Renal

Question 1

Management of AKI

Answer 1

1. ) ASSESS volume and potassium status: 
O/E: BP, JVP, skin turgor, cap refill
Urine output ( catheterize). 
ABG: URGENT K+ 
ECG for hyperkalaemia!!

2) Aim for EUVOLEMIA: Fluids /Fluid restriction
3) Stop NEPHROTOXIC drugs: NSAIDs, ACE-I, gentamicin
4. ) Tx underlying cause

Question 2

Complications of AKI

Answer 2

Complications of AKI 
Uraemia 
Volume overload 
Hyperkalaemia 
Hyperphosphataemia 
Metabolic Acidosis 
Chronic progressive kidney disease

Question 3

What complication of AKI can result in pericarditis

Answer 3

Uraemia.

Can also cause N&V, arrhythmia, pneumonitis etc

Question 4

Symptoms of hyperkalaemia

Answer 4

fatigue or weakness.
a feeling of numbness or tingling.
nausea or vomiting.
problems breathing.
chest pain.
palpitations or skipped heartbeats

Question 5

Symptoms of metabolic acidosis

Answer 5

rapid breathing

confusion

Question 6

Hyperkalaemia Management

Answer 6

10ml 10% calcium gluconate IV ( cardioprotective )
Intravenous insulin + glucose
Salbutamol nebulisers

If patient is acidotic: IV sodium bicarbonate can help drive K+ into cells.

Question 7

Pulmonary odema management

Answer 7

Sit up and high flow oxygen
Venous vasodilator ( eg diamorphine)
Furosemide IV

Question 8

Indications for dialysis in AKI

Answer 8

1. Refractory pulmonary oedema
2. Persistent hyperkalaemia ( >7mmol/L)
3. Severe metabolic acidosis (pH < 7.2 or base excess <10)
4. Uraemic complications : encephalopathy or pericarditis
5. Drug OD : Barbituates, Lithium, Alchohol, Salicylates, Theophyline

Question 9

ESRF cut off

Answer 9

GFR < 15

Question 10

Consequences of CKD

Answer 10

1]Progressive failure of homeostatic function
	-Acidosis 
	-Hyperkalaemia
2]Progressive failure of hormonal function
	-Anaemia
	-Renal Bone Disease
3]Cardiovascular disease
	-Vascular calcification
	-Uraemic cardiomyopathy
4]Uraemia and Death

Question 11

Anaemia of chronic renal disease Tx

Answer 11

Normochromic, normocytic anaemia

Management: EPO replacement

Question 12

Renal Dystrophy

Answer 12

Kidneys cant convert vitamin D3 into calcitriol = hypocalcaemia
Leads to secondary hyperparathyroidism
PTH stimulates bone resorption
Poor quality bones= osteomalacia: pain, fractures

Question 13

Renal osteodystrophy Tx

Answer 13

TREATMENT:
Calcichew- Ca supplement,
Calcium acetate - phosphate binders

Question 14

CKD 1) Limiting progression/ complications

Answer 14

BP: target <130/80 ( <125/75 is diabetic)
Tight glucose control in DM
Decrease CVD risk ( stop smoking, lose weight etc)

Diet: multidisciplinary team: moderate protein, restrict K+, avoid high phosphate foods.

Renal osteodystrophy:
TREATMENT:
Calcichew- Ca supplement,
Calcium acetate - phosphate binders

Question 15

CKD 2) Symptom control

Answer 15

Anaemia: Human EPO might be required

Acidosis: consider sodium bicarbonate supplements for patients with low serum bicarbonate.

Oedema: loop diuretics, restriction of fluids

Question 16

CKD 3) Preparation for Renal Replacement Therapy

Answer 16

The access is a surgically created vein used to remove and return blood during hemodialysis.

1) Arteriovenous fistula :)
2) Arteriovenous graft

Question 17

CKD Management outlineL

Answer 17

1) Limiting progression/ complications
2) Symptom control
3) Preparation for Renal Replacement Therapy

Question 18

Scar for renal transplant

Answer 18

Rutherford Morrison/ hockey stick scar in L/R IF

Question 19

Signs of chronic immunosuppression ( renal transplant)

Answer 19

Cushings disease signs, gingival hyperplasia from cyclosporin

Question 20

Obstructive symptoms

Answer 20

Poor stream 
Hesitancy 
Terminal dribbling 
Incomplete voiding 
Overflow incontinence 
Near retention

