UKMLA Prep > Renal System 🫘 > Flashcards

Renal System 🫘 Flashcards

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1
Q

What is metabolic acidosis commonly classified according to?

A

Anion gap

Metabolic acidosis is categorized into normal anion gap and raised anion gap.

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2
Q

What are some causes of normal anion gap metabolic acidosis? (4)

A
  • Gastrointestinal bicarbonate loss: diarrhoea, ureterosigmoidostomy, fistula
  • Renal tubular acidosis
  • Drugs: e.g. acetazolamide, ammonium chloride injection
  • Addison’s disease
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3
Q

What conditions are associated with raised anion gap metabolic acidosis? (4)

A
  • Lactate: shock, hypoxia
  • Ketones: diabetic ketoacidosis, alcohol
  • Urate: renal failure
  • Acid poisoning: salicylates, methanol
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4
Q

What causes metabolic alkalosis?

A
  • Loss of hydrogen ions
  • Gain of bicarbonate

It is mainly due to problems of the kidney or gastrointestinal tract.

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5
Q

List some causes of metabolic alkalosis.

A
  • Vomiting / aspiration
  • Diuretics
  • Liquorice, carbenoxolone
  • Hypokalaemia
  • Primary hyperaldosteronism
  • Cushing’s syndrome
  • Bartter’s syndrome
  • Congenital adrenal hyperplasia
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6
Q

What conditions may lead to respiratory acidosis?

A
  • COPD
  • Decompensation in respiratory conditions (e.g. life-threatening asthma, pulmonary oedema)
  • Sedative drugs: benzodiazepines, opiate overdose
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7
Q

What are common causes of respiratory alkalosis? (6)

A
  • Anxiety leading to hyperventilation
  • Pulmonary embolism
  • Salicylate poisoning
  • CNS disorders: stroke, subarachnoid haemorrhage, encephalitis
  • Altitude
  • Pregnancy
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8
Q

What is the most commonly isolated pathogen in acute bacterial prostatitis?

A

Escherichia coli

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9
Q

What are risk factors for acute bacterial prostatitis?

A
  • Recent urinary tract infection
  • Urogenital instrumentation
  • Intermittent bladder catheterisation
  • Recent prostate biopsy
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10
Q

What are the features of acute bacterial prostatitis?

A
  • Pain referred to perineum, penis, rectum, or back
  • Obstructive voiding symptoms
  • Fever and rigors
  • Tender, boggy prostate gland on digital rectal examination
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11
Q

What accounts for 25% of drug-induced acute kidney injury?

A

Acute interstitial nephritis

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12
Q

List some common causes of acute interstitial nephritis.

A
  • Drugs: particularly antibiotics (e.g. penicillin, rifampicin, NSAIDs, allopurinol, furosemide)
  • Systemic disease: SLE, sarcoidosis, Sjogren’s syndrome
  • Infection: Hanta virus, staphylococci
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13
Q

What are the histological features of acute interstitial nephritis?

A

Marked interstitial oedema and interstitial infiltrate in the connective tissue between renal tubules

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14
Q

What are common symptoms of tubulointerstitial nephritis with uveitis (TINU)?

A
  • Fever
  • Weight loss
  • Painful, red eyes
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15
Q

How is acute kidney injury (AKI) characterized?

A

Reduction in renal function following an insult to the kidneys

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16
Q

What percentage of hospitalized patients develop acute kidney injury (AKI)?

A

Approximately 15%

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17
Q

What are the traditional categories of causes of AKI?

A
  • Prerenal
  • Intrinsic
  • Postrenal
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18
Q

What are examples of prerenal causes of AKI?

A
  • Hypovolaemia secondary to diarrhoea/vomiting
  • Renal artery stenosis
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19
Q

What intrinsic causes may lead to AKI?

A
  • Glomerulonephritis
  • Acute tubular necrosis (ATN)
  • Acute interstitial nephritis (AIN)
  • Rhabdomyolysis
  • Tumour lysis syndrome
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20
Q

What are examples of postrenal causes of AKI?

