4th Year Additions Flashcards
what happens if hydronephrosis causes a reduction in kidney function?
post-renal AKI
options for relieving blockage in urinary tract?
nephrostomy (drain inserted into the back)
urethral catheter
suprapubic catheter
what is idiopathic hydronephrosis?
narrowing of the pelvicureteric junction (PUJ)
management of idiopathic hydronephrosis
pyeloplasty
what is vesicoureteral reflux?
urine refluxing from the bladder back into the ureters
where is the renal angle?
12th rib and vertebral column posteriorly
catheter indications
pre-surgery post-surgery monitoring UO in unwell patient relieve obstruction neurogenic complications medication delivery
what cells produce PSA?
epithelial cells in the prostate
what is orchitis?
inflammation of the testicle
parotid gland swelling + orchitis?
mumps (can also cause pancreatitis)
presentation of epididymo-orchitis
pain dragging/ heavy sensation swelling urethral discharge systemic symptoms
management of epididymo-orchitis
ofloxacin
management of prostatitis
ciprofloxacin
causes of testicular lumps
hydrocele varicocele (should disappear when lying flat) epididymal cyst testicular cancer epididymo-orchitis inguinal hernia testicular torsion
what can a left-sided varicocele indicate?
renal cell carcinoma (obstruction to left testicular vein as it drains into the left renal vein)
also called Stauffer’s syndrome
what to consider if varicocele does not disappear when lying flat?
retroperitoneal tumour
leydig tumour presentation
testicular cancer
gynaecomastia
risk factors for bladder cancer
dyes and rubber (aromatic amines)
smoking
schistosomiasis (SCC)
management of bladder cancer
resection cystectomy chemotherapy BCG vaccine urostomy (ileal conduit)
most common type of kidney stone?
calcium oxalate
types of kidney stones
calcium stones
uric acid
struvite
cystine
conservative/ lifestyle management of renal stones
increase oral fluid intake add lemon juice avoid carbonated drinks reduced salt maintain calcium intake
recurrence= potassium citrate or thiazides
most common types of renal cell carcinomas
clear cell
papillary
chromophobe
who get’s Wilm’s tumour?
<5
renal transplant typical immunosuppression regime?
tacrolismus
mycophenolate
prednisolone
side effect of renal transplant immunosuppression
seborrheic warts and skin cancer
tacrolimus= tremor
cyclophosphamide= gum hypertrophy
cushing’s
renal biopsy criteria
BP <160/95
Hb >9
platelets >100
clotting/ stopping anticoagulants
do renal patients have ideal weight?
yes
where does Fanconi’s syndrome affect in the kidney?
PCT
what are thiazides good for?
OP and renal stones
caution in gout and DM
what can acute tubulointerstitial nephritis present with?
eosinophilia
what is erectile dysfunction?
inability to maintain or develop an erection during sex
causes of ED
finasteride psychological back/pelvic trauma stroke MS endocrine hypertension/ diabetes
point and shoot
erection is parasympathetic and ejaculation is sympathetic
what is an indicator that ED is psychogenic?
spontaneous morning erection
management of ED
PDE-5 inhibitors e.g. sildenafil
testosterone treatment
vacuum erection devices
prosthetic implants
side effect of azathioprine
bone marrow suppression
ciclosporin side effect
lymphoma
what antibiotic should be avoided in renal transplant?
trimethoprim
causes of green urine
amitriptyline
propofol
causes of white urine
pyuria
phosphate crystals
what can cause hyaline casts
diuretics
what does uric acid crystals + ARF indicate?
tumour lysis syndrome
what is TURP-syndrome?
hyponatraemia post-TURP due to glycerine and venous plexus absorption
how to calculate anion gap?
(Na+ + K+) – (Cl- + HCO3-).
indicator this needs to be done is being given chloride in the question
normal anion gap?
