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Clincal - Renal > Renal > Flashcards

Renal Flashcards

1
Q

What are the three ways renal disease can present?

A

Asymptomatic disease

With renal tract symptoms

Systemic disorder with renal involvement

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2
Q

Name 4 ways asymptomatic disease can present

A

Non visible haematuria

Asymptomatic Proteinuria

Abnormal range function (GFR)

High BP

Electrolyte abnormalities

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3
Q

How is non-visible haematuria detected?

What investigation should be completed upon detection?

A

Urine dipstick

Urological investigation first line for people aged >40

Most is NOT due to renal disease

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4
Q

What is normal protein excretion?

A

Less than 150mg/24 hours

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5
Q

What two ratios can be used to measure proteinuria?

What does an increased result suggest

A

Albumin:creatinine ratio <2.5 (women) or <3.5 (men)

Protein: creatinine ratio <15

Glomerular (common) or tubular (rare) pathology

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6
Q

What is GFR?

What is used to measure GFR?

What do the results estimate?

What are overestimations due to?

A

Measure of how much blood the kidneys are cleaning per minute

Serum creatinine

EGFR

Non-steady state conditions, conditions which alter serum creatinine (diet, muscle mass)

EGFR less accurate at higher levels of GFR

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7
Q

When should renal aetiology be excluded in relation to hypertension?

A

Hypertension with any indicators of renal disease e.g. proteinuria, haematuria, reduced GFR

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8
Q

What electrolyte abnormalities may occur due to renal disease?

A

Disorders of sodium, K+ and acid-base balance

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9
Q

What urinary symptoms are an indicator of renal disease?

A

Dysuria - sensation of discomfort with micturition and may be accompanied by urgency, frequency, nocturia

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10
Q

What is the primary differential of urinary symptoms?

A

UTI

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11
Q

When do you consider prostatic aetiology with urinary symptoms?

A

If there is difficulty initiating voiding, poor stream and dribbling

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12
Q

What two symptoms would trigger assessment and investigation for AKI?

A

Oliguria <400ml/24hours

Anuria

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13
Q

What is polyuria?

What 4 things can cause polyuria?

A

Voiding of abnormally high volumes of urine

DM
Diabetes insipidus
Hypercalcaemia
Renal medullary disorder - causing impaired concentration of urine

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14
Q

How does hypercalcaemia cause polyuria?

A

High Ca2+ makes the tubular fluid more positive

This inhibits the leak of K+ into the tubular fluid

Inhibits NKCC2 - less Na+ ions absorbed = polyuria

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15
Q

How does hypokalaemia cause polyuria?

A

Low K+ in the tubular fluid

Less K+ to drive the NKCC2 pump in loop of Henle

Reduced Na+ absorption, draws water into the lumen = polyuria

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16
Q

What is a differential for loin pain that is severe and radiates anteriorly and to the groin?

What is it caused by?

A

Ureteric colic

Renal stone, clot or sloughed papilla

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17
Q

What is a differential for loin pain confined to the loin?

A

Pyelonephritis

Renal cyst pathology

Renal infarct

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18
Q

What investigation should be completed for visible haematuria?

What needs to be ruled out?

A

Urological investigation to rule out renal tract malignancy

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19
Q

Name 4 nephrological causes of visible haematuria

A

Polycystic Kidney Disease

Glomerular Disease

Anti-glomerular basement membrane disease

Alport syndrome

Malignancy!!

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20
Q

What are the three symptoms of nephrotic disease?

What investigation should be completed?

A

Proteinuria >3g/24 hours

Hypoalbuminaemia

Peripheral oedema

Renal biopsy

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21
Q

Name some symptoms of CKD

A

Dyspnoea

Anorexia

Weight loss

Pruitus

Bone pain

Sexual dysfunction

Cognitive decline

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22
Q

Name some systemic disorders with renal involvement

A

DM

Metabolic

Autoimmune

Infection

Malignancy

Pregnancy

Drugs used in systemic disorders

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23
Q

What types of metabolic disease can cause renal impairment?

A

Sickle cell disease

Tubular sclerosis

Cystinosis

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24
Q

What types of infection can cause renal impairment?

