Home › PLAB 1 › Renal & Urology

Master Renal & Urology
for PLAB 1

Access 50+ high-yield questions tailored for the 2026 syllabus. Includes AI-powered explanations and performance tracking.

Start Free Practice View Full Syllabus

HIGH YIELD NOTES ~5 min read

Core Concepts

Kidneys: Filter waste, regulate fluid/electrolytes, produce hormones (Erythropoietin, Renin, active Vitamin D).
AKI (Acute Kidney Injury): Rapid decline in renal function, often reversible.
CKD (Chronic Kidney Disease): eGFR <60 ml/min/1.73m² for >3 months, irreversible.
Nephrotic Syndrome: Triad of severe proteinuria (>3.5g/day), hypoalbuminaemia, oedema. Often with hyperlipidaemia.
Nephritic Syndrome: Haematuria (often dysmorphic RBCs/casts), sub-nephrotic proteinuria, hypertension, oliguria, AKI.
UTI (Urinary Tract Infection): Cystitis (bladder), Pyelonephritis (kidney).
Urolithiasis: Kidney stones.
BPH (Benign Prostatic Hyperplasia): Non-cancerous enlargement of the prostate.
RCC (Renal Cell Carcinoma): Kidney cancer.
Glomerulonephritis: Inflammation of the kidney's glomeruli.

Clinical Presentation

AKI/CKD: Fatigue, nausea, anorexia, pruritus, peripheral oedema, reduced urine output, altered mental status (uraemia).
Cystitis: Dysuria, frequency, urgency, suprapubic pain, gross or microscopic haematuria.
Pyelonephritis: Flank pain, fever, rigors, nausea/vomiting, often with lower UTI symptoms.
Urolithiasis (Renal Colic): Sudden, severe, colicky flank pain radiating to groin/testes, haematuria, nausea/vomiting.
BPH (LUTS - Lower Urinary Tract Symptoms): Nocturia, frequency, urgency, weak/intermittent stream, hesitancy, straining, incomplete emptying.
Nephrotic Syndrome: Pitting oedema (ankles, periorbital), frothy urine (proteinuria).
Nephritic Syndrome: "Cola-coloured" urine (haematuria), hypertension, oedema.
RCC/Bladder Cancer: Often asymptomatic, but painless gross haematuria is the most common presenting symptom.

Diagnosis (Gold Standard)

AKI/CKD: Serum U&Es (Creatinine, Urea), eGFR. Renal Ultrasound (kidney size, hydronephrosis).
Urinalysis: Urine dipstick (blood, protein, nitrites, leukocytes); MSU (Mid-Stream Urine) for culture & sensitivity.
Urolithiasis: Non-contrast CT KUB (Kidney, Ureter, Bladder) is the gold standard. Renal Ultrasound for hydronephrosis.
BPH: Digital Rectal Examination (DRE). PSA (Prostate-Specific Antigen) for screening/monitoring (requires careful interpretation). Uroflowmetry.
Glomerulonephritis: Renal biopsy is definitive. Blood tests: ANA, ANCA, C3/C4, ASO titre.
Proteinuria: Urine Albumin:Creatinine Ratio (ACR) or Protein:Creatinine Ratio (PCR) on a spot urine sample.
Renal Masses/Cysts: CT abdomen/pelvis with contrast (after initial USS).

Management (First Line)

