renal investigations

Question 1

AKI stage 1

Answer 1

mild: creatinine 1.5-1.9x baseline creatinine or urine output <0.5 ml/kg/hour for 6 hours.

Question 2

AKI stage 2

Answer 2

moderate: 2-2.9 x baseline creatinine or urine output <0.5 ml/kg/hour for >12 hours.

Question 3

AKI stage 3

4 points

Answer 3

severe: 3/>3 x baseline creatinine

or urine output <0.3 ml/kg/hour for 24 hours

or anuria for 12 hours

or serum creatinine >354umol/dl

Question 4

what does the creatinine KINASE have to be to diagnose rhabdomyolosis

Answer 4

5x normal limit

Question 5

what would the urea:creatinine ratio of a pre renal cause of AKI be

Answer 5

> 100

Question 6

what would the urea:creatinine ratio of an intrinisc renal aki be

Answer 6

<100

Question 7

diagnostic criteria for AKI
(3 )

Answer 7

increase creatinine >26micromol/L in 48 hrs

or

increase in creatinine by >50% in 7 days

or
decrease in urine output <0.5ml/kg/hr for more than 6 hours

Question 8

Alport syndrom diagnostic test

Answer 8

Biopsy of kidneys showing thickenig and thinning of the GBM, splitting of the lamina densa

“basket weave appearance”

Question 9

Myeloma diagnosis
1st line Ix

Answer 9

1st line Ix: serum protein electrophoresis (tests for globulins in blood) and BJP from urine

Question 10

How to classify lupus nephritis

Answer 10

ISN classification
1-6
Based on the severity of mesangial proliferation> glomerular sclerosis

Question 11

gold standard test for bladder cancer

Answer 11

cytoscopy

Question 12

Ixs and their results for minimcal change disease

Answer 12

electron microscopy shows fusion of podocytes and effacement of foot processes

urinalysis: highly selective proteinuria is also a sign

Question 13

when is renal biopsy carried out for minimal change disease

Answer 13

after failure to respond to steroids

Question 14

screening test for CKD in diabetics

Answer 14

urinary Albumin/creatinine ratio (ACR) on a spot urine sample.

If abnormal, repeat with a first pass morning urine specimen

Question 15

first indicator of diabetic nephropathy

Answer 15

microalbumineria

Question 16

Ix for membranous glomerulonephritis and the results of it

Answer 16

renal biopsy:
electron microscopy shows basement membrane is thickened with subepithelial electron dense deposits.

this creates a “spike and dome” appearance

Question 17

what is used to confirm diagnosis of recent streptococcal infection (in PSGN)

Answer 17

bloods: raised anti-streptolysin 0 tire

Question 18

what must be monitored for HSP patients

Answer 18

blood pressure and urinalysis monitoring

Question 19

what investigation is used to screen for ADPKD
and what is the diagnostic criteria for patients with a positive family history

Answer 19

ultrasound

<30yrs: 2 cysts unilateral or bilateral

30-59yrs: 2 cysts in both kidneys

> 60yrs: 4 cysts in both kidneys

Question 20

initial screening test
and
gold standard test for CKD caused by hypertension/renal artery stenosis

Answer 20

initial: abdominal duplex ultrasound

Renal MRA (magnetic resonance angiogram)

Question 21

Prostate cancer intial investigation
Issues with this ix
Most useful for

Answer 21

Psa

High grade cancers may not produce PSA

Useful for monitoring post treatment

Question 22

What is the gleason grading system for

Answer 22

Predicts the prognosis of the prostatic tumour

3 is the lowest - well differentiated
5 is the highest- least differentiated

you get 2 scores but so lowest is acc 6 and highest is 10

the lower the score the better
(the higher the score the more abnormal the cancer therefore the prognosis is worse)

Question 23

normal range of protein in the urine

Answer 23

<150mg/24 hrs

Question 24

how much protein in the urine is classed as nephrotic

Answer 24

> 450mg/25hrs 3+ on dipstick reading

Question 25

stage 1 CKD:

Answer 25

eGFR> 90ml/min/1.73m2 w/ demonstratble kidney damage eg haemuturia/proteinuria

has to be for 3 months or greater !

Question 26

stage 2 CKD

Answer 26

60-89ml/min/1.73m with demonstratable kidney damage eg proteinuria/heamaturia/inc ACR

Question 27

stage 3 ckd

Answer 27

30-59ml/min/1.73m

can be split into 3a and 3b

Question 28

stage 4 ckd

Answer 28

eGFR is 15-30 ml/min/1.73m2.

Question 29

stage 5 ckd

Answer 29

eGFR is <15 ml/min/1.73m2

Question 30

Gold stanfard test for renal colic

Answer 30

low dose non contrast CT scan of kidneys, ureters and bladder

Question 31

indications for treating obstructed kidney immedietley

Answer 31

pain persisting, pyrexia, persistent nausea/vomiting, impaired renal function

Question 32

frank haemuturia type of referral and Ixs

Answer 32

2 week wait referral

cytoscopy and uss

Question 33

twisted testicle ix

Answer 33

surgical exploration as it is an emergency

Question 34

renal trauma injury Ix

Answer 34

triple face CT scan

Question 35

gold standard investigation for Anti-GBM disease/goodpastures

Answer 35

renal biopsy: light microscopy- can show rpgn

immunoflouresence will also show linear deposits of IgG at GBM

Question 36

1st line Ix for suspected prostate cancer

Answer 36

MRI

Question 37

what does a positive phrens sign indicate

Answer 37

+ phrens= relief on lifting the testicle. differentiates between epidydmitis and torsion (torsion would result in a negative phrens sign)

Question 38

Ix for renal tb

Answer 38

urinary auramine staining and microscopy

Question 39

Ix for an infection in a kidney cyst

Answer 39

blood culture

Question 40

diagnostic test for pyelonephritis

Answer 40

mid stream urine microscopy and culture

(this is done to guide the antibiotic treatment)