RENAL

Question 1

who is the ckd-epi equation not validated in

Answer 1

children (age <18 years), pregnant women, or in some racial or ethnic subgroups, such as Hispanics.

Question 2

AKI definition 1: increase in scr by how much within 48h?

Answer 2

1. Increase in SCr by ≥ 26.5 mmol/L within 48 hours

Question 3

AKI definition 2: assume to occur within the 7 days, how much is the increase in SCr

Answer 3

more than 1.5 times baseline

Question 4

AKI definition 3: how much urine volume the last 6 hours

Answer 4

less than 0.5ml/kg/h

Question 5

what is the main cause of pre-renal aki, and the conditions associated with it

Answer 5

reduced blood flow to kidneys

haemorrhage, dehydration, medications eg ACEi/ARB/NSAID, diuretics

Question 6

main cause of intrinsic kidney damage

Answer 6

medication related - AG, vanco

Question 7

main cause of post-renal aki

Answer 7

trauma, benign prostatic hyperplasia, tumours

Question 8

which types of AKI have proteinuria

Answer 8

intrinsic, post-renal

Question 9

which type of AKI has high urine osmolarity

Answer 9

pre-renal

Question 10

how to manage pre-renal aki

Answer 10

fluid replacement, maintain BP, stop any drugs that cause volume depletion

Question 11

how to manage intrinsic AKI

Answer 11

discontinue nephrotoxins, treat underlying infection

Question 12

how to manage post renal AKI

Answer 12

remove obstruction, reinstate urine flow by insertion of a catheter

Question 13

how does nsaid cause aki

Answer 13

constriction of afferent arteriole, leading to decreased renal perfusion

Question 14

how does acei cause aki

Answer 14

dilatation of efferent arteriole, decreased glomerular filtration pressure

Question 15

gfr categories

Answer 15

g1 - more than 90
g2 - 60-89
g3a - 45-59
g3b - 30-44
g4 - 15-29
g5 - less than 15

Question 16

labs to look out for in renal scripts

Answer 16

urea, phosphate, calcium, potassium, bicarb, anemia, pth

Question 17

when to use iron supplementation

Answer 17

tsat less than 30 and ferritin less than 500

Question 18

drug interactions with oral iron

Answer 18

calcium, tetracyclines, fluoroquinolones, thyroxine, antacids

Question 19

what is the composition of iron
1. sangobion
2. iberet folate

Answer 19

12%
20%

Question 20

if a patient is acutely ill, what to do with IV iron

Answer 20

can cause increased risk for infections
* Withhold during acute infections, restart after infection resolves (usually after the end of
the abx course)
* May consider switching to oral iron

Question 21

when to start ESA

Answer 21

Hb is between in 9-10

Question 22

what happens when the target hb is more than 11 in ckd patients with esa

Answer 22

increased risk of cv events and stroke

Question 23

how to dose adjust esa

Answer 23

25% increments
titrations not more often than every 4 weeks
maximal increase in hb is 1 every 2-4w

Question 24

when the monitor hb when on esa

Answer 24

initiation: 2-4w
maintenance: monthly (dialysis), 3 monthly (non-dialysis)

Question 25

list 5 adverse effects of ESA

Answer 25

1. Pure red cell aplasia 2. HTN (most common) 3. Vascular access thrombosis 4. Seizures 5. Flu-like syndrome

Question 26

calcium based phosphate binders side effects

Answer 26

hypercalcemia, GI upset, constipation, LOA, nausea, vomiting

Question 27

sevelamer, lanthanum, sucroferric side effects

Answer 27

both: GI upset, diarrhoea, vomiting sucroferric: discoloration of stools sevelamer: constipation, flatulence

Question 28

side effect of vitamin d analogues

Answer 28

increase GI absorption of calcium and phosphate, causing hyperca and hyperphos

Question 29

what is the place of finerenone in ckd patient?

Answer 29

for patients with DKD and proteinuria, finererone resulted in lower risks of CKD progression and cvs events than placebo

Question 30

list 4 PD related complications

Answer 30

1. peritonitis 2. exit-site and tunnelled-catheter infections 3. hypoK 4. hyperglycemia (change PD fluids from glucose to icodextrin)

Question 31

diagnosis of PD peritonitis

Answer 31

at least 2 of the following: 1. clinical features consistent with peritonitis (ab pain, cloudy dialysis) 2. dialysis effluent white > 100 with >50% polymorphonuclear leukocytes (PMN); 3. positive dialysis effluent culture

Question 32

ideal empiric therapy for PD peritonitis

Answer 32

vancomycin (Gram pos) + aminoglycoside/ ceftazidime (gram neg) or cefepime

Question 33

3 medicines that PD patient should be on

Answer 33

1. potassium supplementation 2. TOP genta cream for infection prophylaxis 3. laxatives to ensure daily bowel movement (AVOID FLEET due to high phosphate)

Question 34

list 4 complications associated with HD and how to manage

Answer 34

1. Intradialytic hypotension - Midodrine - Adjust timing of anti-hypertensives - Set accurate dry weight 2. muscle cramps - Keep dialysate Na greater than serum Na 3. vascular access thrombosis 4. catheter associated infections

Question 35

dosing of amikacin in PD peritonitis

Answer 35

2mg/kg daily

Question 36

dosing of other AGs besides amikacin in PD peritonitis

Answer 36

0.6mg/kg daily

Question 37

dosing of cefazolin in PD peritonitis

Answer 37

15 mg/kg daily

Question 38

when to avoid oral phosphate containing bowel prep

Answer 38

gfr <60

Question 39

when to initiate acei/arb for proteinuria

Answer 39

uacr between 30-300

Question 40

how does sevelamer act as a phosphate binder

Answer 40

nonabsorbable, nonelemental hydrogel

Question 41

additional benefits of sevelamer (cholesterol)

Answer 41

lower hdl, increases hdl

Question 42

main side effects of phosphate binders

Answer 42

NVD, ab pain

Question 43

why are aluminium binders not preferred (2 reasons)

Answer 43

CNS toxicity, worsening of anemia

Question 44

why are magnesium binders not preferred (2 reasons)

Answer 44

hypermagnesiumia, hyperk

Question 45

goal for pth in esrd

Answer 45

2-9 times uln

Question 46

side effects of vitamin D analogs

Answer 46

hypercalcemia, hyperphosphatemia

Question 47

how do calcimimetics work (eg cinacalcet)

Answer 47

reduce PTH secretion by increasing sensitivity of clacium sending recfeptor

Question 48

side effects of calcimimetics

Answer 48

nausea vomiting

Question 49

what to do with statins in adults on dialysis

Answer 49

continue if already on prior to dialysis, otherwise do not start