Renal/Urology Prep Flashcards
What are the 5 red flags of haematuria?
- weight loss
- painless haematuria
- trauma
- smoking
- working in dye factory
What are the some of the differentials associated with haematuria?
- renal cell carcinoma
- transitional cell carcinoma
- renal calculi
- urinary tract infection
- glomerulonephritis
others include urinary tract injury, coagulopathy, prostatitis, BPH+prostate carcinoma, beetroot
What are the 4 red flags associated with dysuria?
- haematuria
- weight loss
- rigors
- systemically unwell
What are some of the differentials associated with dysuria?
- UTI (most common)
- pyelonephritis
- STIs
- renal calculi
- endometriosis
- atrophic vaginitis
- BPH
What are some of the differentials associated with polyuria?
- UTI (most common)
- diabetes mellitus
- hyperactive bladder
- genito-urinary prolapse
- BPH
- diabetes inspidius
others include iatrogenic, psychogenic polydipsia, hypercalcaemia, hypokalaemia
What are the investigations involved in diagnosing an AKI?
Urine dipstick: infection = leucocytes+nitrites, glomerular = blood+protein
Renal USS = obstruction, hydronephrosis, cysts, structural abnormality
Bloods: rise in creatinine over 26mmol/L in 48h OR rise more than 1.5x baseline. Urine output less than 0.5ml/kg/h for 6h
How do you manage an AKI?
Assess volume status, aim for euvolaemia. Stop nephrotoxic drugs (NSAIDs, lithium, gentamycin, nitrofurantoin, ciclosporin)
STOP metformin in creatinine is rising due to risk of lactic acidosis
Treat underlying cause:
PRE-RENAL = correct volume depletion with fluids, treat sepsis with Abx, consider referral to ICU if signs of shock
INTRINSIC = refer to nephrology
POST-RENAL = catheterise + consider CT of renal tract + urology referral if obstruction is a likely cause
What are the indications for RRT? (hint: there’s 6)
- refractory pulmonary oedema
- persistent hyperkalaemia (K over 7)
- severe metabolic acidosis (pH less than 7.2 or BE less than -10)
- uraemic complications (encephalopathy)
- uraemic pericarditis (pericardial rub)
- drug overdose
What is the treatment for hyperkalaemia?
- 10ml of 10% calcium glucoronate IV
- IV insulin and glucose
- Nebulised salbutamol
- Bicarbonate
What are the tests done in a patient with suspected CKD?
Blood = normocytic normochromic anaemia, raised phosphate, ALP and low calcium. PTH raised in stage 3. Serum creatinine raised (more than 97 in females and 105 in males)
Imaging = USS shows small kidneys - less than 9cm
Urine = haematuria +/- proteinuria, microalbuminuria
eGFR less than 60
What are the stages of CKD? (there’s 5)
STAGE1 = GFR over 90 with evidence of renal damage STAGE2 = GFR 60-89 with evidence of renal damage STAGE3A = GFR 45-59 w/out renal damage STAGE3B = GFR 30-44 w/out renal damage STAGE4 = GFR 15-29 with or w/out renal damage STAGE5 = GFR less than 15 with established renal failure
How do you treat CKD?
Treat reversible causes: relieve obstruction, stop nephrotoxic drugs, deal with raised calcium + CV risk, DM
Anaemia - EPO or oral iron
Acidosis - sodium bicarb
Renal bone disease - phosphate binders or Vit D analogues (alfacalcidol)
BP + Fluid Status = ACEi/ARB, must be stopped if AKI diagnosed and contraindicated in pregnancy. CCB = verapimil, diltiazem
If stage 3/4 = educate on RRT
How do you manage nephrotic syndrome?
Reduce oedema with furosemide - fluid restrict 1L/day
Reduce proteinuria with ACEi/ARB
Reduce risk complications - anticoagulate and statins
Treat underlying cause
What is the difference between nephrotic and nephritic syndrome?
NEPHROTIC = normal to mild rise in BP, proteinuria greater then 3.5g/day and normal to mild drop in GFR NEPHRITIC = moderate to severe rise in BP, haematuria, moderate to severe drop in GFR
What tests are done in suspected glomerulonephritis?
BLOOD = U+E, LFT, ESR, CRP, FBC, immunoglobulins, electrophoresis, complement
AUTOANTIBODIES = ANA, ANCA, anti-dsDNA, anti-GBMc
URINE = RBC casts, MC+S, bence-jones proteins, PCR
CXR + renal USS
Renal Biopsy
