Renal Flashcards
(40 cards)
Old man with suprapubic tenderness, palpably full bladder. Decreased urine output.
What do we even do?
US bladder
Urinalysis + culture
PSA
Immediate prostatectomy
US bladder
Someone taking lots of drugs like beta blocker, ACEi, Aspirin, spironolactone. Has eGFR of <35 ish. Regular blood tests would prevent which ADR?
a. Hyperkalaemia
b. Hyponatraemia
c. Acute renal failure
Hyperkalaemia - spirinolactone
Is this the one where the person had a kidney stone and fever/rigors and then kidneys went off. Table provided of biochemistry results. Increased creatinine, increased urea, 30mls urine output for 5 hours. K of 6.4 (honestly bugger em). No ECG changes. What is the best management?
a) IV bicarbonate
b) Risperdronate
c) IV furosemide
d) IV insulin and dextrose
e) Calcium gluconate
IV insulin and dextrose
Guy with CKD, deranged electrolytes. Hella high K+ over 7 (was 7.2) also had hyponatremia, high urea, low bicarb, high other stuff. with bradycardia. How would you manage this?
a) Insulin and dextrose
b) IV Bicarbonate administration
c) IV calcium gluconate
d) Rectal resonium
e) IV fluids
f) Normal saline
Insulin + dextrose.
IV calcium gluconate if there is ECG changes - this stabilises membrane but doesnt help high potassium.
But for all hyperkalemia - salbutamol first while setting it up
Māori kid with haematuria and lower limb oedema. BP 125/85. Electron microscopy showing subepithelial humps with fused podocyte foot processes. Low C3. Had no clear Hx of recent infections but gets ‘colds during winter’, admitted to hospital last year for clavicle fracture.
- Post-infectious glomerulonephritis
- Minimal change
- Membranous GN
- Focal glomerular sclerosis
- Goodpasture syndrome
- Membrane proliferative GN
- Alports
- Mesangial proliferative GN
- Idiopathic crescentic GN
Post-infectious glomerulonephritis
Girl with loin pain - urine showed signs of UTI. Treat with antibiotics. Later on still unwell, now has a palpable loin mass?? What investigation
· CT abdomen
· Renal USS
· DMSA scan
Renal USS
nb DMSA used for size, shape, scarring.
Guy who hasn’t peed for 18hours, large suprapubic mass, cannot catheterise, enlarged uniform prostate. What is next step
· Bladder ultrasound
· Suprapubic catheter
· Suprapubic needle aspiration
- Catheter
· Emergency prostatectomy
· Suprapubic catheter
Needle aspiration is for taking a tiny sample, would take forever and this is an emergency.
Man has urinary problems (think it just said leakage of urine when coming home, causing him to withdraw from social events) preventing from attending social events or something?? Nah think it was the when coming home question from past years. Also was on atenolol (or something) and something else
a. Stress incontinence
b. Detrusor instability
c. Idk what else
d. Medication side effects
e. BPH
Detrusor instability
This is urge incontinence
Old man had urinary incontinence after long trips so had to cut his social events down. At other times struggled to achieve adequate flow/had to push out pee to achieve complete emptying? What’s your next step/management?
a. Urinalysis
b. Rectal exam
c. PSA
Rectal exam
Person with mild hypertension and has family history of CKD. His eGFR was 80. What investigation
a. Urine microalbumin
b. Urine osmolality
c. Renal artery duplex
d. Uric acid
Urine microalbumin
protein:creatinine ratio would pop off
urine shows increased sodium. plasma shows decreased sodium. patient is fatigued.
which part of kidney is affected?-
Most sodium reabsorption occurs in…. Proximal convoluted tubule (PCT)
But the collecting duct is where water is reabsorbed via ADH.. this guy may have SIADH.
Death following renal transplant - most common cause?
Acute rejection immediately
Investigation of renal stones first line
If patient is not pregnant, arrange CT‑KUB (kidneys, ureters, and bladder) (without contrast) as first imaging
Test for kidney scarring in young boy
DSMA
Investigation of choice for quick surgical evaluation at bedside for pyelonephritis
renal USS
Most common organism causing pyelonephritis
E. coli, gram negative bacteria
Best way to monitor fluid load in a patient on dialysis?-
Daily weight
Child with UTI, treated with antibiotics which didn’t help. Now has pain in flank and
palpable mass. What investigation do you use?
USS to look for fluid collection - abscess
Kidney question - proteinuria 3+, fusion of foot processes and sclerotic changes, low C3 complement
membranous GN
Common cause of nephrotic syndrome in adults
PLA2R receptor, Immune complexes deposition on subepithelial location —> thickening
Location of action of thiazides
Distal tubule
Male. Colicky left flank pain radiating to testicle
Ureteric calculi
Patient with mahogany urine and suprapubic pressure
Acute cystitis
Dude with ureteric calculus at Vesicoureteric junction, 4mm. Proximal ureteral
dilation. Treatment?
Probably just conservative - pain relief, fluids and
If a small stone is stuck and creates blockage at UVJ (the junction of the ureter and the bladder), and the patient has symptoms of severe pain, nausea and vomiting, or signs of infection (fever, chills, UTI), then surgical treatment needs to be instituted immediately.
If no infection can look at other options.
Lady with CKD presenting with malaise. Low BP and bradycardia. Blood results: deranged electrolytes, hyperkalaemia (7.2), hyponatremia, high urea, low bicarb. How would you manage this?
IV 1g calcium gluconate
