AKI
Which medication should be stopped in a patient with AKI?
A. Paracetamol
B. Amoxicillin
C. Ramipril
D. Salbutamol
Ramipril
A 67-year-old man with a long history of T2DM and CKD is being followed up in a low-clearance clinic for discussion of renal replacement therapy. He has been experiencing worsening fatigue, itching, insomnia and leg cramps over the last three months. His glomerular filtration rate is estimated at 23 ml/min. The patient is not keen to have to leave his house multiple times a week for treatment.
Which of the following is the most appropriate initial management for this patient?
A. EPO supplementation
B. Haemofiltration
C. Haemodialysis
D. Renal Transplantation
E. Peritoneal dialysis
Peritoneal dialysis
Why can CKD cause normocytic anaemia?
Reduced renal erythropoietin production
Which investigation is most useful to exclude a post-renal cause of AKI?
A. ECG
B. Renal ultrasound
C. Urinalysis
D. Serum potassium
Renal ultrasound
A 55 year old man presents to A&E after routine biochemistry ordered by his GP reveals an acute kidney injury. His U&Es are as follows: sodium 123, potassium 7.9, urea 24.5 (baseline 14.2), creatinine 450 (baseline 150) and eGFR 14.
Which of the following is an indication for dialysis in acute renal failure?
A. Hyponatraemia
B. Resistant hyperkalaemia
C. Thrombocytopaenia
D. Oliguria
E. Resistant metabolic acidosis
Resistant hyperkalaemia
Why does CKD cause secondary hyperparathyroidism?
Phosphate retention and reduced vitamin D activation cause hypocalcaemic drive to PTH release.
A 78-year-old man is admitted with vomiting and diarrhoea for 3 days. His creatinine has risen from 90 to 180 µmol/L. Which is the most likely cause of his AKI?
Dehydration causing reduced renal perfusion
A 65-year-old woman with end-stage renal failure is planned for long-term haemodialysis. She has suitable upper limb vessels.
Which form of vascular access is preferred?
Arteriovenous fistula
What is the main cause of death in CKD patients?
Cardiovascular disease.
A patient with CKD stage 5 is expected to require haemodialysis within the next few months.
How long before use should an AV fistula ideally be created?
8 weeks
Why are NSAIDs risky in CKD? (give pathophysiology)
They constrict the afferent arteriole, reducing renal perfusion/GFR.
A patient has CKD with blood ++ and protein ++ on urine dip, ACR 85 mg/mmol, BP 162/94, and eGFR falling from 62 → 49 → 37 over 8 months. What diagnosis should you worry about, and why?
Worry about glomerulonephritis because blood + protein, significant albuminuria, hypertension, and a rapidly falling eGFR suggest active glomerular disease rather than simple stable CKD