Renal Flashcards
1
Q
There is net excretion if which five things from the kidneys
A
Sodium, potassium, phosphate, acid and uraemic toxins
2
Q
How is the 120ml/min GFR expresses clinically
A
ml/min/1.73m^2 body surface area
3
Q
What complications come with decreasing kidney function
A
Anaemia, bone disease and symptoms from uraemic toxins
4
Q
What is the difference between GFR and eGFR
A
GFR is a concept, eGFR is an estimate by measuring serum creatinine
5
Q
Extremes of muscle mass
A
Cachexia, body builders. Amputees and liver disease
6
Q
What drug makes inhibits creatinine secretion and how does this effect eGFR
A
Trimethoprim. Makes eGFR appear worse
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
8
Q
What is reabsorbed in the PCT
A
70% filtered sodium, phosphate, glucose, amino acids
9
Q
Where do loop diuretics act
A
Loop of henle
10
Q
Where do thiazides act
A
DCT
11
Q
Where does spironolactone act
A
Aldosterone antagonist acting on Na/K channels in collecting duct
12
Q
Which diuretics are the most influential
A
Loop diuretics. 25% are reabsorbed there
13
Q
What part of the juxtaglomerular apparatus detects sodium delivery to the DCT and therefore fluid delivery
A
The macula densa
14
Q
Why do ACE-I and NSAIDS combined cause kidney failure
A
NSAIDS constrict afferent (prostaglandin). ACE-I dilate
15
Q
How are acute potassium changes buffered
A
Insulin and catecholamines
16
Q
Blocking aldosterone has what ion affect
A
Low sodium and high potassium. Metabolic acidosis.
17
Q
Where is vitamin D hydroxylated
A
25 hydroxylated in liver, 1 hydroxylated in kidney
18
Q
What is the active form of vitamin D
A
Calcitriol
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.
20
Q
Daily fluid intake for adults
A
1.5-2L for relatively sedentary lifestyle
21
Q
Name some methods of fluid loss
A
Vomitting, diarrhoea, urinating, sweating, burns and bleeds
22
Q
Symptoms of hypovolaemia
A
Thirst and dizziness
23
Q
Symptoms of hypervolaemia
A
Breathlessness and leg oedema
24
Q
Results of lab tests in hypovolaemia
A
High Cr, Hb and Hct
25
Lab test results in hypervolaemia
Low or normal Cr, Low Hb and Hct
26
Signs in hypovolaemia
Tachycardia, reduced BP,JVP, dry tongue, reduced weight and low urine output
27
Abnormal signs in hypervolaemia
High or normal BP, High JVP, increased weight. normal pulse
28
What is euvolaemia
Where there are no signs or symptoms of hypo or hypervolaemia
29
What are postural BP readings
Where BP is taken standing
30
How is skin turgor measured
Skin with decreased turgor remains elevated after being pulled up and released
31
What is the central venous pressure
pressure within the thoracic vena cava before it enters the right atrium
32
What is the third space
The non functional area between cells where fluid doesnt normally collect
33
When can it be difficult to assess fluid
In obese patients
34
Patients at risk of hypovolaemia
Elderly, short bowel syndrome with bowel obstruction and colostomy bag. On diuretics.
35
Patients at risk of hypervolaemia
Acute and chronic kidney disease, heart and liver failrue
36
What is crystalloid IV fluid
Small molecules which pass into the extravascular space. Containing salt makes it stay longer in intravascular space.
37
What is colloid IV fluid
Large molecules which remain in the intravascular compartment. Increase the oncotic pressure so expand the intravascular volume
38
Name a colloid IV fluid
Gelofusine (contains gelatine)
39
Name diuretics
Furosemide, bumetanide, spironolactone, metolazone
40
Hypovolaemia treatment
Fluids and treat reversible cause
41
Hypervolaemia treatment
Diuretics and treat reversible cause
42
What is the urine output like in chronic kidney patients
Oligouric or anuric
43
Oligouric meaning
Low urine output (below 400-500ml)
44
Anuric meaning
No urine output
45
At what stage of chronic kidney disease does normal urine output stop
Stage 5 <15
46
What to consider when treating oligouric or anuric CKD patients
Urine, dialysis, refluid restriction, reassess fluid status
47
What shouldnt you do when treating oligouric or anuric CKD patients
Prescribe multiple bags without assessment or prescribe Hartmann's solution
48
Why shouldnt you give Hartmann's solution fluid to oligouric or anuric CKD patients
As contains 5mmol potassium
49
What can be causes of rising Cr in CKD
Too many diuretics, extravascular hyper but intravascular hypovolaemia. Progression of CKD
50
The three diagnostic criteria for AKI (need 1)
26mmol/L rise in 48hrs, >50% rise from best in last 6 months, low urine output (<0.5ml/kg/hr) for 6 consecutive hours
51
What do you suspect when someone has been lying down for hours
Rhabdomyolysis so check creatinine kinase
52
Common prerenal AKI causes
Low BP, Low blood volume, heart failure, liver cirrhosis. Dehydration.
