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phase 2 > Renal > Flashcards

Renal Flashcards

1
Q

There is net excretion if which five things from the kidneys

A

Sodium, potassium, phosphate, acid and uraemic toxins

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2
Q

How is the 120ml/min GFR expresses clinically

A

ml/min/1.73m^2 body surface area

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3
Q

What complications come with decreasing kidney function

A

Anaemia, bone disease and symptoms from uraemic toxins

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4
Q

What is the difference between GFR and eGFR

A

GFR is a concept, eGFR is an estimate by measuring serum creatinine

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5
Q

Extremes of muscle mass

A

Cachexia, body builders. Amputees and liver disease

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6
Q

What drug makes inhibits creatinine secretion and how does this effect eGFR

A

Trimethoprim. Makes eGFR appear worse

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7
Q

Why does eGFR start to overestimate GFR as it drops

A

Because more creatinine is secreted by the tubules as the filtration rate lowers

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8
Q

What is reabsorbed in the PCT

A

70% filtered sodium, phosphate, glucose, amino acids

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9
Q

Where do loop diuretics act

A

Loop of henle

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10
Q

Where do thiazides act

A

DCT

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11
Q

Where does spironolactone act

A

Aldosterone antagonist acting on Na/K channels in collecting duct

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12
Q

Which diuretics are the most influential

A

Loop diuretics. 25% are reabsorbed there

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13
Q

What part of the juxtaglomerular apparatus detects sodium delivery to the DCT and therefore fluid delivery

A

The macula densa

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14
Q

Why do ACE-I and NSAIDS combined cause kidney failure

A

NSAIDS constrict afferent (prostaglandin). ACE-I dilate

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15
Q

How are acute potassium changes buffered

A

Insulin and catecholamines

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16
Q

Blocking aldosterone has what ion affect

A

Low sodium and high potassium. Metabolic acidosis.

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17
Q

Where is vitamin D hydroxylated

A

25 hydroxylated in liver, 1 hydroxylated in kidney

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18
Q

What is the active form of vitamin D

A

Calcitriol

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19
Q

What are calcium and phosphate levels like in kidney disease

A

Cause of vit D. Low calcium but as kidney excretes phosphate. Phosphate is high.

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20
Q

Daily fluid intake for adults

A

1.5-2L for relatively sedentary lifestyle

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21
Q

Name some methods of fluid loss

A

Vomitting, diarrhoea, urinating, sweating, burns and bleeds

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22
Q

Symptoms of hypovolaemia

A

Thirst and dizziness

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23
Q

Symptoms of hypervolaemia

A

Breathlessness and leg oedema

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24
Q

Results of lab tests in hypovolaemia

A

High Cr, Hb and Hct

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25
Q

Lab test results in hypervolaemia

A

Low or normal Cr, Low Hb and Hct

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26
Q

Signs in hypovolaemia

A

Tachycardia, reduced BP,JVP, dry tongue, reduced weight and low urine output

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27
Q

Abnormal signs in hypervolaemia

A

High or normal BP, High JVP, increased weight. normal pulse

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28
Q

What is euvolaemia

A

Where there are no signs or symptoms of hypo or hypervolaemia

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29
Q

What are postural BP readings

A

Where BP is taken standing

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30
Q

How is skin turgor measured

A

Skin with decreased turgor remains elevated after being pulled up and released

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31
Q

What is the central venous pressure

A

pressure within the thoracic vena cava before it enters the right atrium

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32
Q

What is the third space

A

The non functional area between cells where fluid doesnt normally collect

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33
Q

When can it be difficult to assess fluid

A

In obese patients

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34
Q

Patients at risk of hypovolaemia

A

Elderly, short bowel syndrome with bowel obstruction and colostomy bag. On diuretics.

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35
Q

Patients at risk of hypervolaemia

A

Acute and chronic kidney disease, heart and liver failrue

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36
Q

What is crystalloid IV fluid

A

Small molecules which pass into the extravascular space. Containing salt makes it stay longer in intravascular space.

