Renal Flashcards
How is potassium affected in vomiting/dehydration?
Incr potassium secretion by beta cells of late distal tubule and collecting duct
- because low H+ causes alkalosis
- create K+ conc gradient
Which cells line prox and distal convoluted tubule?
Prox - simple cuboidal with microvilli
Distal - simple cuboidal cells
Management of CKD patient vomiting with low pH
Hypovolaemia -> metabolic acidosis
IV sodium chloride
Urine appearance indicating ATN
Muddy brown casts
- high fractional sodium excretion
What creatinine level indicates stopping ACE inhibitor?
More than 30% increase in creatinine in 2 weeks
Features of benign prostatic hypertrophy causing post-renal AKI
Urinary retention - tamsulosin
Worsening lower abdo pain
Tender suprapubic mass which is dull to percussion
First line investigation after urine dipstick in suspected nephrotic syndrome
Serum albumin
Describe features of HIV seroconversion illness
Pyrexia
Myalgia
Maculo-papular rash
(most common viral cause of FSGS)
Diagnostic investigation for nephrotic syndrome
Renal biopsy
Complication of membranous nephropathy causing flank pain and haematuria
Renal vein thrombosis
How to differentiate between post-strep GN and IgA nephropathy in patient with haem/proteinaturia after cold symptoms?
48h - IgA
Weeks - post-strep
Child with reclapsing minimal change disease and recurrent infections, why?
Loss of immunoglobulins in urine
- decr ability to fight infections
What drug should pt with high albumin:creat ratio be started on?
ACE inhibitor e.g. ramipril
Stage 2 of CKD
eGFR 60-89
Evidence of kidney damage e.g. haem/proteinuria
Inidication of chronic renal failure on US
Bilateral shrunken kidneys
Why does CKD cause CVD?
Accelerates atherosclerosis
Contraindication for erythropoietin therapy?
Iron-deficient anaemia
Flank pain, fever, urine positive for leucocytes, blood and nitrates?
Pyelonephritis
What type of stroke is associated with ADPKD?
Subarachnoid haemorrhage
Common complication of renal artery stenosis
Flash pulmonary oedema
- sudden fluid overload in lung interstitium
- due to solitary working kidney
- resolves in minutes
Why would you not prescribe ACEi in bilateral RAS?
Can completely switch of kidney filtration and perfusion
Which sided varicocoele is abnormal?
Right sided
Which parts of scrotum drain to which lymph nodes?
Testes - abdo and pelvic
Scrotal skin - inguinal
What part of prostate is affected by BPH?
Transitional
Which tumour marker is most commonly seen in seminomatous testicular cancer?
LDH
Which tumour marker is most commonly seen in seminomatous testicular cancer?
LDH
Which tumour marker is most commonly seen in seminomatous testicular cancer?
LDH
Limb weakness, difficulty in walking, sensory loss or bladder or bowel dysfunction are metastatic complications of which type of cancer?
Prostate cancer
- advanced disease usually metastasises to the spine
What is the cause of peripheral oedema assoc with renal cancer?
IVC obstruction
- not heart failure!!!!
Difficulty passing urine and 3 day history of transient visual loss could suggest which condition?
MS
- investigate with MRI head and spine
First line investigation of testicular lump?
Ultrasound of testes
Management of bacterial prostatitis
Oral Ciprofloxacin
How is creatinine clearance measured?
Cockcroft-Gault formula
- requires the following variables: age, gender, creatinine and weight.
What is the most likely mechanism of low vitamin D in CKD?
Reduced alpha hydroxylase 1 expression
Which antibiotic can increase creatinine?
Trimethoprim
Management of UTI in pregnancy with G6PD deficiency
Cefalexin
Recreational drug causing bladder inflammtion and haematuria
Ketamine
Antibiotic to treat UTI in pregnant person at term
Amoxicillin
- avoid nitrofurantoin due to neonatal haemolysis
Drug acting on kidney assoc with electrolyte loss
Loop diuretics e.g. furosemide
- avoid w digoxin, corticosteroids, aminoglycosides, any condition causing hypokalaemia
How do NSAIDs affect kidneys?
