Renal Extra

Question 1

Fluid in resus in AKI

Answer 1

Saline
Hartmanns contains potassium
Often hyperkalaemic in AKI therefore not a good idea

Question 2

Normal anion gap -

Answer 2

normally 10-18

Question 3

Causes of metabolic acidosis + increased anion gap

Answer 3

Increased production or reduced excretion of fixed/organic acids
Lactic acid (sepsis, tissue ischaemia)
Urate (renal failure)
Ketones (DKA)
Drugs/toxins (salicylates, methanol, ethylene glycol)

Question 4

Causes of metabolic acidosis + normal anion gap

Answer 4

Either loss of bicarb or accumulation of H+
eg. renal tubular acidosis 
diarrhoea 
Addissons
Fistula

Question 5

Minimal change disease - acute or progressive onset

Answer 5

Acute onset - therefore not chronic renal failure

Question 6

Membranous nephropathy - acute or progressive onset

Answer 6

Progressive - chronic not acute renal failure

Question 7

Type of dialysis for diabetic patients

Answer 7

Haemodialysis because peritoneal contains glucose

Also more prone to infection at PD sites

Question 8

Biochemical picture of AKI vs CKD

Answer 8

Calcium and phosphate will be high in AKI due to haemoconcentration (if due to dehydration)
Whereas CKD get hypocalcaemia and then - PTH high from secondary hyperPTH
CKD also get anaemia due to erythropoeitin and iron deficiency
V.high urea and moderately high creatinine - AKI
V.high urea in CKD will also have v.high creatinine

Question 9

Rapid decrease in renal function after starting an ACEi

Answer 9

Suspect renal artery stenosis

Question 10

Cause of nausea and itching in CKD and how to deal with it

Answer 10

High phosphate - therefore give calcichew and sevelamer - will also raise calcium
Sevelamer more effective than calcichew and is used in stage 4 + 5 CKD

Question 11

Hb target for CKD

Answer 11

10-12 g/dl

Question 12

Low citrate causes what type of renal stones

Answer 12

Calcium oxalate - citrate in the urine inhibits the formation of renal stones especially calcium oxalate

Question 13

Cramp post haemodialysis

Answer 13

Too much water being removed

Question 14

What is used to measure dialysis adequacy - which formula

Answer 14

URR urea reduction ratio

Question 15

Albumin needed for nephrotic syndrome diagnosis

Answer 15

Below 25

Question 16

Features of adult polycystic kidney disease

Answer 16

Is autosomal dominant sort - milder than autosomal recessive

Question 17

AKI + eosinophilia

Answer 17

Acute tubulointerstital nephritis

Question 18

Causes of acute interstitial tubulonephritis

Answer 18

Drugs eg. antibiotics including penicllins

NSAIDs

Question 19

Common cause of secondary hypertension

Answer 19

Hyperaldosteronism
Causes retention of Na+ and Cl-
Promotes excretion of K+

Question 20

What happens to K+ during haemodialysis

Answer 20

Can only remove 5% of total body k+ as the rest is intracellular. Therefore always get a transient hypokalaemia post-haemodialysis but this will rise over the next couple of days until next dialysis
Don’t treat post-dialysis hypokalaemia

Question 21

First manifestation of diabetic nephropathy - management

Answer 21

Microalbuminuria - ACEi (even in the absence of HTN)

Question 22

Relationship of renal failure and glycaemia in diabetics

Answer 22

Sulphonylureas and insulin are excreted by the kidney therefore towards the end of more severe renal disease - get hypoglycaemia

Question 23

In which type of diabetes is renal disease more common?

Answer 23

T1DM (50%) because it is common in people who have had diabetes for 20 years
T2DM (15%)

Question 24

Complement in SLE

Answer 24

Low

Question 25

What is targeted by anti-glomerular basement membrane antibodies in Goodpastures

Answer 25

Basement membrane collagen

Question 26

What is associated with poor graft prognosis in renal transplant

Answer 26

Cardiac death donor rather than heart beating donor Cold ischaemic time 18-24hrs Donor >60, hx of HTN, creatinine >130 Recipient - poor initial perfusion of graft, dialysis within 24h of operation, difficult surgery

Question 27

Urine in DKA

Answer 27

Glucose and ketones

Question 28

Which immunosuppressant is associated with gingival hypertrophy and hirsutism

Answer 28

Ciclosporin | Also less effective than tacrolimus at inhibiting calcineurin therefore falling out of favour as post-transplant drug

Question 29

Common complications of nephrotic syndrome

Answer 29

Thrombosis risk Infection risk (loss of complement proteins and immunoglobulin) esp. pneumococcal pneumonia Hyperlipidaemia

Question 30

Complications of CKD

Answer 30

Adynamic bone disease and inadequate 1-hydroxylation of 25OH-vitamin D

Question 31

Biochemical findings in CKD

Answer 31

Anaemia, hypocalcaemia, hyperkalaemia, hyperphosphataemia and metabolic acidosis

Question 32

Which diuretic causes low magnesium and low potassium

Answer 32

Bendoflumethiazide

Question 33

Immunosuppressant causing myelosuppression and GI upset (diarrhoea)

Answer 33

Mycophenolate mofetil

Question 34

Immunosuppressant causing myelosuppression and deranged LFTs

Answer 34

Azathioprine

Question 35

Immunosuppressant associated with haemorrhagic cystitis and an increased risk of bladder cancer in the longer term?

Answer 35

Cyclophosphamide

Question 36

Foods high in oxalate

Answer 36

beetroot, rhubarb, spinach, peanuts, strawberries, blackcurrants, and chocolate