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Renal > Clinical > Flashcards

Clinical Flashcards

1
Q

what is kidney agenesis?

A

a congenital absence of one or both kidneys

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2
Q

what is kidney hypoplasia?

A

a congenital condition causing small kidneys with normal development and function
(reduced capacity)

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3
Q

what is a horseshoe kidney?

A

kidneys congenitally fused at either pole- usually lower

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4
Q

do simple cysts usually cause a functional disturbance?

A

no

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5
Q

what are the 2 main types of polycystic kidney disease?

A
  • autosomal recessive PKD (prev known as infantile)

- autosomal dominant PKD (prev known as adult)

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6
Q

what is the most common subtype of ARPKD?

A

perinatal group

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7
Q

what does the perinatal group of ARPKD cause?

A

terminal renal failure

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8
Q

what happens to the medullary collecting ducts in ARPKD?

A

cystic dilation

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9
Q

what liver condition is ARPKD associated with?

A

congenital hepatic fibrosis

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10
Q

what is the most common inherited kidney disease?

A

autosomal dominant polycystic kidney disease

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11
Q

compare ADPKD 1 and ADPKD2 in terms of chromosomes affected? (give percentages)

A

ADPKD 1: defect on chromosome 16 (90%)

ADPKD 2: defect on chromosome 4 (10%)

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12
Q

what is the aetiology of ARPKD?

A

genetic

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13
Q

what is the aetiology of ADPKD?

A

genetic

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14
Q

when does ADPKD present?

A

usually in middle adult life

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15
Q

what does ADPKD present with?

A

abdominal mass
haematuria
chronic renal failure
hypertension

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16
Q

where do cysts arise in ARPKD?

A

medullary collecting tubules

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17
Q

where do cysts arise in ADPKD?

A

any part of the nephron

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18
Q

which other organs can be affected with cysts in ADPKD?

A

liver
pancreas
lung

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19
Q

what functionally happens to the liver, pancreas, lung when affected in ADPKD?

A

no funcional effect

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20
Q

what aneurysm is ADPKD associated and what can this lead to?

A

berry aneurysm in circle of Willis

can lead to subarachnoid haemorrhage

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21
Q

compare ARPKD and ADPKD in terms of the gross shape of the kidney?

A

ARPKD- enlargment but shape is still there

ADPKD- massive enlargement, shape is distorted

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22
Q

why can haematuria occur in ADPKD?

A

cysts can be filled with blood

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23
Q

compare the causes of intracerebral haemorrhage and subarachnoid haemorrhage in ADPKD?

A

intracerebral- due to hypertension caused by chronic renal faiulre
subarachnoid- due to berry aneurysm in circle of Willis

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24
Q

what is the most common benign renal tumour?

A

fibroma

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25
Q

what part of the kidney does a fibroma originate from?

A

medulla

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26
Q

what is an adenoma? (of anywhere)

A

a benign tumour of the epithelium

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27
Q

where do renal adenomas originate from?

A

usually capillary walls in the cortex

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28
Q

what type of cells do renal angiomyolipomas contain?

A

fat, muscle, blood vessels

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29
Q

what type of cells does a juxtaglomerular cell tumour arise from?

A

juxtaglomerular cells

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30
Q

what renal tumour is tuberous sclerosis associated?

A

renal angiomyolipomas

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31
Q

why can juxtaglomerular cell tumours cause secondary hypertension?

A

they overproduce renin

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32
Q

even though renal angiomyolipomas are benign, why may they cause kidney dysfunction?

A

because they can be large and multiple

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33
Q

what is the most common intra-abdominal tumour in children?

A

nephroblastoma (Wilm’s tumour)

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34
Q

what cells does a nephroblastoma (Wilms tumour) arise from?

A

primitive renal tissue

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35
Q

where do urothelial carcinomas tend to arise?

A

renal pelvis and calyces

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36
Q

where do renal cell carcinomas arise from?

A

renal tubular epithelium

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37
Q

what are renal cell carcinomas also known as?

A

clear cell carcinoma
hypernephroma
grawitz tumour

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38
Q

what is the commonest primary renal tumour in adults?

A

renal cell carcinoma

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39
Q

what age group do renal cell carcinomas tend to present in?

A

55-60 years old

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40
Q

who is more likely to get a renal cell carcinoma- M or F?

A

males

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41
Q

what does a renal cell carcinoma present with?

A

abdominal mass
haematuria
flank pain
systemic features of malignancy

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42
Q

what are the paraneoplastic manifestations of renal cell carcinoma?

A

erythropoietic stimulating substance: polycythaemia and increased haemaglobin
hormone similar to parathyroid: hypercalcaemia

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43
Q

what specific finding is a poor prognosis of a renal cell carcinoma?

A

renal vein extension

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44
Q

compare blood and lymph spread in renal cell carcinoma?

A

blood spread is first

lymph spread is later

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45
Q

which is the most common subtype of renal cell carcinoma?

A

clear cell type

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46
Q

what system is used to histologically grade renal cell carcinomas?

A

Fuhrman grading system

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47
Q

what is the most common type of bladder cancer?

A

transitional cell carcinoma

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48
Q

where can transitional cell carcinomas arise?

A

renal calyces right down to urethra

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49
Q

what industries have occupational risk of transitional cell carcinoma?

A

dye industry
rubber industry
hydrocarbon industry

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50
Q

what is the biggest risk factor of transitional cell carcinoma?

A

smoking

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51
Q

what chronic parasitic infestation is a risk factor for transitional cell carcinoma?

A

schistosomiasis

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52
Q

what is the commonest symptom of transitional cell carcinoma?

A

haematuria

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53
Q

where do 75% of transitional cell carcinomas occur?

A

trigone region

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54
Q

what does a pTa grade transitional cell carcinoma mean?

A

superficial and non invasive carcinomal

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55
Q

what does a pT1 grade transitional cell carcinoma mean?

A

stromal invasion

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56
Q

what does a pT2 grade transitional cell carcinoma mean?

A

detrusor muscle invasion

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57
Q

which lymph nodes do transitional cell carcinomas tend to spread to?

A

obturator nodes in pelvis

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58
Q

why can transitional cell carcinomas in the badder lead to hydroureter and hydronephrosis?

A

obstruction causing back pressure of urine

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59
Q

what are the 3 risk factors of an adenocarcinoma in the urinary tract?

A
  • congenital bladder extroversion
  • urachal remnants
  • long standing cystitis cystica
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60
Q

what are urachal remnants?

A

when the urachus- which connects bladder to umbilical cord- doesnt become fully obliterated

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61
Q

what is cystitis cystica?

A

a benign proliferation of the bladder as a response to chronic irritation

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62
Q

what are the 2 risk factors of a squamous cell carcinoma in the urinary tract?

A
  • calculi

- long term schistosomiasis

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63
Q

why can calculi lead to a squamous cell carcinoma?

A

cause irritation which leads to metaplasia then dysplasia

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64
Q

what is the most common malignant bladder tumour in children?

A

embryonal rhabdomyosarcoma

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65
Q

what is urinary incontinence?

A

complaint of any involuntary leakage of urine

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66
Q

what is stress urinary incontinence?

A

involuntary leakage of urine on effort or exertion (ie sneezing/coughing)

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67
Q

what is urgency urinary incontinence?

A

involuntary leakage of urine accompanied by urgency

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68
Q

what is urgency?

A

complaint of a sudden compelling desire to pass urine which is difficult to defer

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69
Q

what is overactive bladder syndrome/urge syndrome/urgency-frequency syndrome?

A

urgency +/- urge incontinence, usually with frequency, and nocturia

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70
Q

what is detrusor overactivity incontinence?

