AKI + CKD

Question 1

what are the systemic illness that can cause AIN

Answer 1

SLE, sarcoid, sjogren, IgG4

Question 2

how to ensure euvolemia in contrast induced nephropathy ?

Answer 2

(3 ml/hg/hr 1 hour before procedure, 1ml/kg/hr 6 hours after procedure for
CKD

Question 3

c3/c4 - high or low with cholesterol emboli syndrome/atheroembolic disease ? other cutaenous presentation

Answer 3

c3c4 low
livedo reticularis and blue toes

Question 4

if have calcium oxalate stones, should you limit calcium ntake ?

Answer 4

no

Question 5

uric acidd nephrolithiasis seen when ?

Answer 5

heme disorders
ADPKD

Question 6

treatment of uric acid

Answer 6

urine alkalization ( give K citrate)
allopurinol

Question 7

struvite stones seen with ?

Answer 7

• uti ( proteus, klebsiella)

Question 8

etiology cystine stone and tx ?

Answer 8

congenital ( autosomal recessive) urine alklaization

Question 9

continue rasi even if gfr <30?

Answer 9

yes

Question 10

what if hyperK on rasi, what to do ?

Answer 10

give K binders

Question 11

SGLT2 recommendations in CKD

Answer 11

• egfr > 20
• ACR > 20 mg/mmol and or CHF/DM

Question 12

benefits of SGLT2i in CKD ?

Answer 12

Prevent composite of decline in eGFR, progression to ESRD, kidney death, all cause mortality, nonfatal MI, hosp for HF

Question 13

if still have proteinuria , what can you add to ckd patients

Answer 13

NS MRA ( fineronone)

Question 14

if still have proteinuria , what can you add to ckd patients with CHF, Conn’s , refractory htn, what can you add ?

Answer 14

steroidal MRA ( aldosterone, eplerenone)

Question 15

benefits of finerenone in CKD ?

Answer 15

1. decrease progession CKD
2. decrease CV and renal death
3. Decrease afib ( CKD w/ T2DM)

Question 16

benefits of spironolactone on CHF ?

Answer 16

↓↓↓
Less mortality any cause w HFrEF (RALES)

↓ HF hospitalization w HFpEF (TOPCAT)

Question 17

benefit of eplrenone in CKD ? benefit in egfr

Answer 17

• decrease ACR and BP . other risk of high k
• no benefit egfr

Question 18

effect of eplerenone on CHF ?

Answer 18

↓↓↓
Less cardiac mortality and hospitalization w HFrEF (EMPHASIS-HF)

Question 19

per finearts study , impact of finerenone

Answer 19

↓↓↓
HF hospitalization w HFpEF, non sig trend to ↓ mortality

Question 20

PTH target for dialysis patients ?

Answer 20

2-9 times ULN

Question 21

hgb target and tsat target in CKD

Answer 21

100-110
tsat >30%

Question 22

target hgb on ESA ? if more what ahppens ?

Answer 22

115
stroke-CAD-HTN

Question 23

who to be cautious with regarding EPO

Answer 23

1. previous stroke
2. active cancer
3. Uncontrolled BP

Question 24

example of meds to avoid in hyperK ( not Kdur ..)

Answer 24

nsaids

Question 25

when do start bicarb in CKD ?

Answer 25

when metab acidosis with bicarb < 18

Question 26

can you use vit D if hyperphosphatemic and hypocalcemic

Answer 26

no

Question 27

reasonbs to have hypocalcemia in ckd

Answer 27

- hyperpo4 --> hypocal - low 1-alpha-hydroxylase --> low vit d --> low calcium absp

Question 28

tx for high PTH in CKD pts

Answer 28

1. Vit D to suppress pth if not hypercacelmic , high phosphate 2. Cinecalcet to activate Ca sensing receptor to shut OFF pth secretion 3. surgical in some cases

Question 29

risk of what with biphosphonates or denosumab in CKD patients

Answer 29

severe hypocalcemia

Question 30

for symptomatic gout, what to use

Answer 30

- low dose colchicine / steroids

Question 31

what are non urgent/outpatient initiation of dialysis

Answer 31

- uremic : nauseous, fatigue, metallic tastE - QOL

Question 32

uremic pericarditis - does it show with classic ddiffuse ST elevation ?

Answer 32

- no

Question 33

at what egfr do you initiate metformin at half dose

Answer 33

gfr 30-44

Question 34

lowest gfr for mtf in ckd

Answer 34

30

Question 35

flow trial states what

Answer 35

kidney protection of glp1 ( with MACE ) w/ liraglutide and semaglutide

Question 36

max creat rise whgen starting acei/arb for dm2 + ckd + albumineria. if above that threshold, think what ?

Answer 36

30% volume depletion nsaids AKI RAS

Question 37

inidication for finerenone in context of dm + ckd

Answer 37

ForDM2,gfr>25ml/min, normal K albuminuria>3mg/mmol despite max RASi (ACEi or ARB)

Question 38

in dm + ckd, if had to pick between sglt2 and finerone, would pick which ?

Answer 38

SGLT2i better at reducing HHF and progression of CKD

Question 39

over nephropathy - urine ACR and 24H urine

Answer 39

- > 20mg/mmol and 24H >300 mg/day

Question 40

Overflow- overwhelmed resorption capacity of filtered protein ( <3.5)

Answer 40

MM rhabdo hemolysis

Question 41

Glomerular- increased filtration of protein ( nephrotic range)

Answer 41

t2dm SLE Amyloid IgA primary cause

Question 42

Tubulo-interstitial- impaired resorption of filtered protein ( <2g )

Answer 42

Sarcoid Sjogren heavy metals Nsaids ( and AIN causing meds)

Question 43

Post-renal proteinuria <1g/day

Answer 43

Stones Genitourinary tumours UTIs

Question 44

tamm horsfal , what does it mean ?

Answer 44

it's normal

Question 45

hyalin cast seen in ?

Answer 45

ckd

Question 46

wbc cast seen n

Answer 46

ain infection

Question 47

rbc cast seen in

Answer 47

GN

Question 48

granular cast seen in

Answer 48

ATN

Question 49

best to see kidney stone ?

Answer 49

nobn contrast ct

Question 50

bosniak 1-2 , need f/u ?

Answer 50

no

Question 51

renal mass size worried to be cancer? imaging ?

Answer 51

>1 cm. ct/mri

Question 52

if infected cysts, how long duration of atb ?

Answer 52

4 weeks !

Question 53

most common cardiac abN in ADPKD?

Answer 53

mitral valve prolapse Aortic insufficiency

Question 54

extra renal manifestations ADPKD

Answer 54

1. cebral aneurysm 2. pancreatic cyst 3. liver cysts 4. diverticuli

Question 55

number of cysts to dx ?

Answer 55

15-39 : >3cysts/ kidney 40-59 : >2 cysts /kidney

Question 56

adpkd bp target ?

Answer 56

<110/75