ACC core conditions Flashcards
What does frank haematuria refer to?
Blood in urine which is visible (not just picked up on urine dipstick)
What is painless frank (visual) haematuria often a sign of?
Bladder cancer
What are the renal causes of haematuria? (6)
- Renal cancer
- Glomerulonephritis (IgA nephropathy)
- Polycystic kidney disease
- Papillary necrosis
- Pyelonephritis
- Trauma
What are the extra-renal causes of haematuria? (4)
- Calculi
- Neoplasia
- Catheterisation
- Drugs e.g. cephalosporins, ciprofloxacin, furosemide, NSAIDs
What might cause glucose in urine? (4)
- Diabetes
- Pregnancy
- Sepsis
- Renal tubular damage
Causes of ketones in urine? (2)
- Starvation
2. Ketoacidosis
Causes of leucocytes in urine? (2)
- UTI
2. Vaginal discharge
Causes of nitrites in urine? (2)
- UTI
2. High protein meal
Causes of bilirubin in urine? (1)
Obstructive jaundice
Which organism most commonly causes a UTI?
E.coli (75-95%)
What are the symptoms of acute pyelonephritis? (5)
- High fevers
- Rigors
- Vomiting
- Loin pain & tenderness
- Oliguria (if acute kidney injury)
Symptoms of cystitis?
- Frequency
- Dysuria
- Urgency
- Haematuria
- Suprapubic pain
How is an AKI defined?
An abrupt deterioration in kidney function with an increase in serum creatinine of >26umol/l or >50% increase from baseline, or a reduction of urine output <0.5ml/kg per hour for more than 6 hours.
How may an AKI present? (10)
- May be asymptomatic
- Elevated creatinine during biochemical screening
- Oliguria
- Malaise, confusion, seizures or coma
- Nausea, vomiting, or anorexia
- Oliguria or abnormal urine colour
- Haematuria (pink rather than frank blood)
- Drug overdose (paracetamol)
- Vascullitic rash
- Multi-organ failure
In 80% of cases, how can AKI be resolved?
- Adequate volume replacement
- Treatment of sepsis
- Stopping nephrotoxic drugs
What is important to determine/what are the priorities in someone with an AKI?
- Volume assessment and fluid challenge 1L saline over 2 hours, assess urine output
- Stop all nephrotoxic drugs
- Is the patient septic? (pyrexia, high CPR, leucocytosis)
- History: hypertension, diabetes, prostatism, haematuria
- Urgent ultrasound scan - look for obstruction, blood flow, size, cysts, symmetry
- Urinalysis and microscopy to look for red or white cell casts, myoglobinuria and haematuria
What are the pre-renal causes of AKI? (5)
- Hypovolaemia
- Hypotension, shock
- Renal artery emboli
- Renal artery stenosis + ACEi
- Hepatorenal syndrome
What are the renal (parenchymal) causes of AKI? (7)
- Vasculitis (SLE)
- Glomerulonephritis
- Acute tubular necrosis (ishcaemia, septicaemia, toxins, drugs, malaria)
- Thrombotic microangiopathy
- Scleroderma crisis
- Sepsis
- Calcium, urate, oxalate overload
What are the post-renal causes of AKI? (5)
- Renal vein thrombosis
- Increased intra-abdominal pressure
- HIV drugs (indinavir)
- Ureteric stones/tumour
- Urethral - prostatic hypertrophy
What assessments of the patient should be done in someone with pre-renal AKI? (3)
- Check postural BP and HR
- Assess volume status, measure CVP
- Sepsis screen
In the management of AKI, what is the treatment for hyperkalamia? (3)
- 10mL of 10% calcium gluconate IV
- 50mL 50% glucose with 5U soluble insulin over 15min
- Nebulised salbutamol
How do you treat metabolic acidosis?
50-100mL of 8.4% bicarbonate via central line over 15-30 minutes
How do you treat pulmonary oedema?
- O2 - consider CPAP
- IV GTN 2-10mg/h
- IV furosemide 250mg over 1 hour
- IV diamorphine single dose of 2.5mg - relieves anxiety and breathlessness
- Haemofiltration or dialysis
What are the different types of pericarditis? (5)
- Pericardial effusion
- Cardiac tamponade
- Constrictive pericarditis
- Pericardial masses
- Acute/subacute/chronic/recurrent pericarditis
What is the most common infectious cause of pericarditis?
Viral infection - enteroviruses (coxsackie) herpesviruses, adenoviruses, parvovirus B19
What is the most common bacterial cause of pericarditis?
Mycobacterium tuberculosis
What are the common autoimmune causes of pericarditis? (4)
- Systemic lupus erythematous
- Sjogren syndrome
- Rheumatoid arthritis
- Scleroderma
Which two cancers are most common to cause metastatic spread pericardial masses?
- Lung cancer
2. Breast cancer
Other than ones previously listed, what are the other causes of pericarditis? (4)
- Amyloidosis
- Aortic dissection
- Chronic heart failure
- Pulmonary arterial hypertension
What are the signs/symptoms of acute pericarditis? (3)
- Chest pain - typically sharp and pleuritic, improved by sitting up and leaning forward
- Pericardial friction rub - superficial scratchy or squeaking sound best head with the diaphragm of the stethoscope over the left sternal border
- Pericardial effusion
What may be seen on an ECG of someone with pericarditis?
Widespread ST elevation or PR depression
What blood markers may be raised in someone with acute pericarditis? (3)
CRP
ESR
WCC
Chest X-ray of someone with pericarditis is usually normal, unless the pericardial effusion exceeds what amount?
300ml
