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Renal > Background Renal Disease and Haematuria > Flashcards

Background Renal Disease and Haematuria Flashcards

(48 cards)

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1
Q

What are the functions of the kidney [8]

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

How do you measure kidney function [6]

A 
Dipstick 
eGFR 
U+E
BP
Urine output - good for acute illness 
Cystatin C
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3
Q

What is shown on dipstick and what does it suggest [9]

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 [6]

A 
Breakdown product of AA so protein catabolism will increase
ACUTE GI BLEED
Acute illness
Increased intake
Steroids 
Dehydration
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5
Q

What causes decreased urea

A

Liver disease

As its made in the liver

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6
Q

How do you differentiate a high urea caused by renal or dehydration [2]

A

Dehydration

  • Higher urea rise than creatinine
  • Associated hypernatramia
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7
Q

What is creatinine [2]

A

By product of protein turnover

Higher risk 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 cystitis C

A

Predictor of CVD disease

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10
Q

What does proteinuria suggest [5]

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

What should you do if proteinuria found on dipstick [4]

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 [4]

A

Protein >1g / day
Decreased renal function but normal sized kidney
Suspected RPGN
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 [3]

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 [4]

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 [2]

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 [3]

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 [5]

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

What does loin colic pain suggest

Study These Flashcards
A

Stone or clot

22
Q

What does loin constant pain suggest [3]

Study These Flashcards
A

Pyelonephritis
Renal cyst
Infarct

23
Q

What are differentials of visible haematuria [3]

Study These Flashcards
A

Malignancy
PKD
Glomerulus disease

24
Q

What do you do if someone presents with oedema/ nephrotic [2]

Study These Flashcards
A

Dipstick to avoid missing renal disease

Biopsy if adult

25
What are features of symptomatic CKD [8]
``` Dyspnoea Anaemia Weight loss Pruritus Bone pain Sexual Cognitive decline ```
26
How is metabolic acidosis classified [2]
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? [5]
``` Loss of bicarb or increase in H = acidosis Addison's Diarrhoea Pancreatic fistula Renal tubular acidosis Drugs ```
29
What causes a raised metabolic acidosis [4]
Ketones - DKA / alcohol Lactic acdisois Urate renal failure Acid poison
30
What causes lactic acidosis [4]
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 [3]
Visible Non-visible symptomatic Non-visible asymptomatic
33
What are important tests after haematuria found
Dipstick + urine culture to exclude UTI ACR / PCR FBC, U+E incase refer to renal BP
34
What are causes of haematuria in order of most common [4]
UTI / infection (urethritis) Stone Malignancy - often painless GN
35
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 ```
36
What causes renal vein thrombosis
Malignancy
37
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
38
Can you attribute haematuria to anti-coagulant
NO | Always investigate
39
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%)
40
When should you refer [6]
``` eGFR <60 Proteinuria Hypertension FH renal / cancer Dysuria WCC raised ```
41
What should also get referral in elderly [2]
>60 | Persistent UTI
42
When do you admit to ward? [2]
If clot retention | Suspected Hb drop
43
What suggest clot retention
Had visible haematuria | Now no urine output
44
How do you manage clot retention [5]
``` ABCDE Transfuse if <80 or <100 + IHD Catheter +- wash out TWOC Outpatient USS + cystoscopy ```
45
Young female presents with hematuria [3]
MSSU Pregnancy test Renal USS
46
What do you do if ongoing haematuria [2]
Irrigation | USS to look for clot / theatre to evacuate
47
What do you do if no cause of haematuria found [4]
BP, eGFR, ACR every 6 months
48
What do you do if <40, NVH, normal renal and no BP and bo protein
Manage primary care

Renal (29 decks)

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