Renal

Question 1

What symptoms should you ask about in a CKD history?

Answer 1

Restless Legs Anaemia Sx Fatigue Pruritis Bone Pain Uraemic Fetor Weight Breathlessness Appetite Gout Peripheral Neuropathy

Question 2

Causes of CKD

Answer 2

Hypertension Infection Diabetes Drugs Exotic - SLE Nephritis

Question 3

Why do you place cannulas far apart as possible in diaylsis?

Answer 3

To avoid recirculation loop

Question 4

What are the disadvantages of central venous dialysis?

Answer 4

Causes more a recirculation loop cause dual lumen next to each other

Higher infection and thrombosis rates

Inadaquete flow rates

Risks of pneumothorax, air embolous, arterial puncture

Question 5

What causes the thrill over the fistula?

Answer 5

Arterial blood flow

Question 6

Which vessels are usually connected?

Answer 6

Radiocephalic then when both have failed brachiocephalic

Question 7

Features of CAPD

Answer 7

Tenckhoff catheter Less expensive than haemodialysis More convenient eg holidays Easy technique Mainly have to stop due to peritonitis Eventual fibrosis of peritoneal membrane 3l of fluid 4x/day with half hour exchanges

Question 8

What is removed during CAPD?

Answer 8

Urea Creatinine Potassium Phosphate - all along conc gradient w/ isotonic fluid Water removed with hypertonic fluid

Question 9

Problems with CAPD?

Answer 9

Social Anorexia Peritonitis Malaise

Question 10

Investigations for severity of CKD

Answer 10

Urine microscopy - infection, casts

FBC - anaemia of chronic disease

U+E - eGFR (vague indicator of disease severity)

Cr clearance

24hr urinary protein

Serum urate + phosphate - retained

Calcium, Alk phos - low calc and high ALP suggests renal bone disease

Question 11

Indications for dialysis

Answer 11

Progressive decline in renal function Symptomatic uraemia Volume overload Co-morbid: pericarditis, bone disease, hyperkalaemia (All despite treatment)

Question 12

Causes of CKD

Answer 12

HTN Infection Diabetes Drugs Exotic (lupus, vasculitis) Nephritis

Question 13

AV fistula

Answer 13

Arterial blood causes thrill Usually cephalic, if radiocephalic thromboses then use brachiocephalic In order to access high pressure high flow arterial blood without scarring up artery from repeated stabs

Question 14

Av fistula: Complications

Answer 14

Infection Stenosis Thrombosis Bleeding Steal syndrome - distal tissue ischemia from bypassing circulation)

Question 15

AV fistula: Counseling

Answer 15

Body image - long sleeves Avoid tight clothing/watches Don’t shave arm Don’t let anyone take BP or blood Avoid trauma

Question 16

CKD: Signs

Answer 16

Pigmentation Pruritis Pulmonary edema Peripheral neuropathy Parathyroid overactivity Painful big toe (gout) Pericarditis

Question 17

Renal bone disease: Types

Answer 17

Osteoporosis Hyperparathyroidism Osteomalacia Osteosclerosis

Question 18

Renal bone disease: Symptoms

Answer 18

A symptomatic Low back pain Brachydactyly Acronecrosis

Question 19

Symptoms of Uraemia

Answer 19

Pruritis Lethargy Anorexia Nausea/vom Cramps Mental/visual change Thirst

Question 20

Diet changes for CKD

Answer 20

Low phosphate (beans,nuts,greens) Low potassium (bananas, coffee, chocolate) Low fluids (1l/day)

Question 21

Temporary/Emergency access for dialysis

Answer 21

Uncuffed central venous catheter

only short term eg AKI

Question 22

Semi permenant access for dialysis

e.g when waiting for fistula formation

Answer 22

tunnelled cuffed catheter TCC dual lumen placed in superior vena cava/right atrium

Question 23

Complications of haemodialysis

Answer 23

Headache, muscle cramps, itching

Hypotension

Hypokalaemia

Disequilibrium syndrome - if urea falls too quickly osmotic pressure on brain side of BBB relatively high → cerebral edema

Fluid imbalance

Infection, stenosis, thrombosis

Aneurysm

Amyloid

Question 27

Which factors are considered when calculating eGFR?

Answer 27

CAGE

Cr

Age

Gender

Ethnicity

Question 28

Factors which can affect eGFR (Cr)

Answer 28

Pregnancy

Muscle Mass

Red Meat

Question 29

eGFR kidney disease

Answer 29

>90 = stage 1 CKD = only with other kidney path

60-90 = stage 2 only with other kidney path

30-59 = stage 3 = moderate

15-29 = stage 4 = severe

<15 = stage 5 = transpant/dialysis

Question 30

What is the definition of an AKI?

Answer 30

26+ rise Cr in 48h

50% rise Cr in 7 days

drop in UO to 0.5ml/kg/hr for 6hrs (8hrs kids)