clinical Flashcards
pyelonephritis?
inflammation of kidneys
nephrotoxicity?
renal damage due to toxins
pyuria?
standard level
increase wbc in urine - means infection
at least 10 WBC/m^2 of urine
proteinuria standard levels?
protein excretion more than 150mg/day
different types of haematuria?
visible -macro - visibly red
microscopic
dipstick - after dipstick
definition of microscopic haematuria?
more/equal to 3 abc in urine per high power field
standard level of oliguria?
urine output less than 0.5ml/kg/hour
anuria?
no urine output
polyuria?
urine output larger than 3L/24HRS
NOCTURIA definition?
waking up at night more than/equal to 1 occasion to pee
serum creatinine? measures?
waste product that comes from normal wear and tear - sign that kidneys don’t work well -
more kidney damage/more creatinine
normal gfr level? and what level does the kidney not work well?
more than/equal to 90 = 90-120
less than 60 = kidney doesn’t work well
microalbuminua?
can also do?
sensitive dipstick test that detects tiny amounts of albumin in urine
albumin:creatinine ratio to check for kidney damage
functions of kidney? 5
- regulate bp
- electrolyte balance(sodium/potassium/chlorine)
- excretory functions(drugs/urea)
- body fluid balance
- acid/base balance
chronic renal failure is?
gradual loss of kidney function
dialysis?
artificially removes waste products and extra fluid from blood - can be placed catheter form
like an artificial kidney
how can trauma occur to ureter?
cut or tied during hysterectomy or colon resection
trauma from surgery
obstruction of ureter occurs in what 3 ways?
intra-luminal - in lumen = stone
intra-mural - scar tissue/tumour
extra-luminal - pelvic mass/LN
tcc?
transitional cell carcinoma
hydronephrosis?
1/both kidneys become stretched and swollen - due to increased urine in them
renal colic?
pain in flanks - pain in lower back
two tumours in bladder?
squamous cell carcinoma
TCC of bladder
LUTS?
clinical symptoms involving bladder/urethra
voiding - poor stream, urinary retention, incontinence, incomplete voiding
storage - increase freq., increase urgency
urinary incontinence means?
loss of bladder control
pneumaturia?
air in urine - due to cold-vesical fistula - from colon
what is risk of bladder/renal cancer in patient with visible haematuria?
bladder = 25-30%
renal = 0.5-1%
pelvic floor dysfunction? lead to?
damage to pelvic floor muscles - lead to stress and incontinence
3 levels of control of micturition?
cortical centre - cortex - bladder sensation of fullness and inhibition of micturition
pons - micturition centre
sacral segments - micturition reflex - automatic/somatic/parasympathetic
mucturition cycle occurs how?
storage/filling phase
voiding phase
sympathetic & parasympathetic & somatic innervation on micturition?
sympathetic - relaxation of urethral sphincter -open
parasympathetic - contraction of detrusor muscle - squeeze out
somatic - relaxation of external urethral sphincter - open
acute urinary retention define?
main cause
painful
inability to void - with palpable and permissible bladder
-due to BPO
chronic urinary retention define?
MAIN CAUSE
painless
palpable and percussible bladder AFTER voiding
muscle detrusor inactivity
two types of chronic urinary retention?
high pressure or low pressure - bladder filling pressure
what can occur due to catheter?
diuresis - increase urine freq.
diagnosis of UTI requires what 2 things?
microbiological evidence & symptoms
2 types of UTI?
UNCOMPLICATED
COMPLICATED
MESANGIAL CELLS?
group of cells which support capillaries in glomeruli
albumin - filtration?
cannot be filtered - albumin cannot be filtered too large
4 presentations of Glomerulonephritis ?
haematuria
heavy proteinuria
slowly increasing proteinuria
acute renal failure
nephrotic syndrome? due to?
increase protein in urine -
due to damage to bv in kidney
main causes of haematuria?4
uti
urinary tract stone
urinary tract tumour
Glomerulonephritis
kimmelsteil-wilson lesion?
long standing diabetes - leading to kidney condition - affects the bv in the glomeruli -
signs of diabetic nephropathy?
first sign of diabetic kidney disease - albumin in urine - - microalbuminuria
sign of acute renal failure?
rapidly risisng creatinine
what properties make urine bacteriostatic? 3
low pH
high osmolarity
high ammonia - NH3
what contaminates the urine?
by terminal urethral flora
is contamination present in MSSU?
YES - but less contamination
results of MSSU culture means?