A

involuntary leakage of urine due to an involuntary detrusor contaction

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71
Q

what is mixed urinary incontinence?

A

involuntary leakage of urine associated with urgency and also exertion/effort

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72
Q

what is the name of this collection of symptoms- slow stream, splitting of urinary stream, spraying of urinary stream, hesitancy, straining?

A

voiding symptoms

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73
Q

what is a frequency volume chart?

A

a chart which records volumes voided and times of each micturation for at least 24 hours

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74
Q

what are the 4 types of urinary incontinence? (urethral route)

A

overflow incontinence
stress incontinence
urge incontinence
mixed incontinence

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75
Q

what are the 2 main causes of extraurethral route of urine?

A

ectopic ureter

fistula

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76
Q

in storage phase, compare intravesical and urethral pressure?

A

intravesicle pressure is less than urethral pressure

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77
Q

in voiding phase, compare intravesical and urethral pressure?

A

intravesicle pressure is more than urethral pressure

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78
Q

what is urodynamic testing?

A

determines pressures within the micturation system

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79
Q

in a normal situation, what happens to the intravesicle pressure on coughing?

A

increases

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80
Q

in a normal situation what happens to the abdominal pressure on coughing?

A

increases

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81
Q

in a normal situation what happens to the detrusor pressure on coughing?

A

no change

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82
Q

what is the underlying cause of overflow incontinence?

A

bladder outflow obstruction causing chronic retention

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83
Q

in overflow incontinence, is there an urgency to urinate?

A

no, you don’t realise you have done it

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84
Q

compare the frequency of urination in a normal patient to someone with urge syndrome?

A

frequency is increased

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85
Q

compare the volume of urine voided in a normal patient to someone with urge syndrome?

A

small voided volumes

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86
Q

in a patient with urge syndrome due to detrusor overactivity, what happens to the detrusor pressure on coughing?

A

increases

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87
Q

what is the main cause of urge syndrome?

A

detrusor overactivity

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88
Q

what are the causes of detrusor overactivity?

A
  • something in the wall of the bladder causing irritation (stone, tumour)
  • loss of central inhibition of micturation reflex (paraplegia)
  • idiopathic
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89
Q

compare loss of central inhibition of micturation reflex (paraplegia) to destruction of S2,3 centre in terms of cause of urge incontinence?

A

loss of central inhibition (paraplegia)- overacitivty of detrusor

destruction of S2-3 centre- loss of detrusor muscle function

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90
Q

what is idiopathic detrusor overacitivity?

A

urge syndrome caused by detrusor overacitivty with no undelying cause

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91
Q

how do you diagnose urge incontinence/syndrome?

A

urodynamic testing

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92
Q

what causes stress incontinence?

A

damage to pelvic floor or urethral function

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93
Q

what is the most common underlying cause of damage to pelvic floor/urethral function in stress incontinence?

A

childbirth

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94
Q

how do you diagnose stress incontinence?

A

urodynamic testing

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95
Q

is there urgency in stress incontinence?

A

no

unless mixed incontinence

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96
Q

in a patient with stress incontinence, what happens to the detrusor pressure on coughing?

A

nothing (detrusor is working normally)

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97
Q

what happens to the volume of the urine leak in stress incontinence as the bladder becomes fuller?

A

volume increases

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98
Q

why might people with stress incontinence go to the toilet frequently even though there is no sense of urgency?

A

a learned habit, a technique to prevent the bladder volume getting large therefore preventing leaking volumes being large

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99
Q

what is the most likely cause of a painless palpable mass arising from the pelvis which is dull to percus and unable to get below it in a female who has amenorrhoea?

A

pregnancy

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100
Q

what is the most likely cause of a painless palpable mass arising from the pelvis which is dull to percus and cannot get below it in a middle aged male?

A

bladder

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101
Q

how do you treat overflow urinary incontinence?

A

catheterise and teach patient to intermittently self catheterise (rehabilitates the bladder)

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102
Q

what is the dietary treatment of urge urinary incontinence?

A

avoid caffeine

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103
Q

what is the pharmacological treatment of urge urinary incontinence?

A

antimuscarinics (oxybutynin, tolterodine)

beta 3 adrenergic (mirabegron)

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104
Q

what invasive surgery can be done for the treatment of urge urinary incontinence?

A

bladder pacemaker

enterocystoplasty (makes bladder larger)

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105
Q

what is the lifestyle treatment of stress incontinence?

A

weight loss

stop smoking

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106
Q

what is the physio treatment of stress incontinence?

A

pelvic floor exercises

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107
Q

what is the surgical treatment of stress incontinence?

A

colposuspension

tape procedures

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108
Q

what is the cause of an ectopic ureter?

A

congenital

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109
Q

what is the main cause of a vesico-vaginal fistula in developing countries?

A

prolonged obstructed labour

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110
Q

describe the appearance of bowen’s disease of the penis?

A

dry crusty appearance

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111
Q

describe the appearance of erythroplasia of queyrat?

A

red velvety appearance

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112
Q

what type of ‘carcinoma-in-situ’ are bowen’s disease and erythroplasia of queyrat when sited on the penis?

A

squamous carcinoma-in-situ

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113
Q

which has a bigger risk of squmaous carcinoma of the penis- circumscised or uncircumcised?

A

uncircumcised

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114
Q

where in the penis does squamous carcinoma tend to occur?

A

glans or prepuce

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115
Q

what are the risk factors of squamous carcinoma of the penis?

A

poor hygiene
HPV
phimosis

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116
Q

what occupational risk can predispose to SCC of scrotum?

A

chimney sweeps

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117
Q

what is benign nodular hyperplasia of the prostate?

A

irregular proliferation of both glandular and stromal prostatic tissue within the prostate

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118
Q

what is the aetiology of benign nodular hyperplasia?

A

hormonal imbalance

alteration of androgen:oestrogen ratio

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119
Q

what is prostatism?

A

a group of symptoms caused by prostate disease

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120
Q

what are the main consequences of benign nodular hyperplasia of the prostate?

A

bladder hypertrophy
diverticulum
hydroureter/hydronephrosis
infection

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121
Q

what is the management of benign nodular hyperplasia?

A

usually drugs: alpha blockers, 5 alpha reductase inhibitors

surgery: transurethral resection

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122
Q

what is the peak incidence of prostate carcinoma?

A

60 - 80 years old

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123
Q

where in the prostate are carcinomas most likely to occur?

A

peripheral ducts and glands

usually posterior lobe

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124
Q

why are symptoms of prostatism a sign of advanced prostate cancer?

A

peri-urethral zone involved at a later stage

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125
Q

why are prostatic cancer bone mets distinct?

A

osteosclerotic instead of osteolytic

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126
Q

what protein is usually increased in prostatic carcinomas?

A

prostate specific antigen (PSA)

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127
Q

how do you take a biopsy of the prostate?

A

transurethal resection

multiple needle core biopsies under US (trans rectal)

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128
Q

what might you feel on a PR exam of a prostate carcinoma?

A

craggy, hard, irregular mass

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129
Q

what is the drug management of a prostate carcinoma?

A

hormone therapy:
anti-androgens
LHRH agonists
oestrogens

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130
Q

what is the management of prostatic carcinoma bone mets?

A

radiotherapy

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131
Q

what is the surgical management of a prostate carcinoma?

A

radical prostatectomy

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132
Q

what type of prostate carcinoma is a radical prostatectomy reserved for?

A

organ-confined disease

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133
Q

what is a major risk factor for a testicular tumour?

A

maldescent

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134
Q

what is the usual presenting complaint of a testicular tumour?

A

testicular enlargement

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135
Q

describe the pain felt with testicular enlargement in a testicular tumour?

