Renal Disease

Question 1

List 5 functions of the kidneys

Answer 1

Filtration and excretion of water 
Electrolyte homeostasis
Hormone production - erythropoietin and active Vit D
BP control via RAAS
Acid base homeostasis

Question 2

Why is creatinine not a good measure of kidney function?

Answer 2

Affected by muscle mass / sex / age

Question 3

What can cause change in urine colour?

Answer 3

Food dyes, beetroot, porphyria, rifampicin

Question 4

What is AKI?

Answer 4

Rapid decline in renal function over hours or days

Serum creatinine >26/48hrs OR urine output >0.5ml/kg for 6hrs OR serum creatinine rise 1.5x in 1 week

Question 5

List risk factors for AKI

Answer 5

Being in hospital 
Major surgery 
N&V 
>75yrs 
CKD 
Prev AKI 
Hypotension 
Sepsis 
Hypovolaemia 
Nephrotoxins

Question 6

What are the 3 categories of AKI causes?

Answer 6

Pre renal
Renal
Post renal

Question 7

List pre renal causes of AKI

Answer 7

hypotension, hypovolaemia, low CO

Question 8

List renal causes of AKI

Answer 8

acute tubular necrosis
glomerulonephritis
vasculitis
myeloma

Question 9

List post renal causes of AKI

Answer 9

urine obstruction eg blocked catheter

Question 10

What are the Sx for AKI?

Answer 10

Non specific - uraemia Sx, low urine output, dehydration

Question 11

What 4 things do you need to ask in AKI Hx?

Answer 11

Duration?
PMH of vascular / UTI / DM ?
FH of stroke etc?
DH - ketamine, NSAIDS, herbal remedies?

Question 12

List signs of AKI O/E

Answer 12

Low BP, palpable mass (bladder / kidneys)

Question 13

What does +++ protein and +++ blood in urine suggest?

Answer 13

Glomerular disease

Question 14

What does non red clasts in urine suggest?

Answer 14

Tubular disease

Question 15

What is the key investigation you need having received serum creatinine / urine dip results?

Answer 15

Previous renal function information

Question 16

What Ix would you do for AKI?

Answer 16

US and CXR and urinalysis

Question 17

What are the 2 most serious side effects of AKI?

Answer 17

Hyperkalaemia

Pulmonary oedema

Question 18

What may CKD USS show?

Answer 18

Small, scarred kidneys

Question 19

List risks of CKD

Answer 19

Old, HTN, DM, IHD, FH of CKD, black

Question 20

List causes of CKD

Answer 20

DM, chronic glomerulonephritis, HTN, IHD, congenital

Question 21

What is Mx for CKD?

Answer 21

Try and find cause, treat if possible
Regular follow up
IHD prophylaxis

Question 22

What is Tx for CKD?

Answer 22

NO CURE
BP control - ACEi / ARB 
Stop smoking 
Low salt and protein diet 
Avoid dehydration

Question 23

List Sx for proteinuria

Answer 23

Swollen legs, pain, limited walking

Question 24

What is the normal range for proteinuria?

Answer 24

<300mg/day

Question 25

What is the triad of Sx for nephrotic syndrome?

Answer 25

Proteinuria
Hypoalbuminaemia
Oedema

Question 26

What is the proteinuria threshold for nephrotic syndrome?

Answer 26

> 3g/day

Question 27

List some causes of proteinuria

Answer 27

DM, SLE, amyloid, membranous nephropathy or minimal change glomerular disease

Question 28

What is Tx for proteinuria?

Answer 28

Sx control - diuretic

ACEi / ARB to decrease proteinuria

Question 29

Is haematuria is present, where is the problem?

Answer 29

Glomerulus

Question 30

Haematuria + pain = ?

Answer 30

Stones / cancer

Question 31

What is the prognosis for end stage kidney disease?

Answer 31

No recovery, just dialysis Tx