GU Flashcards

1
Q

what is another name for UTI stones

A

Urolithiasis, renal calculi, nephrolothoasis

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2
Q

why do stones form

A

when urine is supersaturated with salt and minerals

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3
Q

what type of minerals form stones

A
  • calcium
  • struvite
  • uric acid
  • cystine
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4
Q

Describe the formation of calcium oxalate stones

A

Calcium oxalate precipitates form in the basement membrane of the thin loops of Henle; these eventually accumulate in the subepithelial space of the renal papillae, leading to a Randall’s plaque and eventually a calculus

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5
Q

what are the causes of bladder stones

A
  • foreign bodies
  • infection
  • obstructions
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6
Q

Risk factors for renal stones

A
  • anatomical abnormalities
  • gout
  • FHx
  • HTN
  • hyperparathyroidism
  • immobilisation
  • dehydration
  • drugs
  • obesity
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7
Q

symptoms of kidney stones

A
  • asymptomatic
  • sudden onset severe pain
  • Rigors and fever.
  • Dysuria.
  • Haematuria.
  • Urinary retention.
  • Nausea and vomiting.
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8
Q

Differential diagnosis of renal colic

A
  • Biliary colic
  • Dissected aortic aneurysm
  • pyelonephritis
  • acute pancreatitis
  • acute appendicitis
  • perforated peptic ulcer
  • Epididymo-orchitis
  • drug misuse
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9
Q

Ix for renal colic

A
  • urine dip
  • MSU & culture
  • FBC
  • CRP
  • U&E
  • Prothrombin time
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10
Q

Where to kidney stones most frequently get stuck

A

vesico-ureteric junction

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11
Q

what are the two complications of kidney stones

A
  • infection

- obstruction

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12
Q

What are the two types of calcium kidney stones

A
  • calcium oxalate

- calcium phosphate

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13
Q

what is a stag horn calculus

A

where a stone forms in the shape of the renal pelvis

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14
Q

what type of kidney stone is stag horn calculus more common in

A

struvite

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15
Q

what is renal colic

A
  • unilateral loin to groin pain that fluctuates in severity = colicky!!
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16
Q

what imaging can be done for kidney stones

A
  • abdo XR
  • non-contrast CT
  • US kidneys/ureters/bladder
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17
Q

what is a common cause of kidney stones

A

hypercalaemia

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18
Q

what are the common symptoms of hypercalcaemia

A

stones, bones, groans and moans

  • renal stones
  • painful bones
  • abdo groans
  • psychiatric moans
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19
Q

3 common causes of hypercalcaemia

A
  • calcium supplementation
  • hyperparathyroidism
  • CA (myoloma/breast/lung)
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20
Q

indications for hospital admission with urolithiasis

A
  • Signs of systemic infection - eg, fever, sweats, sepsis.
  • Increased risk of acute kidney injury - eg, solitary kidney, known non-functioning kidney, transplanted kidney, suspected bilateral renal
    stones.
  • Inadequate pain relief or persistent pain.
  • Inability to take adequate fluids due to nausea and vomiting.
  • Anuria.
  • Inability to arrange imaging within 24 hours.
  • Diagnostic uncertainty
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21
Q

Initial Mx for urolithiasis

A
  • NSAIDs

- antiemetics or rehydration therapy if needed

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22
Q

what is the first line NSAID in urolithiasis

A
  • diclofenac (IM)
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23
Q

what would you use to Mx urolithiasis if NSAIDs are contraindicated

A

IV paracetamol

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24
Q

how quickly does imaging need to occur with ?urolithiasis

A

24hrs

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25
Q

what are the Mx options for urolithiasis

A
  • stones passes by itself with pain management

- surgery

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26
Q

complications of urolithiasis

A
  • decrease in eGFR >48hrs can result in permanent kidney damage
  • infection
  • ureteric stricture
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27
Q

how can you prevent urolithiasis

A
  • ensure pt is well hydrated
  • reduce salt intake
  • eat healthy & maintain healthy weight
  • can consider thiazide diuretics for pts with recurring stones
28
Q

define acute kindey injury (AKI)/ acute renal failure (ARF)

A

the ‘abrupt loss’ of kidney function resulting in the ‘retention’ of urea and other nitrogenous waste products and in the dysregulation of extracellular volume and electrolytes

29
Q

what is the main test done to detect and monitor AKI

A

serum creatine

30
Q

how are the causes of AKI categorised?

