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MBChB - Full Clinical Topics > Renal, Urology & Electrolytes > Flashcards

Renal, Urology & Electrolytes Flashcards

1
Q

What is a normal daily urine output?

A

1000-2800ml/day

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2
Q

What is a normal voiding frequency/ day?

A

3-7x daily

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3
Q

What is a normal volume of voiding?

A

250-500ml

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4
Q

Name 3 features of hypernatraemic dehydration?

A 
Drowsiness/ coma 
Jittery movements 
Increased muscle tone
Hyperreflexia 
Convulsions
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5
Q

What is the defintion of CKD?

A

GFR < 60 for more than 3 months

or structural/ functional impairment for < 3 months

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6
Q

2 most common causes of CKD?

A

Hypertension

Diabetes

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7
Q

What is cinacalcet and what is it used for?

A

Reduces levels of PTH

Often for patients with CKD

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8
Q

What are the main extracellular ions?

A

Na

Cl

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9
Q

What is normal requirements of K, Na and Cl ions per day?

A

1mmol/kg

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10
Q

What are the 5 Rs of fluid prescribing?

A

Resuscitate < acute
Routine maintenance
Replacement (sodium, potassium, chloride)
Redistribution (if passing lots of urine do they need k+)
Reassessment

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11
Q

What antibiotic should be used for an inpatient with a UTI and an eGFR of 14?

A

Cefalexin (nitro and trimethoprim not in severe RI)

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12
Q

How much maintenance fluid should a 75kg person have over a day?

A

Roughly 2l over 24hours

Give NaCl 0.18% Glucose 4% with/without KCl

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13
Q

What is a normal anion gap?

A

4-12 mmol

Metabolic acidosis can be split into those with a high or low anion gap

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14
Q

What are the causes of a) high anion gap and b) low anion gap metabolic acidosis?

A

High: DKA/ lactic acidosis (sepsis)

Low: Diarrhoea/ addisons/ renal tubular acidosis

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15
Q

Name 3 causes of a hyperkalaemia?

A

ACEI
Spironolactone
AKI

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16
Q

How do you treat hyperkalaemia? (3)

A

Nebulised salbutamol
IV insulin/ dextrose
Calcium gluconate

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17
Q

What are the ECG features of hyperkalaemia (3)?

A

Tall ‘tented’ T waves
Wide QRS
Short PR
Small P waves

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18
Q

Name three causes of a hypokalaemia?

A

Vomiting
Diuretics
Cushings
Conn’s

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19
Q

Name three ECG features of hypokalaemia?

A

Flat T waves
U waves
Long PR
ST depression

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20
Q

How do you treat hypokalaemia?

A

Add K+ into fluids

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21
Q

What is the key feature of the relationship between K+ and H+ relevant to hyper/hypokalaemia?

A

H+ and K+ follow each other
So hyperkalaemia = acidosis
Hypokalaemia = Alkalosis

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22
Q

What are the general features of potassium imbalance?

A

Weakness, fatigue, palpitations are common to both hyper and hypo

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23
Q

Name 3 causes of a hypercalcemia?

A

Primary hyperparathyroid
Bone mets
Severe dehydration

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24
Q

How do you manage hypercalacemia?

A

1) Rehydrate with normal saline

Once fluid status sorted give calcitonin and bisphosphonates

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25
Q

What is the role of calcitonin?

A

Opposes the action of PTH (so lowers blood Ca2+)

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26
Q

Name 3 causes of a hypocalcaemia?

A

Hypoparathyroid
CKD (will also cause secondary hyperparathyroid)
Vit D deficiency (will also cause secondary hyperparathyroid)

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27
Q

What is the difference between primary and secondary hyperparathyroid?

A 
Primary = Too much PTH from parathyroid glands
Secondary = High PTH in response to a low blood calcium/ vit D (often due to CKD)
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28
Q

How do you treat hypocalacemia? (1)

A

IV calcium gluconate

10ml of 10% over 10mins

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29
Q

Name three causes of a hypernatraemia?

A

Dehyrdration (low intake, D+V, burns etc)
Diabetes insipidus
Diuretic use

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30
Q

How do you treat hypernatraemia?

A

Fluids

Don’t correct too fast - 0.5mmol/L/hr tops if chronic

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31
Q

What are the two most common causes of hyponatremia?

A 
Euvolemic = SIADH
Hypervolemic = CCF/ renal failure/ hepatic failure
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32
Q

How do you treat hyponatremia?

