Renal

Question 1

what is UTI?

Answer 1

infection in the urinary tract

Question 2

signs and symptoms of UTI

Answer 2

flank pain
high fever
malaise
frequency urgency
dysuria
confusion
rigours
suprapubic tenderness

Question 3

investigation of UTI

Answer 3

Urine dip test
urine microscopy, culture & sensitivities (MC&S)

Question 4

first-line treatment for UTI

Answer 4

simple analgesia
encourage intake of fluids
medications:
Nitrofurantoin 100mg
trimethoprim 200mg

Question 5

Risk factor of UTIs

Answer 5

latrogenic / drugs
behavioural (voiding dysfunction/ recent sexual intercourse)
anatomic / physiologic
genetic

Question 6

how long you’ll have to check on catheterized patients

Answer 6

if more than 7 days then check for blockage and consider removing the catheter

Question 7

first line option for UTI in catheterized patients

Answer 7

nitrofurantoin 100mg
trimethoprim 200mg
amoxicillin 500mg

Question 8

what is cystitis

Answer 8

bladder infection

Question 9

symtoms of cystitis

Answer 9

increased urinary frequency
urgency
dysuria
pain above the pubic region
WBCs & bacteria in urine
possible hematuria

Question 10

first-line treatment for cystitis
& alternatives

Answer 10

still nitrofurantoin
fosfomycin

Question 11

Management on acute urinary retention?

Answer 11

Arrange to hospital admission and urgent catheterization and investigation of the cause

Question 12

what drugs can be used to prevent or manage recurrent urine retention?

Answer 12

Alpha-blocker:
(Alfuzosin 10mg a day)

Question 13

Pyelonephritis
- what is it?
- cause of it?
- symptoms?
- management?

Answer 13

infection of the kidney, cause by bacteria from the bladder

• Escherichia. coli (60-80%)
  Klebsiella species (20%)
  Proteus mirablis (15%)
• unilateral flank pain
  fever
  nausea and vomiting
• cefalexin 500mg
  co-amoxiclav 500/125mg
  trimethoprim 200mg
  ciprofloxacin 500mg

Question 14

Alternatives treatment if ceftriaxone is not available for pt that has pyelonephritis

Answer 14

piperacillin / tazobactam

Question 15

Describe glomerulonephritis and treatment

Answer 15

inflammation of the glomeruli in the kidneys

treatment - supportive care and immunosuppression (corticosteroids)

Question 16

Types of glomerulonephritis

Answer 16

–> IgA nephropathy (burger’s disease)
- primary glomerulonephritis
- igA deposits and mesangial proliferation
–> Membranous nephropathy
–>Membranoproliferative glomerulonephritis (or mesangiocapillary glomerulonephritis)
–> Post-streptococcal glomerulonephritis
–> Rapidly progressive glomerulonephritis
–> Goodpasture syndrome

Question 17

Investigation and treatment of glomerulonephritis

Answer 17

renal biopsy

• supportive care
• immunosuppression (corticosteroids)

Question 18

Nephritic syndrome
- describe the term
- features

Answer 18

inflammation in the kidneys

• haematuria
• oliguria (reduced urine output)
• proteinuria (LESS than 3g per 24 hrs)
• fluid retention

Question 19

Nephrotic syndrome
- describe the syndrome
- features
- predisposes factors
- causes

Answer 19

• basement membrane in the glomerulus becomes highly permeable, result significant proteinuria
• proteinuria (MORE than 3g in 24hrs)
• Low serum albumin (less than 25g per litre)
• peripheral oedema
• hypercholesterolaemia
  frothy urine
• thrombosis, hypertension and high cholesterol
• membranous nephropathy, focal segmental glomerulosclerosis

Question 20

Renal colic
1. what is it?
2. common cause of stones
3. complications?
4. S&S
5. investigations
6. management

Answer 20

1) Urinary stone causing obstruction to the flow of urine and leading to loin pain

2) calcium oxalate stones (80%)
calcium phosphate stones (20%)

3) obstruction of urinary flow and infection

4) dysuria, urinary frequency, straining

5) Urine dipstick test
adults - low-dose non-contrast CT
pregnant - ultrasound

6) SNAID / IV paracetamol
<5mm - monitor
>5mm - medical expulsive therapy
shockwave lithotripsy (SWL)
Percutaneous nephrolithotomy (PCNL)
Ureteroscopy (URS)

Question 21

Acute Kidney injury (AKI)
- symptoms and signs
- risk factors
- stages of AKI
- Examination and investigations
- management of AKI
- types of AKI

Answer 21

• N&V, diarrhoea, suspected dehydration, reduced urine output/ change to urine colour, confusion, fatigue / drowsiness
• Age >65, History of AKI, CKD, cardiac failure, DM, sepsis, Hypovolaemia, nephrotoxic drug use (NSAID), contrast agents
• Stage 1 ) >/= 26.5 mol/L & <0.5ml/kg/hr 6-12hrs
  Stage 2 ) >/= 2-2.9 x baseline & <0.5ml/kg/hr >12hrs
  Stage 3 ) >/= 353.6 mol/L / x3 reference & <0.3ml/kg/hr 24hrs / Anuria for > 12hrs
• Blood test, Blood cultures, Urine output, dip and M,C&S, Blood gas, chest X-ray, ECG
• treat hypovolaemia and correct electrolyte imbalances
• Pre-renal, intra-renal, Post-renal