Renal conditions

Question 1

What organism commonly causes UTIs?

Answer 1

E.coli

Also, proteus mirabalis, klebsiella pneumoniae, staphylococcus saprophyticus (in young women)

Question 2

In UTI, what would be the likely results of a urinalysis?

Answer 2

+ve nitrites and leucocytes

Question 3

What is the normal management course for UTI?

What is used for resistant organisms?

Answer 3

Trimethoprim or nitrofurantoin for 3-5 days, modify if culture results indicate. For resistant organisms, co-amoxiclav or ciprofloxacin may be used.

Question 4

What is the management course for pyelonephritis?

Answer 4

IV cerfuroxime, ciprofloxacin or gentamicin. Switch for further 7 days oral treatment once symptoms improve

Question 5

Why should asymptomatic bacteriuria be treated in pregnancy?

Answer 5

Frequently leads to acute pyelonephritis.

Amoxicillin, nitrofurantoin and cephalosporins safe to use

Question 6

What causes hydronephrosis?

Answer 6

Obstruction of the UT, commonly by stones. Also, pregnancy, cancer of bladder/cervix/prostate, BPH, vesicoureteric reflux

Question 7

How is hydronephrosis managed?

Answer 7

Doesn’t always require treatment. Treat underlying cause i.e. remove kidney stones, stent a narrow ureter, treat tumour

Question 8

What causes AKI?

Answer 8

1. Pre-renal (40-70%): hypoperfusion
2. Intrinsic (10-50%): tubular necrosis, glomerular/interstitial/vascular problems
3. Post-renal (10-25%): UT obstruction
   Commonest are ischaemia, sepsis, nephrotoxins and prostatic disease

Question 9

What are the symptoms and signs of AKI?

Answer 9

Early stages often asymptomatic. Fatigue, malaise, rash, joint pain, N+V, chest pain, palpitations, SOB, fluid overload, abdo pain, oliguria, hypo/hypertension
O/E: palpable kidneys/bladder/pevlic mass

Question 10

Why is it important to do an urgent ABG/VBG and ECG in suspected AKI?

Answer 10

To check for hyperkalaemia predisposing to potentially disastrous arrhythmias

Question 11

How is AKI managed?

Answer 11

Treat underlying cause: replenish fluid in haemorrhage, remove obstruction at least temporarily with catheterisation, dialyse in some cases

Question 12

How long does it normally take for renal function to recover after AKI?

Answer 12

2-3 weeks

Question 13

Define chronic kidney disease

Answer 13

Impaired renal function based on abnormal structure or function or GFR <60ml/min/1.73m squared for >3 months

Question 14

What are the symptoms of CKD?

Answer 14

May not be present til later stages. Weight loss, poor apetite, swollen ankles/feet/hands, SOB, fatigue, haematuria, urgency, nocturia, insomnia, pruritus, muscle cramps, nausea, headaches, impotence

Question 15

On USS of kidneys, what is often the size of the kidneys in CKD?

Answer 15

<9cm

Question 16

What 3 things indicate CKD?

Answer 16

Normochromic anaemia, small kidneys and renal osteodystrophy

Question 17

How is CKD managed?

Answer 17

Aggresively treat underlying cause. Tight glycaemic control, dietry constrictions, blood pressure control, retain Ca and phosphate in normal range, recombinant human EPO for anaemia, sodium bicarbonate for acidosis, furosemide for oedema.
Renal Replacement Therapy.

Question 18

In which ethnic group is BPH less common?

Answer 18

Asians

Question 19

What are the typical differences between BPH and prostate carcinoma?

Answer 19

In BPH, inner transitional zone enlarges rather than peripheral layer of prostate in prostate carcinoma.
O/E: BPH - typically, smooth enlargement. Prostate carcinoma - nodular hard enlargement

Question 20

How is BPH managed?

Answer 20

Mild to moderate disease: Lifestyle changes, avoid caffeine and alcohol, relax when voiding, close monitoring
Moderate: Drugs - alpha blockers such as doxazosin or tamsulosin. 5-alpha reductase inhibitors such as finasteride
Deterioration in renal function: Surgery - TURP, TUIP, retropubic prostatectomy, TULIP

Question 21

What is the most common male cancer in the UK?

Answer 21

Prostate cancer

Question 22

What is the name of the scoring system used to grade prostate tumours?

Answer 22

Gleason scoring system

Question 23

What is the most common form of transitional cell malignancy?

Answer 23

Bladder carcinoma

Question 24

What are some of the risk factors for bladder carcinoma?

Answer 24

Smoking, industrial exposure (particularly rubber), chronic cystitis, drugs, schistomiasis (SCC likely), pelvic irradiation

Question 25

In bladder carcinoma, is haematuria typically painful or painless?

Answer 25

Painless

Question 26

How is bladder cancer managed?

Answer 26

For lower stages: diathermy via transurethral cytoscopy/transurethral resection of bladder tumour (TURBT), also chemo or BCG
Medium stages: Radical cystectomy is gold standard, radio and chemo
Advanced stages: Palliative chemo/radiotherapy

Question 27

In what autosomal dominant disease are bilateral renal cell carcinomas common?

Answer 27

Von Hippel-Lindau disease

Question 28

Why can hypertension be a fairly common complication of renal carcinomas?

Answer 28

Tumour secretes renin leading to increased BP. Similarly, anaemia or polycythaemia can develop due to depression/stimulation of EPO production

Question 29

What kidney tumour is seen typically within the first 3 years of life?

Answer 29

Nephroblastoma or Wilm’s tumour

Question 30

Lifetime incidence of urinary tract stones?

Answer 30

15%

Question 31

What is the most common type of urinary tract stones?

Answer 31

Calcium oxolate (75%).
Struvite (15%), urate (5%), hydroxyapetite (5%), cysteine

Question 32

Symptoms of UT stones?

Answer 32

Asymptomatic or renal colic pain with N+V. Writhing about in pain/can’t lie still. Large staghorn calculi may cause loin pain. Pain may radiate to genitals. Microscopic haematuria common. Pyexia if UTI develops

Question 33

How are UT stones managed?

Answer 33

If <5mm, should pass spontaneously, give analgesia and antibiotics
If >5mm or unresolving, shockwave lithotripsy/medical treatments (nifedipine, tamsulosin)/ureteroscopy/cystoscopy/open surgery