RENAL FAILURE

Question 1

What is a classic cardiac symptom of uremia? Treatment?

Answer 1

Pericarditis

dialysis

Question 2

Explain the 3 broad causes of AKI

Answer 2

1. Pre-renal: insufficient bloodflow to kidneys, causes - dehydration, shock, HF
2. Intrinsic: renal dysfunction, causes - acute tubular necrosis, glomerulonephritis
3. Post-renal: bilateral obstruction causes - stones, prostate, congenital anomalies

Question 3

What is the basic work up for AKI? Five points

Answer 3

• Urine dip
• Ultrasound
• History: drugs, comorbidities, hydration
• Exam: BP, dehydration, HF
• Urea and electrolytes

Question 4

How do you expect urea and creatinine to change in pre-renal failure? Explain

Answer 4

Both rise but urea will rise more than creatinine

Reason for this is the kidneys are resorbing water (due to low perfusion) this drags urea along with it

Question 5

How does creatinine and urea rise in AKI with intrinsic cause? Explain

Answer 5

Both rise and ratio stays the same

This is because there is no resorption of water drawing in urea

Question 6

Anuria is a key feature of which type of renal failure? What is the investigation of choice in these patients?

Answer 6

Post renal failure

Ultrasound will show hydronephrosis

Question 7

What are the two most common causes of chronic kidney disease?

Answer 7

Diabetes, hypertension

Question 8

What is the EGFR of end-stage kidney disease (stage five)?

Answer 8

<15 mL/min

Question 9

What are the five main indications for dialysis?

Answer 9

• Acidaemia
• Electrolyte imbalance (hyperkalamia)
• Intoxication (overdose or dialysable substances e.g. aspirin)
• Overload of fluid (HF)
• Ureamic symptoms

Question 10

What are the three main types of dialysis? Briefly describe each one

Answer 10

1. Haemodialysis: requires vascular access, blood pumped from body filtered, brought back into body, done in sessions
2. Peritoneal dialysis: fluid cycle through peritoneal cavity, daily
3. Haemofiltration: constant filtering of blood, done at bedside for critically ill patients

Question 11

Why are fistulas preferred over Central line access for dialysis?

Answer 11

Lower rates of thrombosis and infection comparatively

Question 12

Explain how kidney disease causes secondary hyperparathyroidism

Answer 12

• High phosphate pulls calcium out of plasma
• Low vitamin D → low calcium absorption from gut

Question 13

Untreated hyperparathyroidism in renal disease can lead to which bone condition? How can this be prevented?

Answer 13

Renal osteodystrophy → bone pain and fractures

prevention: phosphate binders e.g. calcium carbonate, sevelamer

Question 14

Why do people with uremia have a higher tendency to bleed?

Answer 14

Uremia causes platelet dysfunction, believed to be due to decreased platelet aggregation and abnormal adhesiveness