Renal investigations Flashcards
When is a urine dipstick indicated? (5 things)
- Signs and symptoms of UTI
- Fever (+ septic screen)
- Diabetes
- Abdominal pain
- pregnancy
What is a CTKUB? when is it indicated?
Indication:
- Renal stones (non- contrast CTKUB)
What is urodynamics?
A study of the bladder. it uses X-rays to identify how the bladder fills and empties
What is cystoscopy ? when is it indicated? (3 things)
A thin camera that is inserted into the bladder through the urethra
Indication:
- non visible/ visible HAEMATURIA
- frequent UTI’s
- therapeutic treatment for removing bladder stones.
What is lithotripsy?
A treatment that is use to break down renal calculi enabling it to pass through the body.
What is a CT urogram?
An X-ray scan of the urine system.
It uses contrast medium to visualised the organs of the renal system.
How would you investigate haematuria ? (2 things)
note: you would always look at the circumstances and other symptoms.
Investigation:
- 2WW if unexplained visible haematuria
- non urgent referral if persistent/ recurrent unexplained UTI + >60yrs old
Name 5 ways of collecting urine?
- MSU (Collected after the the first void)
- CSU (Catheter specimen urine)
- Clean catch
- Urostomy (when the bladder is removed, this bag connects to the ureter
- Nephrostomy (If theres a blockage in the urinary system, this bag connected directly to the kidney to drain urine)
What is bilirubin and would a raised and a low bilirubin indicate?
Bilirubin is formed from the breakdown of old RBC’s
Raised:
Liver disease
Low:
Blockage in the gallbladder (due to not being able to produce bilirubin)
What is Urobilinogen and what would a raised urobilinogen indicate?
Urobilinogen is produced due to the bacterial breakdown of bilirubin in the colon.
If raised it likely indicates:
- haemolytic anaemia
- Malaria
- Bilirubin turnover (
What would an albumin to creatinine ratio help you identify ?
- Kidney disease that can occur as a complication of diabetes
If a patient has repeated sterile urine pyuria. What condition may you want to check for?
What is pyuria ?
TB
Pyruia- are cells that are inflammatory in nature but do not indicate infection. They are usually found in the absence of bacteria
What is urine cytology and when is it used?
Test looks at cancerous cells in the urine.
It is only used when someone had bladder cancer and their disease Is being investigated/ monitored. OTHERWISE IT IS NOT HELPFUL!
What are 5 different causes of visible haematuria ?
- Renal stones
- Pyellonephritis
- Trauma
- Bladder cancer
- UTI
What is a CTU (CT urogram) and when is it indicated? (3 things)
Uses a CT contrast dye to identify upper and lower tract renal diseases.
Indication:
- frank haematuria
- Upper tract renal disease
- Look at the collecting system anatomy
What is a CTA (CT ) and when is it indicated?
A contrast scan that looks at
Indication:
- Renal artery stenosis
- persisting haematuira
What would you look for when trying to identify cancer on a CTU?
Increased enhancement of the mass.
Hounsfield units- which helps identify how dense the mass is.
What figure would be classed as urinary retention? And how would you treat this?
urine in the bladder >500ml.
Catheterisation is needed
What would a white, black and grey object indicate on USS?
White:
Dense objects
E.g Stones
Black:
Water or urine
Eg. cysts
Grey:
Soft tissue
E.g tumour
What investigations will all patients with non visible haematuria receive?
- Cystoscopy
2. USS
What imaging is best for a prostate cancer diagnosis?
MRI
What is the difference between a DMSA and a MAG3 scan?
DMSA:
- Uses a contrast dye to investigate the function of the kidneys individually.
MAG3:
- Scan looks at the renal excretion of the kidney
What things can cause a raised PSA? (7 things)
- UTI
- Prostatitis
- BPH
- Prostate cancer
- Bike riding
- Recent ejaculation
- PR exam
In a patient with bushings syndrome, what type of urine collection would you do ?
24 hour urinary free cortisol levels
What are the options for a patient with renal stones? (4 things)
- Ureteroscopy (flexible or rigid)
- Lithotripsy
- Watch and wait
- Nephrectomy (if severe and the stone is occupying most of the kidney + the kidney function is <50%)
What would a raised urea indicate? (4 things)
- Dehydration
- Bleeding
- Renal failure
- Chronic cardiac issues
In a patient with chronic renal disease, what would you expect to see on their blood results?
Raised Urea and creatinine.
When is dialysis indicated ?
When kidney function is <15%
What is Renal papillary necrosis? Using the mnemonic ‘POSTCARDS’ What are the causes of this?
This is a form of nephropathy involving the necrosis of the renal papilla.
P-yelonephritis
O-bstruction of the urogenital tract
S-ickle cell disease
T-uberculosis
C-irrhosis of the liver
A-nalgesia/alcohol abuse
R-enal vein thrombosis
D-iabetes mellitus
S-ystemic vasculitis.
What conditions are associated with nephrotic syndrome? (4 Things)
- Hepatitis C
- Hepatitis B
- Drugs such as NSAIDs and penicillamine
- Autoimmune conditions such as lupus.
What is hydronephrosis?
The dilatation of renal pelvis or calyces, and occurs if there is blockage of any part of the urinary system
What is the tool used for assessing prostatic symptoms in men with suspected BPH ? And what are the figures for mild, moderate and severe findings?
-The international prostate symptom score (IPSS).
NOTE:
Investigations should be guided by symptoms.
-It is a tool for classifying the severity of lower urinary tract symptoms (LUTS) and assessing the impact of LUTS on quality of life
Mild: 1-7
Moderate: 8-19
Severe: 20-35
When investigating BPH. When would you measure the creatinine ?
If clinically indicated. For instance if the man has:
- Chronic urinary retention
- Recurrent urinary tract infection.
- History of renal stones
If a patient is symptomatic, what is the next investigations for prostate issues ?
- DRE
- PSA testing
If they have a UTI however, wait until that is treated before investigating any prostate problems.
What staging tool is used for prostate cancer?
Gleason score
What initial investigations would you arrange for chronic kidney disease? (6 things)
- Serum creatinine and eGFR (Advise they don’t eat meat for 12 hours before the test)
- Arrange an early morning urine sample to measure the urinary albumin:creatinine ratio (ACR)
- Urine dipstick to assess for haematuria
- If the eGFR and urine ACR tests are repeated within 3 months:
- Make a diagnosis of CKD if there is a persistent reduction in renal - Check the person’s nutritional status, body mass index (BMI), blood pressure, and serum HbA1c and lipid profile to assess for cardiovascular risk factors
- Consider arranging a renal tract ultrasound if indicated, for example if the person has suspected urinary tract stones or obstruction, or a family history of polycystic kidney disease and is aged over 20 years
During the initial investigations for a patient presenting with chronic renal failure, What values would suggest intervention when measuring earning morning ACR ? (3 values)
- Less than 3 mg/mmol (no proteinuria), no action is needed.
- Between 3 and 70 mg/mmol, repeat the test within 3 months.
- 70 mg/mmol or more, a repeat test is not needed as this indicates significant proteinuria.
