Renal

Question 1

What are the causes of renal disease?

Answer 1

• Pre renal
  
  • Shock
  • Renal vascular:
    
    • RAS
    • Toxins: NSAIDs, ACEi
    • Thrombosis
    • Hepatorenal syndrome
• Renal
  
  • Glomerulonephritis
  • ATN
  • Interstitial disease
• Post renal
  *

Question 2

What are the causes of sterile pyuria?

Answer 2

• TB
• Treated UTI
• Appendicitis
• Calculi
• TIN
• Papillary necrosis
• Polycystic Kidney
• Chemical cystitis (e.g. cyclophosphamide)

Question 3

What counts as a positive urine culture?

Answer 3

• >10⁴ CFU/ml pure growth
• >10³ CFU/ml pure growth of E coli or S saprophyticus
• >10⁵ CFU/ml mixed growth with one predominant organism

Question 4

Which antibiotic should you not give for cystitis in renal failure?

Answer 4

Nitrofurantoin

Question 5

How do you treat pyelonephritis?

Answer 5

• Cefotaxime 1g IV BD for 10d
• No response: augmentin 1.2g IV TDS + gentamicin

Question 6

Which drugs cause glomerulonephritis?

Answer 6

Gold, penicillamine

Question 7

What are the features of Alport’s syndrome?

Answer 7

• Mostly X linked
• Haematuria, proteinuria leading to progressive renal failure
• Sensorineural deafness
• Lens dislocation and cataracts
• Retinal ‘flecks’
• Haematuria only in women

Question 8

What are the features of nephrotic syndrome?

Answer 8

• Proteinuria: PCR >300mg/mM or >3g in 24h
• Hypoalbuminaemia (<35g/L)
• Oedema (periorbital, genital, ascites, peripheral)
  
  • Often intravascularly depleted with lowered JVP

Question 9

How do you classify AKI?

Answer 9

RIFLE classification - determined by worst criteria

• Risk
  
  • Cr up x1.5
  • GFR down by >25%
  • UO <0.5ml/kg/h x 6h
• Injury
  
  • Cr up x2
  • GFR down by >50%
  • UO <0.5ml/kg/h x 12h
• Failure
  
  • Cr up x3
  • GFR down by >75%
  • UO <0.3ml/kg/h x 24h or anuria x12h
• Loss = persistent ARF = complete loss of function >1 month
• ESKD = complete loss of function >3 months

Question 10

What are the ECG features of hyperkalaemia?

Answer 10

• Peaked T waves
• Flattened P waves
• Prolonged PR interval
• Widened QRS
• Sine wave pattern -> VF

Question 11

How do you treat hyperkalaemia?

Answer 11

• 10ml 10% calcium gluconate
• 100ml 20% glucose + 10u insulin (actrapid)
• Salbutamol 5mg neb
• Calcium resonium 15g PO or 30g PR
• Haemofiltration (usually needed if anuric)

Question 12

What are the indications for acute dialysis in AKI?

Answer 12

• Persistent hyperkalaemia (>7mM)
• Refractory pulmonary oedema
• Symptomatic uraemia: encephalopathy, pericarditis
• Severe metabolic acidosis (pH <7.2)
• Poisoning (e.g. aspirin)

Question 13

What are the common causes of acute renal failure?

Answer 13

• Pre-renal: shock (sepsis, hypovolaemia), HRS)
• Renal: ATN, TIN, GN
• Post-renal: stone, neoplasm, catheter

Question 14

What are the causes of interstitial nephritis?

Answer 14

• Drug hypersensitivity (70%):
  
  • NSAIDs
  • Abx: cephs, penicillins, rifampicin, sulphonamide
  • Diuretics: furosemide, thiazides
  • Allopurinol
  • Cimetidine
• Infections in 15%: staphs, streps
• Immune stuff: Sjogren’s, SLE

Question 15

What are some nephrotoxins?

Answer 15

• Exogenous:
  
  • NSAIDs
  • Antimicrobials (AVASTA)
    
    • Aminoglycosides
    • Vancomycin
    • Aciclovir
    • Sulphonamides
    • Tetracycline
    • Amphotericin
  • ACEi
  • Immunosuppressants
    
    • Ciclosporin
    • Tacrolimus
  • Contrast media
  • Anaesthetics: enflurane
• Endogenous
  
  • Haemoglobin, myoglobin
  • Urate
  • Ig e.g. light chains in myeloma

Question 16

What are the stages of chronic renal failure?

Answer 16

By GFR:

1. >90
2. 60-89
3. • 3a: 45-59
   • 3b: 30-44
4. 16-29
5. <15

Question 17

What are the complications of chronic renal failure?

Answer 17

• Cardiovascular disease
• Renal osteodystrophy
• Fluid (oedema)
• HTN
• Electrolyte disturbances (K, H)
• Anaemia
• Leg restlessness
• Sensory neuropathy

Question 18

What are the contraindications for renal transplant?

Answer 18

• Active infection
• Cancer
• Severe heart disease or other co morbidity

Question 19

What immunosuppression is given to renal patients?

Answer 19

• Pre op: campath/alemtuzumab (anti-CD52)
• Post op: prednisolone short term and tacro/ciclo long-term

Question 20

What are the features of thrombotic thrombocytopenic purpura?

Answer 20

1. Fever
2. CNS signs: confusino, seizures
3. MAHA
4. Thrombocytopenia
5. Renal failure

Question 21

What are the features of Fanconi syndrome?

Answer 21

• Polyuria (osmotic diuresis)
• Hypophosphataemic rickets (vit D resistant)
• Acidosis, hypokalaemia

Question 22

What are the differences between Bartter’s syndrome and Gitelman syndrome?

Answer 22

• B - blockage of NaCl reabsorption in loop of Henle (like frusemide), G - blockage in DCT (like thiazides)
• B - hypokalaemia and met alkalosis, G - same but also hypocalciuria

Question 23

What are the features of auto dom PCKD?

Answer 23

• Abdo mass and flank pain
• Infected cyst
• Stones
• Raised SBP
• Haematuria or haemorrhage into cyst
• Aneurysms: berry -> SAH
• Polyuria and nocturia
• Extra renal cysts: liver
• Systolic murmur: mitral valve prolapse

Question 24

What does medullary sponge kidney predispose you to?

Answer 24

• Hypercalciuria and nephrolithiasis
• Recurrent UTIs and pyelonephritis
• Haematuria

Question 25

What are the faetures of tuberous sclerosis?

Answer 25

• Skin: nasolabial adenoma sebaceum, ash-leaf macules, peri-ungual fibromas
• Neuro: low IQ, epilepsy
• Renal: cysts, angiomyolipomas

Question 26

What are the differentials for renal enlargement?

Answer 26

• Polycystic kidneys: ADPCKD, ARPCKD, TS
• Hypertrophy secondary to contralateral renal agenesis
• Obstruction (hydronephrosis)
• Neoplasia: RCC, myeloma, amyloidosis
• Occlusion: renal vein thrombosis
• Systemic: early DM, amyloid