Renal Tract

Question 1

what is cystitis?

Answer 1

inflammation of the bladder

Question 2

what is the major pathogenic cause of UTIs?

Answer 2

E. coli

Question 3

what kind of pathogen is e. coli?

Answer 3

gram-negative, anaerobic, rod-shaped bacteria

Question 4

what is the typical finding of UTIs on MC&S?

Answer 4

nitrites + - gram negative bacteria

leukocytes +

Question 5

what is the treatment of UTIs?

Answer 5

trimethoprim/nitrofurantoin

or nitrofurantoin then cefalexin/amoxicillin if trying to conceive

Question 6

when are nitrofurantoin and trimethoprim avoided?

Answer 6

nitrofurantoin: third trimester
trimethoprim: first trimester

Question 7

what is the treatment for prostatitis?

Answer 7

ciprofloxacin

Question 8

what is the difference in presentation of cystitis and pyelonephritis?

Answer 8

pyelonephritis may have vomiting, febrile and complain of loin pain. they will be pyrexic and have renal angle tenderness

Question 9

what is a side effect of trimethoprim?

Answer 9

isolated creatinine increase

Question 10

what type of Abx should be given to a UTI caused by Klebsiella?

Answer 10

ESBL e.g. pivmecillam and meropenem

Question 11

what is the management of pyelonephritis?

Answer 11

admit patient to hospital for IV Abx: broad spec cephalosporin / quinolone / gentamicin

Question 12

what is AKI?

Answer 12

a rapid (within 7 days) and sustained (lasting > 24 hours) reduction in renal function resulting in oliguria and a rise in serum urea and creatinine
it is usually reversible

Question 13

what are the causes of AKI?

Answer 13

pre-renal: shock e.g. hypovolaemic, and renovascular disease e.g. renal artery stenosis, and dehydration
renal: acute glomerulonephritis, acute tubular necrosis, acute interstitial nephritis (drug induced), haemolytic uraemia syndromes or vasculitides
post-renal: kidney stone, tumour, BPH, strictures

Question 14

what are the investigations for AKI?

Answer 14

bloods: FBC, U&E, LFT, glucose, clotting, calcium ESR
ABG: hypoxia (oedema), acidosis, potassium
urine: dip, MCS
ECG: hyperkalaemia
CXR: pulmonary oedema
renal US: renal size and hydronephrosis

Question 15

what are the indications of dialysis in AKI?

Answer 15

AEIOU:
acidosis (<7.20)
electrolyte imbalance (hyperkalaemia)
intoxication (poisoning)
oedema 
uraemia (encephalopathy or pericarditis)

Question 16

what is the difference in presentation between AKI and CKD?

Answer 16

CKD: weight loss, reduced appetite, pruritis, anaemia, chronic fatigue
AKI: confusion and seizures, OLIGURIA, n/v, SOB dehydration, acute fatigue

Question 17

what is the definition of CKD?

Answer 17

a gradual, irreversible decline in kidney function
this requires either a decreased GFR or markers of kidney damage (albuminuria, electrolyte abnormalities, structural or histological renal abnormalities)
present for >3 months!

Question 18

what are the causes of CKD?

Answer 18

glomerular: IgA nephropathy, SLE
vascular: vasculitis and renal artery stenosis
amyloidosis and myeloma
congenital: polycystic kidney disease and Alport syndrome
systemic: diabetes and hypertension
MOST COMMON: diabetes, hypertension, chronic glomerulonephritis, polycystic kidney disease

Question 19

what are the complications of CKD?

Answer 19

use CRF HEALS:
CVD, renal osteodystrophy, fluid (oedema), hypertension, electrolyte disturbance (hyperkalaemia, acidosis), anaemia, leg restlessness, sensory neuropathy

Question 20

which drugs cause hyponatraemia?

Answer 20

SSRIs e.g. sertraline causes SIADH
carbamazepine
sulfonyureas
tricyclics

Question 21

what is the MOA for spirinolactone?

Answer 21

aldosterone antagonist

Question 22

which stones are related to UTIs?

Answer 22

magnesium carbonate (struvite) stones

Question 23

which stones are related to hyperparathyroidism?

Answer 23

calcium carbonate stones

Question 24

what are the signs of polycythaemia?

Answer 24

HIGHHb:
headaches, I (eye) sight blurry/itching, overGrown spleen-splenomegaly, hearing problems (tinnitus), hypertension, breathlessness