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37
Q

What is colloid IV fluid

A

Large molecules which remain in the intravascular compartment. Increase the oncotic pressure so expand the intravascular volume

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38
Q

Name a colloid IV fluid

A

Gelofusine (contains gelatine)

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39
Q

Name diuretics

A

Furosemide, bumetanide, spironolactone, metolazone

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40
Q

Hypovolaemia treatment

A

Fluids and treat reversible cause

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41
Q

Hypervolaemia treatment

A

Diuretics and treat reversible cause

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42
Q

What is the urine output like in chronic kidney patients

A

Oligouric or anuric

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43
Q

Oligouric meaning

A

Low urine output (below 400-500ml)

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44
Q

Anuric meaning

A

No urine output

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45
Q

At what stage of chronic kidney disease does normal urine output stop

A

Stage 5 <15

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46
Q

What to consider when treating oligouric or anuric CKD patients

A

Urine, dialysis, refluid restriction, reassess fluid status

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47
Q

What shouldnt you do when treating oligouric or anuric CKD patients

A

Prescribe multiple bags without assessment or prescribe Hartmann’s solution

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48
Q

Why shouldnt you give Hartmann’s solution fluid to oligouric or anuric CKD patients

A

As contains 5mmol potassium

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49
Q

What can be causes of rising Cr in CKD

A

Too many diuretics, extravascular hyper but intravascular hypovolaemia. Progression of CKD

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50
Q

The three diagnostic criteria for AKI (need 1)

A

26mmol/L rise in 48hrs, >50% rise from best in last 6 months, low urine output (<0.5ml/kg/hr) for 6 consecutive hours

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51
Q

What do you suspect when someone has been lying down for hours

A

Rhabdomyolysis so check creatinine kinase

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52
Q

Common prerenal AKI causes

A

Low BP, Low blood volume, heart failure, liver cirrhosis. Dehydration.

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53
Q

Common renal AKI causes

A

Glomerulonephritis, acute tubular necrosis, acute interstitial nephritis

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54
Q

Common postrenal AKI causes

A

UT obstruction, kidney stones, obstructed catheter, cancer of the bladder, ureters or prostate

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55
Q

Which investigations are done in AKI

A

FBC, FUB USS, urine dip stick

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56
Q

Why is an ultrasound needed in AKI

A

To ensure no postrenal blockage, as if you gave fluids that would lead to oedema

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57
Q

What would be present on a urine dipstick for pyelonephritis

A

Haematuria, proteinuria

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58
Q

How is hyperkalaemia seen on XRay

A

Tall pointed T waves and small P waves

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59
Q

Hyperkalaemia management

A

Insulin+dextrose, calcium gluconate, IV fluid and salbutamol

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60
Q

What is a wet AKI patient and how are they treated

A

Pulmonary oedema and heart failure, treated with diuretics and treat the original cause

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61
Q

How are dry AKI patients treated

A

They are given fluids

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62
Q

Name risk factors for AKI

A

Age, comorbidiites, reasons for admission and nephrotoxic drugs

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63
Q

Which drugs are nephrotoxic

A

Chemotherapy drugs and some diuretics

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64
Q

What are uremic symptoms

A

Confusion, itchiness of skin, uremic pericarditis

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65
Q

What % of the body is a major burn in an adult

A

30%

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66
Q

What % of the body is a major burn in a child

A

10%

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67
Q

How is the body split up for burns

A

11 9%s. Head and neck, arm, arm, leg(=2), leg(=2), chest(=2), back(=2) and genitals is 1%

68
Q

Define glomerulonephritis

A

inflammation of the glomerulus

69
Q

How does nephritic syndrome present

A

Hypertension and abnormal kidney function

70
Q

How does chronic glomerulonephritis present

A

features of CKD

71
Q

How does nephrotic syndrome present

A

hyperalbuminaemia and hyperlipidaemia

72
Q

What test do you think of when you think glomerulonephritis

A

URINE DIP STICK

73
Q

Who is disproportionally affected by glomerulonephritis

A

Caucasians in their 50s, 60s and 70s

74
Q

Three functions of the urinary tract

A

To collect urine continually produced by the kidneys, to collect and store urine safely, to expel urine when socially acceptable