A

If hypovolemia = Fluids
If euvolemic = Treat cause
If hypervolemic = Fluid restrict

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33
Q

Recognition diagnosis:

Epistaxis + sinusitis + nephritic syndrome

A

Wegners granulomatosis

c-ANCA on bloods

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34
Q

Recognition diagnosis:

Haemoptysis + nephritic syndrome

A

Goodpastures syndrome

Anti-GBM on bloods

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35
Q

Recognition diagnosis:

Sensory-neural deafness + nephritic syndrome

A

Alports syndrome

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36
Q

What history feature unites IgA nephropathy and post-streptococcal glomerulonephritis and what distinguishes them?

A

Both following URTI
IgA nephropathy = 1-2 days after, nephritic syndrome
Post-streptococcal = 1-2 weeks after, nephritic and nephrotic picture

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37
Q

What are the three most common causes of nephrotic syndrome?

A 
Minimal change disease (kids)
Membraneous glomerulonephritis (adults - commonly cause by drugs)
Diabetic nephropathy
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38
Q

What is the most common cause of nephritic syndrome?

A

IgA nephropathy

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39
Q

What is the triad which characterises nephrotic syndrome?

A

Proteinuria (<3g/24hrs)
Hypoalbuinaemia (<30)
Oedema

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40
Q

How do you manage renal stones <5mm?

A

Expectantly

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41
Q

How do you manage renal stones 5mm-2cm?

A

Lithotripsy

or ureteroscopy if pregnant

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42
Q

How do you manage renal stones where hydronephrosis is present?

A

Percutaneous nephrostomy

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43
Q

How do you manage a staghorn calculus?

A

Percutaenous nephrolithotomy

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44
Q

Name three risk factors for renal stones?

A 
Previous stone
Dehydration 
FHx
Hypertension
Hyperparathyroid 
Gout
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45
Q

What are the three most common types of kidney stones?

A 
Calcium oxylate (75%) - Radio-opaque (white)
Calcium phosphate (10%)
Uric acid (5%)
46
Q

What are you first investigations for suspected renal stones?

A 
Obs
B- (Urine dip)
B- (FBC, U+E, Calcium, phosphate, urate)
I- CT KUB
S- (none)
47
Q

What is the definition of AKI?

A

Urine output <30ml/hr (0.5ml/kg/hr) for greater than 6 hours
+
Rise in creatinine 1.5x baseline in <7days

48
Q

Name 5 common causes of AKI?

A 
Pre-renal
- Hypovolemia (sepsis, volume loss, shock)
Renal
- Nephrotoxic drugs or scan contrast media
- Glomerulonephritis
Post-renal
- UTI
- Stones
49
Q

Name 3 investigations you would do in suspect AKI?

A 
Urine dip
Fluid balance 
FBC
U+E (beware high K+)
LFT's
Clotting
50
Q

What are the three most common complications of AKI?

A

Hyperkalaemia
Acidosis
Pulmonary oedema

51
Q

How is AKI managed?

A 
Sepsis etc screen (pre-renal cause)
Toxins (stop NSAID/ ACEI/ gentamycin)
Optimise BP (fluids)
Prevent harm
- Look for cause
- Monitor for hyperkalaemia etc
52
Q

Bladder cancers are most commonly what type?

A

TCC (90%)

10% are SCC (which is caused by schistosomiasis so common in developing countries)

53
Q

How does bladder cancer present? What additional investigations should you do?

A

Painless haematuria
(Always 2ww if over 45)

  • Urinanylsis (exclude infection)
  • FBC/ U+E
  • Cystoscopy (done from 2ww)
54
Q

How are bladder cancers managed?

A

If non invasive:
- Macroscopic transurethral resection (TUR) + single dose intra-vesicle Mitomycin C

If invasive:
- Neoadjuvant chemo and radical cystectomy

55
Q

How should patients be followed up following topical tx for non-invasive bladder cancer?

A

Cystoscopy at 3/9/18 months then yearly afterwards

56
Q

What is the most common kidney cancer in a) adults and b) children

A

a) Renal Cell Carcinoma

b) Wilm’s tumour

57
Q

When does kidney cancer most commonly occur and what is the classic presentation triad?

A

After age 40 (peak 60-70)
Haematuria, loin pain and loin mass

25% present with mets (most commonly lung)

58
Q

What investigations would you do for suspected RCC?

A

Urinalysis + culture
FBC (anaemia or raised EPO causing high RBC)
U+E (often normal)

GOLD = CT urogram
CXR for cannon ball bets

59
Q

How do you manage RCC?

A

Localised:

  • Partial nephrectomy (with or without chemo)
  • Radical if not possible

Advanced
- Nephrectomy +/- interferon alpha

60
Q

How is polycystic kidney disease inherited?

