Renal

Question 1

What are the signs of kidney failure?

Answer 1

Anaemia

Metabolic acidosis

Hyperkalaemia

Hypocalcaemia

Fluid overload/depletion

Uraemia

Question 2

What is uraemia?

Answer 2

It occurs due to an increase in urea/creatinine causing:

Anorexia

Malaise

Confusion

Nausea and vomiting

Fits and coma

Question 3

How do you tell the difference between a pre renal and renal AKI?

Answer 3

Urinary sodium

Pre renal - Low as body keeps it to combat hypovolaemia

Renal - High as body loses it

Question 4

How can you assess fluid levels?

Answer 4

http://www.osce-aid.co.uk/stations/workshop_fluidbalance.pdf

Question 5

How can you assess fluid levels?

Answer 5

Inspect for any signs of fluid loss eg stoma, sick bowl, cathter

Hands - Are they warm, are they well perfused, what is the skin turgor plus sats

Arms - Pulse, RR, BP

Face - Mucous membranes, sunken eyes, angular stomatits

Neck - JVP and carotid pulse

Chest - ?Crackles for pulmonary odema

Oedema - Sarcral and pedal plus actites

Also:

Catheter, examine stoma or bags

Weight chart Fluid chart

?prescribe fluid and monitor response

Question 6

What are the pre renal causes of AKI?

Answer 6

Any cause of reduced perfusion:

Hypovalaemia

Renal artery stenosis

Sepsis

ACEI and NSAIDS

Question 7

What are the renal causes of AKI?

Answer 7

Acute tubular necrosis - toxicity or ischaemia (hypertension)

Drugs - Aminogycosides, contrast

Vasculitis

Glomerulonephritis

Myeloma

Question 8

What are the post renal causes of AKI?

Answer 8

UTI

blocked catheter

Question 9

What is CKD?

Answer 9

Kidney damage for three months or more based on abnormal findings

Question 10

What are the common causes of CKD?

Answer 10

Diabetic nephropathy

Hypertension

Rarer - glomerulonephritis

Question 11

What is the normal amount of urine produced?

Answer 11

0.5ml/kg/hr

Question 12

How do you manage CKD?

Answer 12

Lifestyle advice

Monitor fluids

Treat cause and symptoms

Question 13

How do you treat AKI?

Answer 13

Identify cause

Monitor renal function via U+Es and urine output

Monitor signs of fluid overload/depletion

Replace fluid

Get specialist help

Question 14

1. What is nephrotic syndrome?
2. What commonly causes it?
3. What is associated with it?

Answer 14

1) Triad of:

• Proteinuria
• Hypoalbuminaemia
• Oedema

2) It is commonly caused by glomerulonephritis
3) it is a pro coagulable state and lose IGs so immunosupressent

Question 15

What is nephritic syndrome?

What causes it?

Answer 15

1) Signs of nephrotic

Plus

Haematuria and hypertension

2) cause sinclude SLE, post strep glomerulonephritis, IgA nephropathy

Question 16

Whats the difference between IgA nephropathy and Post strep glomerulonephritis

Answer 16