Meeran Book Renal Flashcards
How can haematuria indicate where the pathology is?
- Present throughout the stream = pathology above the bladder
- Present just at the beginning of the stream = urethral pathology
- Present at the end of the stream = prostatic pathology
What do red cell casts indicate?
Glomerular pathology
What is hyponatraemia due to fluid overload?
A common complication following surgery where the fluid resuscitation is incorrectly balanced, patients will have hypoosomlar blood and urine
What is tubulointerstitial nephritis?
Most commonly a hypersensitivity reaction to drugs such as NSAIDs
How does tubulointerstitial nephritis present?
- Fever
- Arthralgia
- Maculopapular rash
What is renal failure?
Acute loss of renal function, presenting with non-systemic symptoms withijn 48 hours
What is the management of nephrotic syndrome?
- Conservative eg. reduce Na+ intake
- Furosemide
- ACEi
- Albumin adjunct (if other measures haven’t been successful)
What is the first line imaging for renal calculi?
Adults and non-pregnant patients
- CTKUB
Young people (<16) and pregnant patients
- Abdominal USS
How does renal tuberculosis present?
- Flank pain
- Suprapubic pain
- Haematuria
- Increased frequency
- Nocturia
- Sterile pyuria
- White cells in urine without positive MC&S
What is the triad for renal cell carcinoma?
- Haematuria
- Flank pain
- Abdominal/ renal mass
+ FLAWS as with any malignancy
What is a Von Grawitz tumour?
Renal cell carcinoma (another name)
What is the management of UTI in pregnancy?
- Nitrofurantoin
- Cephalexin
Why can trimethoprim not be given in pregnancy?
It’s a folic acid antagonist, therefore can contribute to spinal cord pathologies in the bebe
How can renal failure lead to breathlessness?
Tachypnoea to compensate for metabolic acidosis
What is the first line investigation for suspected renal failure?
Us&Es
(But if the patient is in GP and urinalysis is an option that would be first line according to the bedside, bloods and imaging approach)
Which mutation is associated with polycystic kidney disease?
PKD1 on chromosome 16
What is the first line imaging for polycystic kidney disease?
Abdominal USS
(MRI is better for differentiating soft tissue, therefore would be gold standard but is expensive and not readily availbale in practise)
What is the presentation of polycystic kidney disease?
- Loin or abdominal pain
- Kidneys atrophying
- Haematuria or pyelonephritis symptoms
- Cyst rupture or infection
- Renal failure
What is the management of diabetic patients with new onset proteinuria?
Aggressive blood pressure control to <130/80 mmHg
- ACEi/ ARBs
What is the presentation of a renal abscess?
- Spiking fevers
- Loin pain
- Weight loss
- Malaise
Renal USS used as diagnostic imaging
(Can also use CT, but always better to avoid unnecessary exposure to radiation)
What is a meduallary sponge kidney?
A congenital condition characterised by cysts forming in the papillary zone, obstructing urinary outflow and increasing risk of UTI and renal calculi formation
- Rarely presents before 30
- Diagnosed via excretion urography
What is the first line imaging for acute interstitial nephritis?
Abdominal USS
Can also be diagnosed by CT but radiation :(
What imaging is used to investigation obstructions via a catheter?
Retrograde pyleography
What is acute hyperuricaemic nephropathy?
Uric acid crystallising in the renal system predisposing to infection, it’s common in patients with uraemia
- Tumour lysis syndrome
- Myeloproliferative conditions (particularly haem)
- Chemotherapy
What is the presentation of renal infarction?
Patients will have predisposing factors such as AF presenting with flank/ back pain
What is the most common cause of nephrotic syndrome in children and young people?
Minimal changes nephropathy
What is the triad of Goodpasture’s syndrome?
- Anti-GBM antibodies
- Type IV collagen
- Glomerulonephritis
- Pulmonary damage cause haemorrhage
- Haemoptysis
What is alport syndrome?
Mutation with type IV collagen synthesis
- Nephritis
- Ocular defects
- Cataracts
- Macular retinal flecks
- Sensorineural hearing loss
(I think this is super niche, I’ve only ever done one question on it…)
What is the most common cause of acute tubular necrosis?
Renal ischaemia (pre-renal leading to intra-renal)
What is the most useful investigation for diagnosing diabetic nephropathy?
Urinalysis testing for microalbuminuria
What is the management of minimal changes disease?
Full dose corticosteroids
What are the complications associated with polycycstic kidney disease?
- SAH
- Berry aneurysms
- Mitral valve prolapse
- Mid-systolic click high pitched murmur
- Barlow syndrome
