Clinical Essentials Flashcards
What defines oliguria?
Urine output < 0.5ml/kg/hour
What defines anuria?
Passage of < 50ml urine in 24 hours
Healthy adults will pass roughly how much urine in an hour?
1ml/kg
Polyuria can be caused by which electrolyte abnormality?
Hypercalcaemia
Normal protein excretion is less than how much per day?
150mg
Describe the appearance of urine in people with proteinuria?
Pink and frothy
Nephrotic range proteinuria always indicates what type of disease?
Glomerular disease
What is the triad of nephrotic syndrome?
Oedema, hypoalbuminaemia, proteinuria > 3g/day
Passing how much protein in the urine in one day is defined as heavy proteinuria?
1-3g
Passing how much protein in the urine in one day is defined as asymptomatic low grade proteinuria?
< 1g
Passing how much protein in the urine in one day is defined as nephrotic range proteinuria?
> 3g
What is sometimes considered a fourth feature of nephrotic syndrome, which occurs as an attempt to compensate for protein loss?
Hyperlipidaemia
What investigation should be used ideally to quantify proteinuria?
Spot protein/albumin: creatinine ratio
Haematuria throughout the stream is suggestive of bleeding from where?
Glomerulus
Haematuria at the beginning of the stream is suggestive of bleeding from where?
Urethra
Haematuria at the end of the stream is suggestive of bleeding from where?
Bladder or prostate
What causes myoglobinuria?
Rhabdomyolysis
What causes haemoglobinuria?
Haemolysis
What is the management for any cases of painless visible haematuria?
Urgent referral to urology
CKD is classified according to what?
GFR
When is a spot urine test for calculating albumin: creatinine ratio best done?
Morning
What is a normal albumin: creatinine ratio in a man?
< 2.5mg/mmol
What is a normal albumin: creatinine ratio in a woman?
< 3.5mg/mmol
An albumin: creatinine ratio of what is equal to 0.5g of protein being excreted per day?
30mg/mmol
An albumin: creatinine ratio of what is equal to 1g of protein being excreted per day?
70mg/mmol
To calculate the daily protein excretion from a protein: creatinine ratio, what should you do?
Multiply the number by 10 and then convert into grams
Haematuria is divided into what two types?
Visible and non-visible
Non-visible haematuria is sub-divided into what two types?
Symptomatic and asymptomatic
What type of urine sample should be used for urine microscopy?
Mid-stream sample
On urinalysis, what two indicators are most likely to be raised in someone with a UTI?
Leukocytes and nitrites
What does specific gravity of urine measure?
How concentrated the urine is
What is the normal pH range of urine?
4.5-8
If there is any abnormality detected on dipstick testing, what investigation should be done next?
Urine microscopy
The presence of dysmorphic red cells on urine microscopy suggests what?
Glomerular damage
If a urine dipstick is strongly positive for blood but there are no red cells seen on microscopy, what does this suggest?
Haemoglobinuria or myoglobinuria
What does the presence of red cell casts in the urine indicate?
Glomerular damage
What does the presence of white cell casts in the urine indicate?
Acute infection, usually bacterial
What type of urine casts are usually benign?
Hyaline
What does the presence of granular casts in the urine indicate?
Chronic disease
What happens to urea and creatinine when renal function is impaired?
Increase
Neither urea or creatinine tend to rise significantly until GFR falls to around what value?
30ml/min
What is the normal GFR for an average adult?
125ml/min
Which individuals tend to have higher values of creatinine?
Those with a large muscle bulk
Which drug often causes an isolated rise in creatinine?
Trimethoprim
What is used to calculate a simple estimate of GFR?
Creatinine clearance
Why does creatinine clearance slightly overestimate GFR?
There is a small amount of tubular secretion
What is usually the first line imaging investigation for a suspected renal problem?
Ultrasound
What imaging investigation can be used to assess the patency of renal vessels?
Ultrasound with Doppler
What is the first line imaging investigation for renal colic?
CT-urogram (CT-KUB)
Any histological diagnosis of renal disease requires what investigation?
Renal biopsy
What medications should always be stopped before a renal biopsy?
Anticoagulants
What investigation should always be done before a renal biopsy to establish the kidney anatomy?
Renal ultrasound
What is the most common complication of a renal biopsy? This usually occurs within how long?
Bleeding - usually within 8 hours of the procedure