A
  • Kidney stone in ureter or bladder
  • Benign prostatic hyperplasia
  • External compression of the ureter
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21
Q

What are risk factors for acute kidney injury (AKI)?

A
  • Chronic kidney disease
  • Other organ failure/chronic disease
  • History of acute kidney injury
  • Use of nephrotoxic drugs
  • Age 65 years or over
  • Oliguria
  • Neurological or cognitive impairment
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22
Q

What are two key ways AKI may be detected?

A
  • Reduced urine output (oliguria)
  • Fluid overload
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23
Q

What blood tests are commonly used to detect AKI?

A
  • Sodium
  • Potassium
  • Urea
  • Creatinine
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24
Q

What criteria can be used to diagnose acute kidney injury (AKI)?

A
  • Rise in serum creatinine of 26 micromol/litre or greater within 48 hours
  • 50% or greater rise in serum creatinine within the past 7 days
  • Fall in urine output to less than 0.5 ml/kg/hour for more than 6 hours
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25
What is the management approach for AKI?
Supportive management focusing on careful fluid balance and reviewing medications
26
Which drugs should be stopped in AKI as they may worsen renal function? (8)
* NSAIDs * Aminoglycosides * ACE inhibitors * Angiotensin II receptor antagonists * Diuretics * Metformin * Lithium * Digoxin
27
What is the role of renal replacement therapy in AKI?
Used when a patient is not responding to medical treatment of complications
28
What are the phases of acute tubular necrosis (ATN)?
* Oliguric phase * Polyuric phase * Recovery phase
29
What is the most common inherited cause of kidney disease?
Autosomal dominant polycystic kidney disease (ADPKD)
30
What are the two disease loci identified in ADPKD?
* PKD1 * PKD2
31
What are the ultrasound diagnostic criteria for ADPKD in patients with a positive family history?
* Two cysts, unilateral or bilateral, if aged < 30 years * Two cysts in both kidneys if aged 30-59 years * Four cysts in both kidneys if aged > 60 years
32
What is a common acute phase protein measured in acutely unwell patients?
CRP
33
What are some examples of acute phase proteins?
* CRP * Procalcitonin * Ferritin * Fibrinogen * Alpha-1 antitrypsin * Caeruloplasmin * Serum amyloid A * Serum amyloid P component * Haptoglobin * Complement
34
What are the two types of Autosomal Dominant Polycystic Kidney Disease (ADPKD)?
ADPKD type 1 and ADPKD type 2 ## Footnote ADPKD type 1 accounts for 85% of cases, while type 2 accounts for 15%.
35
What chromosome is associated with ADPKD type 1?
Chromosome 16
36
What chromosome is associated with ADPKD type 2?
Chromosome 4
37
What is the screening investigation for relatives of ADPKD patients?
Abdominal ultrasound
38
What are the ultrasound diagnostic criteria for ADPKD in patients with a positive family history aged < 30 years?
Two cysts, unilateral or bilateral
39
What are the ultrasound diagnostic criteria for ADPKD in patients aged 30-59 years?
Two cysts in both kidneys
40
What are the ultrasound diagnostic criteria for ADPKD in patients aged > 60 years?
Four cysts in both kidneys
41
What medication may be used for select patients with ADPKD?
Tolvaptan
42
What are the features of ADPKD?
* Hypertension * Recurrent UTIs * Flank pain * Haematuria * Palpable kidneys * Renal impairment * Renal stones
43
What is the most common extra-renal manifestation of ADPKD?
Liver cysts
44
What percentage of ADPKD patients develop liver cysts?
70%
45
What is Alport's syndrome usually inherited as?
X-linked dominant pattern
46
What defect causes Alport's syndrome?
Defect in the gene coding for type IV collagen
47
What are common features of Alport's syndrome?
* Microscopic haematuria * Progressive renal failure * Bilateral sensorineural deafness * Lenticonus * Retinitis pigmentosa
48
