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Renal / Urology > Background Renal Disease and Haematuria > Flashcards

Background Renal Disease and Haematuria Flashcards

1
Q

What are the functions of the kidney so if kidney damage what is affected

A 
Body fluid homeostasis
Electrolyte homeostasis
Acid base balance
Regulate BP
Remove physiological waste 
Vit D production 
Calcium / phosphate handling 
Erythropoietin production 
Renin production
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2
Q

How do you measure kidney function

  • Test
  • Exam
  • Molecular
A 
Dipstick 
eGFR 
U+E
ACR / PCR 
24 hour urine 
BP
Urine output - good for acute illness 
Cystatin C
- Biomarker of kidney function
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3
Q

What is shown on dipstick and what does it suggest

A 
Protein 
Haematuria
Leucocytes = UTI
Nitrites = gram -ve UTI 
Glucose = DM / preg / sepsis 
Ketones = DKA / starvation
Bilirubin = haemolysis 
Urobilinogen = haemolysis / liver disease
Specific gravity = dehydration
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4
Q

What. is urea and what does increased level suggest

A

Breakdown product of AA so protein catabolism will increase

ACUTE GI BLEED
Acute illness
Increased intake
Catabolism - Haemorrhage / trauma / steroid 
Steroids 
Tetracycline 
Dehydration
- Higher urea rise than creatinine 
RENAL FAILURE
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5
Q

What causes decreased urea

A

Liver disease - As made in the liver (good marker of chronic)
Pregnancy
Low protein

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6
Q

How do you differentiate a high urea caused by renal or dehydration

A

Dehydration

  • Higher urea rise than creatinine
  • Associated hypernatramia
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7
Q

What is creatinine

A

By product of protein turnover

Higher increase in AKI than urea

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8
Q

What causes other electrolyte disturbances

A

Renal disease

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9
Q

What is cystatin C

A

Predictor of CVD disease in kidney

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10
Q

What does proteinuria suggest and predict

A 
Glomerulus injury 
GN
DM
Amyloidosis 
Myeloma 
Increased risk of CVD disease
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11
Q

What should you do if proteinuria found on dipstick

A

Bloods for CVD disease + autoimmune screen
ACR - picks up earlier stage
PCR
24 hour urine collection = gold standard

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12
Q

What are indications for renal biopsy

A 
Protein >1g / day
Unexplained proteinuria
Unexplained haematuria
Decreased renal function but normal sized kidney and unknown cause 
Suspected RPGN / glomerular
Suspected multi-system disease e.g. RA
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13
Q

What does an atrophied kidney suggest

A

Damage been there for a while

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14
Q

How is a renal biopsy completed

A

LA
USS guidance
Go in lower pole fixed in inspiration

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15
Q

What are the main complications of renal biopsy and how do you prevent

A 
Haemorrhage
Check platelet, BP, coag
Stop anti-coagulation 
Stay in bed 24 hours post
No heavy lifting for 2 weeks
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16
Q

What should you do after biopsy

A

Light + electronmicroscopy to see tubules

Immunoflurescence for immune deposition - IgA

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17
Q

What should you do if dysuria, frequency, nocturia, urgency

A

Primary Ddx = UTI

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18
Q

What suggests prostatic aetiology

A

Difficulty initiating
Poor stream
Dribbling

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19
Q

What should you do if oliguria

A

Assessment and investigation of AKI

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20
Q

What is most common cause of polyuria and other DDX

A 
High fluid intake = most common
DM
DI 
Hypercalcaemia
Renal medullary = impaired concentration
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21
Q

