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Urology (Surgery) > Kidney > Flashcards

Kidney Flashcards

1
Q

what is the most common make up of renal stones ?

A

80% are calcium

35% Oxalate

10% phosphate

35% mixed

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2
Q

what is the basis for formation of renal tract calculi ?

A

over-saturation of urine

due to high levels of purine and cystine in the blood

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3
Q

where are the 3 natural narrowings where ureteric stones are most likely to get stuck?

A

Pelviureteric junction (PUJ)

Vesicoureteric junction (VUJ)

Pelvic brim - where iliac vessels cross over the ureter in the pelvis

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4
Q

most common symptom of renal stones

A

unilateral flank pain

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5
Q

what are the presenting symptoms of renal stones ?

A

severe acute onset unilateral flank pain radiating from loin to groin

associated nausea and vomiting

haematuria present in 90% of cases - usually non-visible

rigors, fevers and lethargy if concurrent infection

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6
Q

what signs should you look out for to indicate concurrent infection in renal tract stones ?

A

lethargy

fever and rigors

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7
Q

differentials for renal tract stones ?

A

ruptured AAA

pyelonephritis

MSK pain

biliary pathology

bowel obstruction

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8
Q

investigations into suspected renal tract calculi?

A

urine dip - check for haematuria and infection

routine bloods

urate and calcium levels can aid diagnosis

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9
Q

imaging for renal tract calculi

A

gold standard = CT KUB

plain AXR can be used but not all stones are radio-opaque and so their use is limited

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10
Q

management of renal tract calculi

A

resus fluids if dehydrated

majority of stones pass spontaneously - so give analgesia and NSAIDs and advise plenty of fluids

if obstructive nephropathy is suspected a stent insertion or nephrostomy to relieve the pressure and remove the urine would be indicated - although this is a temporary fix

definitive management involves shock wave therapy to fragment the stones

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11
Q

complications with recurrent renal stones

A

cause scarring and loss of renal function - CKD

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12
Q

what is the concern with recurrent bladder stones?

A

chronic irritation of the bladder epithelium can predispose to the formation of a SCC bladder cancer

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13
Q

what is pyelonephritis?

A

inflammation of the kidney parenchyma and renal pelvis

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14
Q

most common causative organism in pyelonephritis

A

E.coli (80%)

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15
Q

risk factors for pyelonephritis

A

anything causing urinary retention e.g. BPH, obstructed urinary tract etc.

female urethra - shorter

indwelling catheter

immunocompromised - HIV, diabetes

sex

renal calculi

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16
Q

what is the classical triad of symptoms seen in a person with pyelonephritis

A

unilateral loin pain

nausea and vomiting

fever

often presents with LUTS aswell

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17
Q

what differential is important to rule out in a patient presenting with pyelonephritis

A

ruptured AAA - often patients present very unwell with tachycardia and hypotension

both of which, coupled with the loin pain, could indicate a ruptured AAA

18
Q

investigations into suspected pyelonephritis

A

urinalysis - infection markers

routine bloods

b-hCG in women of childbearing age

renal USS to check for obstruction

CT KUB for further diagnosis

19
Q

management for pyelonephritis

A

empirical antibiotics + IV fluids

analgesia + anti-emetics

20
Q

what is emphysematous pyelonephritis

A

rare and severe form of acute pyelonephritis

caused by gas forming in and around the kidney

high mortality rate

fails to respond to empirical antibiotics

most common in diabetic patients as high glucose allows CO2 production from fermentation by enterobacteria

21
Q

what is the most common form of renal cancer in adults?

A

renal cell carcinoma (RCC)

22
Q

other than RCC what other forms of renal carcinoma are there?

A

TCC

nephroblastoma (children - Wilm’s tumour)

SCC - chronic inflammation

23
Q

most common site of mets for RCC

A

liver

lung

brain

bone

24
Q

risk factors for RCC

A

smoking

obesity

exposure to industrial carcinogens

dialysis

hypertension

25
Q

how are RCCs usually found/diagnosed

A

incidentally through abdominal imaging (50%)

26
Q

most common presenting complaint in RCC

A

haematuria

27
Q

clinical features of RCC

A

flank pain

flank mass

lethargy

weight loss

varicocoele - left sided

28
Q

what paraneoplastic syndromes can RCC cause

A

hypercalcaemia - PTH

hypertension - renin

polycythaemia - erythropoietin

29
Q

investigations into RCC

A

routine bloods

urinalysis - send for cytology

CT imaging is gold standard

30
Q

gold standard imaging for RCC

A

CT KUB

31
Q

management of RCC

A

chemotherapy is ineffective in RCC

requires surgical management - either a partial or radical nephrectomy

biological agents such as tyrosine kinase inhibitors can be used e.g. Sunitinib

32
Q

what % of RCC have mets on presentation

A

25%

33
Q

what is a renal cyst and what are the 2 classifications

A

fluid filled sacs around the kidney

classified into simple and complex

34
Q

simple vs complex renal cysts

A

simple = well defined homogenous features, present in up to 50% of people over 50 yrs. Develop from the renal tubule epithelium

complex = complicated structures involving thick walls, septations, calcifications and heterogenous features. Carry a malignancy risk with the more complex the cyst is the higher the risk of malignancy

35
Q

risk factors for renal cysts

A

smoking

hypertension

polycystic kidney disease (PCKD)

increasing age

36
Q

what is PCKD

A

autosomal dominant inherited disease that results in multiple renal cysts forming in affected individuals

37
Q

what key sign can people with PCKD present with

A

uncontrollable hypertension

38
Q

clinical features of a renal cyst

A

flank pain (if cyst ruptures and becomes infected)

haematuria

flank mass

uncontrollable hypertension

39
Q

investigations/imaging for renal cysts

A

majority are picked up incidentally on imaging

CT or MRI needed for definitive diagnosis

can be seen on USS but they then require further imaging to rule out other causes

40
Q

management of simple renal cysts

A

simple cysts can be managed with analgesia and potentially a needle aspiration if it starts causing problems - doesn’t require further intervention

41
Q

management of complex renal cysts

A

managed depending on their bosniak score (assesses potential malignancy risk)

surveillance and surgery required thereafter depending on bosniak score

Urology (Surgery) (5 decks)

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