AKI: Address underlying cause (e.g., fluid resuscitation for hypovolaemia, relieve obstruction), stop nephrotoxic drugs.
CKD: BP control (<130/80 mmHg, often ACEi/ARB), glycaemic control, manage complications (anaemia with EPO, bone disease with Vit D/phosphate binders), dietary modification, dialysis/transplantation.
Cystitis: Trimethoprim or Nitrofurantoin (3-day course for women, 7-day for men).
Pyelonephritis: Co-amoxiclav or Ciprofloxacin (7-14 days). IV antibiotics if severe.
Urolithiasis: Analgesia (NSAIDs), hydration. Small stones (<5mm): Alpha-blockers (Tamsulosin) for expulsion. Larger/obstructing stones: ESWL (Extracorporeal Shockwave Lithotripsy), Ureteroscopy, PCNL (Percutaneous Nephrolithotomy).
BPH: Watchful waiting for mild symptoms. Alpha-blockers (Tamsulosin) for symptom relief. 5-alpha-reductase inhibitors (Finasteride) for prostate size reduction. Surgical: TURP (Transurethral Resection of the Prostate).
Nephrotic Syndrome: Corticosteroids (e.g., Prednisolone for Minimal Change Disease), diuretics for oedema, ACEi/ARB for proteinuria, statins for dyslipidaemia, anticoagulation if high risk of thrombosis.
RCC: Partial or radical nephrectomy.
Bladder Cancer: TURBT (Transurethral Resection of Bladder Tumour) followed by intravesical chemotherapy/immunotherapy (e.g., BCG) for non-muscle invasive. Radical cystectomy for muscle-invasive disease.

Exam Red Flags

Painless gross haematuria: Consider bladder or renal cancer until proven otherwise.
Acute, severe, unilateral flank pain with fever/sepsis signs: Obstructing stone with superimposed infection (urosepsis) – a *urological emergency* requiring urgent decompression (e.g., stent, nephrostomy).
Rapidly Progressive Glomerulonephritis (RPGN): Acute decline in renal function, haematuria, often systemic symptoms (e.g., vasculitis). Requires urgent renal biopsy and aggressive immunosuppression.
Child with a palpable abdominal mass: Wilms' tumour (nephroblastoma) – requires urgent investigation.
Acute scrotal pain, swelling, high-riding testicle: Testicular torsion – *surgical emergency* (detorsion within 6 hours to salvage testis).
Hypertension refractory to multiple drugs with an epigastric bruit: Renal artery stenosis.
AKI with oliguria/anuria: Suggests severe renal injury or complete obstruction.
Sudden onset of severe loin pain in a CKD patient, especially if on anticoagulants: Consider renal infarction or retroperitoneal haemorrhage.

Sample Practice Questions

Question 1

A 30-year-old pregnant woman (28 weeks gestation) presents to the emergency department with sudden onset severe right flank pain radiating to her groin, associated with nausea and vomiting. She denies fever or dysuria. Her past medical history is unremarkable. On examination, she is afebrile, and there is tenderness in the right costovertebral angle. Urinalysis shows microscopic haematuria but no nitrites or leukocytes. Blood tests reveal normal white cell count and C-reactive protein. What is the most appropriate initial investigation?

A) CT KUB

B) Abdominal X-ray

C) Renal ultrasound

D) Intravenous Urogram (IVU)

Explanation: This area is hidden for preview users.

Question 2

A 45-year-old female presents with sudden onset severe, colicky right flank pain radiating to her groin. She reports associated nausea and one episode of vomiting. She denies fever or dysuria. Her past medical history is unremarkable. On examination, she is in significant distress due to pain. Abdominal examination is soft with mild right flank tenderness. Urinalysis shows microscopic hematuria, but no leukocytes or nitrites. A non-contrast CT KUB is performed. What is the most likely finding on the CT KUB?

A) Hydronephrosis and a ureteric calculus

B) Acute pyelonephritis with perinephric stranding

C) Appendicitis with a fecolith

D) Renal cell carcinoma

Explanation: This area is hidden for preview users.

Question 3

A 42-year-old woman presents to the emergency department with sudden onset, severe, colicky right flank pain radiating to her groin. She reports nausea and has vomited twice. On examination, she is afebrile, and her blood pressure is 130/85 mmHg. Urinalysis shows 3+ blood and no nitrites or leukocytes. Her CRP is normal. What is the most likely diagnosis?

A) Pyelonephritis

B) Acute appendicitis

C) Renal colic due to urolithiasis

D) Ovarian torsion

Explanation: This area is hidden for preview users.