Renal, Urology & Electrolytes Flashcards
(112 cards)
1
Q
What is a normal daily urine output?
A
1000-2800ml/day
2
Q
What is a normal voiding frequency/ day?
A
3-7x daily
3
Q
What is a normal volume of voiding?
A
250-500ml
4
Q
Name 3 features of hypernatraemic dehydration?
A
Drowsiness/ coma Jittery movements Increased muscle tone Hyperreflexia Convulsions
5
Q
What is the defintion of CKD?
A
GFR < 60 for more than 3 months
or structural/ functional impairment for < 3 months
6
Q
2 most common causes of CKD?
A
Hypertension
Diabetes
7
Q
What is cinacalcet and what is it used for?
A
Reduces levels of PTH
Often for patients with CKD
8
Q
What are the main extracellular ions?
A
Na
Cl
9
Q
What is normal requirements of K, Na and Cl ions per day?
A
1mmol/kg
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
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)
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
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
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
15
Q
Name 3 causes of a hyperkalaemia?
A
ACEI
Spironolactone
AKI
16
Q
How do you treat hyperkalaemia? (3)
A
Nebulised salbutamol
IV insulin/ dextrose
Calcium gluconate
17
Q
What are the ECG features of hyperkalaemia (3)?
A
Tall ‘tented’ T waves
Wide QRS
Short PR
Small P waves
18
Q
Name three causes of a hypokalaemia?
A
Vomiting
Diuretics
Cushings
Conn’s
19
Q
Name three ECG features of hypokalaemia?
A
Flat T waves
U waves
Long PR
ST depression
20
Q
How do you treat hypokalaemia?
A
Add K+ into fluids
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
22
Q
What are the general features of potassium imbalance?
A
Weakness, fatigue, palpitations are common to both hyper and hypo
23
Q
Name 3 causes of a hypercalcemia?
A
Primary hyperparathyroid
Bone mets
Severe dehydration
24
Q
How do you manage hypercalacemia?
A
1) Rehydrate with normal saline
Once fluid status sorted give calcitonin and bisphosphonates
25
What is the role of calcitonin?
Opposes the action of PTH (so lowers blood Ca2+)
26
Name 3 causes of a hypocalcaemia?
Hypoparathyroid
CKD (will also cause secondary hyperparathyroid)
Vit D deficiency (will also cause secondary hyperparathyroid)
27
What is the difference between primary and secondary hyperparathyroid?
```
Primary = Too much PTH from parathyroid glands
Secondary = High PTH in response to a low blood calcium/ vit D (often due to CKD)
```
28
How do you treat hypocalacemia? (1)
IV calcium gluconate
| 10ml of 10% over 10mins
29
Name three causes of a hypernatraemia?
Dehyrdration (low intake, D+V, burns etc)
Diabetes insipidus
Diuretic use
30
How do you treat hypernatraemia?
Fluids
| Don't correct too fast - 0.5mmol/L/hr tops if chronic
31
What are the two most common causes of hyponatremia?
```
Euvolemic = SIADH
Hypervolemic = CCF/ renal failure/ hepatic failure
```
32
How do you treat hyponatremia?
If hypovolemia = Fluids
If euvolemic = Treat cause
If hypervolemic = Fluid restrict
33
Recognition diagnosis:
| Epistaxis + sinusitis + nephritic syndrome
Wegners granulomatosis
| c-ANCA on bloods
34
Recognition diagnosis:
| Haemoptysis + nephritic syndrome
Goodpastures syndrome
| Anti-GBM on bloods
35
Recognition diagnosis:
| Sensory-neural deafness + nephritic syndrome
Alports syndrome
36
What history feature unites IgA nephropathy and post-streptococcal glomerulonephritis and what distinguishes them?
Both following URTI
IgA nephropathy = 1-2 days after, nephritic syndrome
Post-streptococcal = 1-2 weeks after, nephritic and nephrotic picture
37
What are the three most common causes of nephrotic syndrome?
```
Minimal change disease (kids)
Membraneous glomerulonephritis (adults - commonly cause by drugs)
Diabetic nephropathy
```
38
What is the most common cause of nephritic syndrome?
IgA nephropathy
39
What is the triad which characterises nephrotic syndrome?
Proteinuria (<3g/24hrs)
Hypoalbuinaemia (<30)
Oedema
40
How do you manage renal stones <5mm?
Expectantly
41
How do you manage renal stones 5mm-2cm?
Lithotripsy
| or ureteroscopy if pregnant
42
How do you manage renal stones where hydronephrosis is present?
Percutaneous nephrostomy
43
How do you manage a staghorn calculus?
