KIDNEY

Question 1

Give two general signs/symptoms of AKI

Answer 1

Raised blood levels of creatinine and reduced urine output

Question 2

Intravascular fluid overload can be managed in AKI by restricting NaCl intake to ___to___g/day if not hyponatraemic

Answer 2

1 to 2 g/day

Question 3

What 4 serum electrolyte parameters should be monitored daily?

Answer 3

Acid base balance, Bicarbonate, Calcium, Phosphate, Potassium

Question 4

List 3 drugs that can cause pre renal AKI…

Answer 4

Diuretics, NSAID’s and ACE inhibitors

Question 5

Patients taking NSAID’s, ACEI or ARB’s need to be adequately _____

Answer 5

Hydrated

Question 6

SICK DAY RULE: Consider stopping ____ and ____ in those with diarrhoea, vomiting or sepsis until clinical condition improved and stabilised

Answer 6

ACE inhibitors or ARB’s

Question 7

CKD may lead to anaemia due to a fall in haemoglobin levels. This is due to damage of peritubular cells leading to inadequate secretion of …..

Answer 7

Erythropoietin - main regulator of RBC proliferation and differentiation in bone marrow

Question 8

The hydroxylation of cholecalciferol takes place in the kidneys to produce active ______

Answer 8

Vitamin D (Calcitriol)

Question 9

What can be used to treat anaemia in CKD caused by low EPO levels?

Answer 9

Erythropoiesis stimulating agents (ESA’s SC or IV) and iron (IV weekly darbepoietin)

Question 10

In CKD Hb should be between 10-12g/dL TRUE or FALSE?

Answer 10

True as if treated to a higher level then hypertension may occur as blood thickens

Question 11

High levels of phosphate can be managed using a phosphate binder such as…

Answer 11

Calcium acetate, calcium carbonate, Sevelamer

Question 12

Low levels of calcium can lead to higher levels of…

Answer 12

PHOSPHATE

Question 13

If the body is deficient in vitamin D and there is not an adequate supply of calcium to be absorbed in the gut then parathyroid hormone is produced to release calcium from _____ instead. This is known as WHAT?

Answer 13

Bones - secondary hyperthyroidism which leads to bone damage

Question 14

To prevent secondary hyperparathyroidism a low dose of ______ can be given. Why is this vitamin D supplement a good choice?

Answer 14

Alfacalcidol - this is post renal vitamin D so is already active.

Question 15

Name a drug that is useful in treating leg cramps

Answer 15

Quinine

Question 16

Uraemia is…

Answer 16

Urea in the blood

Question 17

Low levels of albumin can lead to…

Answer 17

Increased free drug in the body e.g phenytoin, sodium valproate, warfarin, diazepam, digoxin

Due to less binding

Question 18

The MDRD takes WHAT into account? (4)

Is it useful for extremes in weight?

Answer 18

• Race
• Gender
• Serum creatinine
• Age

And NOT useful for extremes in weight

Question 19

Stage 1 CKD = greater/equal to ___ GFR

Answer 19

90 GFR

Question 20

Stage 2 CKD = ___ - 89 GFR

Answer 20

60

Question 21

Stage 5 CKD =

Question 22

15-29 GFR = Stage ?

Answer 22

4

Question 23

Metabolic acidosis is due to what?

Answer 23

Reduced excretion of H+ ions by the kidneys

Question 24

In the cockloft-gault formula F=? and M=?

Answer 24

F=1.04 and M=1.23

Question 25

Dehydration can ____ urea levels

Answer 25

Elevate

Question 26

Is urea a reliable measure of renal function?

Answer 26

No - but it can be used as an indicator of the patient's general condition and state of hydration

Question 27

Most patients with CKD will have ___tension and this may be a cause or a consequence of their kidney disease.

Answer 27

HYPERtension

Question 28

Severe renal impairment leads to sodium _____, which in turn produces circulatory volume expansion with consequent hypertension

Answer 28

Retention

Question 29

What are the symptoms of uraemia?

