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OK. And next back good. Nothing weird in the background. Just my bad. Heck, let's go. Let's go. Um So, hello, thank you for joining us. Um um My name is I'm one of the ones working in Manchester and this one um and we're gonna be presenting um nephology. Um So just before we get started, if you can come to our sessions, we're doing a quick uh survey and our research, I have to see all the details on that survey um and you can get involved. So, moving on. So it's gonna be about an hour long session as with all the other sessions and we'll be covering uh the topics on here and we MLA um content to ground our questions and having done the MLA ourselves, we'll be able to let you know what kind of questions can come up. Um And uh what are the, the common things that you, you actually really need to know? Um So we'll give you about a minute per question. Um In which time you'll be able to answer it in your own time and then we'll go through each answer individually. So 10 questions, first questions, thoughts now. So you're 58. You, well, you're not a 50 year old, you're a male, you're an fy doctor who has a 58 year old male patient on a surgical ward after undergoing a total nephrectomy. Two days previously, he appears well and the examination findings are normal. Although his urine output has dropped. His fluid chart shows he's passed 850 minutes of urine in the past 24 hours and he weighs 80 kg. So blood test show creatinine rise to 100 micromoles from nine of 90. What's the most likely underlying diagnosis? Ok. I'll give you 10 more seconds. 321. So this question is asking whether you know the criteria for an AK I um and what oliguria actually means. So the answer to this question would be these. So AK I and I'll go through why? So I think some people put normal physiological response after surgery. So you can expect uh oliguria a few, a few hours after surgery. Um And that's a normal physiological response after any sort of surgery, whether it's brain heart or, or kidney surgery. Um, but that tends to resolve after uh one day. So he had his nephrectomy two days ago and anything after that you would consider an AK um So postnephrectomy, oliguria, there's a question of whether you'll get oliguria just by having one less kidney. Um And the answer is actually no. So you still produce the same amount of urine, even if you have one less kidney. And that's because your existing kidney can compensate. So why it's not c so benign prostatic hypertrophy can happen in 58 year old gentlemen or elder, elderly gentlemen. It, and it is a common cause of AK I or obstructive A Ks or post renal AKI s. Um but there's nothing in the stem to suggest that he has an enlarged prostate. But as part of your workup, you could consider um uh an examination to see whether the prostate is enlarged and si A DH. So you can get SI A DH, which leads to oliguria um after surgery. But it tends to be more common after pituitary surgery rather than a renal surgery. But if you thought that S IH can occur after any sort of stress, you'd be correct. But in order to diagnose S IH, you would need to do urine and serum osmolalities and they don't, they don't mention this in the question. So yeah, so this is just the calculation that you would do according to the Kadaga criteria. So doing 0.5 times by his weight, times by the number of hours you get 960 mils, which is more than what he actually passed. So just a quick summary of AK I something you just have to learn and remember, um, the way I try to remember is like 6, 1224 for stage 123 and then just rote learning 26.5 micromoles in two days, increase in serum creatinine. Um Those are the main ones, the increase in serum creatinine and the urine output. And then in stage three, you could also get anuria for 12 hours. Um And then on the right, it's just a brief summary of the most common causes of AK if you think of it as prerenal is all anything to do with the blood. So you have a reduced circulating volume. It could be because of heart failure, it could be because of sepsis or blood loss, dehydration, anything that reduces your intravascular volume. Um So there's less blood going to the kidney. So the kidney also outputs less and then your renal problems. Uh anything to do with the, the nephrons or the tub walls or the glomeruli themselves. And they tend to also present with some hematuria because the glomeruli are malfunctioning. And so they're letting like basically anything go through that wouldn't normally go through. Um and then postrenal. So in men, the thing that you think about the most is the prostate. Um So that's when your consultant would ask the poor fy one to do apr exam when they don't really want to do it. And then to see if the prostate is enlarged. Um but it could also be other things like um intraluminal obstruction or extraluminal obstruction. So, intraluminal could be all sorts of um cancers and extraluminal again, more cancers, but could be pelvic in origin or gynecological in origin. Um So we'll just go through the work up of an AK I it sounds like it looks like a lot on this screen. But if you just memorize the basics, so your basics in any scenario, especially in a if they're asking you for, what will you do next? And you're presented with this patient in AK I, you'll say I want to do blood bed type tests, imaging and consider some special tests. So if you remember those four categories, so in your bloods, you're gonna think about FP CS you use in these course and all your basic blood and your bone profile, bone profile um would show your calcium levels and all these sorts of electrolytes including magnesium and phosphate, um can impact on your kidneys. So that will be your blood bedside test. Um For some reason, consultants get really aggy if you don't do urinalysis. So any sort of urine dip, if you ask for your aosis for a urine dip, um and then ask for any sort of urine cultures, you can take a set of herbs and ECG S and then your ABG S and BBg S can also indicate sort of lactate levels and whether this person's in any sort of metabolic acidosis, which can also affect the kidneys imaging. So the most common one that you would do on the ward is a bladder scan. And then if it's over, I think 500 mils, it indicates that you're in retention. So that would indicate that you've got a post obstructive, a post renal obstructive cause. Um uh But you could also consider a renal ultrasound if you're thinking there's some sort of hydronephrosis. Um A CT K UB could uh point towards any stones. Um and fundoscopy, fundoscopy in the eye. I can't remember why I put that in there but it was on the BMJ best practice and then special tests. Um can you can consider renal screens and biopsies? But that would be after you refer to renal. So that's not something you would order as an F I one and in terms of management for an AK II, think of it in terms of supporting.