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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
What types of autoimmune disease can cause renal impairment?
ANCA Assocaited vasculitis SLE Systemic sclerosis Sarcoid Sjogren’s syndrome
26
What types of malignancy can cause renal impairment?
Obstruction Hypercalcaemia Direct toxicity e.g. myeloma
27
What types of drugs can cause renal impairment?
NSAIDs ACEi ARB Aminoglycosides Chemotherapy
28
What pregnancy disorders can cause renal impairment?
Obstruction Pre-eclampsia
29
What investigation should be done when you suspect renal disease?
Dipstick urinalysis
30
Name some causes of a raised albumin:Creatinine ratio? What does proteinuria give an increased risk of?
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
Name two transient causes of haematuria
UTI Menstruation
32
How can haematuria be classified?
Visible haematuria Non-visible haematuria - found on microscopy/dipstick - this can be subdivided into presence of urinary symptoms or asymptomatic
33
Name some causes of haematuria
Malignancy - Kidney, ureter, bladder Calculus IgA nephropathy Alport Syndrome Other glomerulonephritis Polycystic kidney disease Schistosomiasis
34
What people with haematuria should undergo urological assessment and why?
Over 40’s To exclude renal tract malignancy and calculi
35
What conditions may cause glucose to be present in the urine?
DM Pregnancy Sepsis Proximal renal tubular pathology
36
What two conditions may cause ketone to be present in the urine?
Starvation Ketoacidosis
37
What two conditions may cause leukocytes to be present in the urine?
UTI Vaginal discharge
38
What condition may cause nitrites to be present in the urine?
UTI (Enteric gram -ve organism)
39
What condition may cause bilirubin to be present in the urine?
Haemolysis
40
What condition may cause urobiliogen to be present in the urine?
Liver disease Haemolysis
41
What casts are seen in normal urine microscopy?
Hyaline casts
42
What does a red cell cast on urine microscopy signify?
Inflammatory process of the glomerulus
43
What does a white cell cast on urine microscopy signify?
Pyelonephritis Interstitial nephritis Glomerulonephritis
44
What does a granular cell cast on urine microscopy signify?
Degenerated tubular cells - seen in CKD
45
What are the causes of WBC on urine microscopy?
UTI Glomerulonephritis Tubulointerstitial nephritis Renal transplant rejection Malignancy
46
What do RBC on urine microscopy signify? What are the two types of RBC seen on microscopy?
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
When are crystals in urine often seen?
Common in old or cold urine - may not signify pathology
48
What are the three types of crystal that may be found in urine microscopy? When are each of them found?
Uric acid - uric acid stones, tumour lysis syndrome Calcium oxalate - stones, high oxalate diet Cystine - seen in cystinuria
49
What is bacteruria?
Bacteria in the urine - may be asymptomatic or symptomatic Bacteruria is not a disease
50
How is a UTI diagnosis made?
Based on symptoms and signs Tests which prove bacteria in the urine may provide additional information
51
Name two causes of lower UTIs Name one cause of upper UTIs
Lower UTI - bladder (cystitis), prostate (prostatitis) Upper UTI - pyelonephritis (infection of kidney/renal pelvis)
52
What is the classification for UTIs?
Complicated - men, children, structural/functional abnormality of genitourinary tract e.g. catheter, stones, neurogenic bladder, renal transplant Uncomplicated - normal renal tract structure/function
53
Name 4 risk factors for UTIs
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
Name some symptoms of cystitis
Frequency Dysuria Urgency Suprapubic pain Polyuria Haematuria
55
Name some symptoms for acute pyelonephritis
Fever Rigor Vomiting Loin pain/tenderness Costovertebral pain Associated cystitis symptoms - frequency, dysuria, urgency, suprapubic pain, polyuria, haematuria Septic shock
56
Name some symptoms for prostatitis
Pain -perineum, scrotum, rectum, penis, bladder, lower back Fever Malaise Nausea Urinary symptoms Swollen or tender prostate
57
What should you consider if a patient present with urinary symptoms, fever, abdominal/loin tenderness and vaginal discharge?
Pelvic inflammatory disease
58
What should you do in a non-pregnant women under 65 present with less than 3 symptoms of cystitis?
Treat empirically without further tests
59
When should urine dipstick be used? When should it not be used?
Women under 65 with less than symptoms Dont use in pregnant women
60
What are the 4 urological investigations that can be done?
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
When should an MSU culture be used?
Pregnant women Men Children If they fail to respond to empirical antibiotics
62
When should urological imaging be used?
Men with upper UTI Failure to respond to treatment Recurrent UTI >2/year Pyelonephritis Unusual organism Persistent haematuria
63
What organisms usually affect the urinary tract?
Anaerobes Gram -ve bacteria from bowel and vagina flora E.Coli - main organisms in community Staphylococcus saprophyticus (5-10%)
64
How do you manage non-pregnant worms with three or more symptoms of cystitis and no vaginal discharge? What if first line treatment fails?
Treat empirically with 3 day course of Trimethorpim or Nitrofuratoin Culture urine and treat according to bacteria sensitivity
65
How should you treat an upper UTI in non-pregnant women with no vaginal discharge?
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
How should pregnant women with UTI be managed? What is a UTI in pregnancy indicative of?
Get expert help - asymptomatic bacteruria should be confirmed on second sample, treat with antibiotics Pre term labour or intra-uterine growth restriction
67
How should men with a lower UTI be managed? When should men be referred for further investigation?
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
Why is a fluoroquinolone (e.g. ciprofloxacin) used for prostatitis?
Due to its ability to penetrate prostatic fluid
69
When should an MSU of a catheterised patient be sent? What should you do to the catheter prior to starting antibiotics?
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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