General questions in dialysis :

1- What is KT/V

2- Which is better HD or PD

3- What are the lessons from CANUSA study

4- What is the definition of adequate dialysis

5- What are the targets of PTH for patients on HD

6- When is the appropriate time for HBV vaccination for CKD patients

7- When would you construct AVF for CKD patients

8- What is hard water

9- what is ultrapure water for HD

10- What is your approach to catheter infection



1- What is shown above

2- What abnormal about the above

3- Where is the position of the catheter

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1- What is shown above

2- What are the complications possible

3- What are the types of peritoneal membranes according to transport capabilities

4- What is the test used to know the type of membrane

Click here for non infectious complications of CAPD




Picture 1   Picture 2

CAPD patient presented with abdominal pain

1- What is your diagnosis

2- What is your plan of action

3- What are the indications of catheter removal

Terms used for Peritonitis .Click here



Plain erect abdominal X-ray showing catherter migration or malposition leading to dysfunction

1- What are the causes of catheter migration

2- How would you manage such condition





An ultrasound scan of the fetal kidneys shows an abnormality. Repeated ultrasounds show progressive dilatation of the urinary tract and decreasing fetal urine output (oligohydramnios). The decision is made to insert a vesicoamniotic shunt.

Katie is delivered at term by normal vaginal delivery. She has initial problems with breathing as a result of the oligohydramnios and she needs a short period of ventilation and has a pneumothorax. Urine output is minimal.

After birth, a renal ultrasound test and blood tests are ordered to check urea, electrolytes and creatinine.


Katie passes inadequate urine and needs dialysis.


What sort of dialysis would you offer?

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David is 8 years old and presents with a long history of polydipsia and polyuria, and the onset of nocturnal enuresis. He is not as large as his younger sibling.

On examination
On examination, David is small, but otherwise well with normal blood pressure. A renal ultrasound is ordered, and blood tests to check urea, electrolytes and creatinine. The renal ultrasound will either show small dysplastic kidneys or normal-sized kidneys possibly with cysts, which is more typical of nephronophthisis.

Management plan

A plan is made to start dialysis.

1 - What sort of dialysis would you offer?

2 - What information and support should be provided to David and his family/carer?

Clich here to check your answer





Initial presentation
Mohammed is a 72-year-old man and has been diagnosed with hypertension (blood pressure 184/102). Blood tests show him to have serum creatinine levels of 172 micromol/litre (estimated glomerular filtration rate (eGFR) 36 ml/minute/1.73 m 2 stage 3b CKD). Haemoglobin is normal (11.3 g/100 ml). An ACE inhibitor is prescribed. He attends for a couple of review appointments and his blood pressure comes under control. Reassured by this, he is not then seen in the surgery for 18 months.

Return visit
When his blood is next tested, his serum creatinine has risen to 587 micromol/litre (eGFR 9 ml/minute/1.73 m 2 stage 5 CKD), haemoglobin has fallen to 8.9 g/100 ml and his serum potassium is 6.5 mmol/litre. He is breathless on exertion and looks unwell. His ACE inhibitor is discontinued but there are no reversible factors for his poor renal function and, after ultrasound confirmation that he had shrunken kidneys, it is decided to recommend dialysis. He initially receives haemodialysis, using a temporary dialysis neckline to treat his breathlessness and hyperkalaemia.

1- What are the next steps you would take to ensure Mohammed has been given the right support and choices about his treatment?

2- What are the next steps?

Clich here to check your answer





Denise is 24 years old and has progressive renal failure that has not responded to several varied courses of immunosuppressive therapy. She finds frequent attendance at hospital very tiresome, and is dreading the need for dialysis.

Denise does not want to have to come to a haemodialysis unit for treatment but is also very concerned by the thought of abdominal distension if treated with peritoneal dialysis.

How should you approach providing Denise with information, support and choice to help her decide which treatment modality is right for her? 

Clich here to check your answer





Emma is 81 years old and lives alone on a farm. Her daughter lives close and helps with looking after Emma.

Emma has type 2 diabetes and multiple sclerosis, and uses a wheelchair.

Emma is admitted to hospital with chronic kidney disease stage 5 and is not known to renal services. She starts on haemodialysis, with the intention of eventually receiving treatment from a satellite unit closer to home. At this stage Emma had not been reviewed by a pre-dialysis team.

After 1 month Emma is admitted to hospital. She has hypotensive   episodes and is struggling with haemodialysis; her mobility difficulties    have made the travelling a problem.

1- What would be the best plan?

2 - What are the next steps?

Clich here to check your answer




Phil is 50 years old and lives with his wife and sons. He has an active lifestyle, a manual job and enjoys holidays. He has IgA nephropathy.

Phil Initially starts peritoneal dialysis, and has this for 2 years before he receives a kidney transplant. After 8 years the transplant fails and he requests to go back on peritoneal dialysis. After 2 years on peritoneal dialysis, problems become apparent with adequacy and ultra-filtration. He is generally not doing well but wants to continue to be independent.


What would be the best plan?

Clich here to check your answer





Robeena is a 54-year-old woman who is married with three children. She does not work. She has stage 5 CKD, hypertension, and chronic pyelonephritis (sp).

Robeena is admitted to hospital with stage 5 CKD and a chest infection after attending a clinic. She has presented late in the chronic kidney disease care pathway as she has presented with stage 5 CKD. She does not require urgent dialysis (within the first few days of admission).

What are the next steps?

Clich here to check your answer




A 15 years boy with end-stage renal disease is receiving continuous ambulatory peritoneal dialysis. The nurse is monitoring him for signs of complications associated with peritoneal dialysis.

All are true except:
1. Pruritus
2. Fever.
3. Tachycardia
4. Cloudy outflow
5. Abdominal pain

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A 67-year-old man with mild dementia, in whom peritoneal dialysis was recently initiated because of end-stage renal disease, is brought to the office by his wife because he has had abdominal pain for the past 48 hours. The patient's wife says he has been reusing one cap to close off his peritoneal dialysis catheter. On analysis, a sample of fluid from the catheter is cloudy and grows gram-positive cocci. Which of the following is the most appropriate next step?

(A) Intraperitoneal administration of antibiotics

(B) Intravenous administration of antibiotics

(C) Retraining of the patient regarding catheter procedures

(D) Retraining of the patient's wife regarding catheter procedures

(E) Transfer of the patient to a hemodialysis clinic

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