What is the characteristic finding in renal biopsy for Alport's syndrome?
Longitudinal splitting of the lamina densa of the glomerular basement membrane
49
What is amyloidosis?
Extracellular deposition of an insoluble fibrillar protein termed amyloid
50
What is the most common form of amyloidosis?
AL amyloidosis
51
What precursor protein is associated with AL amyloidosis?
Immunoglobulin Light chain fragments
52
What diagnostic test shows apple-green birefringence in amyloidosis?
Congo red staining
53
What is the normal range for anion gap?
8-14 mmol/L
54
What are causes of normal anion gap metabolic acidosis?
* Gastrointestinal bicarbonate loss * Renal tubular acidosis * Drugs (e.g. acetazolamide) * Addison's disease
55
What is Anti-glomerular basement membrane (GBM) disease commonly known as?
Goodpasture's syndrome
56
What are the main features of Anti-GBM disease?
* Pulmonary haemorrhage * Rapidly progressive glomerulonephritis
57
What is the main complication of Anti-GBM disease?
Pulmonary haemorrhage
58
What is the cause of Autosomal Recessive Polycystic Kidney Disease (ARPKD)?
Defect in a gene located on chromosome 6 which encodes fibrocystin
59
What are the risk factors for Benign Prostatic Hyperplasia (BPH)?
* Age * Ethnicity (black > white > Asian)
60
What are the storage symptoms associated with BPH?
* Urgency * Frequency * Nocturia
61
What is the International Prostate Symptom Score (IPSS) range for severely symptomatic patients?
20-35
62
What is the most common type of bladder cancer?
Urothelial (transitional cell) carcinoma
63
What is the primary risk factor for urothelial carcinoma of the bladder?
Smoking
64
What is the staging classification for bladder cancer associated with no evidence of tumor?
T0
65
What percentage of patients with T2 bladder cancer are expected to have a good prognosis?
60%
66
What condition is characterized by recurrent renal stones due to a defect in membrane transport?
Cystinuria
67
What test is used to diagnose cystinuria?
Cyanide-nitroprusside test
68
What is a key feature of chronic pyelonephritis?
Scarring of the renal parenchyma
69
What is the genetic basis for cystinuria?
Defect in the SLC3A1 gene on chromosome 2 and SLC7A9 on chromosome 19
70
What are the common symptoms of diabetes insipidus?
Decreased secretion of antidiuretic hormone (ADH)
71
What is the mnemonic for arginine?
COLA
72
Which chromosomes contain the SLC3A1 and SLC7A9 genes?
Chromosome 2 (SLC3A1), Chromosome 19 (SLC7A9)
73
What is a classic feature of recurrent renal stones?
They are classically yellow and crystalline, appearing semi-opaque on x-ray
74
Which test is used for the diagnosis of renal stones?
Cyanide-nitroprusside test
75
What is the management for renal stones?
* Hydration * D-penicillamine * Urinary alkalinization
76
What characterizes diabetes insipidus (DI)?
Decreased secretion of antidiuretic hormone (ADH) or insensitivity to ADH
77
What are the causes of cranial diabetes insipidus?
* Idiopathic * Post head injury * Pituitary surgery * Craniopharyngiomas * Infiltrative diseases (e.g., histiocytosis X, sarcoidosis) * DIDMOAD syndrome * Haemochromatosis
78
What are the causes of nephrogenic diabetes insipidus?
* Genetic mutations affecting ADH receptors or aquaporin 2 channel * Electrolyte imbalances (e.g., hypercalcaemia, hypokalaemia) * Lithium * Demeclocycline * Tubulo-interstitial disease
79
What are the main features of diabetes insipidus?
* Polyuria * Polydipsia
80
What findings would you expect in the investigation of diabetes insipidus?
High plasma osmolality, low urine osmolality
81
What is the urine osmolality threshold that excludes diabetes insipidus?
>700 mOsm/kg
82
What is a management option for nephrogenic diabetes insipidus?
* Thiazides * Low salt/protein diet
83
What is the most common cause of end-stage renal disease (ESRD) in the western world?
Diabetic nephropathy
84
What percentage of patients with type 1 diabetes mellitus develop diabetic nephropathy by age 40?