A

painless

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136
Q

why can gynaecomastia be a feature of testicular tumour?

A

hormonal secretion

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137
Q

what is the main type of testicular tumour?

A

germ cell tumours

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138
Q

what are the types of germ cell testicular tumours?

A

seminoma
teratoma
mixed

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139
Q

what are the types of stromal testicular tumour?

A

sertoli cell

leydig cell

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140
Q

which specific stromal testicular cell tumour is known to cause gynaecomastia?

A

leydig cell tumour

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141
Q

what is the most common type of germ cell testicular tumour?

A

seminoma

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142
Q

what is the peak age of incidence of a seminoma?

A

30-50 years old

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143
Q

which lymph nodes does a seminoma usually spread to?

A

para-aortic lymph nodes

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144
Q

why is there such a high cure rate for seminomas, even with mets?

A

very radiosensitive

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145
Q

what is the peak age of incidence of a teratoma?

A

20-30 years

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146
Q

what cells does a teratoma arise from?

A

all 3 cell lines: endoderm, mesoderm, ectoderm

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147
Q

what are the 4 types of teratoma?

A

differentiated teratoma (DT)
malignant teratoma intermediate (MTI)
malignant teratoma undifferentiated (MTU)
malignant tertoma trophoblastic (MTT)

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148
Q

which of the teratomas is benign?

A

differentiated teratoma (DT)

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149
Q

which of the teratomas is entirely malignant?

A

malignant teratoma undifferentiated (MTU)

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150
Q

which of the teratomas contains trophoblastic (placental) tissue?

A

malignant teratoma trophoblastic (MTT)

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151
Q

which of the teratoma contains a mixture of differentiated and undifferentiated tissue?

A

malignant teratoma intermediate (MTI)

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152
Q

what hormone can malignant teratoma trophoblastic tumours secrete?

A

human chorionic gonadatrophin (bHCG)

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153
Q

what is a mixed seminoma teratoma tumour?

A

a type of germ cell tumour of the testes with seminoma and any variant of teratoma

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154
Q

what hormone can seminomas secrete?

A

placental alkaline phospatase (PLAP)

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155
Q

what part of the embryo secretes alpha fetoprotein? (AFP)

A

yolk sac

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156
Q

what tumours can secrete alpha fetoprotein? (AFP)

A

germ line tumours (testicular or ovarian)
hepatocellular carcinomas
liver mets

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157
Q

compare glomerulonephritis and pyelonephritis in terms of what causes it?

A

glomerulonephtiris- immunologcal basis

pylonephritis- infectious agent

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158
Q

why can glomerulonephritis occur several weeks after an infection despite it being non-infective?

A 
immunological mechanism
(ie antibody production)
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159
Q

what are the 2 main types of glomerulonephritis?

A

diffuse

focal

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160
Q

which is more common- diffuse or focal glomerulonephritis?

A

diffuse

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161
Q

what is the main type of infectious agent which causes pyelonephritis

A

bacterial infection

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162
Q

what parts of the kidneys are involed in pyelonephritis?

A

renal pelvis, calyces

spread into the tubules and interstitium

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163
Q

what is the most common organism of pyelonephritis?

A

E. Coli

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164
Q

what are the 2 subtypes of pyelonephritis?

A

acute

chronic

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165
Q

is pyelonephritis more common in F or M?

A

females

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166
Q

what are the 2 ways of infection spread causing pyelonephritis? -which is more common?

A 
haematogenous (rare)
ascending infection (common)
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167
Q

what is cystitis?

A

infection/inflammation of the bladder

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168
Q

why is pyelonephritis more common in females?

A

they have a shorter, wider urethra

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169
Q

why can pregnancy be a risk factor for pyelopnephritis?

A

ureteric dilatation with urine stasis because of:

  • hormonal effects
  • anatomial effects
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170
Q

what hormonal effects in pregnancy causes ureteric dilation with urine stasis? (a risk factor for pyelonephritis)

A

relaxation of smooth muscle in ureters

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171
Q

what anatomical effects in pregnancy cause ureteric dilation with urine stasis? (a risk factor for pyelonephritis)

A

obstruction from pregnant uterus

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172
Q

what is a major risk factor for pyelonephritis due to urine stasis?

A

urinary tract obstruction

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173
Q

what type of reflux can be a risk factor for pyelonephritis?

A

vesico-ureteric reflux

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174
Q

how can vesico-ureteric reflux be congenital?

A

ureters enter bladder perpendicular instead of oblique

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175
Q

what condition is a risk factor for pyelonephritis due to sugar content of urine?

A

diabetes

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176
Q

why do patients with chronic pyelonephritis urinate large volumes?

A

kidney damage so isn’t able to concentrate urine as effectively

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177
Q

what infection of the kidney does ‘sterile pyuria’ indicate?

A

TB

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178
Q

how does TB spread to the kidneys?

A

haemotengous spread (usually from lung primary)

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179
Q

what is dysuria?

A

painful passing of urine

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180
Q

what is the principle techniquie for diagnosing TB?

A

PCR

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181
Q

what is the type of inflammation/necrosis that occurs with TB?

A

caseating granulomatous inflammation

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182
Q

when can cystitis become necrotising?

A

if associated with outlet obstruction

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183
Q

what can form within the benign hyperplasia of ureteritis or cystitis cystica?

A

fluid filled cysts

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184
Q

is urethral obstruction more common in F or M?

A

M

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185
Q

why is urethral obstruction more common in males?

A

they have a longer, tortuous urethra

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186
Q

what is the main cause of bladder outlet obstruction in a newborn male?

A

posterior urethral valves (in utero development abnormality)

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187
Q

what are the 2 main causes of hydronephrosis?

A

urinary tract obstruction

prolonged vesico-ureteric reflux

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188
Q

would a neurogenic disturbance (ie in a paraplegic patient) cause unilateral or bilateral hydronephrosis?

A

bilateral

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189
Q

would a urethral obsturcion cause unilateral or bilateral hydronephrosis?

A

bilateral

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190
Q

would a calculi or neoplasm in a ureter cause unilateral or bilateral hydronephrosis?

A

unilateal

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191
Q

what happens to urine production if there is a sudden and complete obstuction?

A

urine production quickly ceases

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192
Q

what happens to urine production if there is gradual and partial obstruction?

A

urine production remains the same

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193
Q

compare sudden and complete obstruction to gradual and partial obstruction in terms of hydronephrosis?

A

sudden: little dilation
gradual: dilation

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194
Q

what is the term for secondary infection of a hydronephrotic kidney?

A

pyonephrosis

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195
Q

how do you determine whether there is haematuria?

A

urine dipstick test

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196
Q

what does macroscopic haematuria mean?

A

visible haematuria

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197
Q

wht does microscopic haematuria mean?

A

non-visible haematuria

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198
Q

what is a common contaminate of urine in a women of child-bearing age, causing it to become red?

A

menstruation

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199
Q

why might there be myglobin within the urine? (causing it to become red)

A 
rhabdomyolisis
mcArdle disease (metabolic disorder)
bywaters/crush syndrome
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200
Q

what drugs cause red urine?

A 
doxyrubicine
chloroquine
rifampicin
nitrofurantoin
senna containing laxatives
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201
Q

what toxins can cause red urine?

A

lead

mercury

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202
Q

what colour urine might increased urobilinogen in the urine cause?

A

brown coloured urine

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203
Q

what causes pneumaturia?

A

any connection between bowel and bladder

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204
Q

what causes faecaluria?

A

any connection between bowel and bladder

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205
Q

on CT urogram, what is indicated if there is a defect of bladder filling?

A

there is an obstruction within the bladder

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206
Q

what is a urethrocystoscopy?