10^5 = infection present 10^3/4 = infection 50% if asymptomatic/ probable infection if symptoms
10^2 = no infection
hydroureter?
dilation/enlargement
HORMONES that the kidney produce? 3
erythropoietin
vit D
renin
how much of the cardiac output do kidneys take?
20-25%
what does creatine serum levels depend on? 4
age ethnicity gender weight muscle mass
classification of ckd?
1 to 5
what molecules do not cross filtration barrier?
abc/albumin/globulins
definition of ckd?
prescence of kidney damage - abnormal blood/urine etc
or
gfr less than 60 present for over/equal to 3 months
what two things used to see prognosis of ckd?
by albumin levels in urine and gfr level
RRT includes?
dialysis and transplant
PCR & ACR means?
24hr UC MEAN?
pcr - protein creatinine ratio
acr- albumin creatinine ratio
24HR urine collection
complications of prolonged low eGFR? 6
anaemia bone disease fluid overload hypertension acidosis electrolyte imbalance
size of prostate? measured in?
cc-cubic centimetres
any! continuously growing as you grow up
prostatic zones - which Is most likely for prostate cancer?
peripheral zone
benign prostatic hyperplasia?
occurs In what prostatic zone?
fibromuscular and glandular hyperplasia
transition zone
assessment of Luts by? 2
IPSS score sheet -prostate symptoms
freq volume charts
two types of LUTS? examples of each
voiding - hesitancy.poor stream, dribbling, incomplete emptying
storage - freq, nocturia, urgency, urge
avg number of times to go to bathroom a day?
4-8
examination looking for?
penis?
DRE?
PHIMOSIS
external urethral meatus
prostate size
nodules/firmness
what bloods to test for prostate?
PSA
goes up as prostate size goes up
size of prostate mean?
size doesn’t mean anything - can have large and no symptoms etc
all about investigations and symptoms
flow rate study values for BPO?
Qmax less than 10ml/s - means most likely BOO
ALPHA BLOCKERS?
mechanism?
used in BOO
tamsulosin
relaxes smooth muscle of prostate and bladder neck
5A-reductase inhibitors?
mechanism?
used in BOO
finasteride
dutasteride
converts testosterone into something else
reduces prostate size
TURP?
SCOPE into urethra
and removes parts of prostate
followed by use of catheter
two ways of catheter?
suprapubic
urtheral
uterocele?
doesn’t allow urine to flow - blocks it
too narrow
bulge in ureter
nephrostomy?
tube through back to drain kidney directly
CT UROGRAM?
INJECT dye in and take x rays to see clear flow of urinary tract
common place for upper tract TCC? can lead to?
renal pelvis and collecting system
lead to bladder TCC
END STAGE RENAL disease? gfr is?
irreversible damage to persons kidneys
gfr is less than 15
advanced ckd is called?
uraemia - increased level of urea in blood - should be removed by kidneys
when is RRT indicated?
when eGFR IS less than 10
requirements in a dialysis? 4
semipermeable membrane
blood exposure to membrane
dialysis access
anticoagulation
what are the markers on how well dialysis works?
creatinine and urea
what restrictions are there in dialysis patients? 2
fluid and diet
what risk is there in haemodialysis?
blood clots risk and air embolus risk!
how peritoneal dialysis works?
2 types - EXPLAIN
via a cuffed catheter using peritoneal membrane
CAPD - DURING DAY
APD - OVERNIGHT
ARRYHTMIAS are related to what?
related to removal of K electrolyte
mortality of dialysis patients?
increased
what is conservative kidney management?
supportive care
end of life care
just priority to symptoms management
2 principles/mechanisms of dialysis? explain each
diffusion and ultra filtration
diffusion - equalising and balancing on both sides
ultrafiltration - shifting fluid and some molecules
pyuria?
standard level?
presence of pus cells in urine
more than 10 WBC
means presence of inflammation/uti
pyelonephritis?
infection in upper urinary tract ivolving kidneys
chronic pyelonephritis?
renal scarring and loss of function
infection/prescence of uti
catheter related infection explain?
due to long term catheters - lead to bacteriuria
vesicle-ureteric reflux?
abnormal flow of urine from bladder back up ureters
if urine is sterile does that mean okay?
no might still have pus cells
uraemia? why? sign of? mechanism explain?
increase urea in plasma
clinical sign of renal failure
where kidney lost ability to remove urea/waste from blood
donor transplant method?
