Clinical Skills

Question 1

As there are more nephrons in each kidney than needed to sustain life ________

Answer 1

significant renal damage can occur without obvious clinical effects

Question 2

Describe when pain may occur in renal disease

Answer 2

Uncommon

May occur in obstruction (renal stones), infection or inflammation

Question 3

Proteinuria can produce ______ urine

Answer 3

frothy

Question 4

Dark urine can occur in …

Answer 4

myoglobinuria in rhabodymyolysis ( destruction of muscle tissue)
Haemoglobinuria of haemolysis (destruction of red blood cells in a haemolytic anaemia)
These excess products due to destruction of muscle or blood cells enter plasma and are filtered by kidneys into the urine.

Question 5

Recurrent intermittent frank haematuria suggests ________

Answer 5

IgA glomerulonephritis in young people or renal tract cancer in older people

Question 6

Bleeding that is present throughout the stream suggests _____1_____
Bleeding only at the beginning of the stream suggests ____2_____
Bleeding only at the end of the stream suggests _____3________

Answer 6

1) Glomerular bleeding
2) urethral bleeding
3) bladder or prostate bleeding

Question 7

What is the difference between increased urinary frequency and polyuria?

Answer 7

Increased frequency: increased frequency in micturation

Polyuria: increase in total urine volume

Question 8

Increased urinary frequency especially at night can suggest __________

Answer 8

prostatic enlargement in men or urinary tract infection

Question 9

What does polyuria suggest?

Answer 9

Defect in urine concentrating system or excess water ingestion

Question 10

What can prostatic enlargement cause?

Answer 10

increased urinary frequency, hesitancy, dribbling and obstruction and urinary retention

Question 11

Useful signs to assess fluid status?

Answer 11

Peripheral pitting oedema, signs of pulmonary oedema, effusions, cardiac gallop rhythm > fluid overload
Decreased skin turgor and decreased BP > hypovolaemic

Question 12

Cardiac gallop rhythm may be present in

Answer 12

hypervolaemia

Question 13

Deformed dysmorphic red cells on urine microscopy suggest ________

Answer 13

glomerular bleeding

Question 14

White cells on urine microscopy suggest ______

Answer 14

inflammation

Question 15

Casts on urine microscopy suggest ________

Answer 15

Red cells- glomerular bleeding
White cells- inflammation
Hyaline and granular- normal finding
Fatty- nephrotic syndrome
Waxy- dilated tubules in chronic renal failure

Question 16

What are casts?

Answer 16

Cylindrical aggregates formed in distal tubule or collecting duct

Question 17

Crystals on urine microscopy suggests ______

Answer 17

may suggest a stone forming tendency but might be a normal finding

Question 18

What 2 things detectable on dipstick may suggest infection?

Answer 18

Nitrites and Leukocyte esterases

Question 19

In CKD is blood pressure often high or low?

Answer 19

High

Question 20

What renal symptoms may you ask about in a consultation? (8)

Answer 20

Fatigue
Itch
Nausea or Vomiting
Weight loss or gain
Shortness of breath  
Urine output (blood?)
Ankle oedema
Pain

(a lot of systemic symptoms to do with changes in toxins in blood changing apetite etc or alternatively symptoms of fluid overload e.g. SOB)

Question 21

What may be relevant to ask about in a renal past medical history and why?

Answer 21

Previous UTIs
Congenital abnormalities
Previous AKI
renal tract surgery
previous illnesses (potential triggers of IgA nephropathy, post infectious glomerulonephritis etc)
Systemic conditions e.g. hypertension and diabetes

Question 22

What may be relevant to ask about in a renal drug history?

Answer 22

NSAIDs
Diuretics
ACEs
ARBS
Metformin
Gentamicin