A

an endoscopic picture of the bladder by placing an endoscope through the urethra

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207
Q

what is post-obstructive diuresis?

A

dramatic increase in urine output (200ml/hr) after release of urinary tract obstruction (must be bilateral- ie both kidneys affected)

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208
Q

what are the 2 factors necessary for post-obstructive diuresis?

A

accumulation of total body water, sodium and urea (eg oedema, CCF, hypertension, uraemia)
OR
impairement of tubular re-absorption

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209
Q

compare physiological post-obstructive diuresis to pathological post-obstructed diuresis?

A

physiological- self limiting, stops after return to euvolaemic state
pathological- inappropriate diuresis beyond euvolaemic state

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210
Q

usually post-obstructive diuresis is self limiting, how long does this take?

A

24-48 hours

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211
Q

in severe cases of post-obstructive diuresis beyond euvolaemic state, what management is needed?

A

IV fluid

sodium replacement

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212
Q

what is the treatment for ureteric colic?

A

NSAIDs +/- opiate,
+ alpha blocker (tamsulosin) for small stones expected to pass
wait for 1 month to see if surgical intervention is necessary

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213
Q

what is the likelihood of spontaneous passage of renal stones if they are less than 4mm?

A

80%

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214
Q

what is the likelihood of spontaneous passage of renal stones if they are between 4-6mm?

A

50-60%

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215
Q

what is the likelihood of spontaneous passage of renal stones if they are above 6mm?

A

20%

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216
Q

what are the indications for urgent intervention of a renal stone?

A

pain unrelieved
pyrexia
persistent nausea and vomiting
high-grade obstruction

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217
Q

what is the intervention for renal stones in the absence of infection?

A

ureteric stent

stone fragmentation

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218
Q

what is the intervention for renal stones with infected hydronephrosis?

A

percutaneous nephrostomy

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219
Q

what age is torsion of the spermatic cord most common?

A

puberty

220
Q

torsion of spermatic cord is usually spontaneous but may occur with what?

A

trauma

athletic activities

221
Q

describe the pain with torsion of spermatic cord?

A

sudden onset severe pain
may have prev episodes of self limiting pain
referral of pain to lower abdomen

222
Q

on examination of torsion of spermatic cord what signs do you see?

A

testis high in scrotum
transverse lie
absence of cremasteric reflex

223
Q

what is the management of torsion of spermatic cord?

A

prompt surgical exploration

224
Q

why must you fix the contralateral side in testicular torsion?

A

to prevent it occuring to the other testis

-due to bell clapper deformity

225
Q

what is the most common cause of testicular torsion?

A

bell clapper deformity

226
Q

how is torsion of appendage differentiated from torsion of spermatic cord?

A

testis should be mobile
cremasteric reflex present
blue dot sign

227
Q

what is generally seen in the history of epididymitis?

A

UTI
urethritis
catheterisation/instrumentation

228
Q

is the cremasteric reflex present in epididymitis?

A

yes

229
Q

what is a general indicator of epididymitis over testicular torsion?

A

pyrexia

230
Q

what will you see on doppler US of epididymitis?

A

swollen epididymis, increased bloodflow

231
Q

what is the management of confirmed torsion of appendage?

A

will resolve spontaneously

232
Q

what is the management of epididymitis?

A

analgesia + scrotal support
bed rest
ofloxacin 400mg 14 days

233
Q

instead of pain, what may be felt in idiopathic scrotal oedema?

A

pruiritis

234
Q

what is paraphimosis?

A

painful swelling of foreskin distal to a phimotic ring

235
Q

what often causes paraphimosis within hospital?

A

forgetting to replace foreskin in natural position after catheterisation or cystoscopy

236
Q

what is priapism?

A

prolonged (often painful) erection >4hours

237
Q

is priapism associated with sexual arousal?

A

no

238
Q

what are the 5 causes of priapism?

A
  • intracorporeal injection for erectile dysfunction
  • trauma
  • haematological conditions (eg sickle cell)
  • neurological conditions
  • idiopathic
239
Q

what are the classifications of priapism?

A

ischaemic (low flow)

non-ischamic (high flow)

240
Q

what is seen in the aspirate of blood from corpus cavernosum in low flow (ischaemic) priapism?

A

dark blood, low O2, high CO2

241
Q

what is seen in the aspirate of blood from corpus cavernosum in high flow (non-ischaemic) priapism?

A

normal arterial blood flow

242
Q

what is seen in duplex US in low flow (ischaemic) priapism?

A

minimal or absent flow

243
Q

what is seen in duplex US in high flow (non-ischaemic) priapism?

A

normal to high flow

244
Q

what is the management of ischaemic priapism?

A

aspiration +/- irrigation with saline
injections of alpha-agonist
surgical shunt
(only if early presentation)

245
Q

what is the management of a non-ischaemic priapism?

A

observe, may resolve spontaneously

if not: selective arterioal embolisation with non-permanent materials

246
Q

what is fornier’s gangrene?

A

necrotising fasciitis occuring around the male genitalia

247
Q

what are the 4 main risk factors of fornier’s gangrene?

A

diabetes
local trauma
periurethral extravasation
perianal infection

248
Q

how does fornier’s gangrene start?

A

as a cellulitis: swollen, red, tender, pain, fever

249
Q

what investigations can confirm gas in the tissues in fornier’s gangrene?

A

US or X-ray

250
Q

what is the management of fornier’s gangrene?

A

antibiotics

surgical debridement

251
Q

what types of pathogens cause emphysematous pyelonephritis?

A

gas forming uropathogens

usually E coli

252
Q

what risk factors predisposed to emphysematous pyelonephritis?

A

diabetics

ureteric obstruction

253
Q

what investigations can confirm gas in the tissues in emphysematous pyelonephritis?

A

CT KUB

254
Q

what does a perirenal abscess usually result from?

A

a rupture of an acute cortical abscess

or from haematogenous seeding from other sites of infection

255
Q

how do you investigate a perirenal abscess?

A

CT

256
Q

what is the management of a perinephric abscess?

A

antibiotics

percutaneous or surgical drainage

257
Q

describe renal trauma type 1?

A

non-expanding haematoma, subcapsular, no parenchymal laceration

258
Q

describe renal trauma type 2?

A

laceration less than 1cm parencymal depth

no urinary extravasation

259
Q

describe renal trauma type 3?

A

laceration greater than 1cm

no collecting system rupture or extravasation

260
Q

describe renal trauma type 4?

A

laceration through cortex, medulla and collecting system

arterial/venous injury with contained haemorrhage

261
Q

describe renal trauma type 5?

A

shattered kidney
avulsion of hilum
devascularised kidney

262
Q

what are the indications for imaging the kidneys after trauma in an adult?

A

frank haematuria

non visible haematuria + shock/penetrating injury

263
Q

what are the indications for imaging the kidneys after trauma in a child?

A

frank or non-visible haematuria

264
Q

what is the investigation for imaging the kidneys after trauma?

A

CT contrast

265
Q

what fracture is bladder injury most commonly associated with?

A

pelvic fracture

266
Q

what are the 6 main signs of bladder injury?

A 
suprapubic/abdo pain
inability to void
suprapubic tenderness
lower abdo bruising
guarding
diminished bowel sounds
267
Q

what is the imaging investigation of choice for possible bladder trauma?

A

CT cystography

268
Q

on examination of a urethral injury what 5 main signs are seen?

A 
blood at external urethra meatus
inability to urinate
palpably full bladder
'high riding' prostate
butterfly perineal haematoma
269
Q

what is the imaging investigation of choice for possible urethra trauma?

A

retrograde urethrogram

270
Q

what fractures are urethral injuries often associated with?

