• Chest pain with widespread ST elevation in a CKD patient, think of uremic pericarditis. Treatment is hemodialysis.
    • In TTP (Thrombotic Thrombocytopenic Purpura) and HUS (Hemolytic Uremic Syndrome), fever, hemolytic anemia and thrombocytopenia, all three are present in both conditions. Kidney insult is typically more severe and more common in HUS. Neurological symptoms are more severe and more common in TTP.
    • Erythropoietin therapy in CKD patients can lead to hypertension as a side effect in these patients requiring antihypertensive medication.

    • Rhabdomyolysis is associated with hypocalcemia and hyperkalemia.
    • Severe hypophosphatemia can lead to rhabdomyolysis.
    • Gentamicin related acute renal failure is usually evident after 5 days of initiation of therapy.
    • Urine microscopy in Gentamicin related acute renal failure is usually normal. If casts are present then they are either granular or epithelial.
    • The goal of treatment in Gentamicin related acute renal failure is tubular regeneration.
    • Gentamicin related acute renal failure patients will not have oliguria.
    • Gentamicin related acute renal failure is not irreversible i.e the patient usually regenerates the tubules after the insult related to the medication is stopped.
    • Gadolinium based contrast studies should be avoided in patients with CKD stage 3 or greater due to the risk of Nephrogenic systemic fibrosis.
    • Hydration with I.V fluids and N acetylcysteine have no role in preventing the damage associated with Gadolinium based contrast studies.
    • Hydration and N acetylcysteine use is more pertinent in case of prevention of radio contrast induced nephropathy.
    • The physiological concentration of saline is taken as 0.9 %. Hypertonic saline include 3 and 5 % solutions, respectively.
    • Reduced creatinine levels subsequent to an amputation can be misleading. It does not indicate improved GFR but shows that the creatinine normally produced is lowered due to the loss of muscle mass.
    • The creatinine levels are mainly determined by the muscle mass and total dietary intake e.g┬ámeat.
    • Antidiuretic hormone synthesis takes place in hypothalamus.
    • Antidiuretic hormone storage takes place in posterior pituitary and it is also released from the posterior pituitary.
    • ADH action is on the collecting ducts of the kidneys, facilitating water absorption through insertion of aquaporin channels in the collecting ducts.
    • Diagnosis of Peritoneal Dialysis related peritonitis requires PD fluid white cell count of greater than 100 mm3 or a PD fluid polys percentage of greater than 50 percent. By polys we mean neutrophils.
    • In SIADH (Syndrome of Inappropriate Anti Diuretic Hormone) there is increased urine osmolality despite a low serum osmolality. The urine is inappropriately concentrated despite a hypotonic serum.
    • Demeclocycline is the treatment for SIADH by blocking the effect of ADH on the distal tubules which are retaining the excess water.
    • In CKD, a high PTH level due to a secondary hyperparathyroidism is responsible for the bone reabsorption and subsequent fractures.

    • The stimulants responsible for the high PTH are low calcium and high phosphate levels. Both of these need to be corrected to keep the PTH in check in CKD.
    • Phosphate binding agents like calcium acetate lower the phosphate levels and hence lower PTH levels preventing bone fractures, ultimately.
    • In a dehydrated and hypovolemic patient, ACE inhibitors should not be continued. They should be withdrawn immediately.
    • In a patient with typical age group and classical minimal change disease picture, renal biopsy is deferred till 3 or 4 episodes of edematous flares have occurred.

  • Low erythropoietin, low vitamin levels including folic acid and B 12, low ferritin levels , chronic blood loss in tubing during dialysis are the factors responsible for an anemia in a CKD patient especially if he/she is dialysis dependent.
  • With regards to the anemia in CKD, iron, folic acid and B 12 should be corrected. If the patient is anemic despite correction of these factors then erythropoietin┬ácan be started.