Renal

Question 1

What are the causes of AKI? - at least 5 for each

1. Pre-renal
2. Renal
3. Post-renal

Answer 1

1. Dehydration, haemorrhage, shock, oedema (liver failure, heart failure), renal hypoperfusion (RAS, AAA, hepatorenal syndrome)
2. Glomerulonephritis, medication, ATN, vasculitis, infection, autoimmune, myeloma, rhabdomyolysis
3. Renal stones, enlarged prostate, cervical carcinoma, blocked catheter, pyonephrosis

Question 2

What is the criteria for AKI? (3)

Answer 2

Rise in serum creatinine by 26 or more in 48h OR
Rise in creatinine 1.5-1.99 x baseline in 7 days OR
Fall in urine output by >0.5ml/k/h for more than 6h

Question 3

Which test should you not forget about when investigating AKI?

Answer 3

Urine dipstick and urinalysis

Question 4

What is the management for AKI? (4)

Answer 4

Identify and treat cause
Stop nephrotoxic drugs
Monitor U&Es
Optimise fluid balance and monitor urine output

Question 5

In what circumstances would you consider RRT?

Answer 5

A - refractory acidosis
E - electrolyte i.e. refractory hyperkalaemia or hypercalcaemia
I - intoxicants
O - refractory oedema
U - uraemic encephalopathy or pericarditis

Question 6

What is found on urinalysis for ATN?

Answer 6

Muddy brown casts

Question 7

What signs or symptoms would suggest CKD? (8)

Answer 7

Pruritus
Nausea
Anorexia
Oedema
Peripheral neuropathy
Pallor
Hypertension 
Muscle cramps

Question 8

What investigations should you order in CKD? (4)

Answer 8

eGFR
Urine ACR
Urine dipstick for haematuria
Renal USS if accelerated or haematuria

Question 9

What are some of the complications of CKD? (4)

Answer 9

Anaemia
Bone disease
Cardiovascular disease
Acidosis

Question 10

What is the treatment for the complications of CKD?

Answer 10

EPO and IV iron
Vitamin D or bisphosphonates if indicated and eGFR >30
Atorvastatin 20mg
Sodium bicarbonate if eGFR <30

Question 11

Which medication can slow the progression of CKD?
When are they offered?
What is the target measurement?

Answer 11

ACE-I or ARBs
Diabetes and ACR >3
Hypertension and ACR >30
All patients with ACR >70

Aim for BP 140/90 or 130/80 if diabetic

Question 12

When should you refer a person with CKD to a nephrologist? (4)

Answer 12

ACR >70
eGFR fall >15 in one year
eGFR <30
Uncontrolled hypertension

Question 13

What are the stages of CKD?

1. eGFR
2. ACR

Answer 13

eGFR

1. > 90
2. 60-89
   3a. 45-60
   3b. 30-45
3. 15-29
4. <15 (kidney failure)

ACR

1. <3
2. 3-30
3. > 30

Question 14

What are the cardiac manifestations of ADPKD? (2)

What are other manifestations? (5)

Answer 14

Mitral valve regurgitation
Aortic root dilatation
Renal calculi, berry aneurysms, cysts in liver, spleen, pancreas, ovaries and prostate, diverticular disease

Question 15

What medication is used for ADPKD?

Answer 15

Vasopressin antagonists e.g. tolvaptan

Question 16

What are 4 causes of nephritic syndrome?

Answer 16

IgA nephropathy
HSP
anti-GBM
Post-strep GN

Question 17

What are 4 causes of nephrotic syndrome?

Answer 17

Minimal change disease
Focal segmental glomerulosclerosis
Membranous nephropathy
Membranoproliferative GN

Question 18

What is the general management of glomerulonephritis? (2)

Answer 18

Immunosuppressants

Blood pressure control e.g. ACEI

Question 19

What is an important complication of rhabdomyolysis?

How do you monitor for it?

Answer 19

Hyperkalaemia

ECG

Question 20

What medication is used to manage renal tubular acidosis?

Answer 20

Oral bicarbonate