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Uraemic Gastropathy — ESENeph MCQ

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HardHaemodialysisUraemic GastropathyESENeph

A haemodialysis patient has persistent nausea, pruritus, poor appetite and declining weight. Delivered dialysis dose has fallen because of repeated shortened sessions. What is the best first renal response?

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Correct answer: A — Assess dialysis delivery, access function and competing gastrointestinal causes

The best answer is “Assess dialysis delivery, access function and competing gastrointestinal causes”. Symptoms can reflect underdialysis, access dysfunction, inflammation, gastrointestinal disease, medicines or depression; delivered clearance and treatment completion are objective starting points. “Treat presumed uraemia with a proton-pump inhibitor trial” is less appropriate because symptoms are nonspecific and the reduced delivered treatment requires assessment “Increase dietary protein after reviewing delivered dialysis adequacy” is less appropriate because nutrition matters but does not correct underdialysis or identify another cause “Change dialysis modality after confirming adequate treatment delivery” is less appropriate because the immediate problem is to understand and optimize delivery “Assess gastroparesis when diabetes or autonomic disease supports it” is less appropriate because this ignores the documented treatment shortfall and broad differential

Reference: UK Kidney Association haemodialysis guideline: https://guidelines.ukkidney.org/haemodialysis/