A
  • pre-renal
  • intrinsic
  • post-renal
31
Q

what are the pre-renal causes of AKI

A
  • fluid depletion
  • Oedematous states: cardiac failure, cirrhosis, nephrotic syndrome
  • Hypotension (eg, cardiogenic shock, sepsis, anaphylaxis).
  • Cardiovascular (eg, severe cardiac failure, arrhythmias).
  • Renal hypoperfusion (eg. NSAIDs, ACEi, AAA, renal artery stenosis)
32
Q

what are the intrinsic renal causes of AKI

A
  • glomerular disease
  • tubular injury
  • Acute interstitial nephritis due to drugs (eg. NSAIDs), infections or autoimmune conditions
  • vascular disease
  • eclampsia
33
Q

what are the extrinsic causes of AKI

A
  • Calculus.
  • Blood clot.
  • Papillary necrosis.
  • Urethral stricture.
  • Prostatic hypertrophy or malignancy.
  • Bladder tumour.
  • Radiation fibrosis.
  • Pelvic malignancy.
  • Retroperitoneal fibrosis.
34
Q

what is the most common cause of AKI in the community

A

hypotension (pre-renal) due to infection = fluid depletion (N+V)

35
Q

what are the risk factors in people having surgery for developing an AKI

A
  • Emergency surgery, particularly in the presence of sepsis or hypovolaemia.
  • Intraperitoneal surgery.
  • CKD (with eGFR <60 in adults).
  • Diabetes.
  • Heart failure.
  • Age ≥65.
  • Nephrotoxic medication.
36
Q

what clinical signs are suggestive of AKI

A
  • reduced UO

- raised serum creatine levels

37
Q

how is AKI defined clinically

A

there must be at least one of the following;

  • A rise in serum creatinine of 26 μmol/L or greater within 48 hours.
  • 50% or greater increase in serum creatinine (1.5 fold from baseline) within the preceding seven days.
  • A fall in urine output to less than 0.5 mL/kg/hour for more than six hours.
38
Q

what are the symptoms of AKI

A
  • reduced UO
  • N+V
  • dehydration
  • confusion
39
Q

what are the signs of AKI

A
  • Hypertension.
  • Abdomen: may reveal a large, painless bladder typical of chronic urinary retention.
  • Dehydration with postural hypotension and no oedema.
  • Fluid overload with raised jugular venous pressure (JVP), pulmonary oedema and peripheral oedema.
  • Pallor, rash, bruising: petechiae, purpura and nosebleeds may suggest inflammatory or vascular disease, emboli or disseminated intravascular coagulation.
  • Pericardial rub.
40
Q

what are the key questions to ask in a ?AKI hx

A
  • Drugs - nephrotoxic drugs, remembering recreational drugs, over-the-counter drugs and herbal remedies.
  • Occupational or recreational history - exposure to sewer systems, tropical diseases, rodents.
  • Urinary symptoms.
  • Past medical history
41
Q

what would you be looking for in an examination of ?AKI

A
  • Signs of infection or sepsis.
  • Signs of acute or chronic heart failure.
  • Fluid status (dehydration or fluid overload).
  • Palpable bladder or abdominal/pelvic mass.
  • Features of underlying systemic disease (rashes, arthralgia)
42
Q

Ix for AKI

A
  • urinalysis
  • bloods (dependent on potential cause)
  • imaging (dependent on potential cause)
43
Q

