Urinary 2 Flashcards

1
Q

Advantage of ACR over PCR and vica versa

A

ACR - can detect microalbuminia

PCR - can detect bence jones and globulins

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2
Q

What are disadvantages of using dipsticks to measure urinary protein?

A

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

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3
Q

How much calcium is filtered by the kidneys daily?

How much is reabsorbed?

A

250mmol

98%

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4
Q

Where is most calcium reabsorbed in the kidneys?

Where is calcium reabsorption controlled in the kidneys?

A

Most in the PCT

Controlled by PTH in the DCT

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5
Q

How is calcium transported in the blood?

A

45% ionised
45% protein bound
10% complexed (citrate, phosphate etc)

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6
Q

Causes of hypercalcaemia?

A
Primary hyperparathyroidism 
Malignancy
Thiazide diuretics
Lithium
AKI
Renal transplant
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7
Q

What two causes of hypercalcaemia make 90% of all cases?

A

Primary hyperparathyroidism

Malignancy

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8
Q

What features would suggest hypercalcaemia is malignant and not from hyperparathyroidism?

A

Rapid rise
Large increase
Low PTH
Malignant symptoms - weight loss, fever, malaise

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9
Q

Do kidney stones in the setting of hypercalcaemia suggest a malignant cause or primary hyperparathyroidism?

A

Primary hpt

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10
Q

What is a secondary hyperparathyroidism?

A

Low calcium driving high pth

A state of compensation due to, for instance, low vit d.

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11
Q

What is tertiary hyperparathyroidism?

A

Unregulated pth secretion following secondary hptism csusing raised calcium

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12
Q

Management options in acute hypercalcaemia?

A
Hydration to increase renal excretion
Loop diuretic
Bisphosphonates
Calcitonin 
Treat underlying condition
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13
Q

How may malignancy cause hypercalcaemia?

A

Release of pthrp - mainly squamous cell carcinomas

Bony destruction - haematological malignancy

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14
Q

A patient presents with hypercalcaemia and suppressed pth. What tests should be run?

A

Serum + urine electrophoresis
PTHrP
Skeletal survey
Chest abdo pelvis imaging

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15
Q

At what calcium level should people be considered for hospital admission?

A

> 3.5 mmol/l

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16
Q

What is the lifetime risk for renal stone formation?

A

Male 20 %

Female 10. %

17
Q

What is the 5 yr recurrance rate for renal stones

A

50%

18
Q

Presenation of renal stones?

A

Sudden onset severe flank pain to groin / testicles / labia
Nausea
Vomiting
Haematouria

19
Q

Examination findings of renal colic?

A
Costovertebral angle tenderness
Withing/pacing
Tacycardia
Htn
Microscopic haematauria
20
Q

Types of stones in renal colic?

A

Calcium
Uric acid
Magnesium ammonium phosphate

21
Q

Mechanism behind uric acid renal stone formation?

A

Supersaturation of urine

Often follows gout or chemotherapy

22
Q

Factors that precipitate renal stone formation?

A

Supersaturation - either high dietary or low fluid intake
Low ionic strengths of na, cl, k
Severe acidosis or alkalosis of urine

23
Q

What investigations for a renal colic patient

A
Xray
Urine screen - blood, pH, sediments, culture
Blood screen - U+Es, PTH, Ca, PO4, 
CT-KUB
Sieve urine for chemical anaylsis
24
Q

What are the commonest calcium stones in renal calculi?

A

Calcium oxalate

Calcium phosphate

25
Q

What pain relief is very effective in renal colic?

A

Diclofenac

26
Q

Management of recurrent idiopathic renal stones long term?

A

High fluid intake

27
Q

Management of recurrent hypercalciuria renal stones long term?

A
Normal calcium diet 
High fluid intake 
Thiazide diuretic (unless hypercalcemia)
28
Q

Why does renal colic cause testicular pain?

A

Referred pain in the L1 nerve root - as testicles descended from abdomen they are innervated by high lumbar nerves

29
Q

Clinical features of polycystic kidney disease?

A

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
30
Q

Management of polycystic kidneys

A

Symptomatic
Monitor for renal replacement therapy
Increased water intake

31
Q

Problems with eGFR

A

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

32
Q

Benefits of eGFR

A

Easy and convenient

Little intraindividual variation so shows trends well

33
Q

Complications of catheterisation

A
Infection 
Trauma
Paraphimosis
Leakage 
Blockage
Allergy 
Pain
34
Q

What to assess if urinary catheter is reported blocked?

A

Kinking
Constipation
Debris
Bag below level of bladder

35
Q

What to assess if a catheter is reported as leaking?

A

Blockage

Spasm symptoms

36
Q

If a patient has a urinary catheter with pain and spams what can be done?

A

Consider smaller size
Assess for allergy
Use analgesia
Give anticholinergic

37
Q

Indications for urinary catheter?

A

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