53
Common renal AKI causes
Glomerulonephritis, acute tubular necrosis, acute interstitial nephritis
54
Common postrenal AKI causes
UT obstruction, kidney stones, obstructed catheter, cancer of the bladder, ureters or prostate
55
Which investigations are done in AKI
FBC, FUB USS, urine dip stick
56
Why is an ultrasound needed in AKI
To ensure no postrenal blockage, as if you gave fluids that would lead to oedema
57
What would be present on a urine dipstick for pyelonephritis
Haematuria, proteinuria
58
How is hyperkalaemia seen on XRay
Tall pointed T waves and small P waves
59
Hyperkalaemia management
Insulin+dextrose, calcium gluconate, IV fluid and salbutamol
60
What is a wet AKI patient and how are they treated
Pulmonary oedema and heart failure, treated with diuretics and treat the original cause
61
How are dry AKI patients treated
They are given fluids
62
Name risk factors for AKI
Age, comorbidiites, reasons for admission and nephrotoxic drugs
63
Which drugs are nephrotoxic
Chemotherapy drugs and some diuretics
64
What are uremic symptoms
Confusion, itchiness of skin, uremic pericarditis
65
What % of the body is a major burn in an adult
30%
66
What % of the body is a major burn in a child
10%
67
How is the body split up for burns
11 9%s. Head and neck, arm, arm, leg(=2), leg(=2), chest(=2), back(=2) and genitals is 1%
68
Define glomerulonephritis
inflammation of the glomerulus
69
How does nephritic syndrome present
Hypertension and abnormal kidney function
70
How does chronic glomerulonephritis present
features of CKD
71
How does nephrotic syndrome present
hyperalbuminaemia and hyperlipidaemia
72
What test do you think of when you think glomerulonephritis
URINE DIP STICK
73
Who is disproportionally affected by glomerulonephritis
Caucasians in their 50s, 60s and 70s
74
Three functions of the urinary tract
To collect urine continually produced by the kidneys, to collect and store urine safely, to expel urine when socially acceptable
75
Between which two levels do the kidneys lie
T11 and L3
76
At which level does the renal artery come off the aorta
L1
77
How much urine is produced by the kidneys each day
2-3L
78
How does urine move
By peristalsis
79
How is reflux of urine prevented
Valvular mechanism at the vesicouteric junction
80
What are the three uteric narrowings
Uteropelvic junction, pelvic brim and where the ureter enters the bladder
81
Which nerve provides the parasympathetic supply of the bladder
Pelvic nerve
82
Which nerve provides the sympathetic supply of the bladder
Hypogastric plexus
83
Which nerve provides the somatic supply of the bladder
Pudendal nerve
84
What is onufs nucleus responsible for
Guarding reflex via the pudendal nerve
85
Normal adult bladder capacity
400-500ml
86
Describe the storage state of the bladder
Receptive relaxationm, detrusor muscle relaxed and external urethral sphincter contracted
87
Describe the micturition state of the bladder
Voluntary control from cortex and PMC detrusor muscle contraction, external urethral sphincter relaxed
88
What is the normal function of the lower urinary tract
To convert the continuous process of urine excretion into an intermittent process of elimination
89
Name LUT storage symptoms
Frequency, nocturia, urgency and urgency incontinence
90
Name LUT voiding symptoms
Hesitancy, straining, poor/intermittent stream, incomplete emptying, post micturition dribbling, haematuria and dysuria
91
Define dysuria
Painful or uncomfortable urination
92
A diagnosis of BPH is based on which findings
Histological
93
A diagnosis of BPE is based on which findings
DRE
94
A diagnosis of BOO is based on which findings
Urodynamic proven obstruction
95
What does DRE stand for
Distal rectal examination
96
What is the histological definition of BPH
Increase in epithelial and stromal cell numbers in the periurethral area of the prostate
97
What is the dynamic component of benign prostatic obstruction
Alpha 1 adrenoceptor mediated prostatic smooth muscle contraction
98
What is the static component of benign prostatic obstruction
The volume effect of BPE
99
Factors which can affect BPH development
Androgens, castration and androgen withdrawal
100
What is IPSS
A system used to objectively give severity of symptoms in lower UT, domains are scored out of 35
101
What questions do you ask during a DRE
Can you feel the finger? Can you close the sphincter?
