Nephrology

Question 1

adverse effect of spironolactone that is more distressing for men?

Answer 1

gynaecomastia

Question 2

NICE recommended analgesic for renal colic

Answer 2

75 milligrams of the NSAID diclofenac sodium given by injection into the muscle

Question 3

AKI nice guidelines

Answer 3

This guideline tells what increases the risk of AKI:

1. Emergency surgery, ie, risk of sepsis or hypovolaemia
2. Intraperitoneal surgery
3. CKD, ie if eGFR < 60
4. Diabetes
5. Heart failure
6. Age >65 years
7. Liver disease
8. Use of nephrotoxic drugs

Question 4

Diagnosing an acute kidney injury

Answer 4

1. not based on history and examination.
2. diagnosed by blood test and urine output and depends on your age.
3. rise of 26 microM in creatinine over 48 hr
   OR
   Rise of 50% in creatinine over 7 days
   OR
   Fall in how much urine you pee out converted from an absolute figure to a rate the rate being less than 0.5mL kg per hour for more than 6 hours in adults/ 8 hrs in children
   OR
   25% rise in creatinine + fall in egfr in children

Question 5

Emergency referral

Answer 5

Refer to a nephrologist if any of the following apply:

1. Renal tranplant
2. ITU patient with unknown cause of AKI
3. Vasculitis/ glomerulonephritis/ tubulointerstitial nephritis/ myeloma
4. AKI with no known cause
5. Inadequate response to treatment
6. Complications of AKI
7. Stage 3 AKI (see guideline for details)
8. CKD stage 4 or 5
9. Qualify for renal replacement hyperkalaemia / metabolic acidosis/ complications of uraemia/ fluid overload (pulmonary oedema)

Question 6

Spot diagnosis question painless haematuria and a 65 plus year old man who has a urine Dip result negative for nitrates

Answer 6

Transitional cell carcinoma

Question 7

A child under 5 years old presenting with painless haematuria and a one sided abdominal mass urine dip results and negative for a urinary tract infection

Answer 7

Wilms nephroblastoma