Renal Flashcards
What are the diagnostic criteria for Acute Kidney Injury?
1) Rise in creatinine >26umol/L in 48hr period
2) Rise in creatinine >50% above baseline in last 6 months
3) Urine output <0.5ml/kg/hr
[Just need one for diagnosis]
Give a cause of pre-renal, renal and post-renal AKI
Pre-renal:
Hypovolemia
Dehydration
Heart failure
Renal:
Diabetic nephropathy
Nephrotoxic drugs
Interstitial nephritis
Post-renal:
Kidney stones
Prostatic Hyperplasia
Bladder cancer
What does a low Hb suggest in a patient with impaired kidney function?
It is a chronic kidney problem
Where are 100% of glucose and amino acids reabsorbed in the kidneys?
Proximal Convoluted Tubule
In the loop of henle which of the ascending and descending limbs are thin and thick?
Descending (Thin) - H20 reabsorbed.
Ascending (Thick) - NaCl reabsorbed.
True or false, creatinine is not reabsorbed or secreted anywhere along the nephron?
True. This is why it is a great constant to measure glomerular filtration.
Name two hormones produced by the kidney
Renin
Calcitriol (1,25-dihydroxycholecalciferol)
Erythropoietin
What is the definition of CKD?
Impaired kidney function or structure for >3months.
Function = eGFR <60 on at least 2 readings 90+ days apart.
At what stage of CKD (measured in eGFR) would it be appropriate to refer a patient on to a nephrologist?
Stage 3 (eGFR <60)
What is the first line antihypertensive in patients with CKD?
ACEi (even if over 55 and or black)
[CCB is 2nd line, BB is 3rd]
What does a high Albumin-Creatinine Ratio (ACR) indicate?
Kidney failure. It narrows the differential and suggests it is a due to a glomerular problem.
What does BUN indicate?
Blood Urea Nitrogen
Indicates how well the kidneys are functioning
True or false, NSAIDs are contraindicated in patients with AKI?
True
What is Azotemia
High urea levels.
[Bleeding, asterixis, coma, frosting on skin, nausea]
How is hyperkalaemia treated?
Insulin + Dextrose
Calcium gluconate (cardioprotective)
Salbutamol
IV fluids
Calcium resonium (excretion)
What kind of anaemia results from CKD?
Normocytic
Reduced Erythropoietin
What are the three indicators of nephrotic syndrome?
Nephrotic
HypOalbuminaemia
PrOteinuria
Oedema
What are the three indicators of nephritic syndrome?
Nephritic
Hypertension
Haematuria
Oliguria
[May also have mild proteinuria]
Give a common cause of nephrotic and nephritic syndrome. How are they treated?
Nephrotic: [DAMNS] DM Amyloidosis Minimal change Neoplasia SLE
Tx: Reduce inflammation i.e. steroids.
Nephritic: [PIG]
Poststreptococcal glomerulonephritis (PSG)
IgA nephropathy
Goodpasture
Tx: Underlying cause e.g. Abx
How do you determine Respiratory/Metabolic acidosis/alkalosis?
Look at pH, CO2 and HCO3.
Reverse = Respiratory saME = Metabolic
pH down CO2 up = resp acidosis (if HCO3 up then compensated)
pH up CO2 up = metabolic alkalosis (if
How do you know if an acidosis or alkalosis is fully compensated?
pH should be within normal range (7.35 - 7.45)
Full compensation suggests it is a chronic problem.
What is the triad of signs for pyelonephritis?
Fever
Unilateral loin pain (rarely bilateral)
Nausea & Vomiting
What antibiotic treatment would you use for pyelonephritis?
Co-amoxiclav
Ciprofloxacin
Trimethoprim
[Nitrofurantoin won’t reach the kidneys!]
What is the first line investigation for testes torsion?
Surgical exploration
[Don’t waste time with US]
How quickly should someone with testes torsion have surgery?
ASAP
Within 24hrs
[<6hrs = 90% chance of saving the testicle].
What is the function of the vas deferens?
Carries sperm from the epididymis to the urethra.
What is the cremasteric reflex?
Stroking the inner thigh results in the retraction of the ipsilateral testicle.
The cremasteric muscle raises the scrotum.
What is paraphimosis/phimosis?
Where the foreskin becomes so tight that it cannot be pulled over the glans and can cause ischaemia.
What are the three types of incontinence?
