Renal

Question 1

raised anion gap metabolic acidosis suggests…

Answer 1

Salicyclate poisoning

Question 2

Patients receiving large volumes of NaCl solution are at increased risk of which metabolic derangement?

Answer 2

Hyperchloraemic metabolic acidosis

Question 3

What is the recommended maintenance fluid requirement per day?

Answer 3

25-30 ml/kg/day

Question 4

What is the normal expected urine output?

Answer 4

0.5ml/kg/hr

Question 5

Give common symptoms of CKD.

Answer 5

Fatigue, itch, N&V, oedema

Question 6

What is the main cause of death in CKD?

Answer 6

Cardiovascular disease

Question 7

How can you predict the risk of a patient developing ESRD?

Answer 7

Kidney Failure Risk Equation

Question 8

What are the top 3 causes of CKD?

Answer 8

Diabetes, Hypertension, PKD

Question 9

What are the mainstays of CKD treatment?

Answer 9

BP management, reducing CV risk, managing complications

Question 10

What are the BP targets in CKD?

Answer 10

< 140/90 in CKD ACR < 70

< 130/80 in CKD + Diabetes or ACR > 70

Question 11

How should CV risk be managed in CKD?

Answer 11

Atorvastatin 20mg

Question 12

What is the Hb target in CKD?

Answer 12

100 - 120

Question 13

How should renal anaemia be managed in CKD?

Answer 13

Replace Iron/B12/Folate then give EPO if still anaemic

Question 14

What dietary advice should be given in CKD?

Answer 14

K+ restriction → vegetables, potatoes, chocolate, crisps

Diary restriction → milk, cheese, eggs are high in phosphate

Question 15

What are the options in ESRD?

Answer 15

Supportive
Haemodialysis/ Peritoneal dialysis
Kidney transplantation

Question 16

What are the options in ESRD?

Answer 16

Supportive
Haemodialysis/ Peritoneal dialysis
Kidney transplantation

Question 17

Which medications are usually given after kidney transplantation?

Answer 17

tri-therapy of steroid, calcineurin inhibitor (eg. tacrolimus), anti-proliferative (eg. mycophenolate)

Question 18

How can you differentiate between AKI and CKD?

Answer 18

CKD - readings should be taken at least 90 days apart

On USS, kidneys will likely be normal in AKI but small & scarred in CKD

Question 19

What is meant by a stage 1 AKI?

Answer 19

Cr 1.5-1.9 times baseline or < 0.5mls/kg/hr for 6-12 hours

Question 20

What is meant by a stage 2 AKI?

Answer 20

Cr 2-2.9 times baseline or < 0.5mls/kg/hr for > 12 hours

Question 21

What is meant by a stage 3 AKI?

Answer 21

Cr > 3 times baseline or < 0.3mls/kg/hr > 24 hours or anuric > 12 hours

Question 22

What are the 3 main groups of causes of AKI?

Answer 22

Pre-renal, renal, post-renal

Question 23

Give pre-renal causes of AKI.

Answer 23

Usually due to hypotension - volume loss or redistribution eg. haemorrhage, vomiting, sepsis or decreased cardiac output

Question 24

Give renal causes of AKI.

Answer 24

Acute tubular necrosis, Acute interstitial nephritis, vasculitis, GN, myeloma, coagulopathy

Question 25

How can you test for renal AKI?

Answer 25

Urinalysis

Question 26

Give post-renal causes of AKI.

Answer 26

Obstruction of the urinary tract or a major vessel

Question 27

What investigation should be used if considering post-renal causes of AKI?

Answer 27

USS

Question 28

What is the management of AKI?

Answer 28

Mainly supportive (fluids, K monitoring, stop nephrotoxics) and identify cause

Question 29

Give indications for urgent dialysis.

Answer 29

Resistant hyperkalaemia Pulmonary oedema Uraemic pericarditis Severe acidosis

Question 30

White cell casts in urine suggest...

Answer 30

Acute interstitial nephritis

Question 31

What is the most common cause of nephrotic syndrome in adults?

Answer 31

Focal segmental glomerulosclerosis (FSGS) or membranous glomerulopathy

Question 32

What is the most common cause of nephrotic syndrome in children?

Answer 32

Minimal change disease

Question 33

'Muddy brown casts' in urine suggests...

Answer 33

Acute tubular necrosis

Question 34

What is Alport Syndrome?

Answer 34

X-linked dominant disease - progressive renal failure, SNHL and retinitis pigmentosa

Question 35

What is the most common viral infection in solid organ transplant recipients?

Answer 35

CMV

Question 36

Nephritic syndrome days after UTRI suggests...

Answer 36

IgA nephropathy

Question 37

Which type of GN does not respond to steroids?

Answer 37

FSGS

Question 38

Nephritic syndrome weeks after URTI suggests...

Answer 38

Post-streptococcal GN

Question 39

Give differentials of crescenteric GN.

Answer 39

GPA, EGPA, Goodpasture's syndrome

Question 40

Which metabolic derangement may result from excess of NaCl fluid?

Answer 40

Hyperchloraemic acidosis

Question 41

Which ECG finding is suggestive of hypocalcaemia?

Answer 41

Prolonged QT interval

Question 42

Which ECG finding is suggestive of hypercalcaemia?

Answer 42

Short QT interval

Question 43

Vasculitis + collapse of nasal bridge suggests...

Answer 43

GPA

Question 44

Nephrotic syndrome + malignancy suggests...

Answer 44

Membranous nephropathy

Question 45

CKD with large kidneys suggests...

Answer 45

HIV nephropathy

Question 46

What is the prognosis for HSP with renal involvement?

Answer 46

2/3 make full recovery

Question 47

What is the treatment for HUS?

Answer 47

Supportive