living donor nephrectomy
preserve donor kidney - use of cold storage
transplantation
transplant surgical complications? 3
bleeding
ureteric leak
infection
2 types of donors?
what’s better?
deceased and living
living over deceased works better and increases graft survival
paired and pooled donation means?
paired donation - cross over between pairs
pooled donation - dominos effect on pairs for donating
consider what in order to be a donor?
age,sex,race
health - gfr, smoking, BMI etc
what complications can occur after donation? 5
rejection - t cell mediated/ acute antibody mediated
diabetes
infection - uti, viral (cmv CYTOMEGALOVIRUS /bk virus)
cvs -hypertension etc
malignancy
what can be used to help. rejection in transplants?
immunosuprresion
antiviral therapy
antibiotics therapy - prophylaxis
why does anaemia occur as complication of renal cancer?
due to kidneys making erthropoeitin
difference between benign and malignant tumours?
differentiation
rate of growth
invasion
mets
benign - well differ., slow growth, localised, no mets
malignant - poor differ., fast growth, invasion, mets
what happens when renal function is impaired?
active drug build up and build up of toxic metabolites
do we want high or narrow therapeutic index? and why?
we want high therapeutic index
as narrow leads to toxicity or death
who are susceptible for drug induced nephrotoxicity?4
elderly
poly pharmacy
children
underlying Renal dysfunction
renal impairment affect on drugs?
increases half life of drugs and protein binding is reduced to allow more free available
ways to prevent drug induced nephrotoxicity? 4
drugs used that have high index
reduce dose
increase dose interval
monitor blood levels
drug induced renal toxicity lead to what 4 syndromes?
acute renal failure
nephrotic syndrome
renal tubular dysfunction with potassium wasting
chronic renal failure
what two drugs most likely to cause nephrotoxicity?
THEN NAME OTHERS
NSAIDS
aminoglycosides antibiotics
ACE inhibitors
what two things are major things to check in kidney systemic disease? 2
proteinuria
haematuria
sepsis leads to what in kidney?
AKD
diabetic nephropathy means?
diabetes 40% leads to nephropathy
mechanism of diabetic nephropathy?
what changes to glomeruli occurs? 4
changes to glomeruli =
glomerular hyperfiltration
altered glomerular composition
renal hypertrophy
glomerular hypertension
what are the results of diabetic nephropathy?
albuminuria -leaky
thickening of membrane
decrease gfr
leads to
increase creatinine levels
scarring fibrosis of glomeruli
and then END STAGE renal failure
what are lesions of present in diabetes nephropathy?
kimmelsteil Wilson nodules in glomeruli
lupus leads to what in kidneys?
lupus nephritis - immune mediated glomerulonephritis and glomerular damage
multiple myeloma means? and can do what to kidneys?
abnormal plasma cells - proliferation of plasma cells
lead to cast nephropathy- abnormal plasma cells enter kidney and enter tubules and block and damage
main symptom of renal stones?
colic pain
stone type most common?
calcium oxalate
explain ESWL AND PCNL?
PCNL = key hole surgery - through incision in back - and use of X-rays and contrast for guidance
ESWL = use of sound waves to break up SMALL stones - creates vibrations - and allow residue mess to be passed in urine
MOST COMMON cancer in men?
prostate
PSA test explain?
normal level
what values we use?
psa a substance naturally produced by prostate - higher level found - enlarged prostate /cancer
0-0.4
WE USE AGE-RELATED RANGE - as with age - prostate size increases naturally
two tests for screening prostate? AND WHEN?
DRE
PSA TEST
for over 50 yrs men
any screening for prostate cancer?
no as not meet wilson-junger criteria
why is PSA alone not good for diagnosing prostate cancer?
as prostate specific NOT cancer specific
staging vs grading- what each mean?
and how each measured?
staging - spread - bY EXAMINATION/TESTS
grading - aggressiveness BY BIOPSY
BRACHYTHERAPY?
radiotherapy
placing radioactive substances in prostate - to treat the cancer
2 HORMONE THERAPY DRUGS USED for prostate cancer explain mechanisms?
LHRH antagonists - stop body producing testosterone
anti-androgens - block testosterone reaching cells
can be used in combo
2 types o testicular cancers?
seminoma - older
nonseminoma - younger
tumour markers for testicular cancer?
AFP
BHCG
LDH
metastases of testicular cancer?
chest-lungs
bone
para-aortic lymph nodes
high levels of potassium in blood leads to what?
normal range? and when is it elevated?
leads to arrythmias - changes in ECG
normal is less than/equal to 5.1
abnormal is 6.5
average size of prostate?
increase age and prostate size increases naturally - 20cc
upper and lower tract of Urinary System?
upper - above bladder
lower - lower bladder
BPH affects what prostatic zone?
transition zone
BOO leads to?
