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URGENT > Core problems > Flashcards

Core problems Flashcards

1
Q

What are the 3 commonest sites for a renal calculi?

A

Ureteropelvic junction, ureters crossing over iliac arteries, uretero-vesical junction

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2
Q

Give 4 compositions of renal calculi. What is the commonest?

A

CALCIUM OXALATE, uric acid, struvate (infected stones w/ magnesium, calcium + ammonium), cysteine

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3
Q

What are struvate stones made from?

A

Bacteria, magnesium,

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4
Q

What are the risk factors for developing renal calculi?

A

Anatomical deformities (trauma, hoarseshoe kidney…etc), urinary factors (increased concentration of substances)….etc

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5
Q

What are the causes of calcium oxalate stones?

A

Hypercalcuria, hyperoxaluria, low dietary calcium

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6
Q

How does low dietary calcium cause struvate stones to form?

A

There is decreased intestinal binding of oxalate and calcium –> ^ oxalate absorption –> ^ urinary oxalate excretion

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7
Q

What diseases are hyperuricaemia associated with?

A

Gout and uric acid stones

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8
Q

What are the symptoms of a kidney stone?

A

Asymptomatic, renal colic (loin pain), recurrent UTIs (LOTS), haematuria

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9
Q

What might a person also have if they suffer from a uric acid stone?

A

Gout

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10
Q

Describe the pain caused by a kidney stone

A

Loin pain, radiates to groin (E.g. testes), rapid onset, VERY severe, unilateral, colicky, worse on fluid loading, associated nausea

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11
Q

Why is the pain colicky (comes and goes) for renal calculi?

A

Due to peristalsis of the ureters

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12
Q

How does renal colic pain differ from appendicitis pain?

A

Appendicitis pain is associated with a fever? It starts of generalised in the abdomen and then localises to the RIF (renal colic is in the loin and radiates to the groin)

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13
Q

What is the DDx for renal colic?

A

AAA, appendicitis, diverticulitis, ectopic pregnancy, testicular torsion…

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14
Q

What urine investigations would you carry out to investigate renal colic?

A

urinalysis/dipstick, 24hr urine collection (cysteine, oxalate…), MSSU/MC&S

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15
Q

What blood tests might you order to investigate renal colic?

A

FBC, U+Es (Ca2+ and urate)

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16
Q

EXAM: what is the gold standard investigation to diagnose/look for kidney stones? What else can you use?

A

NCCT-KUB (non-contrast CT of kidney, ureters and bladder) - can use KUB XR

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17
Q

Why is non-contrast used when investigating renal colic?

A

Toxicity - can make things worse?

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18
Q

What might USS show in renal colic?

A

Hydronephrosis

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19
Q

Give 2 complications of kidney stones

A

UTIs and sepsis

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20
Q

Why is an MRI not used to investigate stones?

A

You can’t see the stones

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21
Q

What is the treatment for small kidney stones?

A

fluids, analgesia, anti-emetic, observe (as most stones pass spontaneously)

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22
Q

What is the management for a larger kidney stone that isn’t passing spontaneously?

A

Admit, IV fluids, analgesia, anti-emetic, observe for sepsis, ESWL –> ureteroscopy w/ laser –> PCNL

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23
Q

give an example of an anti-emetic - how does it work?

A

Serotonin 5-HT3 receptor antagonist (e.g. granisetron)

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24
Q

Why can ACE-I be used in CKD but not AKI?

A

It is nephrotoxic (reduces renal perfusion by vasodilating the efferent arteriole) it causes AKI - but in CKD the cause is hypertension therefore using ACE-I is helpful

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25
Q

What is the commonest cause of AKI?

A

Pre-renal causes

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26
Q

In AKI why do you get SOB/hypoxia?

A

Because reduced GFR means you go into fluid overload causing pulmonary oedema

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27
Q

What is used to to stage AKI?

A

KDIGO: using serum creatinine + urine output

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28
Q

What do the investigations in AKI look for?

A

Staging of severity, causes and complications

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29
Q

Why is contrast imaging avoided in AKI?

A

Nephrotoxic - makes AKI worse

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30
Q

Give examples of nephrotoxic drugs?

A

Gentamicin, ACE-i, NSAIDs,

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31
Q

Give some pre-renal causes of AKI

A

Hypovolaemia (burns, haemorhage), HF (hypotension), infection, NSAIDs, ACE-i, Renal artery stenosis, diarrhoea, thrombosis

32
Q

Give some renal causes of AKI

A

Vasculitits, HUP, TTP, infection, SLE, glomerulonephritis, acute tubular necrosis

33
Q

What is the commonest renal cause of AKI?

A

Acute tubular necrosis

34
Q

Give some post-renal causes of AKI

A

Urinary tract obstruction (stone, tumour [bladder, ureter, prostate], BPH, strictures)

35
Q

What is AKI? What is it characterised by?

