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

list the three definitions of AKI

Answer 2

1. Increase in SCr by ≥ 26.5 mmol/L within 48 hours
2. Increase in SCr to ≥1.5 times baseline, which is known or presumed to have occurred within the prior 7 days
3. Urine volume <0.5 mL/kg/h for 6 hours

Question 3

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

Answer 3

reduced blood flow to kidneys

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

Question 4

main cause of intrinsic kidney damage

Answer 4

medication related - AG, vanco

Question 5

main cause of post-renal aki

Answer 5

trauma, benign prostatic hyperplasia, tumours

Question 6

which types of AKI have proteinuria

Answer 6

intrinsic, post-renal

Question 7

which type of AKI has high urine osmolarity

Answer 7

pre-renal

Question 8

how to manage pre-renal aki

Answer 8

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

Question 9

how to manage intrinsic AKI

Answer 9

discontinue nephrotoxins, treat underlying infection

Question 10

how to manage post renal AKI

Answer 10

remove obstruction, reinstate urine flow by insertion of a catheter

Question 11

how does nsaid cause aki

Answer 11

constriction of afferent arteriole, leading to decreased renal perfusion

Question 12

how does acei cause aki

Answer 12

dilatation of efferent arteriole, decreased glomerular filtration pressure

Question 13

gfr categories

Answer 13

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

Question 14

labs to look out for in renal scripts

Answer 14

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

Question 15

when to use iron supplementation

Answer 15

tsat less than 30 and ferritin less than 500

Question 16

drug interactions with oral iron

Answer 16

calcium, tetracyclines, fluoroquinolones, thyroxine, antacids

Question 17

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

Answer 17

12%
20%

Question 18

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

Answer 18

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 19

when to start ESA

Answer 19

Hb is between in 9-10

Question 20

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

Answer 20

increased risk of cv events and stroke

Question 21

how to dose adjust esa

Answer 21

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

Question 22

when the monitor hb when on esa

Answer 22

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

Question 23

list 5 adverse effects of ESA

Answer 23

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

Question 24

calcium based phosphate binders side effects

Answer 24

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

Question 25

sevelamer, lanthanum, sucroferric side effects

Answer 25

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

Question 26

side effect of vitamin d analogues

Answer 26

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

Question 27

what is the place of finerenone in ckd patient?

Answer 27

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

Question 28

list 4 PD related complications

Answer 28

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

Question 29

diagnosis of PD peritonitis

Answer 29

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 30

ideal empiric therapy for PD peritonitis

Answer 30

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

Question 31

3 medicines that PD patient should be on

Answer 31

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

Question 32

list 4 complications associated with HD and how to manage

Answer 32

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 33

dosing of amikacin in PD peritonitis

Answer 33

2mg/kg daily

Question 34

dosing of other AGs besides amikacin in PD peritonitis

Answer 34

0.6mg/kg daily

Question 35

dosing of cefazolin in PD peritonitis

Answer 35

15 mg/kg daily