33%
85
What histological changes are associated with diabetic nephropathy?
* Basement membrane thickening * Capillary obliteration * Mesangial widening * Kimmelstiel-Wilson nodules
86
What are the modifiable risk factors for developing diabetic nephropathy?
* Hypertension * Hyperlipidaemia * Smoking * Poor glycaemic control * Raised dietary protein
87
What are the non-modifiable risk factors for developing diabetic nephropathy?
* Male sex * Duration of diabetes * Genetic predisposition
88
What effect do thiazide diuretics have on serum potassium levels?
They decrease serum potassium levels
89
What is the mechanism of action of ezetimibe?
Inhibits cholesterol receptors on enterocytes, decreasing cholesterol absorption
90
What is familial hypercholesterolaemia (FH)?
An autosomal dominant condition resulting in high levels of LDL-cholesterol
91
What are the Simon Broome criteria for diagnosing definite FH?
* Total cholesterol (TC) > 7.5 mmol/l and LDL-C > 4.9 mmol/l * Tendon xanthoma or DNA-based evidence of FH
92
What is Fanconi syndrome?
A generalized reabsorptive disorder of renal tubular transport in the proximal convoluted tubule
93
What are the features of Fanconi syndrome?
* Type 2 renal tubular acidosis * Polyuria * Aminoaciduria * Glycosuria * Phosphaturia * Osteomalacia
94
What is the primary use of fibrates?
Management of hyperlipidaemia, particularly raised triglycerides
95
What is focal segmental glomerulosclerosis (FSGS)?
A cause of nephrotic syndrome and chronic kidney disease, presenting in young adults
96
What are the common causes of focal segmental glomerulosclerosis?
* Idiopathic * Secondary to other renal pathology (e.g., IgA nephropathy) * HIV * Heroin * Alport's syndrome * Sickle-cell
97
What is the triad of symptoms in haemolytic uraemic syndrome?
* Acute kidney injury * Microangiopathic haemolytic anaemia (MAHA) * Thrombocytopenia
98
What is the most common cause of typical haemolytic uraemic syndrome in children?
Shiga toxin-producing Escherichia coli (STEC) 0157:H7
99
What is Henoch-Schonlein purpura (HSP)?
An IgA mediated small vessel vasculitis usually seen in children following an infection
100
What are the common features of Henoch-Schonlein purpura?
* Palpable purpuric rash * Abdominal pain * Polyarthritis
101
What is the management for hypercalcaemia?
* Rehydration with normal saline * Bisphosphonates * Calcitonin * Steroids in sarcoidosis
102
What is the management for hyperkalaemia?
Management may include stabilization of cardiac membrane, short-term potassium shift, and removal of potassium from the body
103
What ECG changes are associated with hyperkalaemia?
* Tall-tented T waves * Loss of P waves * Broad QRS complexes * Sinusoidal wave pattern
104
What characterizes hungry bone syndrome?
Occurs after parathyroidectomy with rapid bone remineralization and systemic hypocalcaemia
105
Fill in the blank: Familial hypercholesterolaemia affects about 1 in _____ people.
500
106
What are the initial management steps for hyperkalaemia?
* Address precipitating factors * Stop aggravating drugs
107
What is the frequency of horseshoe kidney in the general population?
1 in 500
108
What is the frequency of horseshoe kidney in Turner's syndrome?
1 in 20
109
What is the initial treatment for severe hyperkalaemia (≥ 6.5 mmol/L)?
Emergency treatment is required, including IV calcium gluconate, insulin/dextrose infusion, and possibly nebulised salbutamol ## Footnote IV calcium gluconate stabilizes the myocardium. Insulin/dextrose infusion helps shift potassium from extracellular to intracellular fluid.
110
What is the Fredrickson classification used for?
It classifies types of hyperlipidaemia based on genetic factors ## Footnote The classification includes types I to V, each with specific genetic abnormalities.
111
What is the cause of type I hyperlipidaemia in the Fredrickson classification?
Lipoprotein lipase deficiency and apolipoprotein C-II deficiency ## Footnote These deficiencies lead to impaired lipid metabolism.