Percutaenous nephrolithotomy
44
Name three risk factors for renal stones?
```
Previous stone
Dehydration
FHx
Hypertension
Hyperparathyroid
Gout
```
45
What are the three most common types of kidney stones?
```
Calcium oxylate (75%) - Radio-opaque (white)
Calcium phosphate (10%)
Uric acid (5%)
```
46
What are you first investigations for suspected renal stones?
```
Obs
B- (Urine dip)
B- (FBC, U+E, Calcium, phosphate, urate)
I- CT KUB
S- (none)
```
47
What is the definition of AKI?
Urine output <30ml/hr (0.5ml/kg/hr) for greater than 6 hours
+
Rise in creatinine 1.5x baseline in <7days
48
Name 5 common causes of AKI?
```
Pre-renal
- Hypovolemia (sepsis, volume loss, shock)
Renal
- Nephrotoxic drugs or scan contrast media
- Glomerulonephritis
Post-renal
- UTI
- Stones
```
49
Name 3 investigations you would do in suspect AKI?
```
Urine dip
Fluid balance
FBC
U+E (beware high K+)
LFT's
Clotting
```
50
What are the three most common complications of AKI?
Hyperkalaemia
Acidosis
Pulmonary oedema
51
How is AKI managed?
```
Sepsis etc screen (pre-renal cause)
Toxins (stop NSAID/ ACEI/ gentamycin)
Optimise BP (fluids)
Prevent harm
- Look for cause
- Monitor for hyperkalaemia etc
```
52
Bladder cancers are most commonly what type?
TCC (90%)
10% are SCC (which is caused by schistosomiasis so common in developing countries)
53
How does bladder cancer present? What additional investigations should you do?
Painless haematuria
(Always 2ww if over 45)
- Urinanylsis (exclude infection)
- FBC/ U+E
- Cystoscopy (done from 2ww)
54
How are bladder cancers managed?
If non invasive:
- Macroscopic transurethral resection (TUR) + single dose intra-vesicle Mitomycin C
If invasive:
- Neoadjuvant chemo and radical cystectomy
55
How should patients be followed up following topical tx for non-invasive bladder cancer?
Cystoscopy at 3/9/18 months then yearly afterwards
56
What is the most common kidney cancer in a) adults and b) children
a) Renal Cell Carcinoma
| b) Wilm's tumour
57
When does kidney cancer most commonly occur and what is the classic presentation triad?
After age 40 (peak 60-70)
Haematuria, loin pain and loin mass
25% present with mets (most commonly lung)
58
What investigations would you do for suspected RCC?
Urinalysis + culture
FBC (anaemia or raised EPO causing high RBC)
U+E (often normal)
GOLD = CT urogram
CXR for cannon ball bets
59
How do you manage RCC?
Localised:
- Partial nephrectomy (with or without chemo)
- Radical if not possible
Advanced
- Nephrectomy +/- interferon alpha
60
How is polycystic kidney disease inherited?
Autosomal dominant
61
How does ADPKD usually present?
Loin pain, haematuria, renal mass (same as renal CA)
| > Raised BP (EPO)
62
How should suspected ADPKD be investigated?
B- Urinanlysis
B- FBC (Hb/ EPO), U+E
I- USS is 1st line but may also need CT urogram to exclude Renal Ca
63
What are the diagnosis criteria for ADPKD?
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
How is ADPKD managed?
C- Avoid contact sports, advise on CVS risk factors (most mortality0
M- Control BP, analgesia, manage compliations
65
What is a common complication of ADPKD?
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
How common is BPH?
40% of people in 50's
| 90% of people in 90's
67
Name 4 common symptoms of BPH?
```
Weak stream
Frequency
Urgency
Hesitancy
Incomplete voidance
```
68
All male patients presenting with LUTS should complete what?
International prostate symptom score (0-35)
69
How should LUTS in an elderly male be investigated?
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
How is BPH treated?
```
Mild syx - Watch and wait
Moderate symptoms (IPPS >8) = Tamulosin
If severe = Tamulosin and Finasteride
```
Surgical (TURP)
71
What is tamulosin, what are it's common SE?
Alpha blocker (reduces muscle tone in neck of bladder)
SE: Dizziness, postural hypotension, dry mouth
72
What is finasteride and what are it's common SE?
5-alpha-reductase blocker
SE: Erectile dysfunction, reduced libido, retrograde ejaculation
73
What are management options in prostate Ca?
C- Watchful waiting, monitor PSA 3mthly
M- Goserelin (GnRH antagonist) or radiotherapy
S- Radical prostatectomy
74
What is your DDx for a scrotal swelling (5)?
