Ad Renal Flashcards
How to check persistant proteinuria
Initial 1+ proteinuria—-> confirm by early morning urine dipstick—-> to check persistant proteinuria - consecutive positive urine dipsticks 1-2 weeks.
Gold standard - 24 hour urinary protein.
Management of Renal artery stenosis
- Control hypertension- by ACE-I or ARB ( careful monitoring done to renal impairment, if renal signs are seen—> stop them and start CCB.
Avoid thiazide diuretics. - Control cholesterol- statins
- Revascularization by renal artery angioplasty -
-for patient who failed medical management
-resistant hypertension
-dialysis dependent kidney failure
-BL renal artery stenosis
-SINGLE kidney with RAS.
PSA elevating and reducing factors
Sclerotic changes of vertebrae means
Highly suggestive of Prostate cancer with SCLEROTIC changes.
If abnormal DRE or high PSA according to the age , what’s next
Transrectal ultrasound scan( TRUS) ( as a guide for biopsy) and prostate biopsy taken.
When to do bone scan in prostate cancer
Positive bone scan probability is very low unless PSA >10. So unless it’s >10 ,unnecessary.
What’s goodpasture syndrome / anti glomerular basement membrane disease ( anti- GBM disease)
Common in younger <30y
Affects only LUNGS and KIDNEYS.
CF- sob , cough, hemoptysis ( due to alveolar hemorrhage) reduced UOP, dark colored urin.
Diagnostic test for goodpasture syndrome
Real biopsy—-> check for anti- GBM antibody
Second most accurate test - anti-GBM antibody assay.
Commonest complication of TURP
Retrograde ejaculation (80-90%)
How does TURP syndrome occur
By fluid overload ,electrolyte imbalance and hyponatremia.( absorption of fluid which was used to irrigate prostate during the procedure )
CF
CNS- restless, headache, confusion,N/V, cerebral edema
CVS- bradycardia,tachypnea, hypoxia, cyanosis
Hypothermia
Abdominal pain and distention.
What’s gold standard for urine incontinence
Urodynamic studies.
Important not for diagnosis but when planning invasive procedures.
Which chronic derangements in CKD are usually well tolerated by the patient
Hypercalcemia ( due to impaired bone metabolism)
Hyperkalemia ( failure to excrete potassium)
Hyponatremia( inability to retain sodium by kidneys) and uremia are not well tolerated
What’s neuropathic bladder ?
Due to secondary neurological damage.
Symptoms- overflow incontinence ,frequency, urgency, urine retention.
It’s a cause rather than a type of UI.
First line for urge incontinence
Bladder training ( first line)
But commonly combined with pelvic floor exercise
In urge incontinence what’s the mx if pelvic floor exercises failed
Surgical ( high cure rates) options considered.
1. Mid urethral string (tension free vaginal tape under urethra)
2. Bladder neck sling ( suspension)
3. Urethral bulking agents injection.
4. Burch colposuspension
Ix of choice for urolothiasis
CT KUB
X-RAY KUB can be used to minimize radiation
USS - can’t visualize stones but hydeonephrosis can.
MRI HAS NO PLACE HERE.
Mechanism of urge incontinence
Overactive bladder due to Detrusor instability
RF for testicular cancer
What are tumor markers of testicular cancer
AFP
Beta HCG
In suspected testicular tortion what to do
Surgery immediately
Window of necrosis 4-6 hours
Testicular mass management
Initial- USS —-> of cancer suspected or cystic TUMOR MARKERS —-> if positive CT for staging and Mets —-> surgey if indicated
What’s the most imp investigation to asses male infertility
FSH
>2.5 times normal FSH indicate IRREVERSIBLE TESTICULAR FAILURE.
Commonest cause of Hematuria in symptomatic and asymptomatic
UTI
Which size of rental stones will pass spontaneously
Less than 7mm