112
List the causes of hypocalcaemia.
* Vitamin D deficiency (osteomalacia) * Chronic kidney disease * Hypoparathyroidism * Pseudohypoparathyroidism * Rhabdomyolysis * Magnesium deficiency * Massive blood transfusion * Acute pancreatitis ## Footnote Contamination with EDTA can falsely lower calcium levels.
113
What are the clinical features of hypocalcaemia?
* Tetany * Perioral paraesthesia * Depression (chronic) * Cataracts (chronic) * Prolonged QT interval on ECG ## Footnote Neuromuscular excitability is a significant feature due to low extracellular calcium.
114
What is Trousseau's sign?
Carpal spasm induced by inflating a blood pressure cuff above systolic pressure ## Footnote It is seen in around 95% of patients with hypocalcaemia.
115
What conditions can cause hypokalaemia with hypertension?
* Cushing's syndrome * Conn's syndrome (primary hyperaldosteronism) * Liddle's syndrome * 11-beta hydroxylase deficiency ## Footnote Carbenoxolone and excess liquorice can also lead to hypokalaemia associated with hypertension.
116
What is the management for acute severe hyponatraemia?
Administer hypertonic saline (typically 3% NaCl) and monitor closely ## Footnote Patients should preferably be monitored in a high-dependency unit or above.
117
What can cause osmotic demyelination syndrome?
Over-correction of severe hyponatraemia ## Footnote Symptoms may include dysarthria, dysphagia, and 'locked-in syndrome'.
118
What are the consequences of hypophosphataemia?
* Red blood cell haemolysis * White blood cell and platelet dysfunction * Muscle weakness and rhabdomyolysis * Central nervous system dysfunction ## Footnote Hypophosphataemia can result from conditions like alcohol excess and diabetic ketoacidosis.
119
What is IgA nephropathy also known as?
Berger's disease ## Footnote It is the most common cause of glomerulonephritis worldwide.
120
What is the main symptom of post-streptococcal glomerulonephritis?
Proteinuria ## Footnote This condition is often associated with low complement levels.
121
What is the typical presentation of lower genitourinary tract trauma?
Most bladder injuries occur due to blunt trauma, often associated with pelvic fractures ## Footnote Up to 10% of male pelvic fractures can result in urethral or bladder injuries.
122
What is the recommended investigation for urethral injury?
Ascending urethrogram ## Footnote This helps to assess the extent of the injury.
123
What is the most common cause of hypopituitarism?
Compression of the pituitary gland by non-secretory pituitary macroadenoma ## Footnote Other causes include pituitary apoplexy and Sheehan's syndrome.
124
What is an ascending urethrogram?
An investigation technique used to visualize the urethra.
125
What management is indicated for suprapubic catheter placement?
Surgical placement, not percutaneously.
126
What are common causes of external genitalia injuries?
* Penetration * Blunt trauma * Continence- or sexual pleasure-enhancing devices * Mutilation
127
What are the two types of bladder rupture?
* Intra-peritoneal * Extra-peritoneal
128
What symptoms suggest a bladder or urethral injury?
History of pelvic fracture and inability to void.
129
What investigation is used to confirm bladder injury?
IVU or cystogram.
130
What is the management for intraperitoneal bladder injury?
Laparotomy.
131
What is Medullary cystic disease?
An autosomal dominant condition leading to progressive tubulointerstitial fibrosis and renal failure.
132
What are the characteristic features of Medullary cystic disease?
* Renal failure * Small kidneys
133
What is another name for Membranoproliferative glomerulonephritis?
Mesangiocapillary glomerulonephritis.
134
What is the most common cause of Type 1 Membranoproliferative glomerulonephritis?
Cryoglobulinaemia, hepatitis C.
135
What is the hallmark appearance of Type 1 Membranoproliferative glomerulonephritis on renal biopsy?
