GU Flashcards
1
Q
what is another name for UTI stones
A
Urolithiasis, renal calculi, nephrolothoasis
2
Q
why do stones form
A
when urine is supersaturated with salt and minerals
3
Q
what type of minerals form stones
A
- calcium
- struvite
- uric acid
- cystine
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
5
Q
what are the causes of bladder stones
A
- foreign bodies
- infection
- obstructions
6
Q
Risk factors for renal stones
A
- anatomical abnormalities
- gout
- FHx
- HTN
- hyperparathyroidism
- immobilisation
- dehydration
- drugs
- obesity
7
Q
symptoms of kidney stones
A
- asymptomatic
- sudden onset severe pain
- Rigors and fever.
- Dysuria.
- Haematuria.
- Urinary retention.
- Nausea and vomiting.
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
9
Q
Ix for renal colic
A
- urine dip
- MSU & culture
- FBC
- CRP
- U&E
- Prothrombin time
10
Q
Where to kidney stones most frequently get stuck
A
vesico-ureteric junction
11
Q
what are the two complications of kidney stones
A
- infection
- obstruction
12
Q
What are the two types of calcium kidney stones
A
- calcium oxalate
- calcium phosphate
13
Q
what is a stag horn calculus
A
where a stone forms in the shape of the renal pelvis
14
Q
what type of kidney stone is stag horn calculus more common in
A
struvite
15
Q
what is renal colic
A
- unilateral loin to groin pain that fluctuates in severity = colicky!!
16
Q
what imaging can be done for kidney stones
A
- abdo XR
- non-contrast CT
- US kidneys/ureters/bladder
17
Q
what is a common cause of kidney stones
A
hypercalaemia
18
Q
what are the common symptoms of hypercalcaemia
A
stones, bones, groans and moans
- renal stones
- painful bones
- abdo groans
- psychiatric moans
19
Q
3 common causes of hypercalcaemia
A
- calcium supplementation
- hyperparathyroidism
- CA (myoloma/breast/lung)
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
21
Q
Initial Mx for urolithiasis
A
- NSAIDs
- antiemetics or rehydration therapy if needed
22
Q
what is the first line NSAID in urolithiasis
A
- diclofenac (IM)
23
Q
what would you use to Mx urolithiasis if NSAIDs are contraindicated
A
IV paracetamol
24
Q
how quickly does imaging need to occur with ?urolithiasis
A
24hrs
25
what are the Mx options for urolithiasis
- stones passes by itself with pain management
| - surgery
26
complications of urolithiasis
- decrease in eGFR >48hrs can result in permanent kidney damage
- infection
- ureteric stricture
27
how can you prevent urolithiasis
- ensure pt is well hydrated
- reduce salt intake
- eat healthy & maintain healthy weight
- can consider thiazide diuretics for pts with recurring stones
28
define acute kindey injury (AKI)/ acute renal failure (ARF)
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
what is the main test done to detect and monitor AKI
serum creatine
30
how are the causes of AKI categorised?
- pre-renal
- intrinsic
- post-renal
31
what are the pre-renal causes of AKI
- 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
what are the intrinsic renal causes of AKI
- glomerular disease
- tubular injury
- Acute interstitial nephritis due to drugs (eg. NSAIDs), infections or autoimmune conditions
- vascular disease
- eclampsia
33
what are the extrinsic causes of AKI
- Calculus.
- Blood clot.
- Papillary necrosis.
- Urethral stricture.
- Prostatic hypertrophy or malignancy.
- Bladder tumour.
- Radiation fibrosis.
- Pelvic malignancy.
- Retroperitoneal fibrosis.
34
what is the most common cause of AKI in the community
hypotension (pre-renal) due to infection = fluid depletion (N+V)
35
what are the risk factors in people having surgery for developing an AKI
- 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
what clinical signs are suggestive of AKI
- reduced UO
| - raised serum creatine levels
37
how is AKI defined clinically
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
what are the symptoms of AKI
- reduced UO
- N+V
- dehydration
- confusion
39
what are the signs of AKI
- 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
what are the key questions to ask in a ?AKI hx
- 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
what would you be looking for in an examination of ?AKI
- 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
Ix for AKI
- urinalysis
- bloods (dependent on potential cause)
- imaging (dependent on potential cause)
43
Differential dx for AKI
- acute kidney disease
| - chronic kidney disease
44
what factors would be suggestive of CKD
- 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
Mx for AKI
mainly supportive
- monitor fluid and electrolyte balance
- optimise haemodynamic status with fluid therapy
- withdrawal of adverse drugs
46
what are the acute complications of AKI
Hyperkalaemia.
Acidosis.
Pulmonary oedema.
Bleeding
47
what are the possible complications of AKI
- progressive uraeamia
- metabolic acidosis,
- hyperkalaemia,
- spontaneous haemorrhage
- pulmonary oedema
48
what is CKD
abnormal kidney function and/or structure
49
what is the definition of CKD
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
what are the main causes for CKD
- HTN
- DM
- acute glomerulonephritis
- PMHx of AKI
- Nephrotoxic drugs
51
which drugs are nephrotoxic?
- aminoglycosides
- ACE inhibitors
- angiotensin-II receptor antagonists
- bisphosphonates
- calcineurin inhibitors (such as ciclosporin or tacrolimus),
- diuretics
- lithium
- mesalazine
- NSAIDs
52
how is CKD classified
into 5 stages
53
define stage 1 CKD
normal - eGFR >90 ml/minute/1.73 m2 with other evidence of chronic kidney damage
54
define stage 2 CKD
mild impairment - eGFR 60-89 ml/minute/1.73 m2 with other evidence of chronic kidney damage
55
define stage 3a CKD
moderate impairment - eGFR 45-59 ml/minute/1.73 m2.
56
define stage 3a CKD
moderate impairment - eGFR 30-44 ml/minute/1.73 m2
57
define stage 4 CKD
severe impairment - eGFR 15-29 ml/minute/1.73 m2
58
define stage 5 CKD
established renal failure (ERF) - eGFR less than 15 ml/minute/1.73 m2 or on dialysis
59
what evidence may be suggestive of CKD
- 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
what are the symptoms of CKD
- asymptomatic
61
what are the symptoms of severe CKD
- anorexia,
- nausea,
- vomiting,
- fatigue,
- weakness,
- pruritus,
- lethargy,
- peripheral oedema,
- dyspnoea,
- insomnia,
- muscle cramps,
- pulmonary oedema,
- nocturia,
- polyuria
- headache
62
what are the signs of CKD
- 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
can pts be screened for CKD
yes
64
what is tested to screen for CKD
- annual GFR checks
| - urinary albumin:creatinine ratio
65
differential diagnosis for CKD
- AKI
| - acute-on-chronic kidney disease