Afferent arteriole constriction
Low BP does what to aldosterone
Increases aldosterone secretion from mesangial cells
Signs of hyperkalaemia on ECG other than T wave changes
Wide QRS complexes, small/absent P waves, sinusoidal waveforms
What is hungry bone syndrome?
The result of a sudden drop in previously high parathyroid hormone levels, assoc with hypocalcaemia
- e.g. post-parathyroidectomy for chronic hyperparathyroidism
How does penicillin cause AKI?
Acute interstitial nephritis
Most important blood test to do in suspected rhabodomyolysis
Creatinine kinase
Mesangial hypercellularity on histology suggests?
IgA nephropathy
Imaging for locoregional spread of bladder cancer post-excision
Pelvic MRI
Sore and swollen scrotum,urinary frequency and dysuria, history of unprotected sex?
Epididmo-orchitis
Management of testicular torsion
Urgent surgical exploration with orchidoplexy fixation
Management of HT in patient with IgA nephropathy
ACE inhibitor
- reduces proteinuria and rate of kidney disease progression
Why does nephrotic syndrome increase risk of DVT?
The loss of proteins such as endogenous anti-coagulants like antithrombin III result in hypercoagulability, which can predispose patients to venous thromboembolic events
FSGS on renal biopsy
Focal areas of mesangial collapse and sclerosis
- cresentic formations = rapidly progressive
Anti-MPO antibodies with necrotising crescentic GN?
Microscopic polyangitis
Goodpasture’s presents with antibodies against which type of collagen
Type IV collagen
Investigation after urine in minimal change
Serum albumin
Complication of nitrofurantoin assoc with SoB
Restrictive lung disease
- normal ratio, low FEV1 and FVC
Most common cause of renal artery stenosis in young women
Fibromuscular dysplasia
Stages of AKI
Stage 1: creatinine rise of 1.5x compared to baseline or urine output <0.5 ml/kg/hour for 6 hours.
Stage 2: creatinine rise of 2x compared to baseline or urine output <0.5 ml/kg/hour for 12 hours.
Stage 3: creatinine rise of 3x compared to baseline or urine output <0.3 ml/kg/hour for 24 hours (or anuria for 12 hours) or serum creatinine >354umol/dl
Can’t pee, can’t see, can’t hear a bee?
Alport’s
Presentation of acute interstitial nephritis
Delayed (2-40 days) picture of:
- rash, fever, acute kidney injury and eosinophilia after a triggering medication
Most common PKD
Autosomal dominant mutation of PKD1
Management of BPH of differing severity
Moderate - alpha-blocker e.g. tamsulosin
Mod-sevre - alpha blocker, 5-alpha reductase inhibitor (finasteride)
Absolute indication for dialysis in ATN
A potassium level of 6.9mmol/L, with minimal response to insulin + dextrose treatment
Management of kidney stones in patient with AKI and hydronephrosis
Percutaneous nephrostomy
3+ protein on dipstick = ?
Approx 300mg
Drugs to stop in AKI
DAMN
- Diuretics, ACEi/ARBs, Metformin, NSAIDs
Dull to percuss mass in suprpubic area with stage 1 AKI may be caused by?
BPH
What are kidney stones most commonly made of?
Calcium oxalate
Subepithelial ‘humps’ on electron microscopy suggest?
Post-strep glomerulonephritis
- caused by lumpy immune complex deposits
Oxalate nephropathy is seen in excess of which vitamin?
Vitamin C
Which immune complexes are deposited in basement membrane in post-strep GN?
IgG, IgM, and C3.
Patient on chemo for leukaemia most likely has kidney stones made out of…
Uric acid
- strongly associated with hyperuricaemia seen in diseases with high cell turnover (e.g. leukaemia)
Urease-positive bacteria e.g. proteus can cause what type of kidney stones?
