renal

Question 1

What are the 5 functions of the kidney?

Answer 1

Fluid balance
Toxin secretion
Controls anaemia
Regulates acid-base balance
BP control

Question 2

What are the three types of renal replacement therapy?

Answer 2

Haemodialysis
Peritoneal dialysis
Kidney transplant

Question 3

What are the main causes of CKD?

Answer 3

Diabetes
Glomerulonephritis
Hypertension/renovascular disease

Question 4

Which drug is given first line to prevent progression of CKD?

Answer 4

ACE-Is

Question 5

What are the two mechanisms by which CKD causes anaemia?

Answer 5

Decreased absorption of iron from gut

Decreased EPO synthesis

Question 6

How can anaemia in CKD be treated?

Answer 6

IV iron

Erythropoietin stimulating agents

Question 7

How does CKD cause bone disorders?

Answer 7

Increased serum phosphate

Decreased hydroxylation of vitamin D

Question 8

How do you treat bone disease in CKD?

Answer 8

Give phosphate binders if phosphate high
Vit D supplements (cholecalciferol)

Calcitriol given if PTH 3 times normal limit

Question 9

Which drug used to tx infections falsely lowers eGFR?

Answer 9

Trimethoprim

Question 10

Which common drugs cause hypokalaemia?

Answer 10

Loop and thiazide diuretics

Question 11

Which common drugs cause hyperkalaemia?

Answer 11

Spironolactone
ACE-I
ARB

Question 12

What triad of symptoms is associated with pyelonephritis?

Answer 12

Loin pain
Fever
Renal tenderness

Question 13

Which cancer can px with a left sided varicocele on exam?

Answer 13

Renal cell carcinoma

Question 14

What system is used to evaluate the risk of malignancy in renal cysts?

Answer 14

Bozniak classification

Question 15

What are the criteria for stage 1 AKI?

Answer 15

Serum creatinine 1.5-1.9 x baseline

UO < 0.5ml/kg/hr for 6-12h

Question 16

What are the commonest causes of AKI/

Answer 16

1) Sepsis
2) Major surgery
3) Cardiogenic shock
4) Hypovolaemia
5) Drugs
6) Hepatorenal syndrome
7) Obstruction

Question 17

What is the most common cause of nephritic syndrome?

Answer 17

Post-streptococcal glomerulonephritis

Question 18

What are the features of nephrotic syndrome?

Answer 18

Heavy proteinuria (>3g/24h)
Hypoalbuminaemia
Oedema
Hyperlipidaemia
Hypercoagubility

Question 19

How is nephrotic syndrome managed?

Answer 19

1) Tx oedema - diuretics, fluid and salt restrict
2) Tx cause (adults = biopsy, children = tx as minimal change)
3) ACE-I t reduce proteinuria

Question 20

What are the comps of nephrotic syndrome?

Answer 20

Infection

thromboembolism (need LMWH and warfarin)

Question 21

Does diabetes cause a nephrotic or nephritic syndrome?

Answer 21

Nephrotic

Question 22

Which drugs are nephrotoxic?

Answer 22

NSAIDs
ARBs
ACE-I
aminoglycosides

Question 23

What are the indications for starting RRT?

Answer 23

Hyperkalaemia
Acidosis
Uraemic complications
Fluid overload

Question 24

Which drugs do you stop in patients in or at risk of AKI/ prior to giving contrast?

Answer 24

DAMN
Diuretics
ACE-I/ARB
Metformin
NSAIDS

Question 25

What is the time for peak creatinine post contrast?

Answer 25

72 hours

Question 26

What is the threshold Hb level for transfusion?

Answer 26

70

Question 27

What are the comps of myeloma?

Answer 27

Hypercalcaemia Spinal cord compression Hyperviscosity (reduced cognition, disturbed vision) Acute renal injury

Question 28

Factors affecting creatine level

Answer 28

Muscle mass | Drugs (e.g. trimethoprim)

Question 29

What are the most common causes of rapidly progressing glomerulonephritis?

Answer 29

Small vessel/ANCA vasculitis Lupus nephritis Anti-GBM nephritis

Question 30

What insulin/dextrose regime to you give in hyperkalaemia?

Answer 30

10u actrapid with 250ml 10% glucose

Question 31

What do you do with LMWH dose if patient is in AKI?

Answer 31

Half dose

Question 32

What do you do with LMWH dose for PE tx if pt just gone into AKI?

Answer 32

Switch to unfractionated heparin as easier to monitor APTT value and doesn't require dose adjustment in renal failure (LMWH requires factor 10a monitoring - not routinely done)

Question 33

What do you do with furosemide if pt in AKI?

Answer 33

Diuretics not nephrotoxic | Decision to stop depends on volume status of patient (only stop if suspect hypovolaemia)

Question 34

When should you stop amlodipine in AKI?

Answer 34

Only stop if BP low

Question 35

How do you manage phenytoin levels in a patient in AKI?

Answer 35

Risk of toxicity therefore monitor levels

Question 36

What do you do if a patient on gentamicin develops AKI?

Answer 36

Stop it and use another abx (e.g. tazocin, meropenem)

Question 37

What to do with diclofenac in pt with AKI?

Answer 37

STOP

Question 38

What to do with morphine sulphate if a patient develops AKI?

Answer 38

Stop as renally excreted (risk of resp and CNS depression) Fentanyl (preferred) and oxycodone safe alternatives Paracetamol also safe

Question 39

What do you do with acyclovir dose if a pt develops AKI?

Answer 39

HALVE DOSE | renally excreted therefore can accumulate and cause neurological comps such as seizures

Question 40

What to do with flucloxacillin dose in AKI?

Answer 40

Renally excreted therefore can accumulate and cause seizures | Consider cutting down

Question 41

What do you do with prednisolone in a patient on long term steroids who develops AKI?

Answer 41

DOUBLE DOSE

Question 42

Which group of patients will deteriorate rapidly when started on an ACE-I to preserve renal function?

Answer 42

Pt with renal artery stenosis