38

How can ACEi affect creatinine? What rise is acceptable?

Answer 38

Can cause rise in creatinine. Rise of up to 30% from baseline is acceptable.

Question 39

How can uraemia affect the heart?

Answer 39

Can cause pericarditis

Question 40

Urine osmolality in pre-renal azotemia vs ATN?

Answer 40

Pre-renal --> high urine osmolality (i.e. very concentrated as the kidneys hold on to sodium and water) ATN - low urine osmolality (i.e. less concentrated as the kidneys lose sodium and water)

Question 41

Urine sodium in pre-renal azotemia vs ATN?

Answer 41

Pre-renal --> low ATN --> high

Question 42

2 drugs used for proteinuria in CKD?

Answer 42

1) ACEi 2) SGLT-2 inhibitors

Question 43

What is the SGLT-2 inhibitor licensed for CKD?

Answer 43

Dapagliflozin

Question 44

4 key complications of AKI?

Answer 44

1) Hyperkalaemia 2) Uraemia - pericarditis & encephalopathy 3) Metabolic acidosis 4) Fluid overload - pulmonary oedema & HF

Question 45

Via what 2 ways can damage to kidney cells occur in ATN?

Answer 45

1) Ischaemia due to hypoperfusion 2) Nephrotoxins

Question 46

How is iron replaced in anaemic patients on haemodialysis?

Answer 46

IV iron (instead of oral iron)

Question 47

What is the main class of Abx that should be stopped in AKI?

Answer 47

Aminoglycosides

Question 48

What is the threshold for stopping metformin in AKI?

Answer 48

eGFR <45

Question 49

Serum urea:creatinine ratio in pre-renal AKI vs ATN?

Answer 49

Pre-renal - raised ATN - normal

Question 50

What murmur can anaemia cause?

Answer 50

Aortic flow murmur (ejection systolic)

Question 51

what is taken into account in eGFR calculation?

Answer 51

CAGE Creatinine Age Gender Ethnicity

Question 52

What are the drugs that can cause ED?

Answer 52

- antihypertensives - beta blockers - diuretics - antidepressants - antipsychotics - alcohol - recreational drugs

Question 53

What are 3 key contraindications for PDE-5 inhibitors (sildenafil)?

Answer 53

1) Concurrent nitrate use (risk of severe hypotension) 2) Hypotension 3) Recent stroke/MI - wait 6 months

Question 54

What test should all patients with ED have?

Answer 54

Serum testosterone

Question 55

What is the most common organic cause of ED?

Answer 55

Vascular causes e.g. CVD, diabetes, HTN, smoking

Question 56

What is 1st line for renal colic pain?

Answer 56

IM diclofenac

Question 57

What can be given instead of IM diclofenac in renal colic if NSAIDs are contraindicated or not giving sufficiency pain relief?

Answer 57

IV paracetamol

Question 58

Cause of periureteric fat stranding vs perinephric fat stranding?

Answer 58

Periureteric = passed stones Perinephric = pyelonephritis

Question 59

What is preferred for the removal of renal stones in pregnancy women?

Answer 59

Ureteroscopy

Question 60

What 2 types of renal stones are radiolucent?

Answer 60

Urate & xanthine stones

Question 61

Mx of renal stones depends on size. a) <5mm b) 5-10mm c) 10-20mm d) >20mm

Answer 61

a) watchful waiting (if asymptomatic) b) shockwave lithotripsy c) shockwave lithotripsy OR ureteroscopy d) percutaneous nephrolithotomy

Question 62

Mx of ureteric stones?

Answer 62

<10 mm --> shockwave lithotripsy +/- alpha blockers 10-20mm --> ureteroscopy

Question 63

1st line imaging in renal stones?

Answer 63

Non-contrast CT KUB

Question 64

Infection with which organism is most likely in struvite renal stones?

Answer 64

Proteus mirabilis