Renal

Question 1

Age related GFR decline

Answer 1

1ml / year from age 35

ie. 85yo man GFR should be ~50ml/min

Question 2

Nephrotic Syndrome causes

Answer 2

Question 3

Nephritic Syndrome Causes

Answer 3

Question 4

Extra-renal manifestations APCKD

Answer 4

• Liver Cysts
• Intracranial aneurysm
• LV hypertrophy
• Renal stones
• Pancreatic cysts
• Hernias
• Hypertension

Question 5

Principles of Management in CKD

Answer 5

• Fluid intake and diet
• Anaemia
• Acidosis
• Bone health (BMD testing, parathyroidectomy)
• Management of cardiovascular risk
• Vascular access consideration / dialysis planning
• Suitability for transplant

Question 6

Dialysis History

Answer 6

• How long on dialysis
• What type
• Where (satellite, hospital, home)
• Current prescription: Dry weight, length, fluid removal, Blood pressure pre and post / during, anticoagulation during.
• Previous access history: fistula, PD, Hickman

Peritoneal dialysis
- CAPD vs APD
- Previous PD Peritonitis
- Tenkoff site infection
- ? residual renal function

Question 7

Transplant Patients

Answer 7

• Details about transplant and immediate complications
• Graft pain / rejection
• Infections
• Steroids nad immunosuppression side effects
• Creatinine levels
• Recurrent GN
• Rejection
• Skin cancers

Question 8

CKD with normal kidney size

Answer 8

• Diabetic nephropathy (sometimes)
• APCKD
• Amyloidosis
• Renal vein thrombosis

Question 9

Management of CKD complications

Answer 9

Question 10

Complications of Dialysis

Answer 10

• Sudden cardiac death
• Accelerated cardiovascular disease
• Amyloidosis (B2microbglobulin)

Question 11

Contraindications for Kidney Donation

Answer 11

Age, Active malignancy, Incurable infection, untreated ischaemic heart disease

Question 12

Survival rate after transplant

Answer 12

1 year 95%
15 year 50%

Question 13

Types of kidney transplant

Answer 13

Cadaveric
Living donor

Paired Kidney Exchange program

Question 14

Contraindications to Renal Transplant

Answer 14

Absolue:
- Malignant disease (2 years minimum remission prior to transplant)
- Severe ischaemic heart disease
-Active vasculitis
- Active sepsis

Relative:
- older than 75yoa
- High risk of recurrent in transplant
- other comorbidities

Question 15

Reason to switch from CNI to mTOR

Answer 15

Toxicity with CNI: renal, neurological

Lower incidence of skin malignancy

Question 16

mTOR Inhibitor Side effects

Answer 16

• Proteinuria
• Poor wound healing
• Cytopaenias

*Withold around time of surgery due to poor wound healing.

Question 17

Transplant OI prophylaxis

Answer 17

• Valganciclovir 6 months
• Lifelong Bactrim PJP prophylaxis
• Influenza vaccination

Question 18

Chronic Rejection Differential

Answer 18

• Recurrence of primary GN
• Chronic allograft nephropathy
• Chronic antibody mediated rejection
• CNI toxicity