Renal II

Question 1

Most common cause of AKI

Answer 1

Acute tubular necrosis

Question 2

Two main causes of ATN

Answer 2

Ischaemia

Nephrotoxins

Question 3

Examples of cases in which ischaemia occurs causing ATN

Answer 3

Shock

Sepsis

Question 4

Nephrotoxins which can cause ATN

Answer 4

Aminoglycosides
Myoglobin secondary to rhabdomyolysis
radiocontrast agents
lead

Question 5

Features of ATN

Answer 5

features of AKI: raised urea, creatinine, potassium

Question 6

What might be seen on urinalysis in ATN

Answer 6

Muddy brown casts

Question 7

Mx of ATN

Answer 7

Supportive management
IV fluids
Stop nephrotoxic medications
Treat complications

Question 8

What is interstitial nephritis

Answer 8

inflammation of the space between cells and tubules (the interstitium) within the kidney.

Question 9

How does acute interstitial nephritis present

Answer 9

AKI
HTN

Rash
Fever
Eosiniphilia(hypersensitivity reaction)

Question 10

what causes acute interstitial nephritis

Answer 10

Drugs (e.g. NSAIDS or antibiotics)

Infection

Question 11

Mx of acute interstitial nephritis

Answer 11

Treat underlying cause

Steroids

Question 12

How does chronic tubulointerstitial nephritis present

Answer 12

chronic inflammation of the tubules and interstitium. It presents with chronic kidney disease.

Question 13

What is HUS

Answer 13

Occurs when there is thrombosis in small blood vessels throughout the body. This is usually triggered by a bacterial toxin called the shiga toxin.

Question 14

HUS triad

Answer 14

Haemolytic anaemia
Acute kidney injury
Low platelet count (thrombocytopenia)

Question 15

Most common cause of HUS

Answer 15

toxin produced by the bacteria e. coli 0157 called the shiga toxin. Shigella also produces this toxin and can cause HUS

Question 16

What can increase risk of HUS

Answer 16

Use of antibiotics and anti-motility medications such as loperamide to treat the gastroenteritis

Question 17

Presentation of HUS

Answer 17

Brief gastroenteritis with bloody diarrhoea

Reduced urine output

Haematuria

Abdominal pain

Lethargy and irritability

Confusion

HTN

Bruising

Question 18

Mx of HUS

Answer 18

Supportive mx
Antihypertensives
Blood transfusions
Dialysis

Question 19

Pathophys of type 1 RTA

Answer 19

pathology in the distal tubule. The distal tubule is unable to excrete hydrogen ions.

Question 20

Causes of RTA 1

Answer 20

genetic 
SLE
Sjogren's 
Primary biliary cirrhosis 
Hyperthyroidism 
Sickle cell disease

Question 21

Presentation of RTA 1

Answer 21

Failure to thrive in children
Hyperventilation to compensate for the metabolic acidosis
Chronic kidney disease
Bone disease (osteomalacia)

Question 22

IX - RTA 1

Answer 22

Hypokalaemia
Metabolic acidosis
High urinary pH (above 6)

Question 23

Rx of RTA 1

Answer 23

Oral bicarbonate

Question 24

RTA 2 pathophys

Answer 24

Pathology in the proximal tubule. The proximal tubule is unable to reabsorb bicarbonate from the urine into the blood. Excessive bicarbonate is excreted in the urine

Question 25

Main cause of RTA 2

Answer 25

Fanconi's syndrome

Question 26

RTA 2 - IX

Answer 26

Hypokalaemia Metabolic acidosis High urinary pH (above 6)

Question 27

Mx of RTA 2

Answer 27

Oral bicarb

Question 28

What is RTA 4 caused by

Answer 28

caused by reduced aldosterone Can be due to adrenal insufficiency, ACE inhibitors/spironolactone or systemic conditions such as SLE/diabetes/HIV

Question 29

RTA 4 - IX

Answer 29

Hyperkalaemia High chloride Metabolic acidosis Low urinary pH

Question 30

Mx of RTA 4

Answer 30

Fludrocortisone Sodium bicarbonate Treatment of hyperkalaemia may be required

Question 31

Indications for acute dialysis - AEIOU

Answer 31

A – Acidosis (severe and not responding to treatment) E – Electrolyte abnormalities (severe and unresponsive hyperkalaemia) I – Intoxication (overdose of certain medications) O – Oedema (severe and unresponsive pulmonary oedema) U – Uraemia symptoms such as seizures or reduced consciousness

Question 32

Indications for long term dialysis

Answer 32

End stage renal failure (CKD stage 5)

Question 33

Options for maintenance dialysis

Answer 33

Continuous Ambulatory Peritoneal Dialysis Automated Peritoneal Dialysis Haemodialysis

Question 34

Complications of peritoneal dialysis

Answer 34

Bacterial peritonitis Peritoneal sclerosis Weight gain Psychosocial effects

Question 35

What does rhabdomyolysis cause release of

Answer 35

Myoglobin (causing myoglobinurea) Potassium Phosphate Creatine kinase

Question 36

Causes of rhabdomyolysis

Answer 36

Prolonged immobility Extremely rigorous exercise Crush injuries Seizures

Question 37

signs and symptoms of rhabdomyolysis

Answer 37

``` Muscle aches and pain Oedema Fatigue Confusion (particularly in elderly frail patients) Red-brown urine ```

Question 38

Mx of rhabdomyolysis

Answer 38

IV fluids IV sodium bicarbonate IV mannitol (increases GFR) Manage electrolyte disturbances

Question 39

What is polycystic kidney disease(PCK)

Answer 39

genetic condition where the kidneys develop multiple fluid-filled cysts

Question 40

Types of PCK

Answer 40

Autosomal recessive and dominant

Question 41

Diagnosis of PCK

Answer 41

kidney ultrasound scan and genetic testing

Question 42

Extra-renal manifestations of PCK

Answer 42

Cerebral aneurysms Hepatic, splenic, pancreatic, ovarian and prostatic cysts Cardiac valve disease (mitral regurgitation) Colonic diverticula Aortic root dilatation

Question 43

Complications of PCK

Answer 43

``` Chronic loin pain Hypertension Cardiovascular disease Gross haematuria Renal stones End-stage renal failure ```

Question 44

Mx of PCK

Answer 44

``` Tolvaptan(slows progression of cysts) Antihypertensives Analgesia Antibiotics Dialysis ```

Question 45

Definition of AKI

Answer 45

a rise in serum creatinine of 26 micromol/litre or greater within 48 hours a 50% or greater rise in serum creatinine known or presumed to have occurred within the past 7 days a fall in urine output to less than 0.5 ml/kg/hour for more than 6 hours in adults and more than

Question 46

Diagnosis of amyloidosis

Answer 46

Congo red staining: apple-green birefringence serum amyloid precursor (SAP) scan biopsy of skin, rectal mucosa, or abdominal fat

Question 47

Features of amyloidosis in renal disease

Answer 47

Commonly presents as nephrotic syndrome (e.g. 70% present with proteinuria in AL amyloidosis). Common in AA amyloidosis (in 80% of cases) & AL amyloidosis, but less likely in ATTR amyloidosis.

Question 48

Neurological presentation of amyloidosis

Answer 48

Ischaemic stroke | Peripheral & autonomic neuropathy