STRESS
Weak sphincter muscle
Triggered by exertion e.g. cough.
URGE [Overactive bladder]
Increased detrusor muscle activity.
OVERFLOW
High residual bladder volume due to detrusor weakness
What is the first line treatment for stress incontinence?
Pelvic floor exercises
Ring pessary
Surgical sling
Tension Free Vaginal Tape (TVT)
Colposuspension
[Can also do a voiding diary]
What is the first line treatment for urge incontinence?
Anticholinergics e.g. oxybutynin or botox injections.
What is the first line treatment for overflow incontinence?
Remove obstruction e.g. by catheterisation.
If caused by enlaged prostate can consider an alpha blocker e.g. doxazosin.
What is the grading system used to assess prostate cancer?
Gleason Grading
[Range 1-5 x2 from well differentiated to anaplastic]
1) Small uniform
2) More stroma between glands
3) Infiltrative margins
4) Irregular masses
5) Only occasional gland formation
[Treat score 7 and above]
What investigations would you perform in a patient you suspect of having prostate cancer?
DRE
Prostate Specific Antigen (PSA)
Tissue biopsy
MRI
What score system is used to assess the severity of prostate symptoms?
International Prostate Symptoms Score (IPSS)
Other than prostate cancer, what else can cause PSA levels to be elevated? (Give two example)
DRE Prostatitis BPH Riding a bike Recent ejaculation
What is the treatment for benign prostatic hyperplasia?
Alpha blockers e.g. doxazosin [relax bladder neck making urination easier] = 1st line
5-alpha reductase inhibitors e.g. Finasteride [reduce size of prostate]
Desmopressins (reduce urine production)
What is tenesmus?
Feeling of needing to empty your bowel
[Can be a sign of an enlarged prostate]
What is double voiding?
A technique of urinating then waiting 30 seconds to allow a second voiding of the bladder. Can be useful in patients with obstruction e.g. BPH.
What is the most common cause of UTI?
E coli [75% of cases]
What would you expect to see on an MSU dipstick for a patient with a UTI?
Raised Nitrites [‘I for infection’] and leukocytes.
True or false, children under 6 months of age with a UTI require further investigation?
True e.g US
[Men with UTI also require further investigation e.g. DM?]
What antibiotics should be avoided when treating UTI in pregnancy?
Nitrofurantoin [avoid at term]
- Remains 1st line in pregnancy.
Trimethoprim [Avoid 1st trimester; folate antagonist]
2nd line choices = amoxicillin /cefalexin
What is the gold standard investigation for kidney stones (/renal colic)?
Non-contrast CT KUB
[US if child or pregnant]
Give two risk factors for kidney stones
Dehydration Immobilisation Obesity Genetics Diet (high protein/sodium)
What is the threshold size of a kidney stone for it to be allowed to pass naturally?
<5mm
When would you perform a percutaneous nephrostomy in a case of renal colic?
If there is a blockage of the ureter e.g. a stone and an infection is causing increasing back pressure on the kidney. The PN drains the urine from the kidney directly. Once the infection clears, the stone can be removed by lithotripsy or percutaneous nephrolithotomy (typically if stone is >20mm).
Why would you perform a contrast CT after a non contrast CT in a patient with renal colic?
Non-contrast CT shows the stone(s).
Contrast CT shows the dilation of the ureter etc.
What is the key differentor between an epididymal cyst and a hydrocele?
Hydrocele is a fluid filled lump which cannot be felt separate from the testis (it is in the tunica vaginalis)
An epididymal cyst can be felt separate from the testis.
How can transillumination be used to differentiate between scrotal cysts and cancer?
Cysts are fluid filled and therefore will transilluminate when light is shone through them.
Cancers are solid and will not.
What scrotal mass classically feels like a “bag of worms”?
Varicocele
What is Von Hippel Lindau disease?
An autosomal dominant genetic condition which disposes the patient to multiple tumours in different organs.
What investigations are done for kidney cancer?
US renal tract (1st) if negative then…
Contast CT chest/abdo/pelvis
Tissue biopsy
Cystoscopy for bladder cancer (US doesn’t pick this up)
What further investigation should be done in a patient with a varicocele?
Abdominal US to investigate the kidneys as varicocele (bag of worms) often is caused by kidney cancer.
Where do kidney cancers tend to metastasize?
To the lungs via the blood (haematogenous spread)