Answer 29

Anorexia, nausea, vomiting, constipation, foul taste and skin discolouration

Question 30

Potassium levels of over __mmol/L are life threatening and should be treated as an emergency

Answer 30

7

Question 31

High potassium levels can lead to ____ ____

Answer 31

Cardiac arrest

Question 32

Name two drugs that are known to cause hyperkalaemia

Answer 32

ARBs and ACEIs

Question 33

Name a sedating antihistamine used to treat pruritis

Answer 33

Chlorphenamine

Question 34

Bendroflumethiazide may not be appropriate for management of hypertension in CKD, as it is ineffective once eGFR falls below 30 mL/minute/1.73 m2. The use of ______ may be preferred in such people.

Answer 34

Loop diuretics - E.G. Furosemide

Question 35

If a patients pre treatment serum potassium levels are greater than 5.0 mmol/L what should NOT be used to treat hypertension?

Answer 35

ACE inhibitor

Question 36

An increased ACR is associated with increase or decrease in adverse outcomes?

Answer 36

increase

Question 37

What should be prescribed to all patients with CKD? (eGFR

Answer 37

Statin 20mg od Atorvastatin - Primary prevention

Question 38

Accumulation of Metformin in those with stage 4 and 5 CKD can lead to...

Answer 38

Lactic Acidosis

Question 39

What are the 4 symptoms of anaemia?

Answer 39

1) Tiredness 2) SOB 3) Lethargy 4) Palpitations

Question 40

Calcium, phosphate and PTH should be measured in those with stage _ to _ CKD

Answer 40

4 to 5

Question 41

How does Calcium Resonium work and what is it used for?

Answer 41

- Ion exchange resin - Exchanges K+ for Ca2+ in GI tract - Enhances potassium excretion - TREAT OF HYPERKALAEMIA

Question 42

How do Salbutamol nebs and insulin work in the treatment of hyperkalaemia?

Answer 42

- Stimulate Na-K pump to increase cellular uptake of potassium - Decreases potassium levels in the blood

Question 43

Is CKD a risk factor for CVD?

Answer 43

YES

Question 44

What might an elderly person experience renal impairment but their serum creatinine levels might not reflect this?

Answer 44

- Because elderly people have reduced muscle mass so less creatinine breakdown product from muscle

Question 45

What useful handbook can be referred to when dealing with a patient with impaired renal function?

Answer 45

Renal drug handbook

Question 46

Why might itching occur in a patient with CKD?

Answer 46

- Due to build up of urea/waste products | - These cannot be excreted by kidneys as efficiently

Question 47

When is bendroflurothiazide rendered ineffective at removing xs fluid in a patient with CKD?

Answer 47

- If their eGFR is below 30ml/min/1.73m2

Question 48

What is a pre-renal cause of renal impairment?

Answer 48

- Reduction in renal blood flow - Cardiac failure, vomiting and diarrhoea without fluid replacement - Diuretics, NSAID's, ACEI - Increased production of waste products (urea) e.g infection, upper GI bleeding, steroid therapy

Question 49

What are some post renal causes of reduced renal function?

Answer 49

- Obstruction of urinary tract - Urinary stones - Constipation - BPHypertrophy

Question 50

Cockroft gault formula should NOT be used for who?

Answer 50

- Children - High muscle mass - Elderly - Pregnant - Heart failure

Question 51

What is ACR used to detect?

Answer 51

- Level of proteinuria

Question 52

What is the role of Calcium gluconate in those with CKD?

Answer 52

- Protects the CV system from fatal arrhythmias in those with hyperkalaemia

Question 53

What happens to bicarbonate levels in those with CKD and why?

Answer 53

- Kidney regenerates bicarbonate in the tubular cells and passes it back into the plasma - This buffers H+ ions - In RF there is reduced bicarb regen so reduced plasma levels of bicarb

Question 54

Why does phosphate accumulate in those with RF? | What effect does this have?

Answer 54

- Reduced filtration and excretion of phosphate - Causes reduction in levels of calcium as inversely linked - Can lead to renal bone disease and secondary hyperparathyroidism

Question 55

What happens if hypercalcaemia persists?

Answer 55

- Lead to formation of renal stones and cause more renal damage

Question 56

What happens to the excretion of sodium if kidney damage?

Answer 56

- Ability to excrete excess sodium is lost - Total ECF volume expansion occurs - Fluid overload

Question 57

What effect can uraemia have on drug binding?

Answer 57

- Urea can displace drug from protein binding sites - Causing more free drug - May be a need for therapeutic drug monitoring - e.g digoxin, phenytoin, warfarin, sodium valproate