Renal Long

Question 1

Secondary causes of hypertension

Question 2

Screening for chronic kidney disease mineral and bone disorder (CKD-MBD)

Answer 2

All patients with eGFR <60 should be screened

• calcium, phosphate, PTH, ALP, calcidiol
  
  • Calcium and phosphate every 1-3 months
  • PTH event 3-6 months
  • ALP in stage 4 CKD +, every 12 months
• Aim PTH 15-22 when eGFR <15
  
  • High PTH = osteitis fibrosa (high bone turnover)
  • Low PTH = adynamic bone disease (low bone turnover; prevalent in dialysis patients)

Question 3

Vaccinations for commencing dialysis

Question 4

what to remember about young women and hypertension

Answer 4

ask about preclampsia

Question 5

Treatment of CKD-MBD

Answer 5

1. Phosphate reduction
   
   1. Dietary (dairy, coke, nuts)
   2. Phosphate binder
   3. Dialysis
2. Vit D analogues if progressive and severe hyperparathyroidism
   
   1. Calcitriol: suppresses PTH, tx hypocalcaemia
3. Cinacalcet
   
   1. PTH>50 on dialysis or 15-50 with hypercalcaemia
4. Surgical treatment
   
   1. Last option for severe secondary ot tertiary hyperparathyroidism that fails to respond to optimum medical treatment

Question 6

Reasons for switching from peritoneal dialysis to haemodialysis

Answer 6

• Loss of ultrafiltration
• Relapsed peritonitis
• Technique failure

Question 7

How do you address the adequacy of dialysis?

Answer 7

• Fractional small solute clearance: urea Kt/V
• Uraemia symptoms
• Fluid management (ECF/BP)