'Tram-track' appearance due to immune deposits.
136
What is Type 2 Membranoproliferative glomerulonephritis also known as?
'Dense deposit disease.'
137
What are common causes of Type 2 Membranoproliferative glomerulonephritis?
* Partial lipodystrophy * Factor H deficiency
138
What is the recommended management for Membranous glomerulonephritis?
* ACE inhibitor or ARB * Immunosuppression if severe
139
What is the prognosis for Membranous glomerulonephritis?
One-third spontaneous remission, one-third remain proteinuric, one-third develop ESRF.
140
What is metabolic acidosis classified by?
Anion gap.
141
What is the normal range for anion gap?
10-18 mmol/L.
142
What causes normal anion gap metabolic acidosis?
* Gastrointestinal bicarbonate loss * Renal tubular acidosis * Addison's disease
143
What are common causes of raised anion gap metabolic acidosis?
* Lactate * Ketones * Urate * Acid poisoning
144
What is the typical presentation of Minimal change disease?
Nephrotic syndrome.
145
What is a common cause of Minimal change disease?
Idiopathic.
146
What is the treatment for Minimal change disease?
Oral corticosteroids.
147
What is Nephroblastoma also known as?
Wilm's tumours.
148
At what age does Nephroblastoma usually present?
In the first 4 years of life.
149
What are the three components of Nephrotic syndrome?
* Proteinuria (> 3g/24hr) * Hypoalbuminaemia (< 30g/L) * Oedema
150
What are primary causes of Nephrotic syndrome?
* Minimal change disease * Focal segmental glomerulosclerosis * Membranous nephropathy
151
What is the pathophysiology of Nephrotic syndrome?
Damage to the glomerular basement membrane leads to increased permeability to proteins.
152
What are common complications of Nephrotic syndrome?
* Increased risk of thromboembolism * Hyperlipidaemia * Increased risk of infection
153
What defines contrast media nephrotoxicity?
A 25% increase in creatinine within 3 days of contrast media administration.
154
What are risk factors for contrast-induced nephropathy?
* Known renal impairment * Age > 70 years * Dehydration * Cardiac failure
155
What preventive measure is recommended for high-risk patients before contrast procedures?
Intravenous 0.9% sodium chloride.
156
What is Oxalate nephropathy caused by?
* Ethylene glycol ingestion * Vitamin C overdose
157
What are common causes of polyuria?
* Diuretics, caffeine & alcohol * Diabetes mellitus * Lithium * Heart failure
158
What is Post-streptococcal glomerulonephritis associated with?
Recent group A beta-haemolytic Streptococcus infection.
159
What laboratory finding confirms recent streptococcal infection in Post-streptococcal glomerulonephritis?
Raised anti-streptolysin O titre.
160
What is the most common cause of infravesical outflow obstruction in males?
Posterior urethral valves.
161
What is the primary treatment for prostate cancer?
Radical prostatectomy.
162
What is the normal upper limit for PSA?
4 ng/ml.
163
What grading system is used for prostate cancer?
Gleason grading system.
164
What is the management for early prostate cancer?
Watch and wait.
165
What percentage of testosterone is derived from the testis?
95%
166
What is the preferred option for low-risk men with prostate cancer according to NICE?
Active surveillance
167
What clinical criteria suggest a candidate for active surveillance in prostate cancer?
* Clinical stage T1c * Gleason score 3+3 * PSA density < 0.15 ng/ml/ml * Cancer in < 50% of biopsy cores * < 10 mm of any core involved
168
What are the treatment options for localized prostate cancer?
* Active monitoring * Watchful waiting * Radical prostatectomy * Radiotherapy (external beam and brachytherapy)
169
What complications are associated with radical prostatectomy for localized advanced prostate cancer?
Erectile dysfunction
170
What is the aim of hormonal therapy in metastatic prostate cancer?
Reducing androgen levels
171
What is the initial effect of GnRH agonists on testosterone levels?
