Renal Disease/Treatments

Question 1

What process does dialysis involve?

Answer 1

diffuse across semi permeable membrane

Question 2

What does dialysis allow for the infusion of?

Answer 2

bicarbonate

Question 3

What does dialysis remove toxin wise?

Answer 3

urea, potassium, sodium

Question 4

What restrictions are placed on patients during dialysis?

Answer 4

fluid, salt, potassium and phosphate intake

phosphate binders taken with meals

Question 5

What is the gold standard of dialysis access?

Answer 5

fistula

Question 6

What else could be used as well as fistula?

Answer 6

tunneled venous catheter - but higher risk of infection

Question 7

What is intradialytc hypotension and why is it a problem?

Answer 7

removing large volumes of water 3 times a week instead of continously is bad - can lead to low BP

Question 8

What is peritoneal dialysis?

Answer 8

diffusion across peritoneal membrane

Question 9

What is osmosis of water out driven by during PD?

Answer 9

high glucose concentration

Question 10

What are the two types of PD?

Answer 10

CAPD (continous)

APD (automated)

Question 11

What problems may arise with PD?

Answer 11

infection
Hernias (increased abdo pressure)
membrane failure due to fluid overload

Question 12

What should you do if membrane failure occurs in PD?

Answer 12

switch to HD

Question 13

What are metabolic complications of dialysis?

Answer 13

photphate retention
low vit D
hypocalcaemia
High PTH
anaemia
sodium/water retention

Question 14

What can dialysis do to cardiovascular disease?

Answer 14

accelarate it

Question 15

What GFR should cause you to start dialysis?

Answer 15

<5

Question 16

What urea should start dialysis?

Answer 16

> 45

Question 17

When else should you start dialysis?

Answer 17

resistant hyperkalaemia
unresponsive acidosis
based on symptoms

Question 18

Why do you need to gradually build up HD treatment?

Answer 18

disequilibrium syndrome may occur

leads to cerebral oedema/ seizures

Question 19

What is the commonest cause of end stage renal failure?

Answer 19

diabetes

Question 20

What is the second commonest cause of end stage renal failure?

Answer 20

chronic Glomerulonephritis

Question 21

What is an important treatable cause of Acute Renal Failure.

Answer 21

Acute glomerulunephritis

Question 22

Define glomerulonephritis.

Answer 22

Immune-mediated disease of the kidneys affecting the glomeruli
(with secondary tubulointerstitial damage)

Question 23

In GN what leads to haematuria and/or proteinuria?

Answer 23

disruption of size and charge barrier

Question 24

In GN, damage to what leads to a proliferative lesion and red cells in urine?

Answer 24

endothelial or mesangial cells

Question 25

In GN, damage to what leads to a non-proliferative lesion and protein in urine?

Answer 25

podocytes

Question 26

How is GN diagnosed?

Answer 26

CLINICAL PRESENTATION BLOOD TESTS EXAMINATION of URINE Urinalysis - haematuria, proteinuria Urine microsopy - RBC (dysmorphic), RBC & granular casts, lipiduria Urine Protein: Creatinine Ratio / 24 hour urine - quantify proteinuria KIDNEY BIOPSY

Question 27

What is involved in nephrItic syndrome?

Answer 27

``` Acute Renal Failure Oliguria Oedema/ Fluid retention Hypertension Active urinary sediment RBC’s, RBC & Granular Casts ``` Indicative of a proliferative process

Question 28

What is involved in nephrOtic syndrome?

Answer 28

``` Proteinuria  3 g/day (mostly albumin, also globulins) Hypoalbuminaemia (<30) Oedema Hypercholesterolaemia Usually normal renal function ``` Indicative of a non proliferative process

Question 29

How is GN classed in terms of primary and secondary?

Answer 29

Primary (Idiopathic): THE MAJORITY Secondary: caused by eg. infections or drugs associated - malignancies or part of systemic disease eg. ANCA - associated systemic vasculitis, lupus, Goodpastures, HSP

Question 30

In what other ways can GN be classed?

Answer 30

Proliferative or non-proliferative Focal/Diffuse (50% glomeruli affected?) Global/Segmental (all or part glomerulus affected) Crescentic (presence of crescents - epithelial cell extracapillary proliferation eg. RPGN in vasculitis)

Question 31

What is the commonest cause of nephrotic syndrome in children?

Answer 31

Minimal Change Nephropathy

Question 32

What is the commonest cause of nephrotic syndrome in adults (35%)?

Answer 32

FOCAL SEGMENTAL GLOMERULOSCLEROSIS

Question 33

What is the commonest GN in the world?

Answer 33

IgA Nephropathy

Question 34

What type of rapidly progressive glomerulonephritis is ANCA positive?

Answer 34

Systemic Vasculitis Wegener’s granulomatosis (Granulomatosis with polyangiitis) Microscopic polyangiitis

Question 35

What type of rapidly progressive glomerulonephritis is ANCA negative?

Answer 35

Goodpasture’s disease-Anti-GBM Henoch Scholein Purpura HSP/IgA Systemic Lupus Erythematosus