Renal

Question 1

Urea

Answer 1

> 40 bad

>50 Neuro compromise

Question 2

Ckd risk depends on

Answer 2

Gfr and albuminuria

Question 3

Causes of ckd in ANZ

Answer 3

Cakut 34% (younger)
GN 29% (older)
Hus 2%

Question 4

Ckd symptoms

Answer 4

Ftt
Poor appettite nausea
Polyuria polydipsia
Lethargy

Question 5

Complications of ckd

Answer 5

Anemia when gfr <45 
Htn 
Vit d deficiency <40
Acidosis <40
Hyperphos, hyperPTH (later)

Question 6

Wuhl 2009 paper

Answer 6

Intensified BP control
( target <50th centile)
Commence treatment when bp>90th centile

More benefit for GN than CAKUT

Question 7

ACEi and ARB

Answer 7

High K limits use in late ckd stages

Stop if unwell due to risk of AKI

Question 8

Anaemia caused by

Answer 8

Epo

Chronic disease

Question 9

Anemia of CKD

Answer 9

Aim for 100-120
Target
- ferritin 200-500 and
- transferrin satn 20-30%

Question 10

Ckd Bone disease

Answer 10

Caused by
Hyperphos and increased fgf23

Maintain pth below twice normal rNge
Calcitriol for hypocal
Sodibic for acidosis

Question 11

Nutritiin in ckd

Answer 11

Adequate calories
Low potassium
Low phosphate 
Adequate protein, extra in PD patients
Extra salt in cakut 

Fluid restrict if oliguric
Fluid target if polyuric

?gastrostomy

Question 12

Ckd growth hormone replacement

Answer 12

growth velocity <25th centile
Gfr<30
May be recommenced 1 year post transplant

Question 13

Plan for end stage renal disease whem gfr is

Answer 13

<20

Question 14

Peritoneal dialysis

Answer 14

Automated/continuous cycling dialysis

• machine run. Overnight
• most common

Continuous ambulatory peritoneal dialysis
- more in adults

Question 15

Manipulating PD fluid

Answer 15

Volume - more volume takes off more fluid
Dwell time - shorter duration takes off more fluid
Sugar solution - more concentrated takes off more fluid

Except urea and phosphate
- needs longer dwell time

Question 16

Av fistula needs to be how heavy

Answer 16

20kg

Question 17

Haemodialysis

Answer 17

3 times a week if good urine output
If not, 4-5 times/week

Can only remove max 5% body weight per session

Question 18

Kidney transplant

Answer 18

> 10kg

Graft survival 12-15 years

Question 19

Cmv

Answer 19

First 3-6 months

If donor cmv pos (high risk), for prophylaxis valganciclovir

Question 20

Post transplant Lymphoproliferative disease

Answer 20

Patients ebv naive at higher risk

Question 21

Bk virus causes

Answer 21

Bk nephropathy

Question 22

In response to post transplant infection, what do u do

Answer 22

Halve mmf, and see if u can stop it

Question 23

Pd fluid types

Answer 23

1% and 2% are commonly used in combination
4% only when dying/pulm edema

Can use 0.5% if doesnt need fluid removal/dehydrated

Question 24

Fmf

Answer 24

Amyloid deposition in kidney

Question 25

Babys gfr starts at

Answer 25

30, comes up to adult by 12 months