102
What does TRUSS stand for
Trans rectal ultrasound scan
103
What is a TRUSS used for in LUTS
Investigating the size
104
When is flexible cystoscopy used in LUTS
If infection, stones, haematuria or recent onset storage symptoms
105
What is the normal flow rate for an hour
20ml
106
Name two causes of reduced flow rate of urine
Obstruction within the lower UT and detrusor muscle underactivity
107
What can cause a high post void residual volume
Detrussor muscle underactivity
108
What are two consequences of raised post void residual volume
Hydronephrosis and elevated creatinine
109
Complications of BPE
Symptom progression, infections, stones, haematuria, urinary retention, interactive obstructive uropathy
110
Define acute retention of urine
Sudden onset of inability to retain urine
111
Is precipitated or spontaneous retention more likely to recur
Spontaneous retention
112
What is ISC
Intermittant self catheterisation
113
What is TWOC
Trial without catheterisation
114
The bladder is normally emptied when it reaches which volume
300ml
115
Long term options for interactive obstructive uropathy
Turp or indwelling catheter
116
Define diuresis
Increased or excessive production of urine
117
What are bladder stones
Aggregates of minerals that occur in the bladder due to obstruction of flow
118
What is hydronephrosis
Dilation of the renal pelvis or calyces
119
Name an alpha adrenergic antagonist
Tamsulosin
120
How do alpha blockers act in prostatic disease
Reduce the tone of the sphincter
121
Name a 5 alpha reductase inhibitor
Finasteride
122
How do 5 alpha reductase inhibitors work in prostatic disease
Inhibit conversion of testosterone to the more active dihydrotestosterone
123
What is the acronym for surgery indications in prostatic disease
RUSHES
124
What does RUSHES for prostatic surgery stand for
Retention, UTIs, Stones, Haematuria, Elevated cr, Symptom deterioration
125
Treatment for interactive obstructive uropathy
Short term: Catheter. Long term: TURP
126
Define obstructive uropathy
Functional or anatomic obstruction of urine flow at any level of the urinary tract
127
Define supravesical obsstruction
Above the level of the bladder
128
Define infravesical obstruction
Below the level of the bladder
129
What does the severity of LUTS obstruction depend on
Extent of obstruction, unilateral or bilateral and whether it has been relieved or not
130
What is the equation for renal blood flow
(Aortic pressure-renal venous pressure)/ renal vascular resistance
131
Name a renal metabolite which causes vasoconstriction and therefore further damage in LUT obstruction
ANP
132
What changes result from obstruction in the kidney
Biochemical, immunoloic, haemodynamic and functional changes
133
Why do you get renal colic in obstruction
Spinothalamic C fibers are excited by utereral wall tension
134
Which scans are used for LUT obstruction
Ultrasound first and then if obstruction seen CT scan for more information
135
What is the first line imaging for suspected ureteral obstruction
CT
136
What does one sided loin pain suggest a problem with
Ureter
137
What does bilateral loin pain suggest a problem with
Bladder, prostate or urethra
138
What is a nephrostomy
Catheter which comes directly out of the kidney
139
Treatment for LUT obstruction in the pregnant
Ultrasound guided percutaneous drainage
140
Common cause of blocked ureter in the young
Kidney stone
141
What is pathologic postobstructive diuresis
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
Short term consequences of LUT obstruction
Renal failure and post obstructive diuresis
143
Who is most likely to get urolithiases
Men who are 30-50
144
What is classed as the upper urinary tract
Kidneys and ureters
145
Congenital anatomical causes of stones
Horseshoe, duplex, PUJO, spina bifida
146
Acquired anatomical causes of stones
Obstruction, trauma and reflux
147
Urinary causes of stones
Metastable urine, calcium, oxalate, urate, cysteine, dehydration.
148
Why does infection cause stones
It changes the acid/base balance of the urine
149
What constituent suggests the stones have come from infection
Struvite, 5-10%
150
Which stones cant be seen on XRay
Uric acid
151
What is a cause of cyteine stones
Congenital 'COLA'- Cystine, ornithine, lyseine and arginine
152
How can stones be prevented
Overhydration, normal diet (dairy and protein), low salt, reduced BMI, active lifestyle. CHECK CALCIUM AND PTH
153
How can you prevent uric acid stone formation
Deacidification of the urine to 7-7.5
154
How can you prevent cysteine stone formation
Alkalinisation through overhydration. Cysteine binders and genetic counselling
155
Stone symptoms
Asymptomatic, loin pain, renal colic, recurrant UTIs and symptoms, haematuria
156
What are UTI symptoms
Dysuria, strangury, urgency and frequency
157
What is strangury
Blockage or irritation of base of the bladder, leading to severe pain and desire to urinate
158
What causes renal colic
Upper urinary tract obstruction
159
Where is the loin
Above the pelvis but below the ribs
160
Uteric colic investigation
NCCT-KUB
161
Red flags in renal colic
Fever, infection signs
162
What does haematuria suggest
Stones
163
Differential diagnosis for renal colic
Ruptured AAA (if over 50, most liikely), diverticulitis, appendicitis, ectopic pregnancy, ovarian cyst torsion, testicular torsion, MSK
164
What does CT stand for
Computerised tomography
165
Cons of CT
No functional information and there is radiation
166
When looking at a NCCTKUB what should you look for on the kidneys
Perinephric tissues, cortical thickness, hydronephrosis+- hydroureter, stones
