Renal

Question 1

In a patient with suspected anaemia of chronic disease secondary to CKD…should be checked before starting treatment with…

Answer 1

In a patient with suspected anaemia of chronic disease secondary to CKD, iron status should be checked prior to commencing EPO

Question 2

Renal transplant patients: the most common malignancy secondary to immunosuppression

Answer 2

Renal transplant patients - skin cancer (particularly squamous cell) is the most common malignancy secondary to immunosuppression

Question 3

first-line drug to slow the progression of CKD and renal insufficiency in patients with ADPKD.

Answer 3

Tolvaptan is a vasopressin receptor 2 antagonist and is the first-line drug to slow the progression of CKD and renal insufficiency in patients with ADPKD. Tolvaptan is given to patients with ADPKD who have CKD stage 2 or 3 and is rapidly progressive.

Question 4

when is haemodialysis used for the treatment of AKI

Answer 4

Renal replacement therapy (e.g. haemodialysis) is used when a patient is not responding to medical treatment of complications, for example hyperkalaemia, pulmonary oedema, acidosis or uraemia (e.g. pericarditis, encephalopathy).

Question 5

Indication for renal replacement therapy

Answer 5

HUMP
Hyperkalaemia
Uraemia
Metabolic acidosis
Pulmonary oedema

there’s also aeiou:
* acidosis
* electrolyte imbalance
* intoxication (salicylates/lithium)
* overload for fluid overload
* uremia

Question 6

how can ureamia present

Answer 6

encephalopathy or pericarditis

Question 7

first line in the acute management of renal colic

Answer 7

IM diclofenac in the acute management of renal colic (analgesia)

Question 8

presentation of dehydration on bloods

Answer 8

This patient is presenting with confusion, which is an unspecific symptom in elderly patients, especially with dementia, and anuria.

The blood tests show high sodium and urea.
The urine test shows normal osmolarity with sodium inferior to 20 mmol/L.
This is a hallmark in the diagnosis of prerenal uraemia.
One of the most common causes of prerenal uraemia, especially in elderly patients is dehydration.

In prerenal uraemia think of the kidneys holding on to sodium to preserve volume

Question 9

Prerenal disease/ureamia vs acute tubular necrosis

Answer 9

Acute tubular necrosis - poor response to fluid challenge

Prerenal disease/ureamia - urine sodium < 20 mmol/L

Prerenal disease/ureamia - good response to fluid challenge

Question 10

one of the most common causes of acute tubular necrosis

Answer 10

Haemorrhage is one of the most common causes of acute tubular necrosis.
hypotensions and compensatory tachycardia
poor response to fluid challenge

Question 11

Period of hypotension followed by renal impairment with urinary casts →

Answer 11

Period of hypotension followed by renal impairment with urinary casts → acute tubular necrosis

Question 12

imaging of choice in suspected renal colic

Answer 12

Non-contrast CT-KUB is the imaging of choice in suspected renal colic

Question 13

how is AKI staged?

Answer 13

Question 14

What changes in patients with nephrotic syndrome predispose to the development of venous thromboembolism?

Answer 14

loss of antithrombin III

Question 15

Answer 15

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