Renal/Uro

Question 1

CKD definition

Answer 1

reduction in kidney function (eGFR <60) and/or structural kidney damage that persists for 3+ months

Question 2

CKD stages

Answer 2

based on serun eGFR

G1 90+ normal and high
G2 60-89 mild reduction related to normal range for a young adult
G3a 45-59 mild to moderate reduction
G3b 30-44 moderate to severe reduction
G4 15-29 severe reduction
G5 <15 end-stage kidney failure

Question 3

CKD pathophysiology

Answer 3

chronic damage to the glomeruli which causes various types of remodelling

causes:
DM
HTN
meds eg NSAID
primary glomerular diseases
obstructive uropathies
systemic disease eg SLE

Question 4

CKD presentation

Answer 4

generally unwell (fatigue, SOB, cramps)
polyuria, oliguria, nocturia
pallor, cachexia, malnourished
hypertensive, oedema, flank masses if PKD,
frothy urine

Question 5

CKD Ix

Answer 5

first test- urine dipstick to look for blood and exclude UTI
ACR urinalysis
serum Cr
eGFR (repeat in 6mo then 3mo)
- no meat 12 hours before test
BMI, lipids, HbA1c, lipid profile
renal USS

Question 6

AD polycystic kidney disease pathophysiology

Answer 6

AD condition, multiple cysts in kidneys, destroys parenchyma

PKD1, PKD2

Question 7

ADPKD presentation

Answer 7

middle age
large bilateral flank masses
haematuria
hypertension
associations (aneurysm > SAH), CKD

Question 8

ADPKD diagnosis

Answer 8

USS shows multiple cysts in kidney, sometimes also liver

Question 9

types of renal artery stenosis

Answer 9

atherosclerotic
fibromuscular dysplasia

Question 10

renal artery stenosis epidemiology

Answer 10

men with ASCVD risk factors
young women

Question 11

renal artery stenosis presentation

Answer 11

resistant hypertension
flash pulmonary oedema

Question 12

renal artery stenosis diagnosis

Answer 12

1st: duplex USS
most useful: CTA
gold standard: DSA

Question 13

renal cell carcinoma pathophysiology

Answer 13

malignancy of kidney
most common type is clear cell adenocarcinoma
originates from PCT cells

gene deletion of chr3 (acquired or inherited as part of vHL syndrome)

Question 14

renal cell carcinoma presentation

Answer 14

50-70 yrs
triad: flank pain, haematuria, palpable mass
maybe FLAWS
Internist tumours (paraneoplastic syndrome)

Question 15

renal cell carcinoma diagnosis

Answer 15

CT scan

Question 16

amyloidosis pathophysiology

Answer 16

multisystem disease due to deposition of abnormal amyloid proteins

type 1 is AL
type 2 is AA
familial is ATTR

Question 17

amyloidosis presentation

Answer 17

multisystem
key ones are cardiomyopathy and amyloid kidney disease

Question 18

amyloidosis diagnosis

Answer 18

gold standard is biopsy, fat pad most easily accessible
- congo red
- apple green birefringence under polarised light

Question 19

common causes of UTI

Answer 19

most common overall - E.coli

young women - S.saprophyticus
ppl with chronic UTI and staghorn kidney stone - P.mirabilis

Klebsiella

Question 20

UTI presentation

Answer 20

dysuria, polyuria, urgency
suprapubic discomfort
delirium, confusion in elderly
change in urine appearance

Question 21

red flags for upper UTI

Answer 21

fever
costovertebral angle tenderness
vital sign derangements

Question 22

UTI investigations

Answer 22

1st: urine dip
- unreliable in women >65 and if catheterised
- if positive for nitrite or leukocyte of RBC likely UTI
- if neg for nitrite and positive for WBC send for culture to confirm
- if neg for all nitrite, WBC and RBC consider other diagnosis

send urine sample for culture if pregnant, plastic, paediatric, persistent or peeing blood

Question 23

UTI mx

Answer 23

assess for sepsis risk or risk of upper UTI
simple analgesia
nitrofurantoin or trimethoprim 1st line for uncomplicated UTI
no improvement after 48 hrs - pivmecillinam

Question 24

UTI complications

Answer 24

upper UTI (pyelonephritis) > septic shock
renal abscess
renal papillary necrosis