A

Autosomal dominant

61
Q

How does ADPKD usually present?

A

Loin pain, haematuria, renal mass (same as renal CA)

> Raised BP (EPO)

62
Q

How should suspected ADPKD be investigated?

A

B- Urinanlysis
B- FBC (Hb/ EPO), U+E
I- USS is 1st line but may also need CT urogram to exclude Renal Ca

63
Q

What are the diagnosis criteria for ADPKD?

A

If under 30: At least two cysts
30-59years: At least two cysts in each kidney
Over 60: At least 4 cysts in each kidney
Note: At age 30-49 almost 2% of people will have at least one cyst, this rises to 11% of those age 50-70

64
Q

How is ADPKD managed?

A

C- Avoid contact sports, advise on CVS risk factors (most mortality0
M- Control BP, analgesia, manage compliations

65
Q

What is a common complication of ADPKD?

A

Secondary hyperparathyroid
- Kidneys not converting vitD to active form

Shows low Ca and high PTH (high phosphate = renal disease, low phosphate = primary vitD deficiency)

66
Q

How common is BPH?

A

40% of people in 50’s

90% of people in 90’s

67
Q

Name 4 common symptoms of BPH?

A 
Weak stream
Frequency
Urgency 
Hesitancy
Incomplete voidance
68
Q

All male patients presenting with LUTS should complete what?

A

International prostate symptom score (0-35)

69
Q

How should LUTS in an elderly male be investigated?

A

B- Abdo exam, DRE, urine dip and culture
B- FBC, LFT (bone), consider PSA but rarely useful (only if ?DRE findings)
I- USS of bladder for post void volume
S- Flow studies

70
Q

How is BPH treated?

A 
Mild syx - Watch and wait
Moderate symptoms (IPPS >8) = Tamulosin
If severe = Tamulosin and Finasteride

Surgical (TURP)

71
Q

What is tamulosin, what are it’s common SE?

A

Alpha blocker (reduces muscle tone in neck of bladder)

SE: Dizziness, postural hypotension, dry mouth

72
Q

What is finasteride and what are it’s common SE?

A

5-alpha-reductase blocker

SE: Erectile dysfunction, reduced libido, retrograde ejaculation

73
Q

What are management options in prostate Ca?

A

C- Watchful waiting, monitor PSA 3mthly
M- Goserelin (GnRH antagonist) or radiotherapy
S- Radical prostatectomy

74
Q

What is your DDx for a scrotal swelling (5)?

A

Inguinal hernia < can’t get above it
Epidiymal cyst < Painless lump, often young
Hydrocele < Painless swelling, transilluminates
Testicular tumour < Discrete nodule
Varicocele < Usually on left

(R/o torsion)
- Also consider epididymo-orchitis

75
Q

What is epididymo-orchitis and how does it present?

A

Infection (commonly Chlamydia or honorrhoeae)
- Unilateral pain and swelling
(+ Possible urethral discharge and urinary syx)

76
Q

How is epididymo-orchitis treated?

A

Ceftriaxone 500mg IM

Doxycycline 100mg Oral BD (10-14days)

77
Q

What is the most common testicular cancer and how should it be investigated?

A

Germ-cell tumours (95%), most common subtype is seminoma

Painless lump = USS

78
Q

What is the mainstay of treatment for testicular cancer?

A

Orchidectomy

79
Q

Who is affected by acute urinary retention and what is the most common cause?

A

M13:1F
Most common cause is BPH

(Can also be caused by constipation, neurological etc)

80
Q

How does acute urinary retention present and how does this differ to chronic urinary retention?

A

Acute:
- Lower abdo discomfort and considerable pain (plus no urine)

Chronic:
- Often no pain

81
Q

A patient presents with acute urinary retention, what investigations should be performed?

A

Obs
B- Urine dip, urinanlysis + culture (after catheter), bladder USS
B- Serum U+E’s, FBC and CRP (infection)

82
Q

What volume of fluid in the bladder confirms a diagnosis of retention?

A

> 300mls

83
Q

What volume of fluid drained from a catheter excludes urinary retention?

A

<200mls in 15mins

Over 400mls means catheter should be left in place

84
Q

How long should patients be treated for a UTI?

A 
Women = 3 days
Preg women = 7 days
Men = 7 days 
Children = 3 days
Children <3mths = Immediate paediatrican referal
85
Q

Name two features in a patient with dysuria and frequency which would raise suspicion of an upper UTI?

A

Fever

Loin pain or tenderness

86
Q

How is a TURP performed?

A

Under general or spinal
Takes up to an hour
1-3days to recover in hospital (needs catheter to stay in place for a few days, then can go home)

87
Q

Name the three main complications of a TURP?

