Renal and urology

Question 1

what is the indication for RRT in CKD?

Answer 1

It should depend on the patient’s views and wishes.

In general, patients usually begin dialysis when their GFR reaches 10 mL/minute, or 15 mL/minute if they are diabetic (ie stage 5 CKD)

Question 2

what is the indication for RRT in AKI?

Answer 2

Presence of clinical features of uraemia (eg, pericarditis, gastritis, hypothermia, fits or encephalopathy).

Refractive pulmonary oedema

Refractive hyperkalaemia (above 6.5 mmol/L)

Serum sodium above 155 mmol/L or below 120 mmol/L

Refractive severe acid-base disturbance (pH under 7.0)

Severe renal failure (urea greater than 30 mmol/L, creatinine greater than 500 μmol/L).

Toxicity with drugs that can be dialysed.

Question 3

Eighteen months after a patient received a kidney transplantation she shows evidence of rejection.
(i) Give TWO clinical features that would indicate kidney rejection
(ii) What single histological feature of the biopsy would confirm the
diagnosis of rejection?

Answer 3

(i) chronic graft rejection presents with
- a gradual rise in serum creatinine and proteinuria
- resistant hypertension

(ii) Graft biopsy shows vascular changes, fibrosis, and tubular atrophy.