Urinary 2 Flashcards
Advantage of ACR over PCR and vica versa
ACR - can detect microalbuminia
PCR - can detect bence jones and globulins
What are disadvantages of using dipsticks to measure urinary protein?
Only detects albumin so misses bence jones proteins and globulins
Not sensitive enough for microalbuminia
Is effected by urine dilution - false +ve if concentrated false -ve if dilute
How much calcium is filtered by the kidneys daily?
How much is reabsorbed?
250mmol
98%
Where is most calcium reabsorbed in the kidneys?
Where is calcium reabsorption controlled in the kidneys?
Most in the PCT
Controlled by PTH in the DCT
How is calcium transported in the blood?
45% ionised
45% protein bound
10% complexed (citrate, phosphate etc)
Causes of hypercalcaemia?
Primary hyperparathyroidism Malignancy Thiazide diuretics Lithium AKI Renal transplant
What two causes of hypercalcaemia make 90% of all cases?
Primary hyperparathyroidism
Malignancy
What features would suggest hypercalcaemia is malignant and not from hyperparathyroidism?
Rapid rise
Large increase
Low PTH
Malignant symptoms - weight loss, fever, malaise
Do kidney stones in the setting of hypercalcaemia suggest a malignant cause or primary hyperparathyroidism?
Primary hpt
What is a secondary hyperparathyroidism?
Low calcium driving high pth
A state of compensation due to, for instance, low vit d.
What is tertiary hyperparathyroidism?
Unregulated pth secretion following secondary hptism csusing raised calcium
Management options in acute hypercalcaemia?
Hydration to increase renal excretion Loop diuretic Bisphosphonates Calcitonin Treat underlying condition
How may malignancy cause hypercalcaemia?
Release of pthrp - mainly squamous cell carcinomas
Bony destruction - haematological malignancy
A patient presents with hypercalcaemia and suppressed pth. What tests should be run?
Serum + urine electrophoresis
PTHrP
Skeletal survey
Chest abdo pelvis imaging
At what calcium level should people be considered for hospital admission?
> 3.5 mmol/l
What is the lifetime risk for renal stone formation?
Male 20 %
Female 10. %
What is the 5 yr recurrance rate for renal stones
50%
Presenation of renal stones?
Sudden onset severe flank pain to groin / testicles / labia
Nausea
Vomiting
Haematouria
Examination findings of renal colic?
Costovertebral angle tenderness Withing/pacing Tacycardia Htn Microscopic haematauria
Types of stones in renal colic?
Calcium
Uric acid
Magnesium ammonium phosphate
Mechanism behind uric acid renal stone formation?
Supersaturation of urine
Often follows gout or chemotherapy
Factors that precipitate renal stone formation?
Supersaturation - either high dietary or low fluid intake
Low ionic strengths of na, cl, k
Severe acidosis or alkalosis of urine
What investigations for a renal colic patient
Xray Urine screen - blood, pH, sediments, culture Blood screen - U+Es, PTH, Ca, PO4, CT-KUB Sieve urine for chemical anaylsis
What are the commonest calcium stones in renal calculi?
Calcium oxalate
Calcium phosphate
What pain relief is very effective in renal colic?
Diclofenac
Management of recurrent idiopathic renal stones long term?
High fluid intake
Management of recurrent hypercalciuria renal stones long term?
Normal calcium diet High fluid intake Thiazide diuretic (unless hypercalcemia)
Why does renal colic cause testicular pain?
Referred pain in the L1 nerve root - as testicles descended from abdomen they are innervated by high lumbar nerves
Clinical features of polycystic kidney disease?
Presents in adulthood
- ruptured renal cyst - loin pain and haematuria
- mass increase in kidney - abdominal discomfort
- berry aneurysm - SAH
- liver cyst - bile duct compression
- chronic renal failure - uraemia, anaemia, bone mineral disorders
Management of polycystic kidneys
Symptomatic
Monitor for renal replacement therapy
Increased water intake
Problems with eGFR
Not validated in mild renal impairment thus not a good screening tool
Large interindividular variation
Single result may be influenced by surge in creatinine, eg. Protein meal
Body muscle mass alters amount
Small amounts of creatinine are reabsorbed
Benefits of eGFR
Easy and convenient
Little intraindividual variation so shows trends well
Complications of catheterisation
Infection Trauma Paraphimosis Leakage Blockage Allergy Pain
What to assess if urinary catheter is reported blocked?
Kinking
Constipation
Debris
Bag below level of bladder
What to assess if a catheter is reported as leaking?
Blockage
Spasm symptoms
If a patient has a urinary catheter with pain and spams what can be done?
Consider smaller size
Assess for allergy
Use analgesia
Give anticholinergic
Indications for urinary catheter?
Urinary retention
Urine output monitoring
Prolonged surgery
End of life care if in patients best interests
To inject medications into the bladder or perform urological tests and proceedures
