Background Renal Disease and Haematuria Flashcards
What are the functions of the kidney [8]
Body fluid homeostasis Electrolyte homeostasis Acid base balance Regulate BP Remove physiological waste Vit D production Erythropoietin production Renin production
How do you measure kidney function [6]
Dipstick eGFR U+E BP Urine output - good for acute illness Cystatin C
What is shown on dipstick and what does it suggest [9]
Protein Haematuria Leucocytes = UTI Nitrites = gram -ve UTI Glucose = DM / preg / sepsis Ketones = DKA / starvation Bilirubin = haemolysis Urobilinogen = haemolysis / liver disease Specific gravity = dehydration
What is urea and what does increased level suggest [6]
Breakdown product of AA so protein catabolism will increase ACUTE GI BLEED Acute illness Increased intake Steroids Dehydration
What causes decreased urea
Liver disease
As its made in the liver
How do you differentiate a high urea caused by renal or dehydration [2]
Dehydration
- Higher urea rise than creatinine
- Associated hypernatramia
What is creatinine [2]
By product of protein turnover
Higher risk in AKI than urea
What causes other electrolyte disturbances
Renal disease
What is cystitis C
Predictor of CVD disease
What does proteinuria suggest [5]
GN DM Amyloidosis Myeloma Increased risk of CVD disease
What should you do if proteinuria found on dipstick [4]
Bloods for CVD disease + autoimmune screen
ACR - picks up earlier stage
PCR
24 hour urine collection = gold standard
What are indications for renal biopsy [4]
Protein >1g / day
Decreased renal function but normal sized kidney
Suspected RPGN
Suspected multi-system disease e.g. RA
What does an atrophied kidney suggest
Damage been there for a while
How is a renal biopsy completed [3]
LA
USS guidance
Go in lower pole fixed in inspiration
What are the main complications of renal biopsy and how do you prevent [4]
Haemorrhage
- Check platelet, BP, coag
- Stop anti-coagulation
- Stay in bed 24 hours post
- No heavy lifting for 2 weeks
What should you do after biopsy [2]
Light + electronmicroscopy to see tubules
Immunoflurescence for immune deposition - IgA
What should you do if dysuria, frequency, nocturia, urgency
Primary Ddx = UTI
What suggests prostatic aetiology [3]
Difficulty initiating
Poor stream
Dribbling
What should you do if oliguria
Assessment and investigation of AKI
What is most common cause of polyuria and other DDX [5]
High fluid intake = most common DM DI Hypercalcaemia Renal medullary = impaired concentration
What does loin colic pain suggest
Stone or clot
What does loin constant pain suggest [3]
Pyelonephritis
Renal cyst
Infarct
What are differentials of visible haematuria [3]
Malignancy
PKD
Glomerulus disease
What do you do if someone presents with oedema/ nephrotic [2]
Dipstick to avoid missing renal disease
Biopsy if adult
What are features of symptomatic CKD [8]
Dyspnoea Anaemia Weight loss Pruritus Bone pain Sexual Cognitive decline
How is metabolic acidosis classified [2]
Normal anion gap
Raised anion gap
What is the anion gap?
Na+K - Cl+HCO3
Normal = 10-18
If question supplies Cl then indicates to calculate to work out cause
What will cause a normal anion gap? [5]
Loss of bicarb or increase in H = acidosis Addison's Diarrhoea Pancreatic fistula Renal tubular acidosis Drugs
What causes a raised metabolic acidosis [4]
Ketones - DKA / alcohol
Lactic acdisois
Urate renal failure
Acid poison
What causes lactic acidosis [4]
Shock
Sepsis
Hypoxia
Metformin
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
What can haematuria be classed as [3]
Visible
Non-visible symptomatic
Non-visible asymptomatic
What are important tests after haematuria found
Dipstick + urine culture to exclude UTI
ACR / PCR
FBC, U+E incase refer to renal
BP
What are causes of haematuria in order of most common [4]
UTI / infection (urethritis)
Stone
Malignancy - often painless
GN
What are other causes of hematuria
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 nephritis Dehydration Menstruation Exercise Sex
What causes renal vein thrombosis
Malignancy
Haematuria + other Sx and what do these indicate? [4]
Painless + smoking Hx = TCC
Mild renal impairment / painless = PCKD
Prostate Sx = BPH or catheter
Confusion = UTI / AKI
Can you attribute haematuria to anti-coagulant
NO
Always investigate
What do you do for all haematuria >40 [5]
Exclude UTI U+E, PCR, BP Urology assessment Renal USS or CT if RF or FH \+ cystoscopy to exclude malignancy
2 weeks if VH (25%)
4 weeks if NVH (5%)
When should you refer [6]
eGFR <60 Proteinuria Hypertension FH renal / cancer Dysuria WCC raised
What should also get referral in elderly [2]
> 60
Persistent UTI
When do you admit to ward? [2]
If clot retention
Suspected Hb drop
What suggest clot retention
Had visible haematuria
Now no urine output
How do you manage clot retention [5]
ABCDE Transfuse if <80 or <100 + IHD Catheter +- wash out TWOC Outpatient USS + cystoscopy
Young female presents with hematuria [3]
MSSU
Pregnancy test
Renal USS
What do you do if ongoing haematuria [2]
Irrigation
USS to look for clot / theatre to evacuate
What do you do if no cause of haematuria found [4]
BP, eGFR, ACR every 6 months
What do you do if <40, NVH, normal renal and no BP and bo protein
Manage primary care