A

fracture of pubic rami

271
Q

when do penile fractures typically occur?

A

during sex

-buckling injury when penis slips out of vagina and strikes pubis

272
Q

what sound is heard on penile fracture?

A

cracking or popping

273
Q

what are the symptoms of penile fracture?

A

pain
rapid detumescence
discolouration
swelling

274
Q

what is the management of a penile fracture?

A

prompt exploration and repair

‘degloving of penis’ to expose all 3 compartments

275
Q

what is the investiation of choice for testicular trauma?

A

ultrasound

276
Q

what is the management of a urethral injury?

A

supraupubic catheter

delayed reconstruction after at least 3 months

277
Q

what is the management of bladder injury with no indications for immediate repair?

A

antibiotics

repeat cystogram in 14 days

278
Q

what is the verumontanum of the prostate?

A

where the ejaculatory ducts drain to each side of the prostatic urethra

279
Q

what is the transitional zone of the prostate?

A

the area which surrounds the urethra, proximal to the verumontanum

280
Q

what is the central zone of the prostate?

A

cone shaped region which surrounds the ejaculatory ducts

281
Q

what is the peripheral zone of the prostate?

A

posteriolateral prostate

282
Q

which zone of the prostate gives rise to benign prostate hyperplasia?

A

transitional zone

283
Q

which zone of the prostate gives rise to the majority of carcinomas?

A

peripheral zone

284
Q

what is the anterior part of the prostate made up?

A

fibromuscular stroma

285
Q

what is the most common malignancy affecting men in the UK?

A

prostate cancer

286
Q

what type of cancers are the majority of prostate cancers?

A

multifocal adenocarcinomas

287
Q

what scoring system grades prostate cancers?

A

gleason’s scoring

288
Q

what hormones is the growth of prostate cancer cells under the influence of?

A

testosterone

dihydrotestosterone

289
Q

what happens if prostate cells are deprived of androgenic stimulation?

A

undergo apoptosis

290
Q

what can initially happen on treatment of prostate carcinoma with LHRH agonists?

A

initial androgen surge

291
Q

what can be given to prevent initial androgen surge with LHRH?

A

anti-androgens

292
Q

what is the function of LHRH in prostate carcinoma?

A

cause suppression of pituitary LH and FSH secretion and therfore testosterone production

293
Q

compare steroidal and non-steroidal anti-androgens in terms of libido and sexual interest?

A

steroidal (eg cyprosterone): loss of libido and sexual interest
non-steroiral: no loss of libido or sexual interest

294
Q

what are the 2 types of transitional cell carcinoma? and give percentages

A

papillary 80%

non papillary 20%

295
Q

compare papillary and nonpapillary transitional cell carcinomas in terms of percentage that are considered to be malignant?

A

papillary: 50%

non-papillary: all considered to be malignant

296
Q

what are the 2 subtypes of papillary transitional carcinoma?

A

papilloma

invasive papillary carcinoma

297
Q

what are the 2 subtypes of nonpapillary transitional carcinoma?

A

flat non invasive carcinoma

flat invasive carcinoma

298
Q

what are the most common benign asymptomatic renal lesions?

A

benign renal cysts

299
Q

what imaging is best for looking at a renal cyst?

A

ultrasound

300
Q

what is the main consequence of angiomyolipomas?

A

haemorrhage

may have wunderlich’s syndrome- massive retroperitoneal bleeding

301
Q

what imaging is best for looking at a suspected angiomyolipoma?

A

CT

302
Q

what benign renal tumour can appear to be a carcinoma?

A

oncoytoma

303
Q

what feature of oncocytoma is very characteristic?

A

stellate scar

304
Q

what type of carcinoma is a renal cell carcinoma?

A

adenocarcinoma

305
Q

what part of the kidney is affected by renal cell carcinoma?

A

proximal convoluted tubule

306
Q

if renal cell carcinoma is multifocal or bilateral then what syndrome should you suspect?

A

von hippel-lindau syndrome

307
Q

what is the best imaging for diagnosing a renal cell carcinoma?

A

triple phase contrast CT

308
Q

what is the main form of renal cell carcinoma treatment?

A

radical or partial nephrectomy

309
Q

what are the 4 main premalignant conditions of penile cancer?

A

Bowen’s disease
Erythroplasia of Queyrat
Balanitis Xerotica Obliterans
Leukoplakia

310
Q

what do you see in balanitis xerotica obliterans of the penis?

A

white patches, fissuring, bleeding, scarring of prepuce and glans

311
Q

what is the treatment of balantis xerotica obliterans?

A

circumcision

may need glans resurfacing

312
Q

what is the main difference in location of bowen’s disease and erythroplasia of queyrat of the penis? (both are squamous cell carcinoma in situ)

A

erythroplasia of queyrat is on glans, prepuce or shaft

bowen’s is on the other parts of genitalia

313
Q

what is the treatment of bowen’s disease or srythroplasia of queyrat of the penis?

A

circumcision

topical 5-fluorouracil

314
Q

what is the surgical treatment of a penis carcinoma?

A

total/partial penectomy

reconstruction

315
Q

what is the best imaging technique for suspected testicular tumour?

A

ultrasound

316
Q

what hormone is 100% elevated in a malignant teratoma trophobastic?

A

bHCG

317
Q

what is the main underling cause for glomerulonephritis?

A

immune-complex deposition

318
Q

why can renal artery stenosis worsen pre-existing hypertension?

A

RAS kicks in

319
Q

what type of necrosis is found in the kidneys due to malignant hypertension?

A

fibrinoid necrosis

320
Q

compare seminomas and teratomas in terms of radio/chemotherapy?

A

seminomas- radiosensitive

teratomas- chemosensitive

321
Q

why can a patient become anaemia due to kidney failure?

A

loss of production of erythropoietin

322
Q

what must you do to a patient who has a pericardial rub in the presence of uraemia?

A

immediate dialysis

323
Q

why might vomiting cause acute kidney injury?

A

due to dehydration

324
Q

what does ACEI/ARBs have a protective function against?

A

proteinuria

-help preserve kidney function

325
Q

what does ACEI/ARB have a negative effect on?

A

dehydration

ie in vomiting

326
Q

who is at risk of contrast nephropathy?

A

patients who are dehydrated

patients who already have renal impairment

327
Q

in what condition are you most likely to feel palpable kidneys?

A

ADPKD

328
Q

why must you always correct hypotension in kidney disease?

A

kidneys need a certain perfusion to work

329
Q

below what blood pressure should you aim to get a patient who has kidney disease?

A

less 130/80

330
Q

what is the diastolic pressure above in accelerated hypertension?

A

above 120mmHg

331
Q

what can be seen on fundoscopy of accelerated hypertension?

A

papilloedema

332
Q

what is leukonychia found in?

A

profound hypoalbuminaemia

333
Q

what immunoglobulin is involved in Henoch-Schonlein Purpura?

A

IgA

334
Q

what is the classic distribution of Henoch-Schonlein Purpura?

A

extensor surfaces of legs and buttocks

335
Q

what is rhabdomyolysis and why can it cause kidney injury?

A

muscle breakdown

myoglobin is a product and cannot be processed properly by the kidney

336
Q

what is the CK like in rhabdomyolysis?

A

very high

337
Q

how many grams of protein in the urine classes as asymptomatic low grade proteinuria?

A

up to 1g

338
Q

how many grams of protein in the urine classes as heavy proteinuria?

A

1-3g per day

339
Q

how many grams of protein in the urine classes as within nephrotic range?

A

> 3g per day

340
Q

what are the 2 main ways to quantify urine protein?

