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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
Q

What are features of symptomatic CKD

A 
Dyspnoea
Anaemia 
Weight loss
Pruritus
Bone pain
Sexual
Cognitive decline
26
Q

How is metabolic acidosis classified

A

Normal anion gap

Raised anion gap

27
Q

What is the anion gap

A

(Na+K) - (Cl+HCO3)
Normal = 10-18
If question supplies Cl then indicates to calculate to work out cause

28
Q

What will cause a normal anion gap acidosis

A

Loss of bicarb or increase in H = acidosis
Addison’s
Bicarb loss
Chloride

Pancreatic fistula
Renal tubular acidosis

29
Q

What causes a raised metabolic acidosis

A 
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
Q

What causes lactic acidosis

A

Shock
Sepsis
Hypoxia
Metformin

31
Q

What causes a metabolic alkalosis

A 
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
Q

What can haematuria be classed as

A

Visible
- 20% malignancy
Non-visible symptomatic
Non-visible asymptomatic

33
Q

What are common causes of haematuria

A 
Malignancy - often painless
Infection / UTI 
Stone 
Trauma - catheter etc 
Think for each part of tract
Kidney, ureter, bladder, prostate and urethra

GN

34
Q

What are other causes

A 
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
Q

What causes renal vein thrombosis

A

Malignancy

36
Q

Haematuria + other Sx

A

Painless + smoking Hx = TCC
Mild renal impairment / painless = PCKD
Prostate Sx = BPH or catheter
Confusion = UTI / AKI

37
Q

Can you attribute haematuria to anti-coagulant

A

NO

Always investigate

38
Q

What do you do for all haematuria >40

A

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
Q

When should you refer to kideney

A 
eGFR <60
Proteinuria
Hypertension
FH renal / cancer
Dysuria / WCC raised
40
Q

What should also get referral in elderly

A

> 60

Persistent UTI

41
Q

When do you admit to ward

A

If clot retention
Suspected Hb drop
Shock

42
Q

What suggest clot retention

A

Had visible haematuria

Now no urine output

43
Q

How do you manage clot retention

A 
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
Q

Young female presents with hematuria

A

MSSU
Pregnancy test
Renal USS

45
Q

What do you do if ongoing haematuria

A

Irrigation

USS to look for clot / theatre to evacuate

46
Q

What do you do if no cause of haematuria found

A

BP, U+E - eGFR, ACR every 6 months

47
Q

What do you do if <40, NVH, normal renal and no BP and normal protein

A

Manage primary care

48
Q

What proportion of CO does kidney receive

A

25%

49
Q

What cells make up glomerulus

A

Endothelial
Glomerular basement membrane
Podocyte
Mesangial cell

50
Q

What are endothelial cells

A

Fenestrated and vulnerable to immune injury

51
Q

What makes up the BM

A

Type IV collagen

52
Q

What synthesis collagen

A

Podocyte and endothelial cells

53
Q

What proteins make up podocyte

A

Podocin

Nephrin

54
Q

What is role of mesangial cell

A

Support glomerulus

Embedded in GBM

55
Q

How does lactic acidosis present

A

N+V
Muscle pain
Weakness
Fatigue

56
Q

Resp acidosis

A

See disease table

Renal / Urology (16 decks)

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