Renal Failure

Question 1

AKI definition

Answer 1

An acute drop in kidney function

> 25 umol/L rise in creatinine in 48 hours
50% rise in creatinine in 7 days
<0.5ml/kg/hour urine output for >6 hours

Question 2

AKI risk factors (8)

Answer 2

Chronic kidney disease
Heart failure
Diabetes
Liver disease
>65 years old
Cognitive impairment
Nephrotoxic medications e.g. NSAIDs/ACE inhibitors
Use of contrast medium e.g. CT Scan

Question 3

AKI causes

Answer 3

Pre-renal (most common)
Inadequate blood supply
Dehydration, hypotension, heart failure, renal artery stenosis

Intrinsic Renal
Reduced filtration of blood
Glomerulonephritis
Interstitial nephritis
Acute tubular necrosis 

Post-Renal
Obstruction to outflow of urine
Kidney stones
Masses e.g. cancer in abdomen or pelvis
Uretral strictures
Enlarged prostatectomy

Question 4

AKI investigations

Answer 4

Urinalysis
Protein/blood - acute nephritis
Leukocytes/nitrites - infection
Glucose - diabetes

Ultrasound of urinalysis tract - obstruction

Question 5

AKI stages

Answer 5

1. Serum creatinine >26umol/L or 1.5-1.9 x baseline
2. 2.0-2.9 x baseline
3. > 3 x baseline

Question 6

AKI management

Answer 6

Treat underlying cause

Pre-renal: correct volume depletion via circulatory support, correct any sepsis

Renal: refer for biopsy and specialist treatment

Post-renal: catheter, nephrostomy or urological intervention

Question 7

CKD definition

Answer 7

Abnormal kidney structure or function, present for >3 months, with implications for health

Question 8

CKD risk factors (6)

Answer 8

Diabetes
Hypertension
Age related decline
Glomerulonephritis
Polyscystic kidney disease
Medications e.g. NSAIDs, PPIs, lithium

Question 9

CKD classification

Answer 9

Based on eGFR, presence of albuminuria and the cause of kidney disease

Question 10

CKD classification by eGFR

Answer 10

G1 - >90
G2 - 60-89
G3a - 45-59
G3b - 30-44
G4 - 15-29
G5 - <15 (kidney failure)

Question 11

CKD stage G1 eGFR

Answer 11

> 90, only CKD if other evidence of kidney damage

Question 12

CKD stage G2 eGFR

Answer 12

60-89, only CKD if other evidence of kidney damage

Question 13

CKD stage G3a eGFR

Answer 13

45-59

Question 14

CKD stage G3b eGFR

Answer 14

30-44

Question 15

CKD stage G4 eGFR

Answer 15

15-29

Question 16

CKD stage G5 eGFR

Answer 16

<15, kidney failure

Question 17

CKD stage A1

Answer 17

Albumin excretion <30 mg/24 hr

A:CR - <3

Question 18

CKD stage A2

Answer 18

Albumin excretion 3–300 mg/24 hr

A:CR 3-30

Question 19

CKD stage A3

Answer 19

Albumin excretion >300

A:CR >30

Question 20

Glomerular CKD example (2)

Answer 20

diabetes, amyloid

Question 21

Tubulointerstitial CKD example (6)

Answer 21

UTI, pyelonephritis, stones, drugs, toxins, sarcoid

Question 22

Blood flow/vessel CKD example (3)

Answer 22

Renal limited vasculitis, heart failure, TTP

Question 23

Cystic/congenital CKD example (3)

Answer 23

Renal dysplasia, Alport syndrome, Fabry disease

Question 24

Transplant CKD example (3)

Answer 24

Recurrence of renal disease, rejection, calcineurin toxicity

Question 25

CKD symptoms (9)

Answer 25

``` Usually asymptomatic Itching Loss of appetite Nausea Oedema Muscle cramps Peripheral neuropathy Pallor Hypertension ```

Question 26

CKD investigations

Answer 26

eGFR (U&Es) 2 tests required 3 months apart to confirm diagnosis Proteinuria Haematuria Renal ultrasound

Question 27

CKD management

Answer 27

1. slow progression of disease 2. reduce risk of CVD 3. reduce risk of complications 4. treat complications

Question 28

Anaemia of CKD cause

Answer 28

Damaged kidney cells in CKS cause a drop in EPO --> drop in RBCs --> anaemia

Question 29

Renal bone disease cause

Answer 29

CKD --> increased serum phosphate due to reduced phosphate excretion.

Question 30

What is Berger’s disease?

Answer 30

Most common cause of primary glomerulonephritis

Question 31

Berger’s disease peak age

Answer 31

20s

Question 32

Berger’s disease histology

Answer 32

IgA deposits and glomerular mesangial proliferation

Question 33

Membranous glomerulonephritis causes

Answer 33

~70% idiopathic | Can be secondary to malignancy, rheumatoid diseases or drugs (e.g.NSAIDs)

Question 34

What is membranous glomerulonephritis

Answer 34

The most common overall cause of glomerulonephritis