Chapter 3- Kidney

Question 1

Define glomerular filtration rate

Answer 1

Volume of fluid filtered from glomerular capillaries to bowmans capsule per unit time

Question 2

What are the 4 clinically important functions of the kidney

Answer 2

Filtration
Salt and water control
Production of EPO
hydroxylation of vitD

Question 3

Two types of markers used to measure filtration

Answer 3

Exogenous

Endogenous

Question 4

Name the three types of exogenous markers used to measure filtration

Answer 4

Inulin
Cr51 EDTA
iohexol

Question 5

Name two types of endogenous markers used to measure filtration

Answer 5

Creatinine

Cystatin C

Question 6

What is creatinine

Answer 6

Waste product from muscle generated at a relatively constant rate in individuals

Question 7

Is creatinine largely removed by filtration?

Answer 7

YES

Question 8

What’s the downside of estimating GFR using actual creatinine clearance

Answer 8

24 collections are cumbersome

Inaccurate

Question 9

What three main things is creatinine significantly affected by

Answer 9

Age
Race
Weight

Question 10

The estimated GFR gives a result standardised for what?

Answer 10

BSA 1.73m^2

Question 11

Which method of measuring filtration is inaccurate for GFR>60ml/min

Answer 11

Estimated GFR

Question 12

What is CKDEPI and what does it aim to do

Answer 12

Chronic kidney disease epidemiology collaboration aims to improve accuracy of eGFR

Question 13

When is CKDEPI better than MDRD eGFR

Answer 13

Better accuracy at higher GFR

Question 14

When is CKDEPI less accurate that MDRD?

Answer 14

Obese
Black
Female

Question 15

What are the stages of CKD

Answer 15

1
2
3A
3B
4
5

Question 16

If you’ve got stage 3A CKD what is your GFR?

Answer 16

45-59

Question 17

If you’ve got stage 1 CKD what is your GFR?

Answer 17

> 90

Question 18

Patient has stage 2 CKD what is there GFR?

Answer 18

60-89

Question 19

Patient stage 3B CKD what’s their GFR?

Answer 19

30-44

Question 20

Stage 4 CKD has what range GFR

Answer 20

15-29

Answer 21

5

Question 22

What is normalised GFR appropriate for estimating?

Answer 22

How abnormal the kidney function is but NOT for dose adjustment

Question 23

Name two drugs that have significant renal clearance

Answer 23

Aciclovir

Gabapentin

Question 24

Name two classes of drug that affect residual renal function

Answer 24

NSAID

ACEI/ARB

Question 25

What are the three types of AKI causes?

Answer 25

Pre renal Intrinsic Post renal

Question 26

Name three types of pre renal causes of AKI?

Answer 26

Volume depletion Sepsis Cardiogenic

Question 27

Name three types of intrinsic causes of AKI

Answer 27

Prolonged pre renal insult causing tubular necrosis Inflammation/glomerulonephritis Drugs

Question 28

Name the causes of post renal AKI

Answer 28

Outflow obstruction e.g bladder, prostate, ureter

Question 29

Why do you get renal anaemia?

Answer 29

Reduction in red cell production and increased red cell turnover

Question 30

How do you treat renal anaemia?

Answer 30

EPO replacement | Iron replacement

Question 31

Why are target ESA and Hb lower in patients with renal failure

Answer 31

Because three major studies showed suggested harm with higher/normal targets: increased risk of VTE

Question 32

What does ESA stand for

Answer 32

Erythropoiesis stimulating agent

Question 33

What is alfacalcidol

Answer 33

Post renal vitD used to treat renal bone disease

Question 34

Two ways of treating tertiary hyperparathyroidism

Answer 34

Parathyroidectomy | Calcimimetics (cincalcet)

Question 35

What's the causes of tertiary hyperparathyroidism in renal patients

Answer 35

After prolonged stimulation of parathyroid glands Sustained CKD High phosphate

Question 36

What does haemofiltration require

Answer 36

Anti coagulation: Heparin Prostaglandins Citrate

Question 37

Explain process of haemofiltration

Answer 37

Water and solutes filtered and discarded Blood re-diluted with solution Constant low efficiency RRT

Question 38

Does haemodialysis require anticoagulation

Answer 38

YES

Question 39

Give two examples of a drug that is not dialysed so would required dose adjustment in dialysis?

Answer 39

Warfarin | Diazepam

Question 40

If a drug is dialysed when would you give it? Give two examples

Answer 40

End/post dialysis | E.g tazocin, meropenem

Question 41

Explain the process of haemodialysis

Answer 41

Removal of solute only (water possible to- ultrafiltration) Semi permeable membrane allows movement of solutes from high to low Three 4hr sessions per week

Question 42

Explain peritoneal dialysis

Answer 42

Fluid placed in peritoneum Peritoneum forms semipermeable membrane High conc to low conc solutes Once fluid reached equilibrium it is removed and replaced

Question 43

Define acute kidney injury

Answer 43

A rapid deterioration in kidney function, rise in creatinine, reduction in urine output

Question 44

Prostaglandins cause what at the afferent blood vessels

Answer 44

Vasodilation

Question 45

NSAIDs inhibit the synthesis of prostaglandin which has what result on afferent blood vessels

Answer 45

Vasoconstriction

Question 46

What's the bodies normal response to a reduction in renal blood flow

Answer 46

Vasodilation of afferent blood vessels | Vasoconstriction of efferent blood vessels

Question 47

What does CANDA mean

Answer 47

``` C- contrast media A- ACEI N- NSAID D- Diuretics A- ARB ```

Question 48

Does CKD often exist with other conditions

Answer 48

YEAH

Question 49

Name 9 further complications of CKD

Answer 49

``` Anaemia Hyperphosphataemia Renal bone disease Oedema Hypertension Itching Nausea Electrolyte imbalance Restless legs/cramps ```

Question 50

In renal patients what's the aim for Hb levels?

Answer 50

10-12 g/dL

Question 51

How do you manage anaemia in renal patients

Answer 51

Erythropoiesis stimulating agents and iron

Question 52

In renal patients how do you manage high phosphate levels?

Answer 52

Dietary control and phosphate binders

Question 53

Give the 5 options of phosphate binders

Answer 53

``` Calcium acetate Calcium carbonate Sevelamer Lanthanum Aluminium capsules ```

Question 54

What's 2 key problems for phosphate binders

Answer 54

Large tablet burden | Can bind to other meds

Question 55

List 4 things that make a drug less likely to removed by dialysis

Answer 55

``` >500Da >80% protein bound >1L/kg Lipid soluble Not normally cleared by kidney ```