Clinical Essentials

Question 1

What defines oliguria?

Answer 1

Urine output < 0.5ml/kg/hour

Question 2

What defines anuria?

Answer 2

Passage of < 50ml urine in 24 hours

Question 3

Healthy adults will pass roughly how much urine in an hour?

Answer 3

1ml/kg

Question 4

Polyuria can be caused by which electrolyte abnormality?

Answer 4

Hypercalcaemia

Question 5

Normal protein excretion is less than how much per day?

Answer 5

150mg

Question 6

Describe the appearance of urine in people with proteinuria?

Answer 6

Pink and frothy

Question 7

Nephrotic range proteinuria always indicates what type of disease?

Answer 7

Glomerular disease

Question 8

What is the triad of nephrotic syndrome?

Answer 8

Oedema, hypoalbuminaemia, proteinuria > 3g/day

Question 9

Passing how much protein in the urine in one day is defined as heavy proteinuria?

Answer 9

1-3g

Question 10

Passing how much protein in the urine in one day is defined as asymptomatic low grade proteinuria?

Answer 10

< 1g

Question 11

Passing how much protein in the urine in one day is defined as nephrotic range proteinuria?

Answer 11

> 3g

Question 12

What is sometimes considered a fourth feature of nephrotic syndrome, which occurs as an attempt to compensate for protein loss?

Answer 12

Hyperlipidaemia

Question 13

What investigation should be used ideally to quantify proteinuria?

Answer 13

Spot protein/albumin: creatinine ratio

Question 14

Haematuria throughout the stream is suggestive of bleeding from where?

Answer 14

Glomerulus

Question 15

Haematuria at the beginning of the stream is suggestive of bleeding from where?

Answer 15

Urethra

Question 16

Haematuria at the end of the stream is suggestive of bleeding from where?

Answer 16

Bladder or prostate

Question 17

What causes myoglobinuria?

Answer 17

Rhabdomyolysis

Question 18

What causes haemoglobinuria?

Answer 18

Haemolysis

Question 19

What is the management for any cases of painless visible haematuria?

Answer 19

Urgent referral to urology

Question 20

CKD is classified according to what?

Answer 20

GFR

Question 21

When is a spot urine test for calculating albumin: creatinine ratio best done?

Answer 21

Morning

Question 22

What is a normal albumin: creatinine ratio in a man?

Answer 22

< 2.5mg/mmol

Question 23

What is a normal albumin: creatinine ratio in a woman?

Answer 23

< 3.5mg/mmol

Question 24

An albumin: creatinine ratio of what is equal to 0.5g of protein being excreted per day?

Answer 24

30mg/mmol

Question 25

An albumin: creatinine ratio of what is equal to 1g of protein being excreted per day?

Answer 25

70mg/mmol

Question 26

To calculate the daily protein excretion from a protein: creatinine ratio, what should you do?

Answer 26

Multiply the number by 10 and then convert into grams

Question 27

Haematuria is divided into what two types?

Answer 27

Visible and non-visible

Question 28

Non-visible haematuria is sub-divided into what two types?

Answer 28

Symptomatic and asymptomatic

Question 29

What type of urine sample should be used for urine microscopy?

Answer 29

Mid-stream sample

Question 30

On urinalysis, what two indicators are most likely to be raised in someone with a UTI?

Answer 30

Leukocytes and nitrites

Question 31

What does specific gravity of urine measure?

Answer 31

How concentrated the urine is

Question 32

What is the normal pH range of urine?

Answer 32

4.5-8

Question 33

If there is any abnormality detected on dipstick testing, what investigation should be done next?

Answer 33

Urine microscopy

Question 34

The presence of dysmorphic red cells on urine microscopy suggests what?

Answer 34

Glomerular damage

Question 35

If a urine dipstick is strongly positive for blood but there are no red cells seen on microscopy, what does this suggest?

Answer 35

Haemoglobinuria or myoglobinuria

Question 36

What does the presence of red cell casts in the urine indicate?

Answer 36

Glomerular damage

Question 37

What does the presence of white cell casts in the urine indicate?

Answer 37

Acute infection, usually bacterial

Question 38

What type of urine casts are usually benign?

Answer 38

Hyaline

Question 39

What does the presence of granular casts in the urine indicate?

Answer 39

Chronic disease

Question 40

What happens to urea and creatinine when renal function is impaired?

Answer 40

Increase

Question 41

Neither urea or creatinine tend to rise significantly until GFR falls to around what value?

Answer 41

30ml/min

Question 42

What is the normal GFR for an average adult?

Answer 42

125ml/min

Question 43

Which individuals tend to have higher values of creatinine?

Answer 43

Those with a large muscle bulk

Question 44

Which drug often causes an isolated rise in creatinine?

Answer 44

Trimethoprim

Question 45

What is used to calculate a simple estimate of GFR?

Answer 45

Creatinine clearance

Question 46

Why does creatinine clearance slightly overestimate GFR?

Answer 46

There is a small amount of tubular secretion

Question 47

What is usually the first line imaging investigation for a suspected renal problem?

Answer 47

Ultrasound

Question 48

What imaging investigation can be used to assess the patency of renal vessels?

Answer 48

Ultrasound with Doppler

Question 49

What is the first line imaging investigation for renal colic?

Answer 49

CT-urogram (CT-KUB)

Question 50

Any histological diagnosis of renal disease requires what investigation?

Answer 50

Renal biopsy

Question 51

What medications should always be stopped before a renal biopsy?

Answer 51

Anticoagulants

Question 52

What investigation should always be done before a renal biopsy to establish the kidney anatomy?

Answer 52

Renal ultrasound

Question 53

What is the most common complication of a renal biopsy? This usually occurs within how long?

Answer 53

Bleeding - usually within 8 hours of the procedure