LUTS
phimosis?
tight forsekin on penis
signs of UTI in urine?
pus cells
blood - severe
cloudy
when is TURP carried out?
when prostate size less than 100cc
2 types of catheters?
suprapubic
urethral
short term urethral catheter should not be left longer than?
4 weeks
long term urethral Catheter should not be left longer then?
12 weeks
pelvic mass compression explain?
compression in women leading to BOO
FRANK haematuria means?
visible blood urine
renal failure occurs only if?
BOTH URETERS are affected and obstructed
hydroureter and hydronephrosis?
hydronephrosis - swollen kidneys
hydrometer - swollen ureters
IVU imaging?
contrast x ray imaging of kidneys and bladder
investigation for renal colic?
CT-KUB
PERCUTANEOUS nephrostomy insertion?
used for urinary tract obstruction - needle to drain
use of CT-KUB vs CT-urogram?
CTKUB - for stones/renal colic/ no contrast
CTUROGRAM - for obstructing masses - pelvic mass/tumour - contrast
what’s the most important first step in septic patient?
resuscitation- IV FLUIDS/ABC/MONITOR
pyelonephritis includes what structures?
cd + PELVIS
confused elderly means?
infection present - uti?
asymptomatic bacteruria meaning?
over 10^5 bacteria in urine but no signs or symptoms of UTI
nephritic syndrome vs nephrotic syndrome?
nephritic - haematuria/red cell casts in urine - damaged end layer by inflammation cells
nephrotic - proteinuria/leaky albumin - leaky membrane no attacking
values to define nephrotic syndrome?
proteinuria more than/equal to 3.5
350 creatinine
serum albumin less than/equal to 30g/L
classification of glomerulonephritis? explain each?
proliferative - excessive numbers of cells in glomeruli - infiltrated by inflammation cells
non-proliferative - glomeruli looks normal but real of scarring
causes of glomerulonephritis? 8
IgA nephropathy post-infection -post-streptcoccal crescentic minimal change ANCA SLE diabetic focal and segmental
what is the exclusion criteria for organ donation?
list a few
situations that are unsuitable for transplant
active invasive cancer in last 3yrs
untreated systemic infection
hiv disease
3 ways authorisation can occur in organ donation?
express - self authorising
deemed authorisation -
nearest relative authorisation - if patient can’t do it themselves
deemed authorisation of donating meaning?
where authorisation is deemed to be given - within safeguards are ensured
- no evidence of unwillingness to donate
- person is not in excepted category
- healthcare professional is able to carry out the duty of inquire
pre death procedure means?
medical procedure carried out for purpose of transplant etc and not to support patients health
2 types of donations?
death by neurological criteria - loss of brain function - on life support
donation after cardiac death - hearts stopped - ceases to be alive
timing of DCD?
is critical - have to rapid with removing organs and transplanting
ureterocele?
dilation of ureter - like a pouch - balloon dilation at opening of bladder
renal colic from what?
pain from stones
OLIGURIA standard levels?
reduced urine output
less than 400mls/24hrs
anuria?
complete absence of urine output
triad for renal carcinoma? 3
flank pain
palpable mass
haematuria
why anaemia arises in kidney damage?
due to kidneys making erythropoietin
epithelium of proximal tubule?
simple cuboidal epithelium
parietal layer of glomeruli lined with what type of epithelium?
simple squamous epithelium
each kidney has what? 3
2 surfaces
2 borders
2 poles
what two 2 nerves run posterior kidney surface?
iliohypogastric nerve
ilioguinal nerve
contrast nephropathy?
kidney damage due to exposure to imaging contrast. material
e.coli is what type of bacteria?
gram -ve bacillus
serum calcium and serum phosphate relationship?
phosphate up
calcium down
MOST COMMON RENAL TRACT STONE?
CALCIUM OXALATE
most common cause of nephrotic syndrome in children?
minimal change
serum and urine urea in dehydration?
serum - increased
urine - decreased
alcohol affect on ADH??
suppresses ADH secretion
ramipril is what?
ACE inhibitor - stop production of angiotensin II
what is used to measure renal plasma flow?
PAH clearance
posterior urethral valves? common in who?
obstructive membranes that develop near bladder - common in infant in males
2 common renal tumours ?
renal cell - mostly of renal tissue
transitional cell - renal calyces/pelvis down
normal Ca level?
