Renal workbook and key points

Question 1

What are the common causes of AKI

Answer 1

Pre renal: decreased CO (HF or LF), hypovolaemia (bleeding vomiting)

Renal: acute GN, tubular injury (sepsis/nephrotoxins)

Postrenal: bladder outlet obstruction

Question 2

Investigations for AKI

Answer 2

Urine dip for protein and blood, FBC, Us and Es, LFTs, bone profile, CRP, CK for rhabdomyalosis, USS KUB (bladder outlet obstruction), measure urine output

Question 3

Initial treatment for AKI

Answer 3

Ensure volume status and perfusion pressure: give IV fluids

Question 4

How does ADH regulate fluid balance

Answer 4

Synthesised in hypothalamus and released by PP, causes more Na+ and water retention, blood volume increases and urine osmolarity also increases.

Kidney tubules become more permeable, more water can leave the kidney tubule and be reabsorbed into the blood

Question 5

Fluids for AKI patient with low bp and dehydration but normal Na+ and K+

Answer 5

Isotonic solution- Normal saline 0.9% NaCl

Question 6

Investigations for CKD staging

Answer 6

EGFR, albumin:creatinine ratio

Question 7

How does hypertension worsen renal function

Answer 7

HTN causes increased renal perfusion pressure, arteries around the kidney are weakened/narrowed/hardened, and cannot delivery enough blood to the kidney

Question 8

Common causes of CKD

Answer 8

Diabetes, HTN, GN, PKD, obstructive nephropathy

Question 9

Clinical examination findings in CKD

Answer 9

Ammonia breath, pallor, cachexia, cognitive impairment, tachypnoea, HTN, volume overload (pulmonary oedema/ascites)

PKD = palpate kidneys, palpate bladder for obstructive uropathy often with prostatic enlargement

Question 10

Tests to confirm cause of CKD

Answer 10

BP, urinalysis, plasma glucose, ECG

FBC to check for anaemia

Us and Es, serum albumin, urinary albumin, Hep B and C and HIV serology

Renal US, CT, MRI

Question 11

3 forms of RRT

Answer 11

Peritoneal dialysis, haemodialysis, transplantation

Question 12

Major complications of RRT

Answer 12

peritoneal- drainage problems, peritonitis

Haemodialysis - infection, cramps

Transplant- rejection/infection/malignancy

Question 13

Principles of managing end stage renal patients with high PTH levels (mineral bone disease)

Answer 13

Reduce severity of mineral bone disease
Reduce symptoms
Reduce cardiovascular mortality

Question 14

End stage renal disease with anaemia principles of management

Answer 14

Measure haematinics and replace if deficient, start ESA, Hb100-120 is aim

Question 15

2 immunosuppressant drugs commonly given after kidney transplant apart from corticosteroids

Answer 15

Calcineurin inhibitors e.g. tacrolimus
Antimetabolites e.g. mycophenolate

Question 16

Things to monitor after transplant

Answer 16

GFR, CN1, proteinuria, Ca2+ and phosphate, PTH, lipids and glucose. Screen for infections, monitor cardiovascular health, screen for malignancies

Question 17

Causes of low Na+

Answer 17

Question 18

Causes of high Na+

Answer 18

Question 19

Marker of small vessel vasculitis

Answer 19

ANCA

Question 20

Marker of Goodpastures

Answer 20

Anti-GBM

Question 21

Marker of auto immune conditions e.g. lupus

Answer 21

ANA/dsDNA high, C3 and C4 low

Question 22

Marker of myeloma or IgA nephropathy (lymphoproliferative disorders)

Answer 22

Serum immunoglobulins and electrophoresis

Question 23

Markers of sarcoidosis (impacts lung (would see lymphadenopathy) and kidney)

Answer 23

Serum ACE

Question 24

Marker of rhabdomyalysis

Answer 24

Creatine kinase

Question 25

Reasons someone may need dialysis

Answer 25

Drug toxins, acidaemia (profound), hyperkalaemia (refractory: given 3 treatments already), fluid overload and anuric, AKI, pulmonary oedema + anuria

Question 26

Increased K+ can cause what arrhythmias

Answer 26

Sinus brady, AV block, ventricular ectopics, (peak T waves, flat or absent p, B-road QRS)

Question 27

Which bottle first when taking bloods

Answer 27

Brown

Question 28

Commonest causes of nephrotic syndrome

Answer 28

Adults: membranous GN
Kids: minimal change disease (lupus)
Elderly: diabetic nephropathy/myeloma/amyloidosis/membranous GN (lupus)

Question 29

When is BNP raised

Answer 29

Anything that stretches atrium

Question 30

Where does vasculitis, membranous GN and minimal change disease affect histologically

Answer 30

Question 31

Name a drug that can cause fluid overload

Answer 31

Amlodipine CCB

Question 32

Why do CCBs cause fluid overload

Answer 32

Decrease in arteriolar resistance that goes unmatched in venous circulation

Question 33

What can you give to patients for itch due to nerve irritation

Answer 33

Gabapentin or Pregablin