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

An 80-year-old male presents to the emergency department with 3 days of diarrhoea and vomiting. He is hypotensive (BP 90/60 mmHg) and his heart rate is 105 bpm. His baseline serum creatinine from 3 months ago was 80 mcmol/L. Today, his creatinine is 250 mcmol/L, and urea is 18 mmol/L. Urine output is reported as 20 ml/hour over the last 6 hours. What is the most likely cause of his acute kidney injury?

A) Acute tubular necrosis (ATN)

B) Pre-renal AKI

C) Post-renal obstruction

D) Acute interstitial nephritis

Explanation: This area is hidden for preview users.

Question 2

A 55-year-old male with a 20-year history of poorly controlled type 2 diabetes mellitus and hypertension presents with increasing fatigue, nausea, and itching over the past few months. His blood tests show a serum creatinine of 450 µmol/L (baseline 120 µmol/L a year ago), eGFR 12 mL/min/1.73m², haemoglobin 95 g/L, and potassium 5.8 mmol/L. Urinalysis shows 3+ proteinuria. Physical examination reveals peripheral oedema and a blood pressure of 160/95 mmHg. Which of the following interventions is most crucial at this stage to prevent further deterioration and manage symptoms?

A) Initiation of a phosphate binder.

B) Dietary protein restriction.

C) Preparation for renal replacement therapy.

D) Prescription of erythropoiesis-stimulating agents (ESAs).

Explanation: This area is hidden for preview users.

Question 3

A 65-year-old male presents with a 3-month history of increasing nocturia, weak urinary stream, and a sensation of incomplete bladder emptying. He denies any haematuria or dysuria. His past medical history includes hypertension well-controlled on ramipril. On examination, his abdomen is soft, and a digital rectal examination reveals a smooth, enlarged prostate with no palpable nodules. His PSA is 3.5 ng/mL. Urinalysis shows no infection. Which of the following is the most appropriate initial management step for this patient?

A) Referral for transurethral resection of the prostate (TURP).

B) Initiation of a 5-alpha reductase inhibitor (e.g., finasteride).

C) Commencing an alpha-1 blocker (e.g., tamsulosin).

D) Immediate cystoscopy to rule out bladder cancer.

Explanation: This area is hidden for preview users.