Renal/Uro

Question 1

What is amyloidosis?

Answer 1

is a clinical disorder caused by extracellular deposition of insoluble abnormal proteins.

Question 2

What is amyloidosis associated with?

Answer 2

• rheumatoid arthritis
• juvenile chronic arthritis
• ankylosing spondylitis
• psoriasis & psoriatic arthritis
• Still’s disease
• Behget syndrome

Question 3

How does amyloidosis present?

Answer 3

• Largely determined by the organ or system affected & the picture is often confused by the underlying disease.
• Renal dysfunction is one of the most common presenting features of patients with systemic amyloidosis.

Question 4

How do we dx amyloidosis?

Answer 4

Amyloidosis is diagnosed when Congo red-binding material (bright green fluorescence observed under polarized light
after Congo red staining) is demonstrated in a biopsy specimen

Question 5

What is the most common genetic cause of renal failure in adults?

Answer 5

Autosomal dominant polycystic kidney disease (ADPKD)

Question 6

How do we treat BPH?

Answer 6

a1-adrenergic receptor antagonists (e.g. terazosin, tamsulosin)
* relaxes smooth muscle in the prostate & bladder neck thereby decreasing the degree of blockage of urine flow.
* 5a-reductase inhibitors (e.g. finasteride)
* inhibits 5a-reductase, which reduces production of dihydrotestosterone, a hormone responsible for enlarging the prostate.

Question 7

How do we manage urethral injury?

Answer 7

If you suspect urethral injury do not attempt urethral catheterisation but refer urgently to the Urologists.
- Some Urologists perform a retrograde urethrogram.
- Others prefer suprapubic catheterisation & subsequent imaging.

Question 8

What is sterile pyuria?

Answer 8

Sterile pyuria is a condition where white blood cells are present in urine, but no bacteria are detected

Question 9

What is the triad in RCC?

Answer 9

Haematuria, loin pain and loin mass

Question 10

What is the most common cancer in men?

Answer 10

Prostate

Question 11

Why do you get metabolic acidosis in renal failure?

Answer 11

In chronic renal failure with ingestion of normal protein, fixed acids (e.g. lactic acid, phosphoric acid etc) will be produced from protein catabolism. Because the failing kidney does not produce enough NH4+ to excrete all the of the fixed acid, metabolic acidosis (with respiratory compensation) results.

Question 12

What is functional incontinence?

Answer 12

involuntary leakage of urine due to environmental or physical barriers to toileting. This type of incontinence is sometimes referred to as toileting difficulty. This may occur in a person with poor memory / eyesight / mobility or who has difficulty removing clothing, or there may be an unwillingness to go to the toilet because of depression,
anxiety, or anger, etc.

Question 13

Which UC tx can cause oligospermia?

Answer 13

Sulfasalazine

Question 14

What is necessary before undergoing a PSA test?

Answer 14

not have an active urinary infection.

• not have ejaculated in the past 48 hours.
• not have exercised vigorously in the past 48 hours.
• not have had a prostate biopsy in the past 6 weeks.

Question 15

How do we classify CKD?

Answer 15

Chronic kidney disease (CKD) is classified using a combination of estimated glomerular filtration rate (eGFR) and urinary albumin:creatinine ratio (ACR). Increased ACR is associated with increased risk of adverse outcomes. Decreased GFR is associated with increased risk of adverse outcomes. Increased ACR and decreased GFR in combination multiply the risk of adverse outcomes.

Question 16

Where do you see the eggplant deformity?

Answer 16

Penile fracture

Question 17

What is the commonest type of renal stone?

Answer 17

Calcium oxalate

Question 18

A 50-year-old man undergoes a CT abdominal scan with contrast. Following the procedure, his renal function has deteriorated. Dx?

Answer 18

Acute tubular necrosis

Question 19

What is the most common causative organism of UTI in young adult women?

Answer 19

S saprophyticus

Question 20

What is the most common cause of glomerulonephritis worldwide?

Answer 20

IgA nepropathy?

Question 21

How does IgA nephropathy present?

