Corrections 2 Flashcards
Why are patients with nephrotic syndrome at an increased risk of thromboembolism?
Due to loss of antithrombin III in the urine
What are 2 key types of thromboembolism seen in nephrotic syndrome?
1) renal vein thrombosis: resulting in a sudden deterioration in renal function
2) DVT & PE
Give some complications of nephrotic syndrome
1) VTE
2) Hyperlipidaemia: increasing risk of ACS
3) CKD
4) Increased risk of infection due to urinary immunoglobulin loss
5) Hypocalcaemia (vitamin D and binding protein lost in urine)
What type of diabetes insipidus can haemochromatosis cause?
Cranial
What CVS features may be seen in ADPKD?
1) mitral valve prolapse
2) mitral/tricuspid incompetence
3) aortic root dilation
4) aortic dissection
What is the most common cardiac defect in ADPKD?
Mitral valve regurgitation
What are 3 key risk factors for focal segmental glomerulosclerosis (FSGS)?
1) HIV
2) Heroin use
3) Sickle cell
FSGS has a high recurrence rate in which patients?
Renal transplant patients
What is the preferred method of access for haemodialysis?
AV fistulas
Cause of osteomalacia in CKD?
High phosphate level ‘drags’ calcium from bones
What can be used instead of spironolactone in patients struggling with gynaecomastia?
Eplerenone
Mx of cranial vs nephrogenic diabetes insipidus?
Cranial –> vasopressin analogue (e.g. desmopressin)
Nephrogenic –> thiazide diuretics, low salt/protein diet
Inheritance of Alport’s syndrome?
X-linked dominant
What is Alport’s syndrome?
There is a defect in the gene which codes for type IV collagen resulting in an abnormal glomerular-basement membrane (GBM)
Features of Alport’s syndrome?
1) microscopic haematuria
2) progressive renal failure
3) bilateral sensorineural deafness
4) lenticonus: protrusion of the lens surface into the anterior chamber
5) retinitis pigmentosa
6) renal biopsy: splitting of lamina densa seen on electron microscopy
How long will it take for an AV fistula to be fully functioning?
6-8 weeks
Mx of increased VTE risk in nephrotic syndrome?
LMWH prophylaxis
Hyperacute vs acute vs chronic graft failure in renal transplant?
Hyperacute: minutes to hours
Acute: <6m
Chronic: >6m
What is seen on urinalysis in AIN?
White cell casts
What is Sevelamer?
A non-calcium based phosphate binder that treats hyperphosphataemia in patients with CKD mineral bone disease
How can myoglobinuria (in rhabdo) cause renal failure?
By tubular cell necrosis
Urinary sodium in pre-renal disease?
low (<20)
What is a key investigation in diagnosising early CKD?
Urine ACR
What is the most common cause of peritonitis secondary to peritoneal dialysis?
Coagulase-negative Staphylococcus e.g. Staph. epidermis
What is the most common cause of SBP 2ary to ascites?
E. coli
What scrotal swelling may be the presenting feature of a renal cell carcinoma?
Varicocele
Do varicoceles usually occur on the L or R?
L (because testicular vein drains into renal vein)
What is the most important risk factor for bladder canceR?
Smoking
What should be co-prescribed when starting GnRH agonists?
Anti-androgen treatment e.g. cyproterone acetate
What is a common complication of a radical prostatectomy?
Erectile dysfunction
What is the most common type of testicular cancer?
Germ cell tumours
What are the 2 key types of germ cell tumours?
1) Seminomas
2) Non-seminomas: embryonal, yolk sac, teratoma and choriocarcinoma
Give 2 types of non-germ cell testicular cancers
1) Leydig cell tumours
2) Sarcomas
Tumours markers for seminomas vs non-seminomas?
Seminomas: hCG may be elevated
Non-seminomas: AFP and/or hCG are elevated
Does a raised AFP indicate a seminoma or a non-seminoma?
Non-seminoma (a raised AFP excludes a seminoma)
How does rhabdo cause AKI?
Due to ATN
What can the causes of ED be split into?
1) Organic
2) Psychogenic
Give 3 factors favouring an organic cause of ED
1) Gradual onset of symptoms
2) Lack of tumescence
3) Normal libido
Which investigation would be of greatest use in demonstrating overactive bladder?
Urodynamic studies
Mx of varicoceles?
Usually conservative
Mx of asymptomatic renal stones <5mm?
Watch & wait
What are varicoceles a significant risk factor for?
Infertility
What investigation do adults with a hydrocele require?
US to exclude an underlying tumour
can a lower UTI cause urinary retention?
Yes
Mx of renal colic if NSAIDs are contraindicated or not giving sufficiency pain relief?
IV paracetamol
Action of tamsulosin?
a-1 antagonist –> promote relaxation of the smooth muscle of the prostate and the bladder to reduce LUTS
What is a useful investigation for priapism?
Cavernous blood gas analysis –> essential to differentiate between ischaemic and non-ischaemic priapism which would guide further management.
Results of cavernous blood gas analysis in ischaemic vs non-ischaemic priapism?
In ischaemic priapism, pO2 and pH would be reduced whilst pCO2 would be increased.
Following relief of urinary retention patients, what complication can occur?
Physiological diuresis can occur –> monitoring of U&Es is required
Can result in hypovolaemia, dehydration, and electrolyte imbalances.
Features of a ‘tumour flare’ that can be caused by GnRH agonists?
Bone pain, bladder obstruction
Most patients presenting with symptomatic renal cell carcinoma have what stage disease?
Stage 4 i.e. metastatic
Most common site of metastasis of renal cell carcinoma?
Lungs
Mx of BPH?
Alpha-1 antagonist & 5a-reductase inhibitor (tamsulosin & finasteride)
What is seen on urinalysis in ATN?
Muddy brown casts
What causes TURP syndrome?
Irrigation with glycine –> hyponatraemia
What is the most effective management option in renal cell carcinoma?
Radical nephrectomy
