renal amk teach 21/05/2022

Question 1

aki is a sudden decrease in kidney function characterised by what

Answer 1

rise in creatinine and urea
fall in eGFR and urine output

CKD stage 5 under 15 up in 15 until CKD2 and CKD1 is 90

Question 2

for CKD when does renal repalcemtn therapy occur

Answer 2

uraemia/hyperkalaemia - usually CKD 4/5

Question 3

CKD first line management

Answer 3

ACEi and ARB

if you start them on this need to check potassium and eGFR baseline functions

Question 4

cause of AKI

pre renal causes - decrease blood supply to kidneys

Answer 4

volume loss ( also includes high ca) , hypotension, decreased effective arterial volume 
renal artery stenosis ( artheroslceroiss, decrease perfusion so activation of RASS, get abdominal bruit) 
medications such as NSAID( constrict afferent) , ACEi( inhibit vasoconstriction of effecent arterioles) 
tacrolimus ( stimulate systemic vasoC)

Question 5

infrarenal - damaged glomeruli cells

Answer 5

acute tubular necrosis 
of epithelial cells 
toxins such as aminoglycosdies( gentamicin) , mehtrotraxate - Hb and myoglobin 
muddy brown casts 
oliguria and polyuria 

acute intestinal nephritis
extra glomerular tissue inflammation
abx, NSAID, infections and autoimmunity, may take weeks
may take weeks

esoniphills present
discoutniune drugs and add fluids
discoutnieu drugs and give fluids

Question 6

68yr man hypertension, amended diet already. history of high high cholesterol, creatinine high. funny sounds over LUQ.
what is most likely diagnosis

Answer 6

renal artery stenosis

Question 7

nephritic syndromes ]
hamturia
pyuria 
portienuria 
hypetension

Answer 7

pos infection 
post strep and IgA 
small vessel vacuities 
GPA 
EGPA 
goodpastures 
alport syndrome

Question 8

nephritic syndromes ]
hamturia
pyuria 
portienuria 
hypetension

Answer 8

pos infection
post strep( 3-12year olds sometimes in elderly) and IgA ( 1-2 days after URTI, gross haematuria)
small vessel vacuities
GPA - cANCA - renal failure , nano involvement , nose Leeds and saddle nose deformity 65-74
EGPA - pANCA esoninophils driven , severe asthma’s, blood esoniophilai . sinusitis , peripheral neuropathy 38-54yr
treat both with steroids
goodpastures -anti GBM, 20-30 60-70 , type 4 collagen antibodies - basement membrane - pulmonary haemorrhage haemoptysis, steroids mamange
alport syndrome - x linked

all lead to rapid destruction of glomeruli due to nephritis , crescent moon formation - high dose steroid sand cyclphasphoamide

Question 9

nephritic syndromes ]
hamturia
pyuria 
portienuria 
hypetension

Answer 9

pos infection
post strep( 3-12year olds sometimes in elderly) and IgA ( 1-2 days after URTI, gross haematuria)
small vessel vacuities
GPA - cANCA - renal failure , nano involvement , nose Leeds and saddle nose deformity 65-74
EGPA - pANCA esoninophils driven , severe asthma’s, blood esoniophilai . sinusitis , peripheral neuropathy 38-54yr
treat both with steroids
goodpastures -anti GBM, 20-30 60-70 , type 4 collagen antibodies - basement membrane - pulmonary haemorrhage haemoptysis, steroids mamange
alport syndrome - x linked - type 4

all lead to rapid destruction of glomeruli due to nephritis , crescent moon formation - high dose steroid sand cyclphasphoamide

Question 10

diabetes insipidus - low urien osmolality and high plasma osmolality
thiazides

Answer 10

SIADG
overproduction of ADH
normal volume, low sodium , high urine osmolality, decrease yrine output

hypertonic saline management