Ammonium magnesium phosphate (struvite)
What class of drugs can decrease risk of kidney stones?
Thiazide diuretics
What are the main causes of increased serum potassium/hyperkalaemia?
M - Medications - ACE inhibitors, NSAIDS
A - Acidosis - Metabolic and respiratory
C - Cellular destruction - Burns, traumatic injury
H - Hypoaldosteronism, haemolysis
I - Intake - Excessive
N - Nephrons, renal failure
E - Excretion - Impaired
What type of GN is assoc with anti-phospholipase A2 antibodies?
Idiopathic membraneous GN
Characteristic finding of amyloidosis
Deposition of light chain fragments
- in tissues including the kidneys, heart and peripheral nerves.
Long QT secondary to hypocalcaemia can precede which heart disorder?
Torsades de Pointes
Dialysis indications
Hypekalaemia over 7
Fluid overload
Acidosis less than 7.15
Urea over 40
What happens when a patient is dialysed too much and too quickly?
Dialysis disequilibrium syndrome
First line investigation of suspected local prostate cancer
Multiparametric MRI
Management of undescended testes
Bilateral -immediate senior peds review to exclude CAH -> review at 3 months -> surgeons at 6m if still present
Unilateral- if at birth -> review at 6-8 weeks -> if still present then, review at 3 months -> if still present, refer to surgeons to be seen by 6 months
OPERATE AROUND 12 MONTHS
WHich complication of prostatectomy can cause LUTS?
Urethral stricture
- prostatic urethra is divided and strictures can form at this anastomosis over time
10 years post-HLA matched renal transplant presenting with direct nephrotoxicity (tubular atrophy and fibrosis), gum hypertrophy and hypertension?
Ciclosporin use
Which electrolyte imbalance presenting with confusion and bradycardia can occur after TURP?
Hyponatraemia
Cyclophosphamide assoc with new onset haematuria?
Haemorrhagic cystitis
Management of epidydmitis secondary to STI?
M Ceftriaxone and PO Doxycycline
- covers gonorrhoea and chlamydia
Side effect of tacrolimus
Tremor
Differentiating between acute and chronic graft rejection
<6 months = acute
>6 months = chronic
Appearance of transitional cell carcinoma
Macroscopically: multifocal with flat to papillary lesions. Microscopically: foci of squamous differentiation or extensive keratinization and intercellular bridges
Appearance of transitional cell carcinoma
Macroscopically: multifocal with flat to papillary lesions. Microscopically: foci of squamous differentiation or extensive keratinization and intercellular bridges
Most common bone complication following renal transplant
Avascular necrosis
Contraindication to tamsulosin
Hypotension and postural hypotension
Type of urinary incontinence caused by patient on loads and loads of pain meds e.g. amitriptyline and gabapentin
Functional incontinence
- can be due to opiates
Stones assoc with gout
Uric acid
Which part of the nephron is involved in SIADH presenting with confusion and hyponatraemia?
Incr water absorption in collecting duct
Is renal stone search contrast or non-contrast CT?
Non-contrast
Acute abdomen, peritonitis or renal stones - how is patient sitting with pain?
Peritonitis - still patient
Stones - writhing around
Urological complication of tricyclic antidepressants e.g. amitriptyline
Urinary retention
What testicular swelling can be a presenting factor of renal cell carcinoma?
Varicocele
Pain management of renal colic
Diclofenac, either PR or IM
Sterile pyuria is caused by…..
TB
UT stones
Partially treated UTI
Bacteria causing perito dialysis peritonitis
Staph epidermidis
FHx of brain bleeds with PCKD screening
MRA head every 5 years
Causes of AIN
5P’s - pee (diuretics), pain (NSAIDs), penicillins (and cephalosporins), PPIs and rifamPin
Investigation for TB urine
Early morning samples for mycobacterium