Answer 21

typically presents as nephritic syndrome (visible haematuria) 24-48 hours after an upper respiratory tract infection. High-dose prednisolone can reduce proteinuria and delay renal impairment, and in patients with deteriorating renal function, immunosuppressive drugs are often used.

Question 22

How do we differentiate between IgA nephropathy and post-streptococcal glomerulonephritis?

Answer 22

IgA nephropathy may be differentiated from a post-streptococcal glomerulonephritis where visible haematuria occurs 1 to 3 weeks after the onset of streptococcal infection.

Question 23

How does Wegener’s granulomatosis present?

Answer 23

Granulomatosis (granulomatosis with polyangiitis [GPA]) is a systemic vasculitis that typically involves small and medium vessels. Although any organ may be targeted, the classic triad consists of upper and lower respiratory tract involvement and pauci-immune glomerulonephritis

Question 24

How does Churg-Strauss syndrome present?

Answer 24

Churg-Strauss syndrome or eosinophilic granulomatosis with polyangiitis (EGPA) whose main features include asthma, gastrointestinal and cardiac involvement with significant (>10% of peripheral WBC count) peripheral eosinophilia or tissue eosinophilia.

Question 25

How does Goodpasture’s syndrome present?

Answer 25

eosinophilia. Goodpasture’s syndrome (anti-glomerular basement membrane antibody disease) is another differential where the presentation of pulmonary haemorrhage and glomerulonephritis is clinically indistinguishable from Wegener’s granulomatosis. But, the presence of involvement in other sites (e.g. upper respiratory tract) argues against a diagnosis of Goodpasture’s syndrome.

Question 26

How does exercise cause hyperkalaemia?

Answer 26

Shifts K+ from cells into blood

Question 27

Which colour does nitrofurantoin cause in urination?

Answer 27

Brown urine

Question 28

How do we prevent renal stones?

Answer 28

Advise to consume less oxalate by reducing tea, chocolate, nuts, strawberries, rhubarb, spinach, beans & beetroot & to drink plenty of fluids especially in the summer.

Question 29

What is Alport syndrome?

Answer 29

Alport syndrome is a X-linked or autosomal recessive inherited rare defect in the genes encoding the chains of type IV collagen of the
basement membranes.

Question 30

How does Alport syndrome present?

Answer 30

Presents as sensorineural deafness, pyelonephritis, haematuria, renal failure.
* Treatment is dialysis or renal transplant for end stage renal failure.

Question 31

What is analgesic nephropathy?

Answer 31

• It begins after several months of NSAID, paracetamol or phenacetin exposure.
• A unique feature of allergic interstitial nephritis caused by NSAIDs is that patients may present with nephrotic syndrome.
• In such patients, massive proteinuria with hypoalbuminaemia and oedema are present in addition to the typical features of acute interstitial nephritis.

Question 32

What is Balkan nephropathy?

Answer 32

Balkan nephropathy was first identified among several small, discrete communities along the Danube River.

Question 33

How does Balkan nephropathy present?

Answer 33

The symptoms are not typical for the common chronic nephritis:
* Incidence only in adults (no children affected)
* lack of high blood pressure
* xanthochromia (presence of bilirubin) of palms and soles (Tanchev’s sign)

Question 34

Tx for pyelonephritis in the community?

Answer 34

Cefalexin

Question 35

What is pneumaturia?

Answer 35

Pneumaturia is the passage of gas mixed with urine, usually as a result of a vesico-colic fistula.
* Causes include diverticulitis (50-70%), malignancy (20%) & Crohn’s disease (10%).
* May occasionally be due to gas-producing bacterial infections of the urinary tract.
* The patient presents with dysuria and frequency, and may describe bubbles in the urine.
* There may also be faecaluria.

Question 36

What is Fanconi syndrome, and how does it present?

Answer 36

Fanconi syndrome is a generalised inherited or acquired disturbance of renal tubular transport.
* Leads to aminoaciduria, glycosuria, phosphaturia, renal tubular acidosis type 2 (proximal), & hypophosphataemic rickets (children) or osteomalacia (adults).

Question 37

Which vaccine can be used to treat non-muscle invasive bladder ca?

Answer 37

BCG

Question 38

How is phenytoin metabolised?

Answer 38

In the liver