Kidney

Question 1

Name 2 surrogates that are used for diagnosis of AKI?

Answer 1

Serum creatinine, urine ouptut

Question 2

What are the 4 main physiological manifestations of kidney dysfunction?

Answer 2

• Na+/water imbalance
• Accumulation of solutes & wastes
• Accumulation of acids
• Abnormalities of endocrine function

Question 3

How long does recovery from acute ATN usually take?

Answer 3

2-6 weeks

Question 4

What are the investigations in the clinical assessment of AKI?

Answer 4

ABG, ECG, UEC, calcium, phosphate, FBE, ESR/CRP, coags, LFTs, CK, urinalysis, urine MCS, urine albumin/creatinine ratio, U/S kidneys

Question 5

What are the STOP causes of AKI?

Answer 5

S - sepsis/hypoperfusion
T - toxin
O - obstruction
P - parenchymal disease

Question 6

Outline management considerations for AKI (6 marks).

Answer 6

1. Discontinue offending agents & nephrotoxins
2. Meticulous volume status assessment
3. Measure urea, creatinine, other electrolytes & venous bicarbonate daily
4. Daily weighs, fluid chart, regular obs & fluid assessments
5. Nephrology input to gauge the need for dialysis
6. Loop diuretics if applicable for volume overload

Question 7

What is the definition of chronic kidney disease?

Answer 7

-eGFR 3 months with or without evidence of kidney damage
OR
-evidence of kidney damage for >3 months - eg/ haematuria, proteinuria, pathological or anatomical abnormalities

Question 8

What are 5 clinical manifestations of CKD?

Answer 8

• Urine change - anuria, oliguria, nocturia, polyuria
• Oedema
• Frothy urine (proteinuria)
• Fatigue, SOB, pallor (anaemia)
• Generalised weakness
• Nausea & anorexia
• Pruritus
• Constipation
• Fractures

Question 9

Name 5 investigations you would perform if you suspect CKD and why.

Answer 9

1. Urine MCS - to rule out infection as a cause for symptoms
2. Urine albumin:creatinine ratio - to determine the degree of renal damage
3. UEC - to determine eGFR & electrolyte imbalances
4. HbA1c - if applicable
5. U/S kidneys - to look for structural abnormalities

Question 10

What is the target BP for patients with CKD?

Answer 10

130/80mmHg
OR
125/75mmHg in proteinuria/diabetics

Question 11

What are 3 medications proven to be effective at reducing proteinuria?

Answer 11

• ACE inhibitors
• ARBs
• Spironolactone

Question 12

Outline the management of CKD (6 marks).

Answer 12

• Identify & treat the underlying cause
• Reduce further progression of kidney disease
• Reduce CV risk
• Early detection & management of metabolic complications
• Medication adjustment/avoidance of renally excreted & nephrotoxic medications

Question 13

What is the definition of nephrotic syndrome?

Answer 13

Proteinuria >3.5g/day

Question 14

What is the definition of nephritic syndrome?

Answer 14

Haematuria ± proteinuria

Question 15

What part of the kidney is required for biopsy - the cortex of medulla?

Answer 15

The cortex

Question 16

What part of the glomerulus is disrupted (seen on EM only) in minimal change disease?

Answer 16

The podocytes (epithelial cells)

Question 17

What is the mainstay of treatment of minimal change disease?

Answer 17

Steroids

Question 18

How long after the precipitating infection does IgA nephropathy usually manifest?

Answer 18

Approx 10 days

Question 19

What are the histologic findings in IgA nephropathy?

Answer 19

Mesangial proliferative glomerulonephritis with segmental lesions & crescents

Question 20

cANCA and pANCA relate to which vasculitides?

Answer 20

cANCA = Wegener's granulomatosis
pANCA = microscopic polyangiitis

Question 21

How does microscopic polyangiitis manifest itself besides renal failure?

Answer 21

Progressive skin rash 
Fever
Myalgia or arthralgia
Weight loss
SOB

Question 22

What histologic feature is characteristic of diabetic nephropathy?

Answer 22

Kimmelstiel-Wilson nodules (nodular sclerosis)