Urinary Formative Flashcards
What are the causes of a high creatinine?
Kidneys not functioning properly so creatinine not cleared
Effect on GFR of efferent arteriolar constriction
Increase
How would drinking a large amount of water affect osmolarity and volume of the ECF?
Decreased osmolarity and increased volume
Where is ADH produced?
Hypothalamus
What triggers the release of ADH?
High osmolarity
Too much Na+
Dehydration
If Drug A’s clearance is greater than inulin clearance, then what would be true of Drug A?
Net secretion
What is the result of impaired renal function? (metabolic/respiratory acid/alkalosis)
Metabolic acidosis (loss of HCO3)
Why are ammonium ions excreted in respiratory acidosis?
Formation of “new” bicarbonate ions results in ammonium secretion
A patient with lung cancer develops the syndrome of inappropriate ADH secretion. What changes in Na+ concentration might be expected to be seen?
Reduced
Name a loop diuretic
Furosemide
Thiazide type diuretic examples
Indapamide
Metolazone
A 6 year old child presents with swelling of his face and legs. His serum albumin concentration is 18g/l (normal 37-42) and his mother notices that his urine is frothy. What is the most likely diagnosis?
Minimal change disease
What is minimal change disease?
Most common cause of nephrotic syndrome (protein lost in urine) without visible changes in the glomerulus on microscopy
Nephrotic syndrome
>3 g proteinuria Hypoalbuminemia Peripheral oedema Hyperlipidemia Hypercoagulability
Nephrotic syndrome treatment
Prednisone (oral steroids)
Nephritic syndrome
Classified by blood in the urine
Normally proliferative
IgA nephropathy symptoms
Severe flank/abdominal pain High blood pressure Hematuria (gross, frank, microscopic) Compromised immune system Oedema in hands and feet
Focal and segmental glomerulonephritis
Sclerosis of segments of some glomerules
Likely to present as a nephrotic syndrome
Membranous nephropathy
Characterized by a thickened glomerular basement membrane without a hyperproliferation of the glomerular cells
Proliferative glomerulonephritis (types)
IgA nephropathy
Post-infectious
Membranoproliferative
Crescentic glomerulonephritis
A 23 year old woman complains of flank pain, dysuria and frequency of micturition. She has taken ibuprofen for the pain. Her urinalysis shows protein, nitrites and blood. What is the likely diagnosis?
Acute pyelonephritis
A 40 year old man was found to have asymptomatic proteinuria and microscopic haematuria during routine employment-related examination. His BP was found to be 160/100mmHg and serum creatinine 170micromol/l (normal 86-116). He has no urinary symptoms. What is the next most important investigation?
Urinary tract US
A 60 year old man has stage 5 CKD with a serum creatinine of 500 micromol/l, (normal 88-116). What are the likely levels of serum calcium and phosphate?
Calcium - low
Phosphate - high
Patients with renal failure are often anaemic. What is the best treatment for their anaemia?
Erythropoietin
Effect of high phosphate
Can pull calcium out of bones, weakening them
Why do people with CKD have a high phosphate?
Unable to remove excess
Why do people with CKD have a low calcium?
Secondary to high phosphate
Which organism is most likely to cause an uncomplicated UTI?
E. coli
A 70 year old man complains of poor stream of urine, nocturia and post-micturition dribbling.
Which of the following is the most likely cause?
Prostatic hypertrophy
A 60 year old man presents with tiredness and malaise. Routine investigations reveal a raised serum creatinine and an estimated GFR of 35ml/min. Which of the following stages of CKD is he in?
Stage 3
What does rifle stand for in AKI?
Risk Injury Failure Loss of function End-stage kidney failure
What is the commonest urological malignancy in patients with painless frank haematuria?
Bladder cancer
What is the commonest type of renal tract stones in adults?
Calcium oxalate
What is the commonest mode of presentation for patients with a renal or ureteric stone?
Loin pain radiating to the flank and/or groin
What are the features of acute urinary retention?
Painful inability to void with a palpable or percussible bladder
Are UTI bacteria mainly gram positive or negative?
Negative - treat with cephalosporins, fluoroquinolones, and aminoglycosides