What does loin colic pain suggest

A

Stone or clot

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22
Q

What does loin constant pain suggest

A

Pyelonephritis
Renal cyst
Infarct

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23
Q

What are differentials of visible haematuria

A 
Malignancy
PKD
Stone 
Glomerulus disease
Infection
24
Q

What do you do if someone presents with oedema/ nephrotic / resistant HTN

A

Dipstick to avoid missing renal disease

Biopsy if adult

25
What are features of symptomatic CKD
``` Dyspnoea Anaemia Weight loss Pruritus Bone pain Sexual Cognitive decline ```
26
How is metabolic acidosis classified
Normal anion gap | Raised anion gap
27
What is the anion gap
(Na+K) - (Cl+HCO3) Normal = 10-18 If question supplies Cl then indicates to calculate to work out cause
28
What will cause a normal anion gap acidosis
Loss of bicarb or increase in H = acidosis Addison's Bicarb loss Chloride Pancreatic fistula Renal tubular acidosis
29
What causes a raised metabolic acidosis
``` MUDPILES Methanol Uraemia - due to renal failure DKA / starvation ketones / alcoholic ketoacidosis - Always check the ketones in a metabolic acidosis Paracetamol Iron / Isonazid Lactic acidosis Ethanol Salcilyates (aspirin) ```
30
What causes lactic acidosis
Shock Sepsis Hypoxia Metformin
31
What causes a metabolic alkalosis
``` Loss of H or gain in bicarbonate Activation of RAAS due to ECF depletion - reabsorb Na in exchange for H Hypokalaemia - K shift out in exchange for H Vomiting Aspiration Diuretic Primary aldosteronism - Conn's Cushing's ```
32
What can haematuria be classed as
Visible - 20% malignancy Non-visible symptomatic Non-visible asymptomatic
33
What are common causes of haematuria
``` Malignancy - often painless Infection / UTI Stone Trauma - catheter etc Think for each part of tract Kidney, ureter, bladder, prostate and urethra ``` GN
34
What are other causes
``` TB Obstruction Prostate / bladder / penile / renal / ureter malignany BPH Renal vein thrombosis - due to carcinoma Alport PCKD Rhabdomyolysis Coagulopathy AV malformation Endometriosis Schistosomiasis Catherer RT Drugs that cause nephritic syndrome Beetroot Dehydration Menstruation Exercise Sex ```
35
What causes renal vein thrombosis
Malignancy
36
Haematuria + other Sx
Painless + smoking Hx = TCC Mild renal impairment / painless = PCKD Prostate Sx = BPH or catheter Confusion = UTI / AKI
37
Can you attribute haematuria to anti-coagulant
NO | Always investigate
38
What do you do for all haematuria >40
CYSTOSCOPY TO EXCLUDE MALIGNANCY ``` Exclude UTI - dip + MSSU Examine abdo, VE or DRE FBC (infection/anaemia), U+E, LFT (mets), CRP (infection) Bone profile if worried about stone Clotting G+S = only if emergency PCR Obs - BP Pregnancy test if reproductive age ``` ``` Urology assessment Renal USS = 1st line for upper tract or CT KUB if RF or FH CT thorax if confirmed cancer Cystoscopy ALWAYS to exclude malignancy ``` 2 weeks if VH (25%) 4 weeks if NVH (5%)
39
When should you refer to kideney
``` eGFR <60 Proteinuria Hypertension FH renal / cancer Dysuria / WCC raised ```
40
What should also get referral in elderly
>60 | Persistent UTI
41
When do you admit to ward
If clot retention Suspected Hb drop Shock
42
What suggest clot retention
Had visible haematuria | Now no urine output
43
How do you manage clot retention
``` ABCDE Transfuse if <80 or <100 + IHD 3 way catheter +- wash out till urine clear then irrigation to stop blockage Treat cause TWOC Outpatient USS + cystoscopy ```
44
Young female presents with hematuria
MSSU Pregnancy test Renal USS
45
What do you do if ongoing haematuria
Irrigation | USS to look for clot / theatre to evacuate
46
What do you do if no cause of haematuria found
BP, U+E - eGFR, ACR every 6 months
47
What do you do if <40, NVH, normal renal and no BP and normal protein
Manage primary care
48
What proportion of CO does kidney receive
25%
49
What cells make up glomerulus
Endothelial Glomerular basement membrane Podocyte Mesangial cell
50
What are endothelial cells
Fenestrated and vulnerable to immune injury
51
What makes up the BM
Type IV collagen
52
What synthesis collagen
Podocyte and endothelial cells
53
What proteins make up podocyte
Podocin | Nephrin
54
What is role of mesangial cell
Support glomerulus | Embedded in GBM
55
How does lactic acidosis present
N+V Muscle pain Weakness Fatigue
56
Resp acidosis
See disease table

Renal / Urology (16 decks)

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