A

Sepsis - common cause of AKI

TB

Malaria

Chronic hepatitis

HIV

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25
Q

What types of autoimmune disease can cause renal impairment?

A

ANCA Assocaited vasculitis

SLE

Systemic sclerosis

Sarcoid

Sjogren’s syndrome

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26
Q

What types of malignancy can cause renal impairment?

A

Obstruction

Hypercalcaemia

Direct toxicity e.g. myeloma

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27
Q

What types of drugs can cause renal impairment?

A

NSAIDs

ACEi

ARB

Aminoglycosides

Chemotherapy

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28
Q

What pregnancy disorders can cause renal impairment?

A

Obstruction

Pre-eclampsia

29
Q

What investigation should be done when you suspect renal disease?

A

Dipstick urinalysis

30
Q

Name some causes of a raised albumin:Creatinine ratio?

What does proteinuria give an increased risk of?

A

Higher the proteinuria, the more chance it is caused by glomerular disease e.g. glomerularnephritis, DM, amyloidosis, myeloma

Increased risk of CVS disease and death

31
Q

Name two transient causes of haematuria

A

UTI

Menstruation

32
Q

How can haematuria be classified?

A

Visible haematuria

Non-visible haematuria - found on microscopy/dipstick
- this can be subdivided into presence of urinary symptoms or asymptomatic

33
Q

Name some causes of haematuria

A

Malignancy - Kidney, ureter, bladder

Calculus

IgA nephropathy

Alport Syndrome

Other glomerulonephritis

Polycystic kidney disease

Schistosomiasis

34
Q

What people with haematuria should undergo urological assessment and why?

A

Over 40’s

To exclude renal tract malignancy and calculi

35
Q

What conditions may cause glucose to be present in the urine?

A

DM

Pregnancy

Sepsis

Proximal renal tubular pathology

36
Q

What two conditions may cause ketone to be present in the urine?

A

Starvation

Ketoacidosis

37
Q

What two conditions may cause leukocytes to be present in the urine?

A

UTI

Vaginal discharge

38
Q

What condition may cause nitrites to be present in the urine?

A

UTI (Enteric gram -ve organism)

39
Q

What condition may cause bilirubin to be present in the urine?

A

Haemolysis

40
Q

What condition may cause urobiliogen to be present in the urine?

A

Liver disease

Haemolysis

41
Q

What casts are seen in normal urine microscopy?

A

Hyaline casts

42
Q

What does a red cell cast on urine microscopy signify?

A

Inflammatory process of the glomerulus

43
Q

What does a white cell cast on urine microscopy signify?

A

Pyelonephritis

Interstitial nephritis

Glomerulonephritis

44
Q

What does a granular cell cast on urine microscopy signify?

A

Degenerated tubular cells - seen in CKD

45
Q

What are the causes of WBC on urine microscopy?

A

UTI

Glomerulonephritis

Tubulointerstitial nephritis

Renal transplant rejection

Malignancy

46
Q

What do RBC on urine microscopy signify?

What are the two types of RBC seen on microscopy?

A

Can come from anywhere in urinary tract

Isomorphic red cells are similar to circulating red cells and may suggest bleeding from genitourinary or external source

Dysmorphic red cells are abnormal in shape/size - may indicate bleeding from glomerulus. Assessment is subjective and dysmorphism also occurs due to changes in pH, osmolality, protein and due to tubular passage

47
Q

When are crystals in urine often seen?

A

Common in old or cold urine - may not signify pathology

48
Q

What are the three types of crystal that may be found in urine microscopy?

When are each of them found?

A

Uric acid - uric acid stones, tumour lysis syndrome

Calcium oxalate - stones, high oxalate diet

Cystine - seen in cystinuria

49
Q

What is bacteruria?

A

Bacteria in the urine - may be asymptomatic or symptomatic

Bacteruria is not a disease

50
Q

How is a UTI diagnosis made?

A

Based on symptoms and signs

Tests which prove bacteria in the urine may provide additional information

51
Q

Name two causes of lower UTIs

Name one cause of upper UTIs

A

Lower UTI - bladder (cystitis), prostate (prostatitis)

Upper UTI - pyelonephritis (infection of kidney/renal pelvis)

52
Q

What is the classification for UTIs?

