Renal

Question 1

What is the normal glomerular filtration rate?

Answer 1

120ml/hr

Question 2

What is the normal age-related decline in GFR?

Answer 2

1ml/hr/year

Question 3

Define renal clearance

Answer 3

The volume of plasma that can be completely cleared of a marker substance in a unit of time

Question 4

When does clearance equal GFR?

Answer 4

When a substance is not bound to serum proteins, can be freely filtered by the glomerulus, and is not secreted or absorbed by tubular cells

Question 5

What is the gold standard measure of GFR, and why is it not used?

Answer 5

Inulin. Not used as requires a steady state infusion and difficult to assay

Question 6

Which substance is used to measure GFR?

Answer 6

Creatinine

Question 7

What tests can be done on a single urine sample?

Answer 7

Dipstick testing, MC&S, proteinuria quantification (protein to creatinine ratio)

Question 8

What tests can be done on a 24h urine collection?

Answer 8

Creatinine clearance estimation, electrolyte estimation, assessment of stone forming elements

Question 9

What does urine microscopy look for?

Answer 9

Crystals, red blood cells, white blood cells, casts, bacteria

Question 10

What are the signs of glomerulonephritis on urine microscopy?

Answer 10

White blood cells, casts

Question 11

What are the signs of UTI on urine microscopy?

Answer 11

Red blood cells, white blood cells, bacteria

Question 12

What is acute kidney injury?

Answer 12

Rise in serum creatinine >26.5 in 48h or to 1.5x baseline in 48h

Question 13

State 5 indications for emergency dialysis in the setting of acute kidney injury

Answer 13

Pulmonary oedema, refractory hyperkalaemia, metabolic acidosis, uraemic encephalopathy, lithium toxicity

Question 14

Describe pre-renal acute kidney injury

Answer 14

Reduced renal perfusion with no structural abnormality of the kidney, responds to volume replacement

Question 15

Describe post-renal acute kidney injury

Answer 15

Obstruction to urinary flow preventing glomerular filtration as this requires a pressure gradient, reversal of flow can cause scarring and permanent renal impairment

Question 16

Name the four types of renal acute kidney injury

Answer 16

Vascular, glomerular, tubular, interstitial

Question 17

Describe stage 1 chronic kidney disease

Answer 17

Kidney damage with normal GFR (>90)

Question 18

State the GFR in stage 2 kidney disease

Answer 18

60-89

Question 19

State the GFR in stage 3 kidney disease

Answer 19

30-59

Question 20

State the GFR in stage 4 kidney disease

Answer 20

15-29

Question 21

State the GFR in stage 5 kidney disease

Answer 21

<15

Question 22

State the 6 most common causes of chronic kidney disease

Answer 22

Diabetes, atherosclerotic renal disease, hypertension, chronic glomerulonephritis, infective or obstructive uropathy, polycystic kidney disease

Question 23

Describe the consequences of chronic kidney disease

Answer 23

Progressive acidosis, hyperkalaemia, anaemia, renal osteodystrophy, vascular calcification and atherosclerosis, uraemia (leading to cardiomyopathy and encephalopathy), death

Question 24

What is required for peritoneal dialysis?

Answer 24

Tenckoff catheter, home dialysis machine

Question 25

Name two agents commonly used for immunosuppression post-kidney transplant

Answer 25

Tacrolimus, ciclosporin

Question 26

What is the standard site of kidney transplant?

Answer 26

Right iliac fossa

Question 27

Name the typical scar left by a kidney transplant

Answer 27

Rutherford Morrison scar (hockey stick scar)