Testosterone level will rise initially for 2-3 weeks before falling to castration levels
172
What is a common anti-androgen medication used in prostate cancer treatment?
Bicalutamide
173
What is the classical triad of symptoms for renal cell cancer?
* Haematuria * Loin pain * Abdominal mass
174
What are the management options for renal cell cancer confined to the kidney?
* Partial nephrectomy * Total nephrectomy
175
What is pseudohyperkalaemia?
A rise in serum potassium due to excessive leakage during or after blood collection
176
What is rapidly progressive glomerulonephritis characterized by?
Rapid loss of renal function with formation of epithelial crescents
177
What causes renal papillary necrosis?
* Severe acute pyelonephritis * Diabetic nephropathy * Obstructive nephropathy * Analgesic nephropathy
178
What percentage of renal stones are calcium oxalate stones?
85%
179
What urinary pH conditions favor the formation of calcium phosphate stones?
Normal to alkaline urine (>5.5)
180
What is the recommended analgesia for renal colic according to NICE?
NSAID
181
What is the risk of over-diagnosis associated with PSA testing in prostate cancer?
High risk
182
What is the PSA threshold for men aged 50-59 years?
> 3.5 ng/ml
183
True or False: PSA testing should be postponed for at least 6 weeks after treatment for prostatitis.
True
184
What is the significance of a PSA level of 4-10 ng/ml?
Around 33% of men will be found to have prostate cancer
185
What is a common feature of nephroblastoma?
It accounts for 80% of all genitourinary malignancies in those under 15 years
186
What is Stauffer syndrome associated with?
Renal cell cancer
187
How does analgesic nephropathy contribute to renal papillary necrosis?
It is one of the causes of coagulative necrosis of the renal papillae
188
What analgesia is recommended by both BAUS and NICE for renal colic?
NSAID ## Footnote Non-steroidal anti-inflammatory drugs are the first-line treatment for managing pain in renal colic.
189
Which NSAID has traditionally been used for renal colic but carries increased cardiovascular risks?
Diclofenac ## Footnote Diclofenac and ibuprofen are noted for their increased risk of cardiovascular events.
190
What is recommended by NICE if NSAIDs are contraindicated or ineffective for pain relief?
IV paracetamol ## Footnote Intravenous paracetamol is suggested for patients who need effective pain management.
191
What type of medication do alpha blockers represent in the management of renal colic?
Smooth muscle relaxants ## Footnote Alpha blockers help dilate the ureter and may facilitate stone passage.
192
For distal ureteric stones less than what size do NICE recommend the use of alpha blockers?
< 10 mm ## Footnote Alpha blockers are particularly considered for smaller distal ureteric stones.
193
What initial investigations are recommended for renal colic?
Urine dipstick and culture, serum creatinine and electrolytes, FBC/CRP, calcium/urate ## Footnote These tests help assess renal function and identify underlying causes.
194
What imaging technique should be performed on all patients with renal colic within 24 hours of admission?
Non-contrast CT KUB ## Footnote This imaging modality is essential for diagnosing ureteric stones.
195
What is the sensitivity and specificity of CT KUB for ureteric stones?
Sensitivity: 97%, Specificity: 95% ## Footnote These high rates make CT KUB a reliable diagnostic tool.
196
What is the first-line management for renal stones < 5 mm according to NICE?
Watchful waiting ## Footnote Stones smaller than 5 mm are likely to pass spontaneously.
197
What procedure is recommended for renal stones measuring 10-20 mm?
Shockwave lithotripsy or ureteroscopy ## Footnote Both options are viable for managing stones of this size.
198
What is shockwave lithotripsy?
A procedure that generates shock waves to fragment stones ## Footnote It is an external method used to treat renal stones.
199
What is a potential complication of shockwave lithotripsy?
