Urinary 2

Question 1

Advantage of ACR over PCR and vica versa

Answer 1

ACR - can detect microalbuminia

PCR - can detect bence jones and globulins

Question 2

What are disadvantages of using dipsticks to measure urinary protein?

Answer 2

Only detects albumin so misses bence jones proteins and globulins
Not sensitive enough for microalbuminia
Is effected by urine dilution - false +ve if concentrated false -ve if dilute

Question 3

How much calcium is filtered by the kidneys daily?

How much is reabsorbed?

Answer 3

250mmol

98%

Question 4

Where is most calcium reabsorbed in the kidneys?

Where is calcium reabsorption controlled in the kidneys?

Answer 4

Most in the PCT

Controlled by PTH in the DCT

Question 5

How is calcium transported in the blood?

Answer 5

45% ionised
45% protein bound
10% complexed (citrate, phosphate etc)

Question 6

Causes of hypercalcaemia?

Answer 6

Primary hyperparathyroidism 
Malignancy
Thiazide diuretics
Lithium
AKI
Renal transplant

Question 7

What two causes of hypercalcaemia make 90% of all cases?

Answer 7

Primary hyperparathyroidism

Malignancy

Question 8

What features would suggest hypercalcaemia is malignant and not from hyperparathyroidism?

Answer 8

Rapid rise
Large increase
Low PTH
Malignant symptoms - weight loss, fever, malaise

Question 9

Do kidney stones in the setting of hypercalcaemia suggest a malignant cause or primary hyperparathyroidism?

Answer 9

Primary hpt

Question 10

What is a secondary hyperparathyroidism?

Answer 10

Low calcium driving high pth

A state of compensation due to, for instance, low vit d.

Question 11

What is tertiary hyperparathyroidism?

Answer 11

Unregulated pth secretion following secondary hptism csusing raised calcium

Question 12

Management options in acute hypercalcaemia?

Answer 12

Hydration to increase renal excretion
Loop diuretic
Bisphosphonates
Calcitonin 
Treat underlying condition

Question 13

How may malignancy cause hypercalcaemia?

Answer 13

Release of pthrp - mainly squamous cell carcinomas

Bony destruction - haematological malignancy

Question 14

A patient presents with hypercalcaemia and suppressed pth. What tests should be run?

Answer 14

Serum + urine electrophoresis
PTHrP
Skeletal survey
Chest abdo pelvis imaging

Question 15

At what calcium level should people be considered for hospital admission?

Answer 15

> 3.5 mmol/l

Question 16

What is the lifetime risk for renal stone formation?

Answer 16

Male 20 %

Female 10. %

Question 17

What is the 5 yr recurrance rate for renal stones

Answer 17

50%

Question 18

Presenation of renal stones?

Answer 18

Sudden onset severe flank pain to groin / testicles / labia
Nausea
Vomiting
Haematouria

Question 19

Examination findings of renal colic?

Answer 19

Costovertebral angle tenderness
Withing/pacing
Tacycardia
Htn
Microscopic haematauria

Question 20

Types of stones in renal colic?

Answer 20

Calcium
Uric acid
Magnesium ammonium phosphate

Question 21

Mechanism behind uric acid renal stone formation?

Answer 21

Supersaturation of urine

Often follows gout or chemotherapy

Question 22

Factors that precipitate renal stone formation?

Answer 22

Supersaturation - either high dietary or low fluid intake
Low ionic strengths of na, cl, k
Severe acidosis or alkalosis of urine

Question 23

What investigations for a renal colic patient

Answer 23

Xray
Urine screen - blood, pH, sediments, culture
Blood screen - U+Es, PTH, Ca, PO4, 
CT-KUB
Sieve urine for chemical anaylsis

Question 24

What are the commonest calcium stones in renal calculi?

Answer 24

Calcium oxalate

Calcium phosphate

Question 25

What pain relief is very effective in renal colic?

Answer 25

Diclofenac

Question 26

Management of recurrent idiopathic renal stones long term?

Answer 26

High fluid intake

Question 27

Management of recurrent hypercalciuria renal stones long term?

Answer 27

``` Normal calcium diet High fluid intake Thiazide diuretic (unless hypercalcemia) ```

Question 28

Why does renal colic cause testicular pain?

Answer 28

Referred pain in the L1 nerve root - as testicles descended from abdomen they are innervated by high lumbar nerves

Question 29

Clinical features of polycystic kidney disease?

Answer 29

Presents in adulthood - ruptured renal cyst - loin pain and haematuria - mass increase in kidney - abdominal discomfort - berry aneurysm - SAH - liver cyst - bile duct compression - chronic renal failure - uraemia, anaemia, bone mineral disorders

Question 30

Management of polycystic kidneys

Answer 30

Symptomatic Monitor for renal replacement therapy Increased water intake

Question 31

Problems with eGFR

Answer 31

Not validated in mild renal impairment thus not a good screening tool Large interindividular variation Single result may be influenced by surge in creatinine, eg. Protein meal Body muscle mass alters amount Small amounts of creatinine are reabsorbed

Question 32

Benefits of eGFR

Answer 32

Easy and convenient | Little intraindividual variation so shows trends well

Question 33

Complications of catheterisation

Answer 33

``` Infection Trauma Paraphimosis Leakage Blockage Allergy Pain ```

Question 34

What to assess if urinary catheter is reported blocked?

Answer 34

Kinking Constipation Debris Bag below level of bladder

Question 35

What to assess if a catheter is reported as leaking?

Answer 35

Blockage | Spasm symptoms

Question 36

If a patient has a urinary catheter with pain and spams what can be done?

Answer 36

Consider smaller size Assess for allergy Use analgesia Give anticholinergic

Question 37

Indications for urinary catheter?

Answer 37

Urinary retention Urine output monitoring Prolonged surgery End of life care if in patients best interests To inject medications into the bladder or perform urological tests and proceedures