2.2-2.6mmol/l
CT KUB used when?
for renal colic
how does nephritic syndrome present?
haematuria
hypertension
post-streptococcal glomerulonephritis presents how?
weeks after infection
haematuria
proteinuria
IgA nephropathy shows how?
days after infection
hameturia
carbimazole - how side effects presents?
bone marrow suppression
mouth ulcers
sorry throat
how is minimal change seen under microscope?
seen with electron microscope - podocyte effacement
what mediates growth in childhood and infancy?
infancy - insluin and nutrition
childhood - gh and th
causes of hyperkalaemia?
MACHINE
MEDS - ACEi and NSAIDS Acidosis cellular destruction - burns/injury etc hypoaldosterone/haemolysis intake up nephrotic failure excretion impaired
which lobe in prostate most likely enlarged in carcinoma OR BPH?
Carcinoma - posterior lobe
BPH - median lobe
signs of hyperkalaemia? 5
tall t waves small p waves widened qrs sinusoidal pattern asystole
what are the drugs to avoid in kidney failure?
ACEI NSAIDS GENTAMICIN DIURETICS METFORMIN
STEROID AFFECT ON MENTAL HEALTH? 2
DEPRESSION
insomnia
etc
when low and high dex tests used?
low - initial OR overnight test done
high - to localise bushings
testicular torsion is what & lead to?
twisting of testicle due to trauma
this can cut blood flow to testicle - necrosis of testicle
EMERGENCY
aki classification explain? 3 stages
aki 1 = creatine rise 1.5x & urine output LESS THAN 0.5 for 6hrs
aki 2 = creatine rise 2x & urine output less than 0.5 for 12hrs
aki 3 = creatine rise 3x &urine output less than 0.3 for 24hrs
Gleason score explain?
3 to 5 score GRADING
majority to second most growth majority
3+3 - 6 LOW GRADE
5+5 - 10 HIGH GRADE
red cell casts mean -
hyaline casts mean -
brown casts mean -
nephritic syndrome
normal after exercise/fever/diuretics
tubular necrosis
affect of exercise on glucose? 3 stages
early drop - glucose uptake GLUT2
occasional rise - adrenaline affect
late drop - use of liver and muscle glycogen
para and sympathetic innervation of urination from where?
s = inferior and superior hypogastric plexuses p = pelvic splanchnic nerves
DKA MOSTLY CAUSED BY WHAT MECHANISM
UNCONTROLLED LIPOLYSIS - excess free FA convert to ketones
PSA level with age?
50 - 3
60 - 4
70 - 5
things that increase PSA level? 5
BPH PROSTATITIS/CANCER VIGOROUS EXERCISE URINARY RETENTION EJACTULCATION
polycystic kidney disease I highly associated with what?
berry aneurysms in brain
2 commonest cause of nephrotic syndrome in adults?
focal segmental glomeruloscleroris THEN
membranous glomerular disease
what is specific gravity?
how conc urine is with solutes
2 main causes of squamous cell carcinoma in bladder ?
schistomiaosis
long term catheter
pheocytochroma treatment?
alpha blockers
then
beta blockers
action of carbimazole?
inhibit thyroid peroxidase enzyme - to stop producing thyroid hormones
renal cell carcinoma how is chemotherapy/radiotherapy done?
insensitive to it - so surgery main option
most common renal cell carcinoma in kids?
nephroblastoma - whilms
primary polidipsia ?
presents how after fluid deprivation & desmopressin?
where you drink lots even though being well hydrated - pyschiatric disorder
like DI
but high osmolarity after both fluid deprivation & desmopressin
worsening Urinary symptoms - means?
urtheral obstruction and stricture
definition of AKI?
rise in creatinine and urea & results in oliguria
management of AKI?
fluids - if hypovaleamic
stop drugs - nephrotoxic etc
catheterisation
what diuretics increase/decrease serum potassium?
decrease K - thiazide, loop
increase K - ACE inhibitors, Spironolactone
when is erythropoietin excreted?
in response to hypoxia
which imaging is best for prostate?
MRI
RA - autoantibodies?2
SLE - autoantibodies ? 2
RF, ANTI-CCP
ANTI-dsDNA, ANA
first line management of UTI?
First line management is with oral nitrofurantoin or trimethoprim.
special type of glomerulonephritis?
persistent activation of compliment pathway
C3
haematuria and proteinuria
