Renal

Question 1

What defines CKD

Answer 1

irreversible loss of function over 3 months

Question 2

List the causes of CKD

Answer 2

HTN
DM
vascular disease
AKI
glomerulonephritis

Question 3

What part of the nephron is responsible for filtering waste

Answer 3

Glomerelus

Question 4

How does DM cause CKD

Answer 4

Glucose sticks to proteins that the kidney is filtering
reduces blood floe through EFFERENT arteriole
Blood cant leave glomerelus
build up of pressure
hyperfiltration and slow decline in filtering ability

Question 5

How does HTN cause CKD

Answer 5

decreased renal perfusion due to narrowing of kidneys
less oxygen reaches kidney
ischaemic injury

Question 6

What is released when a decrease in renal perfusion is identified

Answer 6

Renin
Na+

Question 7

What are the hypertension targets for a patient with an ACR <70
PCR <100

Answer 7

140/90

Question 8

What are the hypertension targets for a patient with an
ACR >70
PCR >100

Answer 8

130/90

Question 9

What should you give a patient as first line hypertensive treatment if their ACR <30

Answer 9

ACEi
ARB

Question 10

What should we pair with ACEi and ARB medicartion wise andwhy

Answer 10

Calcium resonium
helps reduce hyperkalaemia risk

Question 11

What is the only licensed SGLT2 for CKD

Answer 11

Dapagliflozin

Question 12

What serious affects can SGLT2 cause

Answer 12

DKA
Fournier’s gangrene

Question 13

What are the 3 stages of drugs you gice for hypertensives in CKD

Answer 13

ACE/ARB
Cardioseletive beta blocker
SGLT2i

Question 14

What are the dangers of hyperkalaemia

Answer 14

Cardiac arrest
arrythmias

Question 15

How does calcium resonium work

Answer 15

Exchanges K+ ions for H+ ions

Question 16

What is the treatment for acidosis caused by CKD

Answer 16

Sodium bicarbonate 500mg TDS

Question 17

How does CKD cause anaemia

Answer 17

kidney reduces production of erythropoietin
decrease in RBC production
increase in amaemia

Question 18

Wat are the symptoms of anaemia

Answer 18

Breathlessness
fatigue
angina

Question 19

How do we treat anaemia

Answer 19

Iron supplements
erythropoietin injections

Question 20

How does CKD cause renal bone disease

Answer 20

Decrease in vitamin D activation
decrease in Ca2+ absorbed
increase release in parathyroid hormone
increase in bone turnover to try and release more Ca2+
decrease in bone density

Question 21

What is the treatment for renal bone disease

Answer 21

Phosphate binder
decreased phosphate diet

Question 22

Give an example of a phosphate binder

Answer 22

Calcium acetate

Question 23

When is IV iron theapy recommended

Answer 23

<200mcg/L
Start ferinject

Question 24

When do we initiate dialysis

Answer 24

GFR <7ml/min

Question 25

What does dialysis aim to do

Answer 25

Works by filtering waste that the kidney cant mimics glomerulus mimics loop of henle

Question 26

What are the 2 types of dialysis

Answer 26

Haemodialysis peritoneal

Question 27

What is surgically done for haemodialysis

Answer 27

arteriovenous fistula

Question 28

How frequently do you need to go to hospital for haemodialysis

Answer 28

4 hours 3 times a week

Question 29

What is the mac amount of weight a patient can gain inbetween dialysis sessions

Answer 29

1.5kg

Question 30

How is peritoneal dialysis set up

Answer 30

catheter through peritoneal space in abdomen

Question 31

How many exchanges a day do you need with peritoneal dialysis

Answer 31

4

Question 32

How is fluid filtered in peritoneal dialysis

Answer 32

fluid drained out under gravity

Question 33

What type of catheter is used in perioneal dialysis

Answer 33

Tenckhoff

Question 34

What are the advantages of peritoneal dialysis

Answer 34

Reduced anaemia better cardiac stability can be done at home

Question 35

Why does peritoneal dialysis allow for beter cardiac stability

Answer 35

Fluid rate or removal = more gentle

Question 36

What are some disadvantages of peritoneal dialysis

Answer 36

Peritoneal membrane can become fibrosed risk of hyperglycaemia due to high glucose content solutions to provide conc gradient less clearance of urea and creatinine

Question 37

What dietary modifcations do you need to do when on dialysis

Answer 37

Low potassium low phosphate

Question 38

When do we need a high protein diet in dialysis and why

Answer 38

CAPD in peritoneal because you can lose protein through fluid

Question 39

How much urine output do you need for haemodialysis and peritoneal dialysis

Answer 39

Haemodialysis = 500ml/day Peritoneal dialysis = 750ml/day

Question 40

What are the 3 types of AKI

Answer 40

Pre-renal intrinsic post renal failure

Question 41

What are some causes of pre-renal failure

Answer 41

Reduced renal perfusion infection reduced cardiac output hypovolemia

Question 42

What effect do NSAIDs have on the kidney

Answer 42

Inhibits prostaglandins cause constriction of afferent arteriole

Question 43

What drugs effect the efferent arteriole in aki and how

Answer 43

ACEi ARB promote dilation of efferent arteriole

Question 44

What does a constricted afferent arteriole and a dilated efferent arteriole cause

Answer 44

Decrease in GFR and filtratio reduce perfusion and decrease filtration

Question 45

What is intrinsic failure

Answer 45

structual damage ischaemic damage infection damage to renal tissue

Question 46

Give some examples of nephrotoxic drugs

Answer 46

Penicillin's allopurinol azathioprine cephalosporins

Question 47

What is pre-renal failure

Answer 47

obstruction to urinary flow caused by blockage kidney stones structual changes enlarged prostate

Question 48

How does an enlarged prostate cause post renal failure

Answer 48

Puts pressure on the urethra and causes urinary blockage

Question 49

What are the risk factors for AKI

Answer 49

previous AKI over 65 CKD cardiac disease diabetes

Question 50

What do we give a patient if they have fluid overload

Answer 50

Furosemide loop diuretics

Question 51

How do we deal with fluid depletion

Answer 51

fluid resuscitation build up blood volume monitor fluids

Question 52

how is creatinine and urea produced

Answer 52

Byproduct of protein metabolism

Question 53

What is haematuria

Answer 53

Blood in urine

Question 54

What are the albumin:creatinine ratio in non-diabetics

Answer 54

>70mg/mmol

Question 55

What is albumin

Answer 55

A protein in the blood that is a transporter

Question 56

What does high urea levels do in the body

Answer 56

Compete for drug binding sites means drugs cant distribute in the body as easily

Question 57

What does an AKI do to insulin

Answer 57

Decreased insulin metabolism

Question 58

What vitamin do the kidneys metabolism

Answer 58

Vitamin D

Question 59

What routine tests do we do for kidney function

Answer 59

Creatinine urea eGFR albumin:creatinine

Question 60

What test do we do for UTI

Answer 60

Mid-stream urine

Question 61

What can also raise urea

Answer 61

Dehydration muscle injury infection

Question 62

How does AKI effect drug distribution

Answer 62

less protein binding due to high urea an dlow albumin competing with drug

Question 63

How do we correct hyperkalaemia

Answer 63

calcium glutonate 10% to protect heart rapid acting insulin

Question 64

How do we treat muscle dysfunction

Answer 64

Quinine ropinirole

Question 65

What vaccination is given to patiente with CKD every 5 years

Answer 65

Hepatitis B