75
Q

Between which two levels do the kidneys lie

A

T11 and L3

76
Q

At which level does the renal artery come off the aorta

A

L1

77
Q

How much urine is produced by the kidneys each day

A

2-3L

78
Q

How does urine move

A

By peristalsis

79
Q

How is reflux of urine prevented

A

Valvular mechanism at the vesicouteric junction

80
Q

What are the three uteric narrowings

A

Uteropelvic junction, pelvic brim and where the ureter enters the bladder

81
Q

Which nerve provides the parasympathetic supply of the bladder

A

Pelvic nerve

82
Q

Which nerve provides the sympathetic supply of the bladder

A

Hypogastric plexus

83
Q

Which nerve provides the somatic supply of the bladder

A

Pudendal nerve

84
Q

What is onufs nucleus responsible for

A

Guarding reflex via the pudendal nerve

85
Q

Normal adult bladder capacity

A

400-500ml

86
Q

Describe the storage state of the bladder

A

Receptive relaxationm, detrusor muscle relaxed and external urethral sphincter contracted

87
Q

Describe the micturition state of the bladder

A

Voluntary control from cortex and PMC detrusor muscle contraction, external urethral sphincter relaxed

88
Q

What is the normal function of the lower urinary tract

A

To convert the continuous process of urine excretion into an intermittent process of elimination

89
Q

Name LUT storage symptoms

A

Frequency, nocturia, urgency and urgency incontinence

90
Q

Name LUT voiding symptoms

A

Hesitancy, straining, poor/intermittent stream, incomplete emptying, post micturition dribbling, haematuria and dysuria

91
Q

Define dysuria

A

Painful or uncomfortable urination

92
Q

A diagnosis of BPH is based on which findings

A

Histological

93
Q

A diagnosis of BPE is based on which findings

A

DRE

94
Q

A diagnosis of BOO is based on which findings

A

Urodynamic proven obstruction

95
Q

What does DRE stand for

A

Distal rectal examination

96
Q

What is the histological definition of BPH

A

Increase in epithelial and stromal cell numbers in the periurethral area of the prostate

97
Q

What is the dynamic component of benign prostatic obstruction

A

Alpha 1 adrenoceptor mediated prostatic smooth muscle contraction

98
Q

What is the static component of benign prostatic obstruction

A

The volume effect of BPE

99
Q

Factors which can affect BPH development

A

Androgens, castration and androgen withdrawal

100
Q

What is IPSS

A

A system used to objectively give severity of symptoms in lower UT, domains are scored out of 35

101
Q

What questions do you ask during a DRE

A

Can you feel the finger? Can you close the sphincter?

102
Q

What does TRUSS stand for

A

Trans rectal ultrasound scan

103
Q

What is a TRUSS used for in LUTS

A

Investigating the size

104
Q

When is flexible cystoscopy used in LUTS

A

If infection, stones, haematuria or recent onset storage symptoms

105
Q

What is the normal flow rate for an hour

A

20ml

106
Q

Name two causes of reduced flow rate of urine

A

Obstruction within the lower UT and detrusor muscle underactivity

107
Q

What can cause a high post void residual volume

A

Detrussor muscle underactivity

108
Q

What are two consequences of raised post void residual volume

A

Hydronephrosis and elevated creatinine

109
Q

Complications of BPE

A

Symptom progression, infections, stones, haematuria, urinary retention, interactive obstructive uropathy

110
Q

Define acute retention of urine

A

Sudden onset of inability to retain urine

111
Q

Is precipitated or spontaneous retention more likely to recur

A

Spontaneous retention

112
Q

What is ISC

A

Intermittant self catheterisation

113
Q

What is TWOC

A

Trial without catheterisation

114
Q

The bladder is normally emptied when it reaches which volume

A

300ml

115
Q

Long term options for interactive obstructive uropathy

A

Turp or indwelling catheter

116
Q

Define diuresis

A

Increased or excessive production of urine

117
Q

What are bladder stones

A

Aggregates of minerals that occur in the bladder due to obstruction of flow

118
Q

What is hydronephrosis

A

Dilation of the renal pelvis or calyces

119
Q

Name an alpha adrenergic antagonist

A

Tamsulosin

120
Q

How do alpha blockers act in prostatic disease

A

Reduce the tone of the sphincter

121
Q

Name a 5 alpha reductase inhibitor

A

Finasteride

122
Q

How do 5 alpha reductase inhibitors work in prostatic disease

A

Inhibit conversion of testosterone to the more active dihydrotestosterone

123
Q

What is the acronym for surgery indications in prostatic disease

A

RUSHES

124
Q

What does RUSHES for prostatic surgery stand for

A

Retention, UTIs, Stones, Haematuria, Elevated cr, Symptom deterioration

125
Q

Treatment for interactive obstructive uropathy

A

Short term: Catheter. Long term: TURP

126
Q

Define obstructive uropathy

A

Functional or anatomic obstruction of urine flow at any level of the urinary tract