A

The sudden decrease in renal function - reduced GFR, increased serum urea and creatinine, decreased urine output

36
Q

Give 5 complications of AKI - explain how they occur

A

Metabolic acidosis (increased HCO3- excretion), ureamia (reduced excretion of nitrogenous waste - urea), fluid overload (Na+/H2O retention), hyperkalaemia (reduced potassium excretion), decreased urine output

37
Q

Give 2 complications of uraemia

A

Uraemic pericarditis + encephalopathy

38
Q

Give the symptoms of AKI and explain why they occur

A
  1. uraemia –> pruritis, anorexia, nausea, vomiting, drowsiness, confusion, coma
  2. SOB –> due to fluid overload causing pulmonary oedema
39
Q

What signs are there for AKI

A

Fluid overload: pulmonary crackles + hypoxia (therefore ^ RR), ^ JVP, oedema, ascites
Pericardial rub
Skin rash

40
Q

What might you ask in Hx when investigating AKI?

A

Any recent change in or start of new medications

41
Q

What is normal eGFR?

A

100ml/min/1.73m2

42
Q

How would you stage the severity of AKI?

A

KDIGO - serum creatinine + urine output

43
Q

What might you see on a urine dipstick in AKI?

A

Infection (leucocytes + nitrates), blood + protein (glomerulonephritis)

44
Q

What blood tests would you order for AKI?

A

U+E (K+, HCO3-, urea…etc), FBC, Serology

45
Q

What might FBC show in AKI? Why?

A

Anaemia (reduced EPO production)

46
Q

What might U+Es show in AKI?

A

Hyperkalaemia and metabolic acidosis

47
Q

What imaging tests might you do in AKI?

A

USS and CXR

48
Q

What is CXR likely to show in AKI?

A

Pulmonary oedema

49
Q

If the cause is post-renal what will USS show in AKI?

A

Hydronephrosis due to urinary tract obstruction

50
Q

Why would you carry out an ECG in AKI?

A

To look for evidence of hyperkalaemia and uraemic pericarditis

51
Q

What ECG changes are seen in hyperkalaemia?

A

Tall tented T waves, absent P waves, wide QRS complex, prolonged PR interval

52
Q

Why would you do a renal biopsy?

A

To exclude glomerulonephritis + vasculitis

53
Q

How would you treat AKI?

A
  1. Identify + treat cause (e.g. stop nephrotoxins…) –> if pre-renal: IV fluid replacement
  2. renal referral if poor response to above
    - RRT (dialysis)
    - Rx complications: hyperkalaemia, pulmonary oedema, acidaemia, uraemia

Also: Low K+ diet

54
Q

When is a renal referral indicated in AKI?

A

Unknown cause, hyperkalaemia, fluid overload, uraemia, glomerulonephritis suspected (blood + protein on dipstick)

55
Q

How would you treat hyperkalaemia?

A

IV calcium gluconate, IV insulin + dextrose

56
Q

How would you treat pulmonary oedema?

A

Diuretics (furosemide)

57
Q

How would you treat uraemia?

A

Dialysis

58
Q

How would you treat acidaemia?

A

Dialysis + IV/oral sodium bicarbonate

59
Q

How does acute tubular necrosis present?

A

Initially oliguric and then polydipsia (diuresis)

60
Q

What is the sympathetic and parasympathetic control to the bladder?

A

Parasympathetic: S2-4
Sympathetic: T11-L2

61
Q

Who is at risk of developing AKI?

A

> 65, DM, CKD, HF, kidney stones (other urinary obstruction)

62
Q

What is the diagnosis of AKI based on NICE guidelines?

A
  • rise in serum creatinine of >26 mmol/L in 48h
    Or 50%+ rise in serum creatinine in past 7 days
  • drop in urine output to 0.5ml/kg/h for 6h
63
Q

If the cause of AKI was pre-renal, how would you treat it?

A

IV fluids

64
Q

What are the two causes of ADPKD?

A

85% PKD1 mutation (chromosome 16)

15% PKD2 mutation (chromosome 14)

65
Q

What is the commonest cause of PKD?

A

ADPKD

66
Q

Which mutation in ADPKD has the slower course to ESRF (later in life)?

A

PKD2 mutation

67
Q

Give some complications of ADPKD

A

SAH (due to berry aneurysm formation), ESRF, mitral valve prolapse, kidney stones, hypertension, ovarian cyst, UTI

68
Q

What does urinalysis show in PKD?

A

Haematuria, UTI, proteinuria

69
Q

How would you screen for PKD?

A

USS (shows cysts) and genetic testing

70
Q

What must you do with all patients and 1st degree relatives of someone who has PKD?

A

MR angiography to screen for berry aneurysm

71
Q

What system is used to classify cysts?

A

Bosniak classification

72
Q

What symptoms might a person with ADPKD have?

A

Haematuria, loin pain, ^ UTIs, renal calculi

73
Q

What signs might a person with ADPKD have?

A

Palpable enlarged kidney and hypertension

74
Q

What is the treatment for ADPKD?

A

Monitor U+E, ACE-i (hypertension), Rx infections, pain (laparoscopic cyst removal)

75
Q

What drug is in development for ADPKD?

A

V2 receptor antagonist (tolvaptan)

76
Q

How would you treat ESRF in ADPKD patients?

A

RRT

URGENT (2 decks)

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