A

24 hour urinary collection

urine protein/creatinine ratio

341
Q

under microscopy of urine, compare what isomorphic and dysmorphic red blood cells indicate?

A

isomorphic- coming from lower down renal tract

dysmorphic- coming frohigher up the renal tract

342
Q

what biochemistry abnormality does tented T waves on ECG suggest?

A

hyperkalaemia

343
Q

what does hyperkalaemia eventually lead to in terms of patients heart rate/pulse?

A

cardiac arrest

344
Q

what stage of kidney disease does GFR >90 with symptoms indicate?

A

stage 1

kidney damage with normal GFR

345
Q

what stage of kidney disease does GFR from 60-89 with symptoms indicate?

A

stage 2

kidney damage with mildly reduced GFR

346
Q

what stage of kidney disease does GFR from 30-59 indicate?

A

stage 3

moderately reduced GFR

347
Q

what stage of kidney disease does GFR from 15- 29 indicate?

A

stage 4

severely reduced GFR

348
Q

what stage of kidney disease does GFR of less than 15 indicate?

A

stage 5

kidney failure

349
Q

what are the main features of nephrotic syndrome?

A

proteinuria >3g per day
hypoalbuminuria
oedema
(hypercholesterolaemia)

350
Q

why might it be hard to determine if someone has nephrotic syndrome?

A

often have normal renal function

351
Q

oedema of what site is a classical sign of nephrotic syndrome?

A

periorbital oedema

352
Q

compare nephrotic syndrome and nephritic syndrome in terms of pulmonary oedema?

A

no pulmonary oedema in nephrotic syndrome

pulmonary oedema in nephritic syndrome

353
Q

why do you not tend to get pulmonary oedema in nephrotic syndrome even though oncotic pressure is low?

A

becasue the capillary pressure within the lungs is still very low

354
Q

which are you more likely to get with acute kidney injury- nephrotic or nephritic syndrome?

A

nephritis syndrome

355
Q

what are the 5 main symptoms/signs of nephritic syndrome?

A 
oliguria
hypertension
oedema
proteinuria
haematuria
356
Q

what is chronic kidney disease?

A

reduced GFR over a length of time

357
Q

what is eGFR calculated using?

A

serum creatinine

358
Q

when muscle mass is low, is eGFR under or over estimated?

A

over estimated

359
Q

when muscle mass is high is eGFR under or over estimated?

A

under estimated

360
Q

stage 1 and stage 2 of CKD are dependent on evidence of kidney damage, what does this mean?

A

proteinuria, haematuria (in absence of lower urinary tract cause), or abnormal imaging

361
Q

what does CKD do to cardiovascular disease?

A

increases risk

362
Q

what does proteinuria do to the likelyhood of CKD to progress stages?

A

increases risk of progression

363
Q

why can reflux nephropathy cause CKD?

A

due to recurrent UTI causing scarring

364
Q

what is the most common cause of CKD?

A

diabetes

365
Q

what might happen initially to gfr when putting a patient with CKD on an ACEI/ARB?

A

initial fall

366
Q

what do ACEI/ARB do to proteinuria?

A

reduces proteinuria

367
Q

what does smoking do to the rate of progression of CKD?

A

increases rate progression

368
Q

at what stage of CKD are statins recommended?

A

stage 4

369
Q

how do you correct iron deficiency anaemia in CKD?

A

IV iron

370
Q

if patient on CKD is anaemic but iron has been replaced, what hmight be indicated?

A

erythropoietin injections

371
Q

why can bone disease occur in CKD?

A

vitamin D cant be hydroxylated properly
leading to reduced calcium absorption
leading to secondary hyperparathyroidism which takes calcium out of bones to maintain serum calcium

372
Q

what happens to the levels of serum phosphate in CKD and what does this do to the levels of PTH?

A

serum phosphate increases

PTH increases

373
Q

what eventually happens to CKD patients in secondary hyperparathyroidism?

A

tertiary hyperparathyroidism

374
Q

what happens to the blood vessels and heart valves in a patient with CKD who has tertiary hyperparathyroidism?

A

vascular and valvular calficiation

375
Q

how do you treat bone disease in CKD?

A

alfacalcidol (hydroxylated vit D)

phosphate binders

376
Q

at what gfr should dialysis education be started?

A

20ml/min (earlier if progressing fast)

377
Q

what is the best form of access for haemodialysis?

A

arteriovenous fistula

378
Q

how long does it take for an arteriovenous fistula to mature for haemodialysis?

A

6 weeks

379
Q

at what gfr should you refer a patient to vascular surgeons for the creating of an arteriovenous fistula?

A

15ml/min

380
Q

how long after creation of a catheter for peritoneal dialysis can it be used?

A

1-2 weeks

381
Q

when do patients get put on the cadaveric transplantation list for a kidney?

A

within roughly 6 months of dialysis

382
Q

what is acute kidney injury?

A

an abrupt reduction in kidney function defined as an absolute increase in serum creatinine by 26.4micromoles per litre (or 50% increase over baseline)

383
Q

how should you split the causes of AKI?

A

pre renal
renal
post renal

384
Q

what does pre-renal causes of AKI mean?

A

anything that reduces kidney perfusion

385
Q

what does post-renal causes of AKI mean?

A

obstruction of renal outflow

386
Q

what does renal causes of AKI mean?

A

intrinsic causes

387
Q

what are the 3 subgroups of pre-renal AKI?

A

hypovolaemia
hypotension
renal hypoperfusion

388
Q

why might haemorrhages, diarrhoea, vomitting or burns cause AKI?

A

causes hypovolaemia which is a pre-renal cause of AKI

389
Q

why might cardiogenic, septic or anaphylactic shock cause AKI?

A

causes hypotension which is pre-renal cause of AKI

390
Q

why might NSAIDs or ACEI/ARBs cause AKI?

A

reduces renal perfusion which is a pre-renal cause of AKI

391
Q

what is hepatorenal syndrome?

A

kidney failure as a result of liver failure

392
Q

why does hepatorenal syndrome cause AKI?

A

reduces renal perfusion which is a pre-renal cause of AKI

393
Q

how do you calculate urine output depending on weight?

A

0.5ml/kg/hr

394
Q

what defines oliguria?

A

less than 0.5mls/kg/hr of urine output

395
Q

what does untreated pre-renal AKI lead to?

A

acute tubular necrosis

396
Q

what is the commonest form of AKI?

A

acute tubular necrosis due to decreased renal perfusion (from a combination of factors)

397
Q

what is the main aim of pre-renal AKI treatment?

A

reverse factors that have caused it (ie eupportive treatment)

398
Q

to reverse hypotension causing AKI, what do you do?

A

fluid challenge with saline, if over 1000mls has been given with no improvement seek help

399
Q

what are the 4 subgroups of renal AKI?

A

vascular disease
glomerular disease (glomerulonephritis)
interstitial injury
tubular injury

400
Q

what is the main cause of vascular disease causing renal AKI?

A

vasculitis (eg ANCA associated)

401
Q

what are the 3 main causes of interstitial nephritis causing renal AKI?

A

drugs
infection eg TB
systemic causes eg sarcoidosis

402
Q

what types of drugs cause interstitial nephritis?

A

PPI
NSAIDs
antibiotics

403
Q

what type of renal AKI does rhabdomyolysis cause?

A

tubular injury

404
Q

what kind of renal AKI does contrast cause?

A

tubular injury

405
Q

what does renal vascular bruits indicate?

A

renal artery stenosis

406
Q

why can compartment syndrome lead to AKI?

A

causes rhabdomyolysis (a renal cause of AKI)

407
Q

what initial tests alow you to look for myeloma?

A

protein electrophoresis and bence-jones protein

408
Q

what 3 things must you ensure before performing a renal biopsy?

