Summary Book Renal

Question 1

DDx of kidney enlargement

Answer 1

Chronic hydronephrosis, renal cell carcinoma, acromegaly, polycystic kidneys, infiltrative = amyloidosis / sarcoidosis / malignancy - lymphoma

Question 2

Contraindications for renal transplant

Answer 2

Malignant disease (<2years of remission). Severe ILD and lung disease. Active vasculitis. Ongoing sepsis / TB / HIV. Alcohol, smoking, drugs. Severe osteoporosis or uncontrolled diabetes. Over 75 years old. Over 35 BMI. Medication non compliance or physciatric instability.

Question 3

Complications of calcineurin inhibitors (tacrolimus, cyclosprin)

Answer 3

Tremor, AKI, hypertension, hyperglycemia, hyperkalemia, deranged LFT, gingival hyperplasia, hirsutism, gout, haematological malignancy, SCC, post transplant lymphoproliferative disorder

Question 4

Complications of sirolimus (mtor inhibitor)

Answer 4

Hyperlipidaemia, proteinuria, infection, ILD, pulmonary effusion, pericardial effusion, DVT

Question 5

Mycophenolate complications

Answer 5

Nausea, vomiting, diarrhoea, pancytopnea, infections, SCC

Question 6

Azathioprine complications

Answer 6

Hepatitis, rash, pancreatitis, TPMT levels, SCC

Question 7

Steroid complications

Answer 7

Diabetes, weight gain, osteoporosis, myopathy, bruising, infections

Question 8

Define, cause and management of post transplant lymphoproliferative disorder

Answer 8

B cell proliferation becoming lymphoma. EBV status. Reduce immunosuppressants.

Question 9

Management of renal transplant

Answer 9

1. Immunosuppressant- prednisolone/ tacrolimus/ MMF - wean CNI after 6 months. 2. Monitor for signs of pharmacological side effects. 3. If CMV positive then 6 months of valganciclovir. 4. Bactrim for PJP. 5. Annual vaccination and skin checks.

Question 10

Risk factors for renal transplant

Answer 10

Diabetes, glomerulonephritis, hypertension, SLE, IHD, PVD

Question 11

Signs of rejection

Answer 11

Fevers, swelling, reduced urine output, flank pain, acute renal impairment

Question 12

Complications of dialysis

Answer 12

Hypotension, peritonitis, dementia, line infection, social (sexual dysfunction, financial, work)

Question 13

Pros and cons of haemodialysis and peritoneal dialysis.

Answer 13

Peritoneal dialysis- risk of peritonitis, protein loss, hyperglycemia, not as effective, perforation. HD- less total time, less protein loss, access issues (infections or clots), hypotension, amyloid, anaemia.

Question 14

Indications for acute dialysis

Answer 14

Uraemia, fluid overload, hyperkalemia, severe metabolic acidosis

Question 15

Protective and mortality factors for dialysis

Answer 15

Protective- high cholesterol and obesity. Mortality- high phosphate, low albumin, hypertension and diabetes.

Question 16

Management of CKD complications

Answer 16

1. Treat reversible conditions (diabetes, UTI, hypertension, drugs, CCF, dehydration)
2. Non pharmacological- fluid restriction, optimise CVS health, transplant work up
3. Pharmacological- monitor bone health = calcium and phosphate levels, aneamia, renal osteodystrophy (vit D)
   Bicarb can be considered for metabolic acidosis.
   ACEi for hypoalbuminaemia and hypertension

Question 17

Investigations for chronic kidney disease

Answer 17

1. Bloods - FBC, UEC, albumin, myoloma screen, vasculitis screen
2. GN screen - ANA, ENA, dsDNA, C3+4, ANCA (MPO/PR3), anti GBM antibodies
3. Urinalysis- ACR (<30mg/g), casts, blood
4. Us or CT KUB
5. Biopsy to rule out GN

Question 18

Risk factors of chronic kidney disease

Answer 18

Diabetes (33%), glomerulonephritis (24%), hypertension (14%), systemic disease (vasculitis, RF, myoloma, infective endocarditis), polycystic kidney disease, reflux nephropathy, drugs

Question 19

Presentation of chronic renal impairment

Answer 19

Anaemia, ureamia (lethargy, nausea, vomiting, anorexia, fatigue, cramps, confusion), puritis, peripheral neuropathy, pericarditis, nocturia

Question 20

Compare mechanisms of calcitriol and cinacalcet

Answer 20

Calcitriol (active vit D) lowers PTH levels, which reduces turnover, and increases calcium while decreasing phosphate
Cinacalcet increases sensitivity of calcium sensing receptors of PTH which decreases calcium

Question 21

Compare definitions and presentation of nephritic and nephrotic

Answer 21

Nephrotic = > 3.5g of protein and low albumin. Presents with oedema, hyperlipidaemia and hypercoagulant
Nephritic = presents with AKI, hypertension, haematuria, proteinuria and pyuria.