10-14 or 8-14?
normal anion gap metabolic acidosis causes
GI losses
RTA
acetazolamide
addison’s
raised anion gap metabolic acidosis causes
lactate
ketones
urate
acid poisoning (salicylates)
definition of AKI
rise in creatine to >26umol/L
<0.5 urine UO for >6 hours
causes of peritonitis on PD
staph epidermidis
staph aureus
management of peritonitis while on PD
vanc + ceftazidime or ciprofloxacin
usual immunosuppression regime in renal tranpslant
tacrolismus
mycophenolate
prednisolone
management of septic renal stones
percutaneous nephrostomy
JJ stent
management of of stones <7mm
repeat CT in 3-4 weeks
management of stones >7mm
shock wave lithotripsy
laser lithotripsy
ureteric stents (last 1 year)
screening for diabetic neprhopathy?
annual ACR
ACR that indicates microalbuminuria
> 2.5
when are diabetics given ACEI?
ACR >3
TNM staging for renal cell carcinoma
T1 <7cm
T2 >7cm
T3 beyond
T4 beyond Gerota’s fascia
what is acute tubular necrosis?
death of epithelial cells
can you recover from acute tubular necrosis?
yes, epithelial cells regenerate in 7-21 days
diagnosis of ATN
muddy brown casts
management of ATN
IV fluids
stop nephrotoxics
what acidosis does RTA cause?
hyperchloremic metabolic acidosis
four types of RTA?
- Type 1= distal tubule is unable to secrete H+
- Type 2= proximal tubule unable to resorb bicarbonate, usually Fanconi’s anaemia
- Type 3= combination of above
- Type 4= lack of aldosterone
what is rhabdomyolysis?
muscle cell death releasing myoglobin, K+, phosphate and CK
how does rhabdomyolysis cause AKI?
myoglobin release
diagnosis of rhabdomyolysis
CK
U&Es
urinalysis
ECG
management of rhabdomyolysis
IV fluids
IV sodium bicarbonate (for myoglobin)
hyperkalaemia management if needed
when to review alpha blockers?
6 weeks
how long do 5-alpha reductase inhibitors take to work?
6 months
superficial bladder cancer management
resection, chemo
invasive bladder cancer management
radical cystectomy
radical radiotherapy
when to avoid trimethoprim for treatment of UTI?
first trimester (folate antagonist)
when to avoid nitrofurantoin in UTI?
3rd trimester (haemolysis)
hormonal therapies used in prostate cancer
anti-androgens (testosterone antagonists) e.g. bicalutamide
GnRH agonists (goserelin
GNRH e.g. degarelix (bone spread)
bilateral orchidectomy
what must be used with GnRH antagonists?
anti-androgen cover as initially increases test and can cause spinal cord compression
examples of anti-androgens
bicalutamide
cyproterone acetate
flutamide
side effects of finasteride?
ED
secreted into semen so needs condoms
what causes green urine?
amitriptyline
propofol
what is TURP syndrome?
hyponatraemia post-TURP due to venous damage
how to calculate the anion gap?
(Na+ + Cl-) - (H+ + HCO3-)
what is the normal range of the anion gap?
8-14mmol/L
causes of normal anion gap?
hyperchloraemic metabolic acidosis
- GI bicarbonate loss (diarrhoea)
- RTA
- drugs e.g. acetazolamide
- ammonium chloride injection
- Addison’s
causes of a raised anion gap?
lactate ( shock, sepsis, hypoxia, metformin)
ketones (DKA, alcohol)
urate (renal failrue)
acid poisoning (salicylate, methanol)
swelling that you cannot get above in teh testicle?
hernia
which swelling is separate from the body of the testicle?
epididmyal cyst
diagnosis of urethral injury
ascending urethrogram
which diuretics cause renal stones?
loop
ACR sample
first pass urine
paediatric fluid prescribing
100ml/24 hours for every 0-10 kg
50ml/24 hours for every 11-20kg
20ml for each kg after that
maximum K+ infusion rate?
10mmol/hr
DI results
high plasma osmolality
low urine osmolality
what GFR should you stop metformin?
<45
statins <10
can you continue aspirin in AKI?
yes if cardioprotective dose (75mg)
what does fat stranding indicate?
recent passage of stone
method for removing stones if pregnant?
ureteroscopy
USS criteria for ADPKD
- two cysts, unilateral or bilateral if aged <30
- two cysts in both kidneys if aged 30-59
- four cysts in both kidneys if aged >60
staging of hyperkalaemia
mild= 5.5-5.9 mod= 6.0-6.4 severe= 6.5 or more
which drug should be held before coronary angiography?
metformin if at risk of contrast induced nephropathy