A

normal clotting
normotensive
no hydronephrosis

409
Q

what imaging technique do you usually use to assist with renal biopsy?

A

ultrasound

410
Q

what are the 4 indications for immediate dialysis?

A
  • hyperkalaemia over 7 (or 6.5 unresponsive to medical therapy)
  • fluid overload
  • severe acidosis (pH below 7.15)
  • uraemia (urea over 40) with pericardial effusion
411
Q

what are the 2 ways of treating post renal AKI to relieve obstruction?

A

catheter

nephrostomy

412
Q

what is the normal range for serum potassium?

A

3.5-5

413
Q

what range of potassium indicates hyperkalaemia?

A

over 5.5

414
Q

what range of potassium indicates life threatening hyperkalaemia?

A

over 6.5

415
Q

what happens to the T wave, P wave and QRS complex in hyperkalaemia? (on ECG)

A

T wave becomes peaked
loss p of wave
widening of QRS complexes

416
Q

what 4 drugs are indicated in acute life threatening hyperkalaemia?

A

calcium gluconate
insulin
dextrose
nebulised salbutamol

417
Q

what is the function of calcium gluconate in hyperkalaemia?

A

protects myocardium

418
Q

what is the function of insulin, dextrose and salbutamol in hyperkalaemia?

A

moves K back into cells

419
Q

what is the function of calcium resonium?

A

prevents K absorption from the GI tract

420
Q

what drug do you give a patient who is acidotic?

A

sodium bicarbonate

421
Q

what are the 3 main nephrotoxic drugs?

A

NSAIDs
ACEI/ARB
antibiotics (eg gentamicin)

422
Q

what are the 4 main risk factors for AKI development?

A

age, diabetes, CKD, co-morbidities

423
Q

what is the most common cause of end stage renal disease?

A

diabetes

424
Q

what is the second most common cause of end stage renal disease?

A

chronic glomerulonephritis

425
Q

what is glomerulonephritis?

A

immune-mediated disease of the kidneys afecting the glomeruli

426
Q

does damage to endothelial or mesangial cells lead to a proliferative or non-proliferative glomerulonephritis?

A

proliferative

427
Q

does damage to podocytes lead to a proliferative or non-proliferative glomerulonephritis?

A

non-proliferative

428
Q

what abnormality is found in urine in proliferative glomerulonephritis?

A

red blood cells

some protein

429
Q

what abnormality is found in urine in non-proliferative glomerulonephritis?

A

protein

430
Q

what does microalbuminuria mean?

A

30-300mg of albuminuria per day

431
Q

is nephritic syndrome indicative of a proliferative or non-proliferative glomerulonephritis?

A

proliferative glomerulonephritis

432
Q

is nephrotic syndrome indicative of a proliferative or non-proliferative glomerulonephritis?

A

non-proliferative

433
Q

compare nephritic and nephrotic syndrome in terms of renal function?

A

nephritic- renal failure

nephrotic- normal renal function usually

434
Q

why might nephrotic syndrome cause you to become mildly immunosuppressed?

A

lots of antibodies leave in the urine

435
Q

why is there a prothrombotic state in nephrotic syndrome?

A

liver increases production of prothrombotic factors (exacerbated by volume depletion)

436
Q

which vein should you be particularly concerned about thrombosis in within nephrotic syndrome?

A

renal vein thrombosis

437
Q

compare focal and diffuse glomerulonephritis?

A

focal- less than 50% of glomeruli affected

diffuse- more than 50% of glomeruli affected

438
Q

compare global and segmental glomerulonephritis?

A

global- all of glomerulus affected

segmental- parts of glomerulus affected

439
Q

what drugs should be used for hypertension in the treatment of GN and why?

A

ACEI/ARB

also control proteinuria

440
Q

what indicates complete nephrotic syndrome remission?

A

proteinuria less than 300mg per day

441
Q

what indicates partial nephrotic syndrome remission?

A

proteinuria less than 3g per day

442
Q

what is the most common cause of nephrotic syndrome in children?

A

minimal change glomerulonephritis

443
Q

what do you see on light microscopy, electron microscopy and immunofluorescence (renal biopsy) of minimal change glomerulonephritis?

A

LM- normal
IF- normal
EM- foot process fusion

444
Q

can minimal change nephropathy progress to renal failure?

A

no

445
Q

what is the main treatment for minimal change glomerulonephritis?

A

oral steroids

446
Q

is minimal change glomerulonephritis proliferative ir non-proliferative?

A

non proliferative

447
Q

what is the most common cause of nephrotic syndrome in adults?

A

focal segmental glomerulosclerosis

448
Q

can focal segmental glomerulosclerosis progress to renal failure?

A

yes

449
Q

is focal segmental glomerulosclerosis proliferative or non-proliferative?

A

non proliferative

450
Q

what is the 2nd most common cause of nephrotic syndrome in adults?

A

membranous nephropathy

451
Q

what is seen on renal biopsy of membranous nephropathy?

A

immune complex deposition in the basement membrane

452
Q

can membranous glomerulonephritis progress to renal failure?

A

yes

453
Q

is membranous glomerulonephritis proliferative or non-proliferative?

A

non proliferative

454
Q

what is the most common type of glomerulonephritis?

A

IgA nephropathy

455
Q

can IgA nephropathy progress to renal failure?

A

yes

456
Q

is IgA nephropathy proliferative or non-proliferative?

A

proliferative

457
Q

what vasculitis is IgA nephropathy associated with?

A

Henoch-Schonlein Purpura

458
Q

what glomerulonephritis is associated with glomerular crescents?

A

rapidly progressive glomerulonephritis

459
Q

what are the 2 subgroups of rapid progressive glomerulonephritis?

A

anca positive

anca negative

460
Q

what type of glomerulonephritis is SLE associated with?

A

rapidly progressive glomerulonephritis

461
Q

is rapidly progressive glomerulonephritis proliferative or non proliferative?

A

proliferative

462
Q

what type of glomerulonephritis is goodpastures disease associated with?

A

rapidly progressive glomerulonephritis

463
Q

compare post-strep glomerulonephritis and IgA nephropathy in terms of how long after URTI it occurs?

A

post strep- 2-3 weeks

IgA nephropathy- 2-3 days

464
Q

is post strep glomerulonephritis proliferative or non-proliferative?

A

proliferative

465
Q

what does CKD do to the risk of cardiovascular disease?

A

increases it

466
Q

what kind of diet must a patient who is on dialysis have?

A

fluid restricted (1l per day)
low salt
low potassium
low phosphate (take phosphate binders with meals)

467
Q

what is the gold standard dialysis access?

A

fistula

468
Q

compare a fistula to other dialysis access in terms of infection risk?

A

fistula access has a reduced infection risk

469
Q

what can happen if haemodialysis isn’t done by a gradual build up?

A

disequilibrium syndrome

-cerebral oedema and seizures

470
Q

what type of diabetic patients can get a kidney pancreas dual transplant?

A

type 1 diabetic patients

471
Q

which MHC class are HLA A, HLA B and HLA DR?

A 
class 1: HLA A, HLA B
class II, HLA DR
472
Q

what antibiotics are given for pneumocystits jirovecii?

A

co-trimoxazole

473
Q

what type of skin cancer is much increases post transplant?

A

SCC

474
Q

what cancercan does post-transplant EBV infection cause?

A

lymphoma

475
Q

what are the 3 phases of rejection?

A

hyperacute (minutes)
acute
chronic

476
Q

what is hyperacute rejection caused by?

A

preformed antibodies

477
Q

how is hyperacute rejection treated?

A

unsalvageable

478
Q

what is acute rejection caused by?