A 
Retrograde ejaculation (90%)
Erectile dysfunction (10%)
Urinary incontience (common)
Urethral stricture (4%)
88
Q

Name three management options for erectile dysfunction?

A

C- Lower BP + cholesterol
M- Sildenafil (Viagra)

(+ Assess for urinary symptoms, may have BPH)

89
Q

Name 3 common features of pyelonephritis?

A

UTI symptoms
Loin pain
Fever and rigors
Vomiting

(White cell casts in urine)

90
Q

How should pyelonephritis be treated?

A

ABCDE
R- Admission
CMS
(IV Cephalosporins)

91
Q

What is treatment for stress incontinence?

A

1) Pelvic floor exercises TDS for 3 months

2) Surgery

92
Q

What is treatment for urge incontience?

A

1) Bladder retraining for min of 6 weeks

2) Oxybutynin (antimuscarinic)

93
Q

A patient presents with incontience, what are the initial investigations?

A

Bladder diaries
Vaginal examination
Urine dip and culture

94
Q

Name 3 RF’s for urinary incontinence?

A 
Advancing age
Previous childbirth + pregnancy 
Obesity 
Hysterectomy
FHx
95
Q

What is the peak incidence of testicular torsion?

A

13-15yrs

96
Q

Name 3 presenting features of testicular torsion?

A

Sudden, severe onset pain
Pain may be referred to lower abdo
N+V possible

Swollen, tender testis which is retracted upwards, possible red skin
Elevation of the testis does not relieve pain

97
Q

How should testicular torsion be investigated?

A 
Obs
Bedside - Doppler USS 
Bloods - FBC, U+E, LFT
I- /
S- Surgical exploration

(Note doppler first but if high clinical suspicion and -ve doppler straight to surgical exploration)

98
Q

How should testicular torsion be managed?

A

R- Early immediate referral to emergency urology
C- Try reducing (outward rotation) - don’t do if pain increases, should have immediate syx relief
M- Analgesia
S- Surgical reduction and bilateral orchiopexy

99
Q

What are the two options when considering dialysis?

A

Peritoneal

1) Continous ambulatory (CAPD) - exhange 2L QDS
2) APD (automated PD) = Done overnight

Haemodialysis - 3x a day in hospital

100
Q

What variables are used to calculate eGFR?

A

Serum creatinine
Age
Gender
Ethnicity

101
Q

Name 3 factors which could affect an eGFR result?

A

Pregnancy
Muscle mass (bodybuilders, amputees)
Eating red meat within 12 hrs before sample

102
Q

What are the stages of CKD?

A 
Stage 1 - eGFR >90 but some signs kidney damage
Stage 2 - eGFR = 60-90
Stage 3a - eGFR = 45-59
Stage 3b- eGFR = 30-44
Stage 4- eGFR = 15-29
Stage 5- eGFR = <15
103
Q

Name 5 possible features of symptomatic CKD

A
  • Nocturia and polyuria (can’t concentrate urine)
  • Oedema (salt and water retention)
  • Bone pain (hypocalcemia due to not enough VitD converted)
  • Anaemia (low EPO)
  • Anorexia, weight loss, fatigue, weakness
104
Q

How should CKD be managed?

A

R- Stop smoking, control weight and exercise
- Restrict sodium
- Moderate protein intake only
M- Consider effect of medications

Also:
- Annual assessment of CVS risk

105
Q

How is CKD diagnosed?

A

Based off at least two eGFR results, 90 days apart

106
Q

Name 5 common CKD complications and their treatments?

A 
Hyperphosphataemia (Ca + vit D suppliments)
Oedema (furosemide)
Restless legs (Clonazepam)
Anaemia (give EPO)
Acidosis (give Bicarb)
Uremia
107
Q

When is a patient with CKD referred to assess the need for dialysis?

A

When CKD 4/5

108
Q

What is the classic triad of haemolytic uraemic syndrome?

A

Acute renal failure
Haemolytic anaemia
Thrombocytopenia

109
Q

What is the main cause of haemolytic uraemic syndrome?

A

E coli

110
Q

How is haemolytic uraemic syndrome managed?

A

Fluids
(Blood transfusion and dialysis also if required)

No AB’s

111
Q

How is hydronephrosis investigated?

A

USS renal tract

112
Q

What are the causes of a unilateral hydronephrosis?

A 
PACT
Pelvic-ureteric obstruction (congenital or acquired)
Aberrant renal vessels
Calculi
Tumours of renal pelvis

MBChB - Full Clinical Topics (23 decks)

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