A

Complicated - men, children, structural/functional abnormality of genitourinary tract e.g. catheter, stones, neurogenic bladder, renal transplant

Uncomplicated - normal renal tract structure/function

53
Q

Name 4 risk factors for UTIs

A

Increased bacterial inoculation - sexual activity, urinary incontinence, faecal incontinence, constipation

Increased binding of uropathogenic bacteria - spermicide use, decreased oestrogen, menopause

Decrease urine flow - dehydration, obstructed urinary tract

Increased bacterial growth - DM, immunosuppression, obstruction, stones, catheter, renal tract malformation, pregnancy

54
Q

Name some symptoms of cystitis

A

Frequency

Dysuria

Urgency

Suprapubic pain

Polyuria

Haematuria

55
Q

Name some symptoms for acute pyelonephritis

A

Fever

Rigor

Vomiting

Loin pain/tenderness

Costovertebral pain

Associated cystitis symptoms - frequency, dysuria, urgency, suprapubic pain, polyuria, haematuria

Septic shock

56
Q

Name some symptoms for prostatitis

A

Pain -perineum, scrotum, rectum, penis, bladder, lower back

Fever

Malaise

Nausea

Urinary symptoms

Swollen or tender prostate

57
Q

What should you consider if a patient present with urinary symptoms, fever, abdominal/loin tenderness and vaginal discharge?

A

Pelvic inflammatory disease

58
Q

What should you do in a non-pregnant women under 65 present with less than 3 symptoms of cystitis?

A

Treat empirically without further tests

59
Q

When should urine dipstick be used?

When should it not be used?

A

Women under 65 with less than symptoms

Dont use in pregnant women

60
Q

What are the 4 urological investigations that can be done?

A

Dipstick

MSU culture

Blood tests - if systemically unwell - FBC, U&E, CRP

Imaging - USS and referral to urology in men with upper UTI, failure to respond to treatment, recurrent UTI, pyelonephritis, unusual organism, persistent haematuria

61
Q

When should an MSU culture be used?

A

Pregnant women
Men
Children

If they fail to respond to empirical antibiotics

62
Q

When should urological imaging be used?

A

Men with upper UTI

Failure to respond to treatment

Recurrent UTI >2/year

Pyelonephritis

Unusual organism

Persistent haematuria

63
Q

What organisms usually affect the urinary tract?

A

Anaerobes
Gram -ve bacteria from bowel and vagina flora

E.Coli - main organisms in community

Staphylococcus saprophyticus (5-10%)

64
Q

How do you manage non-pregnant worms with three or more symptoms of cystitis and no vaginal discharge?

What if first line treatment fails?

A

Treat empirically with 3 day course of Trimethorpim or Nitrofuratoin

Culture urine and treat according to bacteria sensitivity

65
Q

How should you treat an upper UTI in non-pregnant women with no vaginal discharge?

A

Take urine culture and treat initially with broad-spectrum antibiotics e.g. co-amoxiclav

Hospitalisation should be considered due to risk of antibiotic resistance

Avoid nitrofuratoin as it does not achieve effective concentrations in the blood

66
Q

How should pregnant women with UTI be managed?

What is a UTI in pregnancy indicative of?

A

Get expert help - asymptomatic bacteruria should be confirmed on second sample, treat with antibiotics

Pre term labour or intra-uterine growth restriction

67
Q

How should men with a lower UTI be managed?

When should men be referred for further investigation?

A

7 day course of trimethoprim or nitrofurantoin

If symptoms suggest prostatitis - pain in genitals, pelvis, lower back, buttocks consider a longer course of (4 week) of ciprofloxacin due to a ability to penetrate prostatic fluid

If upper or recurrent UTI - refer for further investigation

68
Q

Why is a fluoroquinolone (e.g. ciprofloxacin) used for prostatitis?

A

Due to its ability to penetrate prostatic fluid

69
Q

When should an MSU of a catheterised patient be sent?

What should you do to the catheter prior to starting antibiotics?

A

Only if patient is symptomatic. All catetherised patients are bacteruric

Change the long term catheter

Refer to local guidelines for antibiotic choice

Clincal - Renal (5 decks)

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