A

T or B cell mediated response

479
Q

what are the 3 phases of transplant immunosuppression?

A

induction
consolidation
maintenance

480
Q

what drug must azathioprine never be given with?

A

allopurinol

481
Q

what are the types of donor kidney?

A
  • deceased brain dead
  • deceased cardiac death
  • live donor
482
Q

what is diabetic nephropathy defined by?

A

albuminuria (greater than 300mg in 24 hours) on 2 occasions 3-6 months apart

483
Q

what are the haemodynamic changes that diabetes does to the afferent arteriolar? and how?

A

vasodilation of afferent arteriole by vasoactive mediaprs

484
Q

why does diabetes initially cause a raised GFR?

A

vasodilated afferent arteriole increases the blood flow and so increases the filtration pressure

485
Q

how does diabetes cause renal hypertrophy?

A

plasma glucose stimulates several growth factos within the kidneys

486
Q

what are kimmelstein wilson lesions?

A

nodular lesions of diabetic glomerulosclerosis

487
Q

why does proteinuria occur in diabetes?

A

glomerular basement membrane thickens and the podocytes become impaired (bigger spaces between them)

488
Q

why may haematuria require renal biopsy in the context of diabetic nephropathy?

A

haematuria is not a feature of diabetic nephropathy so need to look for another cause

489
Q

how do you prevent/treat diabetic nephropathy?

A
  • good glycaemic control
  • good blood pressure control
  • lipid sontrol
490
Q

what drugs are used as anti-hypertensive therapy to prevent/treat diabetic nephropathy?

A

ACE I/ARB

491
Q

what drugs are used to maintain good lipid control to prevent/treat diabetic nephropathy?

A

statin

492
Q

how do ACE I/ARBs help to reduce progression of proteinuria in diabetics?

A

dilates the efferent arteriole so reduces the filtration pressure
(this pressure was initially increased because of filation of the afferent arteriole due to diabetes)

493
Q

what drug should you offer a diabetic patient with persistent microalbuminuria who is normotensive?

A

ACE I/ARB

494
Q

what drugs should you offer a diabetic patient with persistent microalbuminruria and hypertension?

A

ACE I/ARB

plus diuretic or another antihypertensive

495
Q

what is renovascular hypertension?

A

hypertension secondary to renal artery stenosis (renovascular disease)

496
Q

why does renal artery stenosis cause hypertension?

A

reduces renal perfusion activates RAS system

497
Q

what are the 2 main types of renovascular disease?

A

fibromuscular dysplasia

atherosclerotis renovascular disease

498
Q

what is ischaemic nephropathy?

A

reduced renal blood flow (ie renal artery stenosis) beyond the level of autoregulatory compensation so gfr is reduced

499
Q

what does ischaemic nephropathy lead to?

A

renal atrophy and progressive CKD

500
Q

what is the treatment for renal artery stenosis?

A

blood pressure control
reduce cardiovascular risk factors
angioplasy
stenting

501
Q

what is multiple myeloma?

A

a cancer of plasma cells which accumulates in the bone marrow

502
Q

why can you get normocytic anaemia in multiple myeloma?

A

plasma cell accumulation in bone marrow and so intereferes with production of red blood cells

503
Q

what paraprotein does myeloma tend to produce?

A

Bence Jones protein

504
Q

why are the proteins secreted in myeloma not detected on urine dipstick?

A

urine dipstick only tests for albumi so doesnt detect abnormal paraproteins

505
Q

what type of lesions are found on skeletal survey of multiple myeloma?

A

lytic lesions

506
Q

what are the 4 renal manifestations of myeloma?

A

hypercalcaemia (leading to AKI)
monoclonal immunoglobulin deposition disease
cast nephropathy
amyloidosis

507
Q

what are the 2 types of amyloidosis?

A

primary

secondary

508
Q

what type of conditions does secondary amyloidosis occur in?

A

chronic inflammatory conditions

509
Q

what is seen histologically in amyloidosis?

A

positive congo red staining showing apple-green birifringence under polarised light

510
Q

why can GPA, eGPA, MPA have pulmonary haemorrhage?

A

as a consequence of alveolar capillary involvement

511
Q

what is seen on renal biopsy of GPA, MPA and eGPA?

A

segmental necrotising glomerulonephritis

512
Q

what are the 6 classes of lupus nephritis?

A

1: minimal mesangial
2: mesangial proliferative
3: focal proliferative
4: diffuse proliferative
5. membranous
6: advanced sclerosing

513
Q

how do you calculate the therapeutic index?

A

Lethal Dose 50/Effective Dose 50

514
Q

what are the 2 phases of drug metabolism?

A

phase 1: oxidation, reduction and hydrolysis

phase 2: conjugation (makes drug water soluble)

515
Q

do adverse drug reactions tend to happen in phase 1 or phase 2 of metabolism?

A

phase 1

516
Q

what are type A drug reactions?

A

dose dependent and predictable

517
Q

what are type B drug reactions?

A

idiosyncratic

-dose independent and unpredictable

518
Q

what are type C drug reactions?

A

chronic effects

519
Q

What are type D drug reactions?

A

delayed effects

520
Q

What are type E drug reactions?

A

end of treatment efects

521
Q

what are type F drug reactions?

A

failure of therapy

522
Q

what are the most common type of drug reactions?

A

type A

523
Q

compare ADPKD type 1 to ADPKD type 2 in terms of progression to end stage kidney failure?

A

ADPKD 1 develops ESKF at an earlier stage

524
Q

what is the most common extral renal feature of ADPKD?

A

hepatic cysts

525
Q

what is the management of ADPKD before renal failure?

A

hypertension control
hydration
proteinuria control
control cyst haemorrhage/infection

526
Q

what drug treatment can be used to reduce cyst volume and progression in ADPKD?

A

tolvaptan

527
Q

what is the management of ADPKD after renal failure?

A

dialysis

transplant

528
Q

what type of inheritance is Alport’s syndrome?

A

X linked

529
Q

what type of collagen is affected in Alports syndrome?

A

type IV collagen

530
Q

what does alports syndrome cause?

A

hereditary nephritis

531
Q

what is the characteristic feature of alport’s syndrome?

A

haematuria

532
Q

what confers bad prognosis in alport’s syndrome?

A

proteinuria

533
Q

what are the 3 main extra renal manifestations of alports syndrome?

A

sensorineural deafness
ocular lens defect (anterior displacement)
dysphagia

534
Q

what is the treatment of alports syndrome?

A

BP control
proteinuria control
dialysis
transplantation

535
Q

what is seen on renal biopsy of alports disease?

A

variable thickness glomerular BM

536
Q

what is the inheritance of anderson fabrys disease?

A

X linked

537
Q

what causes anderson fabrys disease?

A

inborn error of metabolism

deficiency of a-galactosidase A

538
Q

what is seen on the skin of patients with anderson fabrys disease?

A

angiokeratomas

539
Q

what is the treatment of anderson fabrys disease?

A

fabryzyme (enzyme replacement)

management of complications

540
Q

what is the inheritance of medullary cystic kidney?

A

autosomal dominant

541
Q

where are cysts fund in medullary cystic kidney?

A

corticomedullary junction or medulla

542
Q

what is the gross appearance of medullary cystic kidney?

A

normal or small kidneys

543
Q

what is the treatment of medullary cystic kidney disease?

A

renal transplant

544
Q

what hapens to the collecting ducts in medullary sponge kidney?

A

become dilated

545
Q

how do you diagnose medullary sponge kidney?

A

excretion urography

546
Q

what is seen in the cysts within medullary sponge disease?

A

calculi

547
Q

what is the inheritance of medullary sponge kidney?

A

sporadic

Renal (6 decks)

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