Y5 renal prep for CBD with helen and passmed

Question 1

what is hepatic encephalopathy and what drugs can cause this

Answer 1

Hepatic encephalopathy (HE) is a liver dysfunction that occurs when the liver is unable to process toxins and ammonia properly, causing them to build up in the blood and travel to the brain.

sedatives, analgesics, opiates, benzodiazepines, antidepressants, and antipsychotic agents

Question 2

most common cause of CKD

Answer 2

DM

Question 3

other causes of CKD

Answer 3

chronic glomerulonephritis
chronic pyelonephritis
hypertension
adult polycystic kidney disease

Question 4

what is a good early sign of CKD

Answer 4

high urinary albumin:creatinine (ACR) ratio, usually over 3mg/mmol. ACR

Question 5

sx of ckd

H2 ONOUR

Answer 5

Hypertension – low GFR leads to excessive reabsorption of Na+, increasing ABP

Hypocalcaemia – due to less renal production of 1,25-DHCC and hyperphosphataemia

Oliguria – low urine output, leading to hyperkalaemia with a metabolic acidosis

Normocytic anemia – damage to kidney leads to decreased erythropoietin

Oedema – due to loss of ultrafiltration which leads to fluid overload in the body

Uremia – renal failure leads to a buildup of urea in the blood causing nausea, anorexia,

encephalopathy, pericarditis, and pruritus

Renal osteodystrophy – a form of metabolic bone disease characterised by bone

mineralisation deficiency, associated with secondary hyperparathyroidism

Question 6

preffered way to deliver calcium resonium

Answer 6

rectally
orally - 2nd

in the management of hyperkalaemia

Question 7

causes of haematuria

Answer 7

trauma
infection - TB
malignancy - penile, renal, ureter,
TCC - growns from inside out causing blockage and hydronephrosis - TCC from calcyx all the way down the ureters to bladder wall
glomerulonephritis
stones
BPH
renal vein thrombosis due to RCC
coagulopathy
drugs
exercise
endometriosis
catherterisation
radiotherapy

Question 8

4 things differentiating between IgA nephropathy and

Answer 8

post-streptococcal glomerulonephritis is associated with low complement levels

main symptom in post-streptococcal glomerulonephritis is proteinuria (although haematuria can occur)

there is typically an interval between URTI and the onset of renal problems in post-streptococcal glomerulonephritis

IgA is associated with HSP, alcoholic cirrhosis, coeliac disease

Question 9

what nephropathy is associated with malignancy

Answer 9

membranous nephropathy

Question 10

wnating to do a fluid challenge differeence in heart failure

Answer 10

500ml stat without
250ml stat if with

Question 11

how does calcium resonium remove potassium from body

Answer 11

Calcium polystyrene sulfonate removes potassium from the body by exchanging it within the gut for calcium.

Question 12

Normal anion gap ( = hyperchloraemic metabolic acidosis)

Answer 12

gastrointestinal bicarbonate loss:
prolonged diarrhoea: may also result in hypokalaemia
ureterosigmoidostomy
fistula
renal tubular acidosis
drugs: e.g. acetazolamide
ammonium chloride injection
Addison’s disease

Question 13

Raised anion gap

Answer 13

lactate:
shock
sepsis
hypoxia
ketones:
diabetic ketoacidosis
alcohol
urate: renal failure
acid poisoning: salicylates, methanol

Question 14

high Na and high serum osmolality and low uirne osmoality that only returns to normal with desmopressin is a diagnosis of cranial DI what is a possible cause of this in a patient who has lethargy, arthralgia and skips generations as autosomal recessive

Answer 14

hereditary haemochromatosis

Question 15

what medication may need to be stopped in aki but does not usually worsen it

Answer 15

metformin - as increases toxicity - in the form of lactic toxicity

Question 16

If a patient has a urine output of < 0.5ml/kg/hr postoperatively the first step

Answer 16

consider a fluid challenge, if there are no contraindications or signs of haemorrhage etc
IV crystalloid

Question 17

Anaemia in CKD

Answer 17

correct iron deficiency before starting erythropoiesis-stimulating agents

Question 18

AV fistula takes how long to develop

Answer 18

6-8 weeks

Question 19

why does ATN have a poor response to fluid

Answer 19

Hypotension with compensatory tachycardia is a classic sign seen with AKI due to haemorrhage.

A fluid challenge was done with this patient to identify the cause of the oliguria. In cases of pre-renal uraemia, the fluid challenge would have caused an increase in urine output.
However, in this case, there is tubular cell injury due to the blood loss during the surgery. This cell injury has led to the production of red cell casts which produced brown urine.

Question 20

most common cause of ATN

Answer 20

haemorrhage

Question 21

Calcium acetate is a calcium-based binder used to treat

Answer 21

hyperphosphataemia
Patients with chronic kidney disease (CKD) may suffer from hyperphosphataemia since the kidneys are unable to excrete excess phosphate. Calcium-based binders are used to reduce phosphate levels in patients with CKD. Symptoms of hypercalcaemia include ‘bones, stones, groans and psychic moans’.

Question 22

preferred choice for venous thromboembolism (VTE) prophylaxis

Answer 22

low molecular weight heparin (LMWH)

Question 23

what is ascits and why doe sit occur

Answer 23

Ascites is a condition that occurs when fluid builds up in the abdomen, usually due to high blood pressure in the liver’s veins (portal hypertension).

Question 24

how does spironolactone help with ascites

Answer 24

it decreases Na reabsorption and potassium excretion in the distal tubule.
As a result promotes a sodium diuresis, but maintains body potassium levels.
Spironolactone is particularly helpful in edematous states caused by hyperaldosteronism, which is typical of the edema and ascites caused by cirrhosis

Question 25

acute inflammation of the reno-tubular interstitium

Answer 25

AIN

Question 26

why do you need to correct iron deficiency anaemia before giving EPO

Answer 26

need both iron adn EPO before red bloods cells to be made so by replenishing stores of iron you can then give EPO to make more

Question 27

3 criteria for dx AKI in adults

Answer 27

↑ creatinine > 26µmol/L in 48 hours
↑ creatinine > 50% in 7 days
↓ urine output < 0.5ml/kg/hr for more than 6 hours

Question 28

why does ATN lead to low urine osmollaity

Answer 28

occurs because the damaged kidney tubules are unable to effectively reabsorb water from the filtrate, leading to the excretion of dilute urine that closely resembles the composition of plasma, meaning the urine osmolality is similar to blood osmolality, rather than being concentrated as it normally would be

Question 29

Myoglobinuria causes renal failure by

Answer 29

tubular cell necrosis

Question 30

drug mx of CKD

Answer 30

ACEi or ARB for the proteinuria - ACR over 30
ACR over 70 regardless of BP

SGLT-2i - block reabsorption of glucose in prox tubule lowering the renal glucose threshold - leading to glycosuria

Question 31

Normocytic anaemia, thrombocytopaenia and AKI following diarrhoeal illness

Answer 31

HUS

Question 32

primary aldosteronism is dx by aldosterons/renin ratio which should show high aldosterone levels alongside low renin levels (negative feedback due to sodium retention from aldosterone)
what do you see in secondary hyperaldosteronsim

Answer 32

renin and aldosterone levels are high - most likely renal artery stenosis - when ACEi started worsens stenosis drop EGFR