Renal

Question 1

What is AKI?

Answer 1

Decreased renal function occurring over hours or days

Question 2

How is AKI measured?

Answer 2

Serum creatinine or urine output

Question 3

What are the commonest causes of AKI?

Answer 3

Pre-renal: sepsis, hypovolaemia, cardiogenic shock, MI
Renal: glomerulonephritis, drug toxicity, infiltration, vasculitis
Post-renal: obstruction due to stone, malignancy, stricture, cloth, prostatic hypertrophy, retro-peritoneal fibrosis

Question 4

What investigations should be done for AKI?

Answer 4

Urine dipstick
USS within 24 hours
Check liver function
Check platelets
Investigate for intrinsic disease e.g. Immunoglobulins

Question 5

What are the 3 types of AKI volume status?

Answer 5

Hypovolaemia
Euvolaemia
Fluid overloaded/hypervolaemia

Question 6

Name the triad for nephrotic syndrome.

Answer 6

Proteinuria
Peripheral oedema
Hypoalbuminaemia

Question 7

Name the triad for nephritic syndrome.

Answer 7

Haematuria
Hypertension
Renal failure

Question 8

What is Goodpasture’s Syndrome/anti-GBM disease?

Answer 8

Body produces autoantibodies to type IV collagen in the basement membrane - causes glomerulonephritis. Can also cause pulmonary haemorrhage due to basement membrane damage in lungs.
Anti-GBM antibodies present.

Question 9

What is IgA nephropathy?

Answer 9

Form of nephritic syndrome, IgA deposition in the mesangium leads to glomerular damage.
Occurs a few days after URTI.

Question 10

Name 3 forms of nephrotic glomerulonephritis.

Answer 10

Minimal change glomerulonephritis
Focal segmental glomerulosclerosis
Membranous glomerulonephritis

Question 11

What is Alport Syndrome?

Answer 11

X-linked condition where there is abnormal type IV collagen, can lead to end stage renal failure.

Question 12

What is PRCA, a rare cause of anaemia in CKD?

Answer 12

Pure red cell aplasia - severe reticulocytopenia and reduced RBC production

Question 13

What eGFR value indicates that a patient is unsuitable for CT?

Answer 13

eGFR<40 means the patient is unsuitable for CT, this is because the contrast is nephrotoxic. A good reason for checking U+Es is to see the patient’s kidney function and whether they can have CT.

Question 14

What are the 4 types of graft for a kidney transplant?

Answer 14

Brainstem death with CV support
Non heart-beating donor
Live related
Live unrelated

Question 15

What medication would a post-op renal transplant patient be on?

Answer 15

Steroids (usually prednisolone)
Tacrolimus or ciclosporin (calcineurin inhibitors)
Mycophenolate (antimetabolites)
Most patients are on the ‘triple therapy’ of prednisolone, mycophenolate and tacrolimus.

Question 16

Name some post-op complications of a renal transplant.

Answer 16

Bleeding
Graft thrombosis
Infection
Urinary leaks

Question 17

What are the 3 layers of the glomerulus?

Answer 17

Leaky endothelium
Basement membrane (slightly negative charge)
Foot processes of podocyte cell

Question 18

What stimulates the release of ADH from the posterior pituitary?

Answer 18

Increased plasma osmolality or decreased BP.

Question 19

Which organ is responsible for hydroxylation of vitamin D?

Answer 19

The kidney - alpha-hydroxylation of vitamin D which is controlled by parathyroid hormone.

Question 20

What are the 5 types of diuretics?

Answer 20

Carbonic anhydrase inhibitors
Loop diuretics
Thiazide diuretics
K+ sparing diuretics
Osmotic diuretics

Question 21

Which enzyme is responsible for bicarbonate reabsorption in the PCT?

Answer 21

Carbonic anhydrase (catalyses the conversion of CO2 and water with bicarbonate and H+).

Question 22

What is the anatomical position of the kidneys?

Answer 22

Retroperitoneal
Extend fro, T12-L3, R kidney is slightly lower due to presence of the liver.
Adrenal glands sit immediately superior.

Question 23

Name the 4 layers surrounding the kidneys (from deep to superficial).

Answer 23

Renal capsule
Peri-renal fat
Renal fascia
Para-renal fat

Question 24

Which diuretic is commonly associated with a side effect of gynaecomastia?

Answer 24

Spironolactone (K+ sparing diuretic)

Question 25

Name some risk factors for AKI

Answer 25

Increased age
Diabetes mellitus
Prolonged immobilisation (rhabdomyolysis)
Dehydration
Sepsis
Heart failure
Liver disease
Peripheral vascular disease
Essentially, the risk is higher in those with more pre-existing conditions

Question 26

What is the sepsis 6 bundle?

Answer 26

Give O2 to maintain sats >94%
Give fluid challenge
Give empirical antibiotics
Take blood cultures
Measure serum lactate
Monitor urine output closely

Question 27

Why are patients with nephrotic syndrome at increased risk of pulmonary embolism?

Answer 27

Due to imbalance of thrombotic and antithrombotic factors in the clotting cascade - clotting factors are lost in the urine.

Question 28

What does frothy urine indicate?

Answer 28

Heavy proteinuria

Question 29

What drug is known for turning urine orange/red?

Answer 29

Rifampicin - used in the treatment of TB

Question 30

In patients with diabetic-induced CKD, what antihypertensive should they be given even if they have normal BP?

Answer 30

ACEi/ARB

Question 31

What is APCKD and what is it’s genetic pattern?

Answer 31

Adult polycystic kidney disease
Autosomal dominant
Condition where cysts form on the kidneys, can lead to CKD

Question 32

Why antibody is associated with small vessel vasculitis?

Answer 32

ANCA

Question 33

Which antibodies can be present in SLE?

Answer 33

ANA

Anti-dsDNA

Question 34

What is the mainstay of management for AKI?

Answer 34

Treat underlying cause e.g. give fluids, manage obstruction, stop nephrotoxic drugs. Regardless of mechanism of injury, there is a need to manage fluid balance, acidosis and hyperkalaemia as well as recognise patients who may need RRT.

Question 35

What are the 3 stages of AKI?

Answer 35

1 - creatinine 1.5x normal, GFR decrased by > 25%
2 - creatinine 2x normal, GFR decreased by > 50%
3 - creatinine 3x normal, GFR decreased by > 75%

Question 36

Why do you get an acidosis and hyperkalaemia with AKI?

Answer 36

Acidosis due to reduced renal excretion of organic acids. The increase in H+ causes H+ to be taken up by cells, which in turn causes K+ to be secreted by cells via H+ K+ exchanger. Can lead to life-threatening arrhythmias.