Solid organ injury ## Footnote The procedure can lead to injury due to the passage of shock waves.
200
What is the role of ureteroscopy in the management of renal stones?
Used for complex stone disease and when lithotripsy is contraindicated ## Footnote Ureteroscopy allows direct access to stones via the ureter.
201
What is percutaneous nephrolithotomy?
A procedure to access the renal collecting system for stone removal ## Footnote This method is used for larger stones that cannot be managed with other techniques.
202
What dietary recommendations can help prevent calcium stones?
* High fluid intake * Add lemon juice to drinking water * Avoid carbonated drinks * Limit salt intake ## Footnote These lifestyle changes can reduce the risk of stone formation.
203
What is a risk factor for urate stones?
Gout ## Footnote Gout can lead to elevated uric acid levels, increasing the risk of urate stones.
204
What is the appearance of calcium oxalate stones on X-ray?
Opaque ## Footnote Calcium oxalate stones are the most common type and can be easily identified on radiographs.
205
What is the major histocompatibility complex (MHC) in humans known as?
HLA system ## Footnote The HLA system plays a crucial role in immune response and organ transplantation.
206
What is the relative importance of HLA antigens when matching for a renal transplant?
DR > B > A ## Footnote DR antigen compatibility is prioritized over B and A antigens.
207
What is the 1-year graft survival rate for cadaveric transplants?
90% ## Footnote This statistic reflects the success of cadaveric renal transplants at the one-year mark.
208
What type of urinary cast is associated with glomerulonephritis?
Red blood cell casts ## Footnote These casts indicate damage to the glomeruli.
209
What is hyperacute rejection in the context of renal transplantation?
Rejection occurring minutes to hours due to pre-existing antibodies ## Footnote This is a severe form of rejection that necessitates immediate graft removal.
210
What are the common causes of acute graft failure?
* Mismatched HLA * Cytomegalovirus infection ## Footnote Acute graft failure typically occurs within the first six months following transplantation.
211
What can cause chronic graft failure after renal transplantation?
Fibrosis from both antibody and cell-mediated mechanisms ## Footnote Chronic allograft nephropathy is a common cause of long-term graft failure.
212
What is Wilms' nephroblastoma?
One of the most common childhood malignancies ## Footnote Typically presents in children under 5 years of age, with a median age of 3 years old.
213
What syndrome is associated with Wilms' tumour?
Beckwith-Wiedemann syndrome ## Footnote Also associated as part of WAGR syndrome with Aniridia, Genitourinary malformations, and mental Retardation.
214
What is a common genetic mutation found in Wilms' tumour cases?
Loss-of-function mutation in the WT1 gene on chromosome 11 ## Footnote Around one-third of cases are associated with this mutation.
215
What is the most common presenting feature of Wilms' tumour?
Abdominal mass
216
What are some other features of Wilms' tumour?
* Painless haematuria * Flank pain * Anorexia * Fever
217
What percentage of Wilms' tumour cases are unilateral?
95%
218
In what percentage of patients are metastases found in Wilms' tumour?
20% ## Footnote Most commonly to the lung.
219
What should be done for children with an unexplained enlarged abdominal mass?
Arrange paediatric review within 48 hours
220
What is the primary management for Wilms' tumour?
* Nephrectomy * Chemotherapy * Radiotherapy if advanced disease
221
What is the prognosis for Wilms' tumour?
Good, with an 80% cure rate
222
What are the histological features of Wilms' tumour?
* Epithelial tubules * Areas of necrosis * Immature glomerular structures * Stroma with spindle cells * Small cell blastomatous tissues resembling the metanephric blastema
UKMLA Prep
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