Renal

Question 1

What is the definition of a fistula?

Answer 1

A fistula is an abnormal connection between 2 epithelial surfaces

Question 2

What is the causing the thrill that is palpable in an AV fistula?

Answer 2

Arterial blood from the artery into the arteriolized vein.

Question 3

What are the 3 main AV connections made for AV fistulas?

Answer 3

Artery - Vein
Radio - Cephalic
Ulnar - Basilic
Brachio - cephalic

Question 4

How is the artery connected to the vein in an AV fistula?

Answer 4

Usually side-to-end with ligation of the distal vein

Question 5

Why is an AV fistula needed for haemodialysis.

Answer 5

Haemodialysis requires high-pressure, high-flow arterial blood. However, cannot take from artery as the vessel will rapidly become unusable, often by thrombosis. Hence arteriolization of a vein is required through formation of an AN fistula.

Question 6

What is disequilibration syndrome?

Answer 6

A complication of haemodialysis.

This is where rapid changes in plasma osmolarity → cerebral oedema

N+V, headaches, ↓ GCS

Question 7

What are the complications of an AV fistula?

Answer 7

Thrombosis and venous stenosis
Infection
Bleeding
Aneurysm
Steal Syndrome

Question 8

What are the complications of renal transplant?

Answer 8

1) Post-op
- bleeding
- thrombosis
- infection
- urinary leak

2) Rejection
- hyper-acute
- acute
- chronic

3) Immunosuppresion
- increased infection
- increased malignancy

4) Drug toxicity
- Ciclosporin - nephrotoxicity, gingival hypertrophy
- Tacrolimus - diabetogenic, neurotoxic
- Steroids

Question 9

First line treatment for nephrotic syndrome

Answer 9

Diuretics and Na restricted diet.

Consider prophylactic anticoagulation.

Question 10

Von Grawitz tumour aka …

Answer 10

Renal cell carcinoma