INVESTIGATIONS - renal

Question 1

Choice of imaging for definitive diagnosis of renal calculi?

Answer 1

Non-contrast CT

Question 2

First line imaging for renal colic?

Answer 2

KUB x-ray

Question 3

Imaging choice for calculi in pregnancy?

Answer 3

Ultrasound or MRI

Question 4

A 60 year old patient presents with macroscopic haematuria. What imaging modality would you choose to examine the kidneys and ureters?

Answer 4

CT urogram (with contrast)

Question 5

A 60 year old patient presents with macroscopic haematuria. What imaging modality would you choose to examine the bladder and urethra?

Answer 5

Cystography

Question 6

A 40 year old patient presents with macroscopic haematuria. What imaging modality would you choose?

Answer 6

Ultrasound (to detect calculi and renal parenchymal tumours)

or cystoscopy to look for occasional bladder tumours or calculi, or evidence of prostatitis

Question 7

What would warrant CT urgraphy in a patient <50?

Answer 7

Persistent macroscopic haematuria with normal ultrasound and normal cystoscopy

Question 8

How do most renal masses present?

Answer 8

Incidental finding

Question 9

What imaging modality is used to asses size, density and internal morphology of renal masses?

Answer 9

CT

Question 10

What kind of renal mass may be diagnosed with ultrasound alone?

Answer 10

Simple cyst

Question 11

What’s the choice of imaging for staging malignant renal tumours?

Answer 11

CT

Question 12

What types of imaging are used to examine the renal collecting ducts?

Answer 12

IV urogram (i.e. x-ray KUB with contrast)
CT urogram (with contrast)

Question 13

What type of imaging is used to assess renal pre-renal renal impairment e.g. artery stenosis?

Answer 13

MR (or CT) angiography

Question 14

In a patient with post-renal impairment (i.e. obstruction), what type of imaging would you choose to exclude hydronephrosis?

Answer 14

Ultrasound

Question 15

In a patient with renal impairment due to ureteric obstruction, what type of imaging would you choose to establish the cause of obstruction?

Answer 15

CT

Question 16

What imaging modality would you choose to investigate a painful scrotum or scrotal swelling?

Answer 16

Ultrasound

Question 17

What imaging modality would you use to asses renal trauma / injury?

Answer 17

CT

Question 18

What imaging modality would you use to asses ureteric injury in trauma?

Answer 18

CT

Question 19

What imaging modality would you use to asses bladder injury / trauma?

Answer 19

Contrast cystography

+/- CT

Question 20

What would you do if urethral injury was suspected?

Answer 20

Call a urologist. Contrast and urethrogram needed.

Question 21

How would you investigate a patient with renal impairment due to parenchymal disease, drugs or toxins?

Answer 21

US guided biopsy

Question 22

Give a possible cause of hypervascular testis / epididymis on ultrasound?

Answer 22

Epididymo-orchitis

Question 23

How would testicular torsion appear on ultrasound?

Answer 23

avascular

Question 24

If a patient presents with renal impairment and positive antibodies, what should be done next?

Answer 24

Renal biopsy

Question 25

Give three indications for renal biopsy in AKI

Answer 25

``` Positive immunology (ANA, ANCA, GBM) Renal cause (e.g. drugs, parenchymal disease, toxins) Current management not working ```

Question 26

A patient has high calcium, low Hb and Bence Jones proteins present. What's the likely diagnosis?

Answer 26

Myeloma

Question 27

What size should a healthy kidney be on ultrasound?

Answer 27

10-12 cm

Question 28

ECG findings in hyperkalaemia?

Answer 28

Tall T waves Broad QRS Lost P wave Bradycardia

Question 29

What would you find on investigation of a patient with nephrotic syndrome?

Answer 29

Proteinuria Lipiduria Hypoalbuminaemia (due to loss in urine) Hypercholesterolaemia (liver trying to compensate) Oedema (decreased intravascular oncotic pressure)

Question 30

What type of cell has been damaged if there's protein (but no RBCs) in the urine?

Answer 30

Podocytes

Question 31

What type of cell has been damaged if there's red cells in the urine?

Answer 31

mesangial or endothelial cells

Question 32

What's the definitive investigative test for glomerulonephritis?

Answer 32

Renal biopsy

Question 33

What's the trademark histological finding of diabetic glomerulosclerosis?

Answer 33

Kimmelstiel-wilson nodules | round eosinophilic nodules

Question 34

What do epithelial crescents on histology suggest?

Answer 34

Severe glomerular damage (e.g. rapidly progressive glomerulonephritis)

Question 35

First line imaging in suspected PCKD?

Answer 35

Ultrasound CT / MRI if US is unclear