RENAL

Question 1

What is furosemide? And what is a side effect?

Answer 1

A loop diuretic.
HYPOKALAEMIA
Also, hypocalcemia.

Question 2

What would you do in case of systemic infection?

Answer 2

Sepsis 6
Take 3 
- blood cultures
- urine output
- blood lactate 

Give 3

• antibiotics
• fluids
• oxygen

Don’t let waiting for blood cultures delay antibiotics

Question 3

What antibiotics commonly cause C diff?

What antibiotics treat C diff?

Answer 3

Cause C diff

• fluoroquinolones like ciprofloxacin
• 2nd and 3rd gen cephalosporins
  e. g. cefuroxime and cefixime

Treat C diff
- vancomycin
Or metronidazole

Question 4

How would you grade an Acute Kidney Injury?

Answer 4

KDIGO grading for AKI based on the patients Creatinine and Urine Output

1. Cr 1-2x baseline and urine <0.5ml/kg/hr 6-12hrs
2. Cr 2-3x baseline and urine <0.5ml/kg/hr >12hrs
3. Cr >3x baseline and anuric for >12hrs

Question 5

What are the bacterial causes of bloody diarrhoea?

Answer 5

Shigella
Salmonella
Campylobacter
VTEC

Question 6

What are the indications for acute / emergency dialysis?

Answer 6

A - Acidosis pH <7.1
E - Electrolytes - hyperkalaemia >7mmol/L
I - Intoxications of methanol, salicylate
O - Overload of fluid refractory to dialysis
U - Uraemic pericarditis and uraemic encephalopathy

Question 7

Treat a line infection

Answer 7

Most likely staph aureus or maybe enteroccus ( gram +ve)

so maybe 3rd gen cephalosporin???

Question 8

Antibiotic of choice for MRSA?

Answer 8

Hear MRSA, say vancomycin

Question 9

What is nephrotic syndrome?

Answer 9

The presence of proteinuria >3.5g/24hrs
Hypoalbuminaemia <30g/L
and peripheral oedema

Question 10

What are the most common causes of a nephrotic range proteinuria?

Answer 10

Minimal change disease - responds to steroids
25% rec in kids, 70% rec in adults
Focal Segmental Glomerulosclerosis
Membranous Nephropathy 
Diabetics Nephropathy 
Amyloidosis

Question 11

What is AKI?

Answer 11

AKI is an acute decline in Renal function occurring over hours - days. Manifests clinically as a sudden increase in serum Cr and urea with oliguria.

Question 12

AKI with Proteus cultured suggests

Answer 12

Formation of staghorn calculi
= struvite = Mg, ammonium and Phosphate.
This is a urology emergency

Question 13

What are the complications of CKD?

Answer 13

Hypertension
Cardiovascular disease - Heart failure
Mineral bone disorder with increased PTH and Phosphate and fit D deficiency
Anaemia of CKD

Question 14

Indications for acute dialysis?

Answer 14

Emergency = Acidotic, Electrolytes - hyperkalaemia, Intoxication- methanol ,Overload with fluid refractory to diuresis - ,Uraemic encephalopathy or pericarditis

Question 15

Indications for dialysis of patient with CKD?

Answer 15

• Symptomatic Uraemia - Nausea, anorexia, lethargy, pruritus
• Signs of Uraemia - pericarditis, volume overload, malnutrition
• Severe hyperkalaemia
• Sever metabolic acidosis
• ESRD i.e. GFR<10ml/min

Question 16

What are the options for a patient with ESRD?

Answer 16

Dialysis - HD or PD

Transplant - cadaver, living related, living non-related

Question 17

Why might someone with a failed renal transplant have problem getting another?

Answer 17

3 Reasons they might be sensitised;
these make it more difficult to find a match
- Have antibodies from previous transplant
- Have antibodies from a blood transfusion
- “ pregnancy

Question 18

What complications could occur with dialysis catheters?

Answer 18

• Infection
• HD -> septicaemia
• PD -> peritonitis
• thrombosis of HD catheter
• Malfunction
• PD hernia
• PD weight gain

Question 19

What are the advantages / disadvantages of Haemo vs peritoneal dialysis?

Answer 19

Haemo - very successful tx, well tolerated, widely available. But it requires strict adherence to a schedule, 4hrs 3/7, requires vascular access, ongoing i.e. not curative.
PD - suitable for patients require more lifestyle flexibility, and for patients with inadequate vascular access. Mostly used in infants and children. Can cause weight gain. Option for automated PD at night while patient sleeps. This tx allows for a more liberal diet.

Question 20

Where is a donor kidney put?

Answer 20

Iliac fossa and anastomosed to the external iliac artery and vein.

Question 21

Why might someone not be eligible for a kidney transplant?

Answer 21

• Active infection
• Malignancy
• Severe extra renal disease - hepatic or cardiac failure.
• Non- Compliance ( w/ medical tx?)
• Psychiatric illness

Question 22

What is prograf?

Answer 22

AKI Tacrolimus. = Calcineurin inhibitor.
CIs include cyclosporine, tacrolimus, and pimecrolimus. They are immunosuppressants routinely given after organ transplant.

Question 23

What are the side effects of Calcineurin inhibitors?

Answer 23

Nephrotoxicity
HTN
Hyperuricaemia
Neurologic - tremor, headache.
Metabolic - Glucose intolerance, DM
Hair changes - alopecia, hirsutism 
Gingival Hypertrophy 
Infection 
Malignancy

Question 24

What is AKI?

Answer 24

AKI is acute kidney damage which manifests clinical as a sudden increase in serum creatinine and urea and oliguria.

Question 25

What is the most common cause of death in patients with CKD? How can this be addressed?

Answer 25

risk of death due to Cardiovascular disease is higher than the risk of reaching ESRF.

Question 26

What is Chronic Kidney Disease?

Answer 26

CKD is characterised by a decreased kidney function (seen as reduced GFR <60) or kidney damage ( seen on imagine, pathology, albuminuria, urine sediment abnormalities or a kidney transplant), present for more than 3 months

Question 27

What are the complications of steroids?

Answer 27

* Peptic ulcers ( + GI discomfort) * Osteoporosis * Impaired healing ability * Increased risk of infection * Weight gain - esp trunkal * Electrolyte imbalance + fluid retention * Sleep disorder * Mood alterations * Hirsutism