Rhabdomyolysis, hepatorenal syndrome, Acute kidney injury, Chronic Kidney disease

Question 1

biochemical manifestations of renal failure

Answer 1

• high levels of urea and creatinine
• low pH
• high potassium
• could not excrete water - urine output gone
  
  • peripheral oedema
  • pulmonary oedema

Question 2

tests and treatments required for renal failure

Answer 2

1. catheterisation - monitor urine output
2. raise BP using drugs
3. Improve kidney function - if low GFR diuretics won’t help much since filtered through kidney. Give bicarb ions IV.

Question 3

orthopnoea

Answer 3

short of breath when lying down - sign of pulmonary oedema

Question 4

biochemical features of end stage renal failure

Answer 4

• Hb levels (8)
  
  • kidneys make Hb 0 normocitic anaemia - normal iron levels low Hb
• low calcium high phosphate - long term vitamin D
• PTH 70 - compensate lack of vitamin D

Question 5

how to create a fistula for dialysis?

Answer 5

make a fistula by arterialising the wall of a vein so it can take the needle

Question 6

Acute problems from renal failure?

Answer 6

• pulmonary oedema - fluid overload
  
  • 4 pillow orthopnoea
  • shortness of breath
  • hear the oedema
  • lower limb oedema
  • very high BP
  • JVP raised to 4cm
• hyperkalaemia
  
  • could give arrhythmias

Question 7

pharmacological treatment for end stage renal failure

Answer 7

reduce potassium - calcium resonium (ion exchange)
protect the heart by giving calcium gluconate
aldosterone
salbutamol
sugar - comechanism potassium will absorb into cells

Question 8

Biochemical features of nephrotic syndrome

Answer 8

heavy protein urea
low albumin
high cholesterol

Question 9

complications of nephrotic syndrome

Answer 9

• renal failure
• circulating albumin important because it keeps water
• thrombosis - losing proteins including s and c
  
  • DVT
  • PE
  • renal vein thrombosis

Question 10

tests required for nephrotic syndrome

Answer 10

biopsy

Question 11

short term treatment for nephrotic syndrome

Answer 11

• diuretics - patient is overloaded
  
  • disadvantages - hypovalemic
  • furosemide - loop diuretic
  • aldosterone
  • potassium sparing diuretics
  • ENAC inhibitors
• statins for cholesterol
• ace inhibitor

Question 12

vasculitis

Answer 12

inflammation in blood vessels

Question 13

causes of kidney failure

Answer 13

FSGS focal segmental glomerulosclerosis
minimal change syndrome

diabetic nephropathy
amyloid
lupus