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Example interview questions
Published in David McGowan, Helen Sims, Making the Most of Your Medical Career, 2021
Samantha Fossey, Charles Zammit
In this scenario you are being asked to assess an anuric post-operative patient. To ascertain the cause of this, you need to have a clear understanding of the patient’s fluid balance state. Categorise causes of anuria into pre-renal, renal and post-renal. In simple terms, the vast majority of surgical patients will either have pre-renal (i.e. shock, dehydration) or post-renal (i.e. obstructive) causes of oliguria. Your clinical assessment of a patient should clearly reveal which category is the cause of the patient’s anuria. Don’t forget it is important to note the urine output trend; that is, has the urine output gradually tapered off or has it stopped abruptly? The latter would suggest a possible obstructive cause; is the catheter kinked? If the urine output has gradually tapered off it suggests a pre-renal or renal cause. In this scenario, if you are told the patient is hypotensive, tachycardic and spiking temperatures and day 10 post Hartmann’s procedure then you would be highly suspicious of an abdominal collection causing septic shock resulting in anuria or oliguria. Low urine output management is determined by cause. For example, post-renal causes require intervention to relieve obstruction (e.g. catheter, ureteric stent or nephrostomy), while pre-renal causes require adequate fluid resuscitation.
Hysteria
Published in Francis X. Dercum, Rest, Suggestion, 2019
Polyuria can usually be ignored. Anuria, on the other hand, demands investigation. As we have seen, when it has been seemingly absolute for long periods of time, the conclusion is, of course, inevitable that the anuria is not real but spurious, the patient passing urine at times when she is not under immediate observation. Anuria is, of course, to be treated by the ingestion of large quantities of liquid and the giving of simple diuretics. It Is, as has already been stated, not accompanied by the alarming symptoms that attend true anuria. In a hysteric patient, an exceedingly small quantity of urine may be voided, and yet it may be very concentrated and contain a large percentage of waste products.
Fluid balance and continence care
Published in Barbara Smith, Linda Field, Nursing Care, 2019
Certain abnormalities occur in the production and the elimination of urine: Polyuria: this is the production by the kidneys of abnormally high amounts of urine, sometimes as much as several litres per day. Polyuria is usually associated with diseases such as diabetes mellitus, diabetes insipidus and chronic nephritis (inflammation of the nephrons within the kidney).Oliguria: this is decreased urine output, usually less than 500 mL a day or 30 mL an hour. Oliguria often indicates impaired blood flow to the kidneys or impending renal failure and should be dealt with immediately.Anuria: this is the absence of urine production. Anuria is a serious medical condition that usually follows oliguria. It must be treated immediately in order to prevent death from renal failure. Renal dialysis is used when the kidneys are no longer able to filter blood.
Effects of sacubitril-valsartan in patients undergoing maintenance dialysis
Published in Renal Failure, 2023
Ying Ding, Li Wan, Zhou-cang Zhang, Qing-hua Yang, Jia-xiang Ding, Zhen Qu, Feng Yu
We retrospectively reviewed the data of ESRD patients undergoing HD or PD for at least 3 months in the Department of Nephrology, Peking University International Hospital from January 2015 to April 2022. All patients were regularly followed in the dialysis clinics. Patients with anuria were also included in the study. Those who received SV treatment for more than two weeks were enrolled in the SV group. Age and sex-matched patients who did not receive SV were selected from the rest as the control group (flow-chart presented as Figure 1). PD patients were treated with continuous ambulatory PD (CAPD) or automated PD (APD). HD patients were treated with thrice weekly intermittent HD (IHD). Patients prior prescribed ACEI or ARB were stopped 36 h before switching to SV treatment. SV was initiated by a small dose (50–100mg daily) and gradually titrated to the maximum tolerated dose. Other treatments did not change. The research complied with the Declaration of Helsinki, and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. The study was approved by the China Ethics Committee of Registering Clinical Trials (Ethics number: ChiECRCT20200463) and all participants provided written informed consent.
Acute kidney injury due to thrombotic microangiopathy in a patient with primary Sjögren’s syndrome
Published in Renal Failure, 2022
Yi Wang, Xun Zhou, Xiaoyan Ma, Xinyu Yang, Yishu Wang, Min Tao, Binbin Cui, Tianyu Xiao, Shougang Zhuang, Na Liu
Renal biopsy showed many red blood cells gathered in the glomeruli and arterioles, obstructing the lumen with massive thrombosis, indicating renal TMA (Figure 2). No immune deposits were shown by immunofluorescence microscopy or electron microscopy. We performed hemodialysis and initiated therapeutic plasma exchange (PE) (on hospital days 7, 14) in conjunction with low-molecular-weight heparin (4000 U once every other day). Later on, we ceased PE because of the activity of the von Willebrand factor-cleaving protease ADAMTS13 was 61.37% (normal 42.16–126.37%) and anti-ADAMTS13 IgG was negative. The BM biopsy showed plasma cells was 8% and flow cytometry indicated monoclonal plasma cells accounts for 1.2%. The patient then received Bortezomib 0.8 mg/m2 (d1, d8) subcutaneous injection every month. During this period, we changed hemodialysis into continuous ambulatory peritoneal dialysis (CAPD) and gradually reduce the dose of prednisone to 20 mg daily. The patient recovered from anuria three weeks after admission. When she was discharged, her urine volume had increased to 1000 mL/24h and the Hb was 92 g/L, PLT was 118 × 109/L, LDH was 467 U/L, and Scr was 326 μmol/L. The overall course of disease evolution was shown in Figure 3.
Clinicopathological characteristics and predictors of poor outcome in anti-glomerular basement membrane disease – a fifteen year single center experience
Published in Renal Failure, 2021
Zafirah Zahir, Asif Sadiq Wani, Narayan Prasad, Manoj Jain
Patients <18 years of age were regarded as children. Microscopic hematuria was defined as at least 5 red cells per high-power field on microscopic examination or positive blood by urine dipstick. Nephrotic syndrome was defined as nephrotic range proteinuria of >3.5 g per 24 h per 1.73 m2 (in children, >40 mg/m2/hr or PCR >2000 mg/g [>200 mg/mmol] or >300 mg/dl or 3 + on urine dipstick) along with hypoalbuminemia and edema [7,8]. Rapidly progressive glomerulonephritis (RPGN) was defined as the rapid loss of renal function within days to weeks, accompanied by nephritic syndrome features (proteinuria, glomerular hematuria and often oliguria) [9]. Oliguria was defined as urinary output of <400 mL/24 h while anuria was defined as urinary output of <100 mL/24 h. Advanced renal failure at presentation was defined as serum creatinine >5.7 mg/dl, in accordance with a few previous studies [4]. Dialysis-dependent renal failure was defined as the need to dialyze the patient within 72 h of admission to the hospital [6]. A diagnosis of pulmonary hemorrhage was rendered in patients with overt hemoptysis and/or pulmonary interstitial opacities on computed tomography (CT) chest and/or bronchoalveolar lavage showing alveolar hemorrhage [10].