Differential dx for AKI

A
  • acute kidney disease

- chronic kidney disease

44
Q

what factors would be suggestive of CKD

A
  • Long duration of symptoms.
  • Nocturia.
  • Absence of acute illness.
  • Anaemia.
  • Hyperphosphataemia, hypocalcaemia (but similar laboratory findings may complicate AKI).
  • Reduced renal size and cortical thickness on renal ultrasound (but renal size is typically preserved in patients with diabetes)
45
Q

Mx for AKI

A

mainly supportive

  • monitor fluid and electrolyte balance
  • optimise haemodynamic status with fluid therapy
  • withdrawal of adverse drugs
46
Q

what are the acute complications of AKI

A

Hyperkalaemia.
Acidosis.
Pulmonary oedema.
Bleeding

47
Q

what are the possible complications of AKI

A
  • progressive uraeamia
  • metabolic acidosis,
  • hyperkalaemia,
  • spontaneous haemorrhage
  • pulmonary oedema
48
Q

what is CKD

A

abnormal kidney function and/or structure

49
Q

what is the definition of CKD

A

the presence of kidney damage (ie albuminuria) or decreased kidney function (ie glomerular filtration rate (GFR) <60 ml/minute per 1·73 m²) for three months or more

50
Q

what are the main causes for CKD

A
  • HTN
  • DM
  • acute glomerulonephritis
  • PMHx of AKI
  • Nephrotoxic drugs
51
Q

which drugs are nephrotoxic?

A
  • aminoglycosides
  • ACE inhibitors
  • angiotensin-II receptor antagonists
  • bisphosphonates
  • calcineurin inhibitors (such as ciclosporin or tacrolimus),
  • diuretics
  • lithium
  • mesalazine
  • NSAIDs
52
Q

how is CKD classified

A

into 5 stages

53
Q

define stage 1 CKD

A

normal - eGFR >90 ml/minute/1.73 m2 with other evidence of chronic kidney damage

54
Q

define stage 2 CKD

A

mild impairment - eGFR 60-89 ml/minute/1.73 m2 with other evidence of chronic kidney damage

55
Q

define stage 3a CKD

A

moderate impairment - eGFR 45-59 ml/minute/1.73 m2.

56
Q

define stage 3a CKD

A

moderate impairment - eGFR 30-44 ml/minute/1.73 m2

57
Q

define stage 4 CKD

A

severe impairment - eGFR 15-29 ml/minute/1.73 m2

58
Q

define stage 5 CKD

A

established renal failure (ERF) - eGFR less than 15 ml/minute/1.73 m2 or on dialysis

59
Q

what evidence may be suggestive of CKD

A
  • Persistent microalbuminuria.
  • Persistent proteinuria.
  • Persistent haematuria (after exclusion of other causes - eg, urological disease).
  • Structural abnormalities of the kidneys, demonstrated on ultrasound scanning or other radiological tests - eg, polycystic kidney disease, reflux nephropathy.
  • Biopsy-proven chronic glomerulonephritis
60
Q

what are the symptoms of CKD

A
  • asymptomatic
61
Q

what are the symptoms of severe CKD

A
  • anorexia,
  • nausea,
  • vomiting,
  • fatigue,
  • weakness,
  • pruritus,
  • lethargy,
  • peripheral oedema,
  • dyspnoea,
  • insomnia,
  • muscle cramps,
  • pulmonary oedema,
  • nocturia,
  • polyuria
  • headache
62
Q

what are the signs of CKD

A
  • increased skin pigmentation or excoriation,
  • pallor,
  • hypertension,
  • postural hypotension,
  • peripheral oedema,
  • left ventricular hypertrophy,
  • peripheral arterial disease,
  • pleural effusions,
  • peripheral neuropathy
  • restless legs syndrome
63
Q

can pts be screened for CKD

A

yes

64
Q

what is tested to screen for CKD

A
  • annual GFR checks

- urinary albumin:creatinine ratio

65
Q

differential diagnosis for CKD

A
  • AKI

- acute-on-chronic kidney disease