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CDM - renal..
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- BIOLOGY PAPER 2 Solutions
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- BIOLOGY PAPER 2 Solutions
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CDM - renal.Two options for measuring eGFR - correct answer-Inulin, Creatinine
When to review metformin in kidney disease (eGFR values) - correct answer-review
if eGFR under 45 and stop after 30.
Urine abnormalities in kidney disease - correct answer-Reduced volume - or
absence of urine production
Anuria
Oliguria
Polyuria - diuretic? Renused ADH (diabetes inspidus), ANP release, osmotic diuresis
(hyperglycemia), CKD
Nocturia - diabetes, hypercalcuria, UTIs
Poor urinary stream - sphincter or prostatic disease
Urine colour - cola (nephritic), tea colour (rhabdomyolysis), microscopic haematuria,
frothy (protein), orange to pink-red (beetroot or rifampicin), bright/ strong yellow
(cholestatic jaundice), discolouration of urine on standing.
Dysuria
Three parameters to define an AKI - correct answer-A rise of serum creatinine of
26umol/l or greater in 48 hours
A 50% or greater rise in serum creatinine in 7 days
A fall in urine output to less than 0.5ml/kg/hour for more than 6 hours in adults
AKI Warning Stage 1 - correct answer-Current creatinine ≥ 1.5 x baseline level
AKI warning stage 2 - correct answer-Current creatinine ≥ 2 x baseline level
(or creatinine rise > 26 μmol/L ≤ 48hrs)
AKI warning stage 3 - correct answer-Current creatinine ≥ 3 x baseline level(or
creatinine 1.5 x baseline and > 354 μmol/L)
AKI risk factors - correct answer-pre-existing renal disease
heart failure,
ischaemic heart disease,
malignancy,
liver disease,
T2DM,
aged over 65,
urological disease,
surgery on this admission,
use of iV contrast, hypvolemia,
, BP drop of over 20,
malnourishment
Iatrogenic causes of AKI (3) - correct answer-nephrotoxic drugs i.e. ACE/ ARB/
NSAIDS, vancomycin and gentamicin, contrast administration.
Prerenal causes of AKI - correct answer-Transient renal hypo-perfusion. Most
common cause. Sepsis, bleeding, volume loss through vomiting or diarrhea
Postrenal causes of AKI - correct answer-Obstruction of urine flow:
Prostate
Stone
Gynae malignancy
Constipation
*Higher risk if solitary kidney
Intrinsic causes of AKI - correct answer-Glomerulonephritis (vasculitis, SLE,
Immunoglobulin A nephropathy, post-infectious glomerulonephritis)
Structural issue
Medications (loop, SLE, IgA nephropathy, post-strep)
Infection
Vessels
AKI susceptibilities (9) - correct answer-Dehydration, advanced age, female, Black
race, CKD, chronic disease, DM, cancer, anemia
postobstructive diuresis - correct answer-Elevated urine output occurring after
surgery to remove an obstruction caused by the inability of the renal tubules to
reabsorb water and electrolytes normally.
Acronym for indications for Renal replacement thereapy - correct answer-A -
Metabolic acidosis pH < 7.15 or worsening acidaemia
E - Refractory electrolyte abnormalities (hyperkalaemia >6.5mmol)
I - Intoxication - Presence of dialysable toxins (toxic alcohols, aspirin, lithium)
O - Overload - Refractory fluid overload (diuretic resistant fluid overload in setting of
AKI)
Ureamia - End-organ uraemic complications (e.g. pericarditis, encephalopathy,
uraemic bleeding)
Renal replacement therapy (4) - correct answer-Renal replacement therapy -
haemodialysis, peritoneal dialysis, kidney transplant, conservative care (quality of
life, treat symptoms, prepare for future, residual renal function)
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