Renal Q's

Question 1

Euvolumeic hyponatraemia causes and how to differentiate

Answer 1

Either SIADH or 1o polydipsia
*differentiate with urine osmolality if >100 SIADH, <100 –> 1o polydipsia

Question 2

MDMA toxicity

Answer 2

• Ecstasy
• tachycardia, hypertension pupils dilated, arrhythmias
  *hyponatraemia, hyperactivity

Question 3

VHL disease

Answer 3

• AD
  *haemangioblastomas of the CNS and retina
  *renal cysts and can progress to renal cell carcinoma
  *phaeochromocytoma

Question 4

mgx of hematuria, pyuria (+nitrates and or + leucocytes) and dysuria

Answer 4

*diagnosis UTI
*abx and urine culture

Question 5

HTN, abdominal or neck bruit in a young woman

Answer 5

*fibromuscular dysplasia
*can develop headaches, pulsatile tinnitus, sub auricular systolic bruit 2o int carotid artery stenosis and 2o HTN due to renal artery stenosis

Question 6

pre renal acute kidney injury

Answer 6

*bun:creat >20:1
*urine Na <20Meq/L
*low fractional excretion of Na <1
*urine sedimentation is negative and WBC is negligible

Question 7

pathology of urinary incontinence in pt with MS

Answer 7

*overactivity of detrusor muscle
*urge incontinence
*U/S–> small contracted bladder
*mgx:- antimuscarinic (oxybutynin) and B 3 receptor agonist (mirabegron)

Question 8

Acute Tubular necrosis causes

Answer 8

ischaemic –> hypotension, sepsis
Toxin –> abx e.g gentamicin, amikacin, vancomycin
antivirals, contrast, heavy metals ,cisplatin

Question 9

ATN 2o aminoglycocide

Answer 9

• 5-7/7 after starting abx
• • BUN:CR <20:1
    *muddy down or epithelial casts
    *fractional excretion of Na (FENa) >2%

Question 10

Acute interstitial nephritis

Answer 10

*Allergic interstitial nephritis/drug induced interstitial nephritis
* c/o fever, maculopapular rash, arthralgia and hx of starting medication 5/7 - few weeks before
*Acute kidney injury, pyuria, hematuria, WBC casts, eosinophilia

Question 11

Acute interstitial nephritis causes

Answer 11

Drugs :- SMART NAC
sulfonamides
methicillin
ampicillin
rifampin
TMP-SMX

NSAIDs
allopurinol
cephalosporin/cimetidine

Question 12

Blunt trauma to flank investigation

Answer 12

*if flank pain/tenderness, ecchymosis, gross/ microscopic haematuria –> CT abdominal

Question 13

Diabetes insipidus

Answer 13

polyuria
hypernatraemia
raised serum osmolality
reduced urine osmolality

Question 14

obstructive uropathy features

Answer 14

increased post voidal volume (normal <50ml)
will not cause proteinuria
creatinine normal unless complete obstruction

Question 15

Diabetic kidney disease

Answer 15

hx of diabetes, other microvascular complications
poor glycaemic control, poor BP control
proteinuria

Question 16

urgent treatment of hyperkalaemic emergency

Answer 16

calcium carbonate
glucose +insulin

Question 17

Hepatorenal syndrome

Answer 17

kidney failure in the setting of liver cirrhosis
urinalysis:- no protein no bld
rising creatinine
ascites non repsonsive to diuretics
Low urine Na
no improvement with volume expansion ie iv albumin

Question 18

serum sickness

Answer 18

type III hypersensitivity reaction
2o drugs e.g beta lactams, allopurinol, sulfa drugs, antivenom
fever, urticaria, arthralgia, lymphadenopathy, proteinuria

Question 19

SIADH

Answer 19

*hypotonic –>serum osmolality <275
*hyponatraemia
*urine osmolality >100
*urine Na >40

Question 20

complications of nephrotic syndrome

Answer 20

*hypercoagulability
*hyperlipidaemia
*infections
*protein malnutrition
*intravascular volume depletion

Question 21

ureteral stones mgx

Answer 21

*<5mm –> fluids pain control
*>10mm –> lithotripsy, stent
*5-10mm –>fluids, pain control +alpha 1 blockers e.g tamsulosin

Question 22

magnesium toxicity

Answer 22

lethargy, weakness, hypotonia, absent reflexes, bradycardia, hypotension

Question 23

peritoneal dialysis related peritonitis

Answer 23

2o touch contamination or extension of catheter site infection
*c/o abd pain +/- fever, nausea
*rebound tenderness
*cloudy peritoneal fluid, positive gram stain, netrophilia in fluid

Question 24

1o nocturnal enuresis first line mgx

Answer 24

bedwetting >5yrs
*behavioural modification
*eneuresis alarm
*desmopressin

Question 25

factors needing urgent referral to urology for pt with renal stones.

Answer 25

*complete obstruction (anuria) *acute kidney injury *fever/UTI *intractable pain, N+V

Question 26

uric acid renal stones

Answer 26

* suspect in pts with acidic urine pH<5.5 and hx of gout, myeloproliferative disorder *crystals not seen in xray but can be seen on CT or U/S *high uric acid + low pH --> supersaturation of uric acid in urine

Question 27

intraperitoneal bladder rupture

Answer 27

* blunt trauma to full bladder * rupture at the weakest part --> dome *urine leaks into peritoneum --> ascities *anuria with increased BUN + Cr

Question 28

Acute kidney injury mgx

Answer 28

* aka pre renal injury *BUN:CR = >20:1 *urine - no sediment *urine volume <500mls *mgx:- IV fluids tor restore renal perfusion

Question 29

extraperitoneal bladder rupture

Answer 29

* rupture of ant bladder usually 2o pelvic fracture *no free fluid in peritoneum as extraperitoneal *gross hematuria *suprapubic fullness and tenderness *difficulty voiding

Question 30

Mg ammonium Po4 stones

Answer 30

*struvite * assoc with increased ammonia in urine 2o proteus, klebsiela *c/o fever, dysuria, recurrent UTI's *urine pH high, large stag horn crystals * mgx:- definitive --> complete stone removal

Question 31

bladder Ca presentation

Answer 31

*painless hematuria, throughout micturition in pt >40 *cystoscopy is investigation of choice abdominal u/s can miss small bladder Ca * inc risk in smokers

Question 32

renal artery stenosis affect on RAAS

Answer 32

* on the affected kidney renin will be increased *on contralateral kidney renin will be decreased *aldosterone will be increased

Question 33

acute hyponatraemia mgx

Answer 33

* Na level <130 with symptoms of increased intracranial pressure <48hrs *mgx: IV 3% hypertonic solution

Question 34

severe vomiting acid base imbalance

Answer 34

*hypokalemic, hypochloremic metabolic alkalosis *Low urine Na and urine Cl due to depletion *low urine CL --> means cause either vomiting or diuretic overuse and is responsive to saline treatment