Renal

Question 1

What are the symptoms of nephrotic syndrome?

Answer 1

PHO

Proteinuria
Hypoalbuminemia
Oedema

Question 2

What are the symptoms of nephritic syndrome?

Answer 2

Haematuria

Hypertension

Question 3

What are the GN’s that cause nephrotic syndrome?

Answer 3

FOCME MINI MEMBRANO
Focal segmental
Membranous
Minimal change
Membranoproliferative

Question 4

What are the GN’s that cause nephritic syndrome?

Answer 4

POST RAPID DIFFUSE IGA

Post streptococcal
Rapidly progressive
Diffuse proliferative
IgA nephropathy

Question 5

What is your approach to managing CRF?

Answer 5

1. Diagnose cause; classify severity
2. Address underlying etiology
3. Treat acute symptoms
4. Manage CKD, prevent progression
5. Manage complications
6. Long term issues - transplantation
7. Social issues

Question 6

What investigations for CKD?

Answer 6

• renal function: EUC, CMP, urine protein/casts, urine ACR
• renal structure: U/S, CT KUB, cystoscopy
• underlying disease: renal biopsy, ANA, hepatitis, HIV, EPG/IEPG
• complications: FBC, iron studies, CMP, Vit D, PTH

Question 7

What are the indications for acute/urgent dialysis?

Answer 7

• refractory hyperkalemia
• metabolic acidosis
• fluid overload
• uremic symptoms (encephalopathy, pericarditis, coagulopathy)

Question 8

How to prevent progression of CKD?

Answer 8

• diet: salt restriction
• normalize calcium and phosphate
• ACEi
• control BP
• control BSL
• immunosuppressives in diseases like SLE
• preserve vessels in preparation for dialpysis

Question 9

What is the main factor in mortality in CKD?

Answer 9

Cardiovascular disease

Question 10

What are the complications of CKD?

Answer 10

• anemia
• bone disease
• cardiovascular disease
• calciphylaxis: calific obstruction of blood vessels
• infection risk increased
• neuropathy, encephalopathy
• nutrition
• fluid status/overload
• sexual dysfunction and fertility (anovulatory in CKD)

Question 11

What are the advantages of peritoneal dialysis?

Answer 11

• simple
• cardiovascularly safe
• freedom of diet/fluid intake
• no heparin
• independence

Question 12

What are the advantages of haemodialysis?

Answer 12

• large volumes can be filtrated
• efficient solute removal
• no protein loss

Question 13

What are the issues or disadvantages with PD?

Answer 13

• requires good hygiene
• patient education
• manual dexterity/vision/function
• needs residual urine output
• catheter malfunction
• may worsen DM due to the dextrose in the dialysate
• infection: peritonitis, site infection

Question 14

What are the issues with haemodialysis?

Answer 14

• disruption to life
• cardiovascular instability
• heparin exposure
• infection
• amyloidosis

Question 15

What are the GFR’s fir each stage of kidney disease?

Answer 15

1. > 90
2. 60-90
3. 30-60
4. 15-30
   5.

Question 16

When to start dialysis?

Answer 16

When eGFR 8-11 (usually uremic symptoms by this time)

Question 17

What are causes of worsening renal function in a transplanted kidney?

Answer 17

Consider pre renal and post renal causes
Immediate:
- hyper acute rejection, thrombosis

1-12 weeks:
- rejection, CNI toxicity, infection (CMV, BK), recurrence of primary disease

> 3 months:
- as above plus drugs, sepsis, etc

Question 18

What are long term problems after renal transplant?

Answer 18

• malignancy
• hypercalcemia (tertiary PTH)
• steroid complications
• HTN
• anemia

Question 19

How to investigate and manage CMV disease in renal transplant?

Answer 19

Ix:

• CMV DNA PCR
• biopsy

Mx:

• reduce immunosupression
• avoid rejection
• eliminate virus with ganciclovir