PD Catheter Tunnel Herniation — ESENeph MCQ
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Correct answer: B — Arrange renal ultrasound to assess structure and obstruction
The best answer is “Arrange renal ultrasound to assess structure and obstruction”. NICE offers renal ultrasound when CKD is accompanied by urinary obstruction symptoms, visible or persistent invisible haematuria, accelerated progression, family history of polycystic disease or advanced GFR. It identifies hydronephrosis and structural abnormalities without contrast exposure. “Avoid imaging because CKD can be classified from eGFR alone” is less appropriate because structural disease and obstruction are potentially treatable causes that eGFR does not identify “Use kidney biopsy as the first test for suspected obstruction” is less appropriate because biopsy does not define hydronephrosis or lower urinary-tract obstruction “Order contrast CT urography without considering kidney function or ultrasound” is less appropriate because ultrasound is the indicated initial renal structural assessment in this CKD context “Wait for eGFR to fall below 15 mL/min/1.73m² before imaging” is less appropriate because obstruction should be detected promptly rather than after advanced loss of function
Reference: NICE NG203: CKD assessment and management: https://www.nice.org.uk/guidance/ng203/chapter/Recommendations