Passmed Renal Flashcards
What is the treatment for nephrogenic diabetes insipidus
Thiazide diuretics (paradoxically decreases the volume of urine)
Which renal stones are radio-lucent
Urate & Xanthine stones
Which cancer is associated with textiles, plastic, rubber and dye
Transitional cell carcinoma
What is Wilm’s tumour and who is it most common in
Nephroblastoma
Commonest in children
Does an angiomyolipoma cause proteinuria
No typically causes haematuria
What should you think of in someone with bilateral Angiomyolipoma
Tuberous Sclerosis
Where do angiomyolipoma’s tend to metastasise to
Nowhere benign tumour
Which calculi are associated with Proteus
Struvite Calculi
Staghorn Calculi
What smell is Proteus associated with
Burnt Chocolate
What is a struvite stone made from
Magnesium Ammonium Phosphate
Which cancer is the Gleason score used for
Prostate cancer
What is the lowest Gleason score which indicates malignancy
6
What is the most common infecting organism for someone on peritoneal dialysis and why
Staph Epidermidis
Foreign body
How does Spironolactone cause gynecomastia
Inhibits testosterone binding to androgen receptors on cells of breast tissue
If someone on spironolactone is complaining of gynecomastia, what drug can they be offered instead
Eplerenone
What is the first step of management in someone with hyperkalaemia
Cardiac monitoring via ECG
What changes on an ECG are associated with hyperkalaemia
Tall tented T waves
Broad QRS
flattened/absent p waves
If changes consistent with hyperkalaemia are seen on ECG, what is the next step of management
IV 10mls of 10% caclium gluconate
What is the role of calcium gluconate in hyperkalaemia management
DOES NOT AFFECT POTASSIUM LEVELS
Used to stabilise myocardium to prevent arrhythmias
What can be given to drive the potassium back into cells, in the management of hyperkalaemia
10 units of actrapid insulin
10mg of nebulised salbutamol
When managing hyperkalaemia, what must be given with insulin and why
50mls of 50% dextrose
to prevent hypoglycaemia
What can be given for the long-term management of hyperkalaemia
Calcium resonium –> prevents GI absorption
Why is Erythropoietin given in chronic kidney disease
To improve exercise tolerance
DOES NOT AFFECT RENAL FUNCTION
In the case of a suspected AKI, how can post-renal and pre-renal causes be isolated
The presence of protein in urine dipstick suggests that the problem is renal
In the case of a suspected AKI, what does a high WCC indicate
Indicates an inflammatory process
goes against tubular necrosis
What drugs can cause interstitial nephritis
Penicillins
NSAIDS
What is the most common cause of nephrotic syndrome in kids
Minimal change glomerulonephritis
What is the most common cause of nephrotic syndrome in adults
Focal Segmental Glomerulosclerosis
What does muddy brown casts suggest
Acute tubular necrosis
Which type of AKI can lead to tubular necrosis if left untreated
Pre-renal
How can you differentiate between tubular necrosis and pre-renal AKI
Tubular necrosis will present with high urine sodium (think of the tubules dying and so unable to reabsorb the sodium)
Pre-renal AKI will present with low urine sodium because the tubules are holding onto the sodium to compensate for hypo-perfusion
What is the 1st line treatment of renal colic pain
IM Diclofenac 75mg
In AKI, all NSAID’s should be stopped to prevent further kidney injury. What is the one exception to this
Cardioprotective dose of Aspirin
Which scrotal pathology may be related to infertility
Varicocele
dilation of scrotal venous plexus
What is the commonest cause of death in patients with chronic kidney disease who are on haemodialysis
Ischaemic Heart Disease
What must a patient abstain from and how long for before a PSA test
Ejaculation and vigorous exercise
for 48 hours
What should you think of if a patient on haemodialysis presents with drowsiness but normal blood and clear lung fields
Dialysis Disequilibrium syndrome
cerebral oedema
What is the most common renal malignancy and give 2 names for it
Renal Adenocarcinoma
Grawitz tumour
What is the next step for a patient with overflow incontinence and elevated PSA levels
TRUS-guided biopsy of the prostate
What is 1st line treatment for benign prostatic hyperplasia
Alpha blocker (Tamsulosin)
What are some side effects of alpha-blockers
Postural hypotension
Dizziness
Renal transplantation leaves you at higher risk of developing which cancer
Squamous cell carcinoma of the skin
What is the mode of transmission of Alport syndrome
X-linked dominant
What is the defect in Alport syndrome
A defect in the formation of type 4 collagen - abnormal GBM
Which gene is mutated in Alport syndrome
COL4A5
When does Alport syndrome present
In childhood
Name one renal and one extra-renal symptom of Alport syndrome
Haematuria + bilateral sensorineural hearing loss
What should you monitor following acute urinary retention and why
Serum creatinine
to look for signs of post-renal AKI
Which two genes can be mutated in adult polycystic kidney disease
PKD1 gene on chromosome 16
PKD2 gene on chromosome 4
What is the gold standard screening test for adult polycystic kidney disease
Ultrasound abdomen
Schistosomiasis increases the risk of which malignancy
Squamous cell carcinoma of the bladder
What is the most common type of renal stone
Calcium oxalate
What is the gold standard investigation for renal stones
CT KUB
What is a hydrocele
Collection of serous fluid in the tunica vaginalis
What does the testicle feel like in the presence of a hydrocele
Non-palpable
Is a hydrocele painful and does it transilluminate
Non-tender and fully transilluminates
Contrast is well known to cause nephropathy so what should you do in order to prevent this in a CKD patient requiring a contrast CT
0.9% NaCl saline before and after the procedure
If a patient presents with a scrotal mass which you are unable to get above on examination, what should you think of
Direct inguinal hernia
What are the three main differentials for frank haematuria
Cancer
Stones
Infection
How can you rule out infection and stones in someone with frank haematuria
If there is a lack of lower urinary tract symptoms
Why does Nephrotic syndrome predispose you to venous thromboembolism
Loss of Anti-Thrombin III
Which side do varicocele’s tend to present on
Almost always on the left
What is the nutcracker angle and what is the clinical relevance
Compression of the renal vein can occur at the angle between the abdominal aorta and the superior mesenteric vein
How can a renal cell carcinoma present as a varicocele
Entrapment of the renal vein at the nutcracker angle, leading to dilation of the scrotal venous plexus
What is plasma and urine osmolality like in diabetes insipidus
DI is characterised by low urine osmolality and high plasma osmolality
How do you work out anion gap
(Na+K) - (HCO3 + Cl)
Give an example of a state when the anion gap is increased
Diabetic ketacidosis
What are the 4 hallmarks of the Nephritic syndrome
Haematuria
Proteinuria
Hypertension
Oliguria
What 4 things are included in the MDRD4 equation and what is it used for
estimate GFR
Creatinine, Age, Gender, Ethnicity
What is the triad associated with renal cell carcinoma
Haematuria, Loin pain, Abdominal mass
What is the most common viral infection in transplant patients
Cytomegalovirus
Which drugs are transplant patients prescribed post-op
MMF (Mycophenolate)
Tacrolimus
Prednisolone
