Week 7 - A 40 year old man with a lethargy and hypertension

Question 1

Which organ systems are you concerned about and why? Although his symptoms and signs are non-specific, what condition could explain these findings? What simple test - which should be part of the general examination - other than a blood test, could provide further information?

Answer 1

Question 2

The man agrees to stay to have some blood tests. The urinalysis you ordered reveals moderate proteinuria and microscopic haematuria. Frequent granular, red cell and hyaline casts together with dysmorphic red cells were observed on urine microscopy.
Describe the abnormalities present. How do you interpret these tests?

Answer 2

Question 3

What is the first principle in the management of this patient with chronic renal failure? What non-invasive test would you initially order?

Answer 3

Question 4

Outline what is involved in the conservative management of this patient with Chronic kidney failure?

Answer 4

Question 5

What should be done now?

Answer 5

Question 6

Answer 6

Question 7

Chronic Renal Failure
- Common causes?
- Symptoms?
- Signs?
- Diagnosis?

Answer 7

Question 8

Chronic Kidney Failure
- Management?

Answer 8

Question 9

Define Chronic Kidney Disease.

Answer 9

Chronic kidney disease (CKD) is defined as an abnormality of kidney structure or function that persists for > 3 months.

Question 10

Top causes of CKD?

Answer 10

Question 11

Describe the pathophysiology of Diabetic nephropathy leading to CKD?

Answer 11

Pathophysiology depends on the underlying condition, any of which will eventually lead to progressive nephron loss, structural damage, and impaired kidney function.

Question 12

Describe the pathophysiology of Hypertensive nephropathy leading to CKD?

Answer 12

Question 13

Describe the Consequences of Nephropathy in CKD
- Reduced GFR?
- Reduced endocrine activity?
- Reduced gluconeogenesis>

Answer 13

Question 14

What are the clinical features of CKD - Manifestations of Na+/H2O retention?

Answer 14

Patients are often asymptomatic until later stages due to the exceptional compensatory mechanisms of the kidneys.

Question 15

What are the clinical features of CKD - Manifestations of Uraemia:
- Definition?
- Constitutional symptoms?
- Dermatological manifestations?

Answer 15

Question 16

What are the clinical features of CKD - Manifestations of Uraemia:
- Serositis?
- Neurological symptoms?
- Hematologic symptoms?

Answer 16

Question 17

What are the Diagnostic criteria for Chronic Kidney Disease?

Answer 17

Question 18

What are the Diagnostic criteria for:
- CKD Progression?
- End-stage renal failure?

Answer 18

Question 19

Answer 19

Question 20

What initial laboratory studies would you order in the diagnosis of CKD?

Answer 20

Question 21

What are 5 findings of renal ultrasound that suggest chronic kidney damage?

Answer 21

Question 22

Answer 22

Question 23

Answer 23

Question 24

Is a renal biopsy needed to diagnose CKD?

Answer 24

Question 25

CKD - Nutritional Management?

Answer 25

Question 26

CKD - Medication Management?

Answer 26

Question 27

CKD - Renal Replacement Therapy?

Answer 27

Question 28

Which risk assessment should be performed for all CKD patients? What does it involve?

Answer 28

Atherosclerotic cardiovascular disease (ASCVD) Risk Assessement

Question 29

Describe the Blood pressure control measures for patients with CKD?

Answer 29

Question 30

Describe the lipid management measures for patients with CKD?

Answer 30

Question 31

Describe the Diabetes management measures for patients with CKD?

Answer 31

Question 32

What 7 screening tests should you perform to check for complications of CKD?

Answer 32

Question 33

What are 4 complications of CKD?
- 5 Acute?

Answer 33

1. 5 Acute complications
2. Anemia of chronic kidney disease
3. Chronic kidney disease-mineral and bone disorder (CKD-MBD)
4. Growth delay and developmental delay in children

Question 34

How does CKD result in Anemia? How is this managed?

Answer 34

Question 35

Chronic kidney disease-mineral and bone disorder (CKD-MBD)
- Definition?
- Pathophysiology?
- Histological classification?

Answer 35

Question 36

Chronic kidney disease-mineral and bone disorder (CKD-MBD)
- Clinical features?
- Diagnostics?

Answer 36

Question 37

Chronic kidney disease-mineral and bone disorder (CKD-MBD)
- Treatment?

Answer 37