Question 21

Irritative Symptoms

Answer 21

Frequency (polyuria)
Urgency
Dysuria
Nocturia

Question 22

Prostate cancer most commonly metastasise to which areas

Answer 22

BONES, Lungs, liver, brain

Question 23

Ix for prostate cancer

Answer 23

Examination
DRE: hard nodules/ lumps, irregular surface

Investigations
Urine dip: haematuria
Bloods: PSA
Trans-rectal US with biopsy

Question 24

MOST common presenting complain of bladder cancer

Answer 24

Haematuria

Question 25

Ix for bladder cancer

Answer 25

``` Investigations Urine dip: haematuria Urine cytology – Ca cells Cystoscopy with tissue sampling CT and MRI (if further imaging required) ```

Question 26

RFs for Bladder cancer

Answer 26

-->Smoking --> Aromatic amines used in rubber and dye --> Schistosomiasis Being Egyptian (most common cancer in Egyptian males – probably due to schistosomiasis) Age FH

Question 27

Inheritance of polycyctic kidney disease

Answer 27

Autosomal dominant inheritance,

Question 28

O/E PKD

Answer 28

Examination HTN Liver cysts Bilateral palpable kidneys

Question 29

Renal Cell Carcinoma Triad

Answer 29

Also known as von Grawitz tumour Clasical triad: haematuria, loin pain, abdominal mass. Histology Renal tubular cell Adenocarcinomas

Question 30

Ix for renal cell carcinoma

Answer 30

``` Investigations Urine dip: haematuria Bloods: work up for paraneoplastic syndromes Imaging: US, contrast enhanced CT Tissue sample: US guided biopsy ```

Question 31

Management of renal stones

Answer 31

Immediate ANALGESIA (diclofenac IM or PR) Rehydration if necessary Antiemetics if necessary Conservative Most stones will pass by themselves within 3 weeks. Progress should be monitored at weekly intervals If signs of infection/ obstruction/ too painful will need intervention Medical CCBs and alpha blockers – medical expulsive therapy ``` Surgical Extracorporeal shock wave lithotripsy (ESWL) Percutaneous nephrolithotomy Ureteroscopy (with laser) Open surgery ```

Question 32

Normal Pressure Hydrocephalus | Causes and Px

Answer 32

Causes: meningitis, head injury and indipathic Px: wobbly gait, urge incontience, wacky dementia

Question 33

Urge incontinence causes

Answer 33

Causes UMN pathology → loss of higher inhibition of micturition reflex Eg. Parkinson’s, MS, stroke Detrusor muscle overactivity Temporary causes – infection, urethritis

Question 34

Urge incontinence is percipitated by

Answer 34

``` Precipitated by The cold Sound of running water Coffee, tea or cola Obesity ```

Question 35

When do you preform an doppler US for torsion

Answer 35

if unsure, will show decreased blood flow

Question 36

Ix and Tx for epidydimorchitis

Answer 36

Investigations MSU Swabs Management Chlamydia → azithromycin/ doxycycline Gonorrhoea → ceftriaxone EColi after UTI

Question 37

Dull Ache

Answer 37

Variocele

Question 38

Tumor markers for testicular cancer

Answer 38

Seminoma - ↑βhCG, αFP normal (better prognosis) | Teratoma - ↑αFP, ↑βhCG

Question 39

Tx for testicular cancer

Answer 39

Seminoma: surgery and radiotherapy Teratoma: chemo and surgery

Question 40

Management of hydrocele

Answer 40

Management | Tap fluid, plicate tunica vaginalis (Lord’s repair)

Question 41

Ureteric stones, (no contrast required, more sensitive and specific than IV pyelography) Tumour staging – bladder, renal

Answer 41

CTKUB

Question 42

Good imaging of kidney and bladder, not very good for ureters due to overlying bowel gas

Answer 42

US kidney

Question 43

Urge incontinence that is not resolving

Answer 43

Urodynamic Study

Question 44

contrast + X-Ray images → filling defects within collecting system, identification of congenital urinary tract abnormalities, strictures

Answer 44

IV pyelography

Question 45

If have irritative symptoms suggestive of UTI

Answer 45

MC&S

Question 46

Scope inserted into bladder + biopsy

Answer 46

Cystoscopy

Question 47

Generally done for staging, higher radiation

Answer 47

CTKUB

Question 48

Done as work up of haematuria to determine presence of renal masses

Answer 48

USS

Question 49

Intrinsic renal abnormality (signs of renal failure, HTN, haematuria)

Answer 49

Renal Biopsy

Question 50

Drug that can cause thyroid problems

Answer 50

amiodarone