Renal

Question 1

Nephrotic syndrome triad

Answer 1

Proteinuria
Hypoalbuminaemia
Oedema

(Hyperlipidaemia may also be present)

Question 2

Complications of AKI

Answer 2

Uraemia 
Volume overload 
Hyperkalaemia
Hyperphosphataemia 
Metabolic acidosis
Chronic progressive kidney disease

Question 3

Hyperkalaemia symptoms

Answer 3

Fatigue or weakness
Numbness or tingling
Nausea or vomiting
Palpitations, chest pain

Question 4

General management of AKI

Answer 4

1) Assess volume and potassium status. ECG for hyperkalaemia

2) Aim for euvolaemia
Fluid/ fluid restriction

3) Stop nephrotoxic drugs (NSAID, gentamicin, ACE-I)
4) Treat underlying cause (eg abx for sepsis, removal of obstruction)

Question 5

Hyperkalaemia management

Answer 5

10ml 10% calcium gluconate IV (cardioprotective)

IV insulin (with glucose)

Salbutamol nebs

Question 6

Pulmonary oedema management in AKI setting

Answer 6

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

Question 7

Causes of CKD

Answer 7

Diabetes
Atherosclerosis
HTN
Chronic glomerulonephritis
Polycystic kidney disease

Question 8

Management of CKD

Answer 8

1)Limiting progression/complications
BP target <130/80 125 if diabetic
Tight glucose control
Decrease CVD risk (stop smoking, lose weight)

2) Symptom control 
Human EPO for anaemia
Ca supplements
NaHCO3 if acidosis present 
Oedema: loop diuretics, restriction of fluids 

3) Preparation for Renal replacement therapy
Haemodyialisis
Transplantation for ESRF

Question 9

Commonest sites of prostate cancer metastasis

Answer 9

LNs, Bone, Liver, Brain

Question 10

PKD definition

Answer 10

Fluid filled cysts grow on the kidney.
Cysts increase in size with advanced age and lead to renal enlargement and the progressive destruction of normal kidney tissue

Question 11

PKD mode of inheritance

Answer 11

Autosomal dominant
(Onset 30-60 yo)

Question 12

PKD complications

Answer 12

HTN (RAS increased activation)
Raised Hb (increased erythropoietin production)
SAH (possibly due to HTN, five times more likely if PKD present)

Question 13

Risk factors for kidney stones

Answer 13

Dehydration
Hypercalcaemia
Hyperuraemia

Question 14

Types of kidney stone

Answer 14

1) Calcium stones (75%)
- Calcium oxalate or calcium phosphate (Seen on x-ray)

2) Magnesium ammonium phosphate (15%)
- Infection with urease producing organisms eg proteus

3) Uric acid stones (5%)
Due to high protein diet, obesity, gout
(Not visible on x-ray)

Question 15

Young boy
Sudden onset pain in one testes
Abdominal pain
Vomiting

Answer 15

Testicular torsion

Other key points:
Tender, hot, swollen
Testis may lie high or transversely

Question 16

Management of testicular torsion

Answer 16

Surgical exploration! (required within 6 hours)

Doppler may show decreased blood flow, however do not delay surgical exploration!

Question 17

Commonest cause of nephrotic syndrome in adults

Answer 17

Children: Minimal change nephropathy

Younger adults: Focal segmental glomerulosclerosis

Older: membranous nephropathy

Question 18

Presence of red cell casts in urine indicate

Answer 18

glomerular pathology

Question 19

Renal cell carcinoma triad

Answer 19

Heamaturia
Flank pain
Abdominal or flank mass

(FLAWS)

Question 20

ATN usual triad

Answer 20

Fever
Skin rashes
Painful joints

Blood results will often show eosinophils