Chronic Kidney Disease

Question 1

Apart from CKD, suggest 6 other causes of proteinuria

Answer 1

1. Physical exercise
2. Fever
3. Pregnancy
4. UTI
5. Abnormally high BP
6. Nephrotic/ Nephritic syndrome

Question 2

In normally anatomy, at what vertebral level can the kidneys be found?

Answer 2

T12-L3

Question 3

Recall the eGFR definition for CKD

Answer 3

< 60 ml/min/1.73m2 on at least 2 occasions separated by a period of at least 90 days

Question 4

What is eGFR?

Answer 4

Creatine based estimation of glomerular filtration rate

Question 5

Outline the therapeutic action of ACE inhibitors in the treatment of diabetic nephropathy

Answer 5

Reduction in glomerular hydrostatic pressure by preventing vasoconstriction of the efferent arterioles

Question 6

Suggest 4 potential side effects of ACE inhibitors

Answer 6

1. Dry cough
2. Angio-oedema
3. Hyperkalemia
4. Hypotension

Question 7

What 2 metabolic complications are associated with CKD Mineral bone disease?

Answer 7

1. Hypocalcemia

2. Hyperparathyroidism

Question 8

Suggest 4 potential metabolic complications of CKD

Answer 8

1. CKDMBD
2. Renal anemia
3. Metabolic acidosis
4. Hyperkalemia

Question 9

Define azotemia

Answer 9

Elevation of nitrogenous metabolic waste in the blood due to failure of clearance by the kidneys

Question 10

Define Uraemia

Answer 10

Clinical syndrome resulting from failing kidneys and progressive azotemia

Question 11

Outline the 2 main endocrine functions of the kidney

Answer 11

1. Activation of vitamin D

2. Renin and EPO synthesis

Question 12

Suggest 6 population subgroups that are at increased risk of developing CKD during their lifetimes

Answer 12

1. The elderly
2. Family history of CKD
3. Reduced kidney mass
4. Low birth weight
5. Ethnic minorities
6. Low income

Question 13

Outline 8 medical conditions that can cause direct kidney damage

Answer 13

1. Diabetes
2. Hypertension
3. Autoimmune disease
4. Systemic sepsis
5. UTI
6. Urinary stones
7. Urinary obstruction
8. Drug toxicity

Question 14

Name 2 medical conditions that (in the setting of CKD) warrant immediate referral to renal services

Answer 14

1. Malignant hypertension
2. Hyperkalemia

(urgent referral also required for patients with nephrotic syndrome)

Question 15

What is the target BP for patients with CKD?

Answer 15

130/80

Question 16

What is the target BP for patients with CKD in a proteinuric state?

Answer 16

125/75

Question 17

Name the immunisations required for patients on renal replacement therapy

Answer 17

1. Pneumococcal
2. Influenza
3. Hep B

Question 18

What is the normal average alveolar ventilation volume?

Answer 18

~ 5L/min

Question 19

Normal gas exchange is dependent on what 3 factors?

Answer 19

1. Adequate alveolar ventilation
2. Adequate pulmonary perfusion
3. Minimal barrier to gaseous diffusion

Question 20

Recall 6 indications for dialysis in patients with kidney failure

Answer 20

1. pH <7.25
2. K+ >6.5
3. Fluid overload
4. Toxins (SLIME)
5. Creatine >400
6. Uraemic pericarditis

Question 21

Recall the 5 absolute contra-indications to peritoneal dialysis

Answer 21

1. Active inflammatory bowel disease
2. Ischaemic bowel
3. Acute diverticulitis
4. Abdominal abscess
5. 3rd trimester of pregnancy

Question 22

What is the average survival of a kidney transplant graft

Answer 22

7-8 years

Question 23

Which arteries are involved in the arterial anastomosis of a renal transplant?

Answer 23

Renal artery of the graft is anastomosed to the right iliac artery of the recipient

Question 24

Briefly outline the mechanism of action of cyclosporine/ tacrolimus as immunsuprresive agents following solid organ transplantion

Answer 24

Inhibition of T lymphocyte activity.

Question 25

Name 2 immunosuppressive agents that target and interpret cell cycling in B and T cells

Answer 25

1. MMF | 2. Azathioprine

Question 26

What is the additional advantage of Sirolimus as an immunosuppressive agent in the management of solid organ transplantation?

Answer 26

Also target tumour cells thus used in the management of transplant related malignancy

Question 27

Recall 2 infections that are exclusively seen in immunosuppressed patients

Answer 27

1. Cytomegalovirus colitis | 2. PCP

Question 28

Recall 3 causes of 'abdominal catastrophe' in the immunocompromised patient

Answer 28

1. Diverticulitis +/- Perforation 2. Cholecystitis 3. Pancreatitis

Question 29

What is the most common malignancy seen in renal transplant patients?

Answer 29

Squamous carcinoma of the skin

Question 30

What 2 characteristics of an AV fistula if observed in tandem - indicate an >90% chance of adequacy for dialysis

Answer 30

1. Diameter >0.4 cm | 2. Fistula blood flow > 500ml/min

Question 31

What are the 3 most common types of AV fistula used?

Answer 31

1. Radiocephalic 2. Brachiocephalic 3. Transposed basilic fistula

Question 32

Suggest 2 clinical signs of central veins stenosis that may be seen in patients with an AV fistula

Answer 32

1. Swollen extremity | 2. Collateral veins

Question 33

Where is the hormone PTH secreted from?

Answer 33

Chief cells of the parathyroid gland

Question 34

What is the effect of serum calcium levels on PTH secretion?

Answer 34

High serum calcium levels inhibits the secretion of PTH

Question 35

Name the enzyme present in the kidney that catalyses the transfer of calcidiol into the active form of vitamin D Calcitriol

Answer 35

Vitamin D 1 alpha -hydroxylase

Question 36

Give 3 pre-renal causes of acute renal failure

Answer 36

1. Renal artery stenosis 2. Heart failure 3. Haemorrhage

Question 37

Give 5 causes of renal papillary necrosis

Answer 37

1. Severe acute pyelonephritis 2. Diabetic nephropathy 3. Obstructive nephropathy 4. Analgesic nephropathy 5. Sickle cell anemia