Renal

Question 1

What is allopurinol contraindicated in?

Answer 1

Kidney disease

Question 2

What is the earliest sign of kidney disease?

Answer 2

Microalbuminuria

Question 3

What are the indications for urgent dialysis?

Answer 3

If patient has acute renal failuire (i.e. oliguria or anuria with deranged renal function) and one of the following:

Hyperkalaemia (at least 6.5mM), high urea (at least 30mM), high creatinine (at least 1000 mcM), high acid content (acidosis, pH less than 7.2) and intractable fluid overload => severe pulmonary oedema => uraemic encephalopathy

Question 4

What are the main complications of urethral bladder catheterisation? What is a common causative agent of UTI caused by catheterisation?

Answer 4

Urethral scarring/stricture => pain during micturition, slow-flowing micturition, urinary retention
Urinary tract infection => dysuria, pyelonephritis, confusion. Proteus mirabilis is a highly mobile bacterium.
Urethral trauma => pain, bleeding
Bladder perforation => pain, bleeding, peritonitis
Creation of false passage in the urethra => pain, infection

Question 5

What are the main complications of chronic urinary retention?

Answer 5

Bladder stones due to urinary stasis
Bladder wall hypertrophy (trabeculations) and out-pouchings (diverticuli)

Hydronephrosis and renal failure (secondary to hydronephrosis): dilatation of ureters and kidney calices
UTI due to urinary stasis

Urinary incontinence. Patient only can ‘dribble’ small amounts
Acute-on-chronic urinary retention: painful, unlike chronic urine retention

Question 6

What are the principal physiological mechanisms for regulating volume and serum osmolarity?

Answer 6

Renin released by kidney => Ang I => Ang II => vasoconstriction and release of aldosterone from adrenal cortex => increased Na+ uptake in distal tubule

Osmolarity regulated by ADH produced by posterior pituitary. ADH increases water BUT NOT SODIUM reabsorption in the distal tubule.

Question 7

A 55 year old man has painless haematuria. He has no other Hx. Creatinine is normal, urine has 2+protein. The most useful  investigation is 
A  CT scan
B  renal biopsy
C  urine protein quantification
D  Cystoscopy
E  Ultrasound

Answer 7

All of the above

Question 8

A 30 year old woman presents with ankle oedema. She is found to have 4+ proteinuria. She has no other Hx. The most useful  investigation is 
A) IVU
B) renal biopsy
C) echocardiography
D) cystoscopy
E) renal ultrasound

Answer 8

Renal biopsy

Question 9

How common are the following (very common, common, rare, increasingly uncommon in the developed world):
Prostatic hypertrophy and cancer
Bladder tumours
Renal tumours
Renal stone disease

Answer 9

Prostatic hypertrophy and cancer: very common
Bladder tumours: common
Renal tumours :rare
Renal stone disease: increasingly uncommon in developed world

Question 10

Which of the following are indications for a renal biopsy?
Acute renal impairment
bladder tumour
Haematuria
Proteinuria
Renal stone disease

Answer 10

Haematuria
Proteinuria
Acute renal impairment

Question 11

Which of the following statement regarding acute renal failure are correct?
Overal incidence: 100 per million population (pmp)
Over a long period of time
90 day survival 40%
Usually occurs in the context of catastrophic illness

Answer 11

ARF usually occurs in the context of catastrophic illness. ARF is usually multi-factorial and is common in the context of cricial illness. The overall incidence is 240 pmp and the 90 day survival is 62%.

Question 12

ARf is defined as the “rapid decline in renal function over hours or days”, however it is irreversible. True or false?

Answer 12

False.

Question 13

Chronic renal failure is defined as impaired renal function, usually progressive, and potentially resulting in end stage renal failure (ESRF) over months to years. True or false?

Answer 13

True. Also, it is associated with metabolic complications from renal impairment. When distinguishing ARF and chronic renal failure, the history is crucial.

Question 14

With which of the following signs and symptoms does ARF usually present?
Uraemia (nausea, vomiting, anorexia)(
Increased urine output
Rash
Myalgia
Decreased serum urea and creatinine
Acidosis, hyperkalaemia

Answer 14

Non-specific symptoms
Systemic features such as rash, myalgia, arthralgia and headaches
Uraemic symptoms (nausea, vomiting, anorexia)
Abnormal biochemistry - rise in serum urea and creatinine) - and acidosis, hyperkalaemia, and salt and water retention
Features of underlying disease
Decreased urine output

Question 15

With which of the following signs and symptoms does ARF usually present?
Uraemia (nausea, vomiting, anorexia)(
Increased urine output
Rash
Myalgia
Decreased serum urea and creatinine
Acidosis, hyperkalaemia

Answer 15

Non-specific symptoms
Systemic features such as rash, myalgia, arthralgia and headaches
Uraemic symptoms (nausea, vomiting, anorexia)
Abnormal biochemistry - rise in serum urea and creatinine) - and acidosis, hyperkalaemia, and salt and water retention
Features of underlying disease
Decreased urine output

Question 16

Patients with ____ are likely to have a cardiac arrest and cannot be resuscitated.

Answer 16

Hyperkalaemia. They need IV calcium, insulin and dextrose,nebulised salbutamol, calcium resonium and dialysis

Question 17

Pulmonary oedema kills from fluid overload. True or false?

Answer 17

True. It presents with breathlessness, hypoxia, hypercapnia and acidosis.

Question 18

How do you manage pulmonary oedema?
IV nitrates?
Dialysis?
Oxygenate patient?
High doses of loop diuretics?
Opiates to decrease the work of breathing?

Answer 18

o UNCONTROLLED PROTEINURIA IS A MAJOR RISK FOR PRESSIVE KIDNEY DISEASE AND ULTIMATELY RENAL FAILURE
o Control oedema – low salt diet, diuretics
o Angiotensin blockade
o Treat cause
o Sometimes steroids or immunosuppression
Answer: all of the above

Question 19

What are the causes of haematuria?

Answer 19

Stones, infection, medical, trauma, cancer