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ICM - OBS > Renal > Flashcards

Renal Flashcards

1
Q

Ways of collecting urine

A
  1. MSU
  2. CSU
  3. Clean catch
  4. Urostomy
  5. Nephrostomy
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2
Q

What is tested on urine dipstick?

A 
Specific gravity
pH
Billirubin
Urobilligen 
Blood
Protein
Glucose
Ketones
Leucocyte
Nitrites
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3
Q

When to perform a urine dipstick?

A
  • Abdominal pain
  • Signs and symptoms of UTI (dysuria, frequency, urge)
  • Fevers
  • Pregnancy
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4
Q

What does specific gravity in urine indicate?

A
  1. High specific gravity indicates concentrated urine
  2. Specific gravity indicates the amount of solute dissolved in urine
    - E.g. ↓ in diabetes insipidus
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5
Q

What does bilirubin in urine indicate?

A

Low = blockage in gall bladder

High = liver disease

Indicates ↑ conjugated bilirubin (water soluble) –↑ biliary tract obstruction

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6
Q

What does urobiligen indicates?

A

Raised indicates:
↑ bilirubin turnover
↑malaria
↑haemolytic anaemia

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7
Q

What does blood in urine indicate?

A 
Menses
Stones
Cancer
Trauma
Infection
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8
Q

What does glucose in urine indicate ?

A

Diabetes mellitus

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9
Q

What does ketones in urine indicate ?

A
  • Uncontrolled DM
  • Pregnancy
  • Diet (e.g. Atkins/keto), starvation
  • Dehydrated
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10
Q

Nitrites in urine indicate?

A

infection

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11
Q

When to send a urine culture?

A

Women

  • Impaired renal function
  • Abnormal urinary tract
  • Immunosuppression
  • Symptoms persist

Pregnancy

Men
- Send if UTI is clinically suspected

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12
Q

Investigation for haematuria

A

CT Urinary tract

  • looks at upper and lower tract disease
  • Iv of choice for frank haematuria
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13
Q

When is CT angiography used?

A

When suspecting renal artery stenosis

In persisting haematuria

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14
Q

When is MRI used in renal medicine?

A
  1. Staging cancers (prostate, penile, bladder)
  2. Indeterminate renal masses
  3. Penile trauma
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15
Q

Difference between KUB, USS, CT & nuclear medicine

A

KUB, CT, USS: Anatomical info

Nuclear medicine: functional info

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16
Q

What can cause an elevated PSA?

A
  1. Enlarged prostate
  2. Prostatitis (UTI)
  3. Prostate cancer
  4. Recent ejaculation
  5. Bicycle riding
  6. DRE
  7. Vigorus exercise

PSA is sensitive but not specific

17
Q

Next step after raised PSA

A

? biopsy

18
Q

When is bladder scan indicated?

A
  • urinary retention
  • trial without catheter evaluation (TWOC)
  • aids bladder retraining
  • residual urine volume if catheter blocked or non draining
19
Q

Contraindications for bladder scan

A
  • Wound over site for scan

- patient does not consent

20
Q

What can give false readings in bladder scan

A
  • patient lying on their side
  • pregnancy
  • obesity
  • volumes under 100mls or over 1000mls
  • fluid filled cyst
21
Q

Indications for 24 hour urine collection

A
  1. Kidney stone: stone risk assessment (two 24 hour urine collections)
  2. Pheochromocytoma: 24 hour metanephrines
  3. Cushing Syndrome: Measuring 24 hour urinary free cortisol
22
Q

What investigations are indicated for renal calculi?

A
  1. Urine dip - blood +
  2. ? raised WCC
  3. ?raised creatinine
  4. Imaging = non-contrast CT/ USS
23
Q

What non-contrast CT findings may you have in renal stone?

A
  1. position of stone
  2. dilation of ureter
  3. perinephric stranding
24
Q

What are the interventions once renal stones are confirmed?

A
  1. Extra-corporeal shock wave lithotripsy (ESWL)
  2. ureteroscopy
  3. PCNL
  4. Nephrectomy
25
Q

Complications of ESWL

A
  • Pain
  • haematuria
  • infection
  • obstruction
  • steinstrasse
  • haematoma
26
Q

Limitations of ESWL

A
  • Limited by body habitus
  • dependent on visualisation
  • stone composition
  • stone size
  • limited availability
  • multiple visits
27
Q

Upper GI bleed, U & E result

A

Urea raised - digest blood

28
Q

2WW indication in male health

A

Haematuria
Raised PSA, abnormal prostate on DRE
Testicular abnormality
Penile mass or non-STI lesion

ICM - OBS (18 decks)

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