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
What is epididymo-orchitis and how does it present?
Infection (commonly Chlamydia or honorrhoeae)
- Unilateral pain and swelling
(+ Possible urethral discharge and urinary syx)
76
How is epididymo-orchitis treated?
Ceftriaxone 500mg IM
| Doxycycline 100mg Oral BD (10-14days)
77
What is the most common testicular cancer and how should it be investigated?
Germ-cell tumours (95%), most common subtype is seminoma
Painless lump = USS
78
What is the mainstay of treatment for testicular cancer?
Orchidectomy
79
Who is affected by acute urinary retention and what is the most common cause?
M13:1F
Most common cause is BPH
(Can also be caused by constipation, neurological etc)
80
How does acute urinary retention present and how does this differ to chronic urinary retention?
Acute:
- Lower abdo discomfort and considerable pain (plus no urine)
Chronic:
- Often no pain
81
A patient presents with acute urinary retention, what investigations should be performed?
Obs
B- Urine dip, urinanlysis + culture (after catheter), bladder USS
B- Serum U+E's, FBC and CRP (infection)
82
What volume of fluid in the bladder confirms a diagnosis of retention?
>300mls
83
What volume of fluid drained from a catheter excludes urinary retention?
<200mls in 15mins
| Over 400mls means catheter should be left in place
84
How long should patients be treated for a UTI?
```
Women = 3 days
Preg women = 7 days
Men = 7 days
Children = 3 days
Children <3mths = Immediate paediatrican referal
```
85
Name two features in a patient with dysuria and frequency which would raise suspicion of an upper UTI?
Fever
| Loin pain or tenderness
86
How is a TURP performed?
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
Name the three main complications of a TURP?
```
Retrograde ejaculation (90%)
Erectile dysfunction (10%)
Urinary incontience (common)
Urethral stricture (4%)
```
88
Name three management options for erectile dysfunction?
C- Lower BP + cholesterol
M- Sildenafil (Viagra)
(+ Assess for urinary symptoms, may have BPH)
89
Name 3 common features of pyelonephritis?
UTI symptoms
Loin pain
Fever and rigors
Vomiting
(White cell casts in urine)
90
How should pyelonephritis be treated?
ABCDE
R- Admission
CMS
(IV Cephalosporins)
91
What is treatment for stress incontinence?
1) Pelvic floor exercises TDS for 3 months
| 2) Surgery
92
What is treatment for urge incontience?
1) Bladder retraining for min of 6 weeks
| 2) Oxybutynin (antimuscarinic)
93
A patient presents with incontience, what are the initial investigations?
Bladder diaries
Vaginal examination
Urine dip and culture
94
Name 3 RF's for urinary incontinence?
```
Advancing age
Previous childbirth + pregnancy
Obesity
Hysterectomy
FHx
```
95
What is the peak incidence of testicular torsion?
13-15yrs
96
Name 3 presenting features of testicular torsion?
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
How should testicular torsion be investigated?
```
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
How should testicular torsion be managed?
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
What are the two options when considering dialysis?
Peritoneal
1) Continous ambulatory (CAPD) - exhange 2L QDS
2) APD (automated PD) = Done overnight
Haemodialysis - 3x a day in hospital
100
What variables are used to calculate eGFR?
Serum creatinine
Age
Gender
Ethnicity
101
Name 3 factors which could affect an eGFR result?
Pregnancy
Muscle mass (bodybuilders, amputees)
Eating red meat within 12 hrs before sample
102
What are the stages of CKD?
```
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
Name 5 possible features of symptomatic CKD
- 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
How should CKD be managed?
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
How is CKD diagnosed?
Based off at least two eGFR results, 90 days apart
106
Name 5 common CKD complications and their treatments?
```
Hyperphosphataemia (Ca + vit D suppliments)
Oedema (furosemide)
Restless legs (Clonazepam)
Anaemia (give EPO)
Acidosis (give Bicarb)
Uremia
```
107
When is a patient with CKD referred to assess the need for dialysis?
When CKD 4/5
108
What is the classic triad of haemolytic uraemic syndrome?
Acute renal failure
Haemolytic anaemia
Thrombocytopenia
109
What is the main cause of haemolytic uraemic syndrome?
E coli
110
How is haemolytic uraemic syndrome managed?
Fluids
(Blood transfusion and dialysis also if required)
No AB's
111
How is hydronephrosis investigated?
USS renal tract
112
What are the causes of a unilateral hydronephrosis?
```
PACT
Pelvic-ureteric obstruction (congenital or acquired)
Aberrant renal vessels
Calculi
Tumours of renal pelvis
```
