renal problems

Question 1

progressive chronic kidney disease, has what effect on kidney size

Answer 1

smaller and shrunken kidneys (unless obstructive)

Question 2

progressive chronic kidney disease effect on blood

Answer 2

EPO made in the kidneys and produces red cells. Therefore, a decreased kidney function causes progressive anaemia

Question 3

define AKI

Answer 3

change in renal function that occurs over hours to days

can be pre-renal, renal or post renal

Question 4

approach to AKI

Answer 4

• identify patient at high risk and optimise care
• stop all nephrotoxic agents
• assess and optimise volume status
• monitor creatinine and CO
• non-invasive diagnostic workup
• imaging
• invasive diagnostic workup
• revise drugs
• diet

Question 5

how do you assess volume status

Answer 5

• pulse
• BP
• JVP
• listen to lungs
• oedema

Question 6

how do you diagnose glomerulonephritis

Answer 6

presence of haematuria and proteinuria

Question 7

describe acute interstitial nephritis

Answer 7

• immune-mediated form of AKI
• characterised by an inflammatory infiltrate in renal interstitial and tubules
• diagnosed by renal biopsy

Question 8

define CKD

Answer 8

abnormalities of kidney structure or function, present for >3 months, with implication for health

defined based on cause, GFR category, and albuminuria category

Question 9

what are the 5 glomerular stages of CKD

Answer 9

1. GFR = > 90ml/min
2. GFR = 60-90ml/min
3. GFR = 30-60ml/min
4. GFR = 15-30ml/min
5. GFR = <15ml/mol

Question 10

what are the albumin stages of CKD

Answer 10

A1 = < 3mg/mmol

A2 = 3-30mg/mmol

A3 = >30mg/mmol

Question 11

CKD affect on minerals

Answer 11

mineral bone disorder

• phosphate retention due to reduced renal clearance
• disordered vitamin D metabolism
• secondary hyperparathyroidism

Question 12

CKD mineral bone disorder tx

Answer 12

• dietary phosphate restriction
• phosphate binders to minimise absorption (e.g. calcium carbonate)
• 1a (OH) vitamin D

Question 13

CKD affect on K and tx

Answer 13

hyperkalaemia

• restrict dietary K
• review medication e.g. ACEi
• correct metabolic acidosis
• consider ion exchange resins

Question 14

describe haemodialysis

Answer 14

• blood is removed from the body and passed through an artificial kidney
• done at least 3 times a week for 4-5 hours each time
• done at home or in dialysis unit

Question 15

peritoneal dialysis

Answer 15

• a tube is placed into the abdomen through which specialised peritoneal dilate fluid is drained
• waste products diffuse into the fluid and then are drained out
• done everyday - either 4 bags a day or by a machine overnight