127
Q

Define supravesical obsstruction

A

Above the level of the bladder

128
Q

Define infravesical obstruction

A

Below the level of the bladder

129
Q

What does the severity of LUTS obstruction depend on

A

Extent of obstruction, unilateral or bilateral and whether it has been relieved or not

130
Q

What is the equation for renal blood flow

A

(Aortic pressure-renal venous pressure)/ renal vascular resistance

131
Q

Name a renal metabolite which causes vasoconstriction and therefore further damage in LUT obstruction

A

ANP

132
Q

What changes result from obstruction in the kidney

A

Biochemical, immunoloic, haemodynamic and functional changes

133
Q

Why do you get renal colic in obstruction

A

Spinothalamic C fibers are excited by utereral wall tension

134
Q

Which scans are used for LUT obstruction

A

Ultrasound first and then if obstruction seen CT scan for more information

135
Q

What is the first line imaging for suspected ureteral obstruction

A

CT

136
Q

What does one sided loin pain suggest a problem with

A

Ureter

137
Q

What does bilateral loin pain suggest a problem with

A

Bladder, prostate or urethra

138
Q

What is a nephrostomy

A

Catheter which comes directly out of the kidney

139
Q

Treatment for LUT obstruction in the pregnant

A

Ultrasound guided percutaneous drainage

140
Q

Common cause of blocked ureter in the young

A

Kidney stone

141
Q

What is pathologic postobstructive diuresis

A

Where there is impaired concentrating ability of sodium absorption as there is less sodium transports in thick limb, more ANP and poor response to ADH

142
Q

Short term consequences of LUT obstruction

A

Renal failure and post obstructive diuresis

143
Q

Who is most likely to get urolithiases

A

Men who are 30-50

144
Q

What is classed as the upper urinary tract

A

Kidneys and ureters

145
Q

Congenital anatomical causes of stones

A

Horseshoe, duplex, PUJO, spina bifida

146
Q

Acquired anatomical causes of stones

A

Obstruction, trauma and reflux

147
Q

Urinary causes of stones

A

Metastable urine, calcium, oxalate, urate, cysteine, dehydration.

148
Q

Why does infection cause stones

A

It changes the acid/base balance of the urine

149
Q

What constituent suggests the stones have come from infection

A

Struvite, 5-10%

150
Q

Which stones cant be seen on XRay

A

Uric acid

151
Q

What is a cause of cyteine stones

A

Congenital ‘COLA’- Cystine, ornithine, lyseine and arginine

152
Q

How can stones be prevented

A

Overhydration, normal diet (dairy and protein), low salt, reduced BMI, active lifestyle. CHECK CALCIUM AND PTH

153
Q

How can you prevent uric acid stone formation

A

Deacidification of the urine to 7-7.5

154
Q

How can you prevent cysteine stone formation

A

Alkalinisation through overhydration. Cysteine binders and genetic counselling

155
Q

Stone symptoms

A

Asymptomatic, loin pain, renal colic, recurrant UTIs and symptoms, haematuria

156
Q

What are UTI symptoms

A

Dysuria, strangury, urgency and frequency

157
Q

What is strangury

A

Blockage or irritation of base of the bladder, leading to severe pain and desire to urinate

158
Q

What causes renal colic

A

Upper urinary tract obstruction

159
Q

Where is the loin

A

Above the pelvis but below the ribs

160
Q

Uteric colic investigation

A

NCCT-KUB

161
Q

Red flags in renal colic

A

Fever, infection signs

162
Q

What does haematuria suggest

A

Stones

163
Q

Differential diagnosis for renal colic

A

Ruptured AAA (if over 50, most liikely), diverticulitis, appendicitis, ectopic pregnancy, ovarian cyst torsion, testicular torsion, MSK

164
Q

What does CT stand for

A

Computerised tomography

165
Q

Cons of CT

A

No functional information and there is radiation

166
Q

When looking at a NCCTKUB what should you look for on the kidneys

A

Perinephric tissues, cortical thickness, hydronephrosis+- hydroureter, stones

phase 2 (17 decks)

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