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Medicine Phase 2A (OWN) > Kidney and GU > Flashcards

Kidney and GU Flashcards

1
Q

Describe the two types of kidney stones caused by hypercalcaemia

A

Calcium oxalate stones: black/ dark brown, radiopaque, form in acidic urine
Calcium phosphate: dirty white, radiopaque on x-ray, form in alkaline urine

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2
Q

Give 3 risk factors for calcium oxalate and calcium phosphate stones

A

Hypercalcaemia: Increased GI absorption/ hyperparathyroidism
Hypercalciuria: Impaired renal tubular reabsorption
Hyperoxaluria: Genetic defect causing increased oxalate excretion, defect in liver metabolism or diet heavy in oxalate-rich foods

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3
Q

Describe uric acid kidney stones

A

Red-brown
Radiolucent
Uric acid forms urate ion –> monosodium urate

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4
Q

Describe struvite kidney stones (infection stones)

A 
Mg2+
Ammonium
Phosphate 
Bacteria use urease to break urea down into carbon dioxide and ammonia (which makes urine more alkaline and favours precipitation)
Dirty white/ radiopaque
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5
Q

Give 3 risk factors for struvite kidney stones

A

Urinary tract infections
Vasicoureteral reflux
Obstructive urpathies

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6
Q

Describe the pattern of pain with kidney stones

A

Dull/ localised flank pain in the mid-lower back
Renal colic
Pain due to dilation stretching and spasm, worse at uteropelvic pelvic junction

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7
Q

How would you diagnose kidney stones?

A

History and physical exam
Imaging: XR, CT, US
Urinalysis: microscopic/ gross haematuria

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8
Q

How would you treat kidney stones?

A

Hydration
Medication: analgesics, potassium citrate to reduce stone formation
Alpha adrenergic blockers/ CCB to help pass stones
Shockwave lithotripsy
Surgery/ stent placement

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9
Q

What is the usual BUN to creatinine ratio?

A

(5-20) : 1

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10
Q

Give 4 causes of absolute fluid loss leading to decreased blood flow in pre renal AKI

A

Haemorrhage
Vomiting
Diarrhoea
Severe burns

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11
Q

Give 2 causes of relative fluid loss leading to decreased blood flow in pre renal AKI

A

Distributive shock

Congestive HF

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12
Q

Give the equation for GFR

A

Blood filtered (ml) / minute

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13
Q

Describe the effect of reduced GFR in pre renal AKI

A

Less urea and creatinine filtered therefore more in the blood (azotemia)
Oliguria: low urine
RASS activated
Water and sodium reabsorption is tied to urea reabsorption therefore BUN: creatinine is >20:1

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14
Q

Give the percentage of sodium excreted compared to sodium filtered in pre-renal AKI

A

<1%

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15
Q

How is urine concentration affected in pre-renal AKI

A

More concentrated urine, Uosm >500 mOsm/ kg

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16
Q

Where is the damage in intrarenal AKI?

A

Tubules

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17
Q

How can the tubules become damaged causing intrarenal AKI?

A 
Acute tubular necrosis (due to pre-renal AKI)
Nephrotoxins:
Aminoglycosides (Abx)
Lead
Myoglobin
Ethylene glycol
Radiocontrast dye
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18
Q

What is tumour lysis syndrome and how can it cause intrarenal AKI?

A

Uric acid is released during cancer treatment, excess uric acid damages the tubules

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19
Q

How would you treat intrarenal AKI?

A

Hydration (improves from)
Medications:
Allopurinol
Urate oxidase

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20
Q

How does the necrosis of cells in intrarenal AKI cause problems in the kidney?

A

Dead cells slough off and clog the tubules, increasing pressure
There is a decrease in GFR: oliguria, azotemia
Hyperkalaemia and metabolic acidosis since dead cells are not absorbing
Dead cells form a brown granular cast

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21
Q

How does glomerulonephritis cause intrarenal AKI?

A

Antigen-antibody complexes are deposited in tubules
Activates the complement system, other immune cells are attracted with lysosomal enzymes which cause damage
Increase the permeability of podocytes so large molecules can pass through

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22
Q

What is the effect of fluid leakage due to tubular damage in intrarenal AKI?

A

Reduced pressure difference, reduced GFR, causing: oedema, HTN, oliguria, azotemia

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23
Q

Describe acute interstitial nephritis including symptoms

A

Infiltration of immune cells (type I or IV hypersensitivity) causing oliguria, eosinophiluria, fever, rash

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24
Q

Give 3 causes of type I or Iv hypersensitivity in acute interstitial nephritis

A

NSAIDs
Penicillin
Diuretics

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25
Q

What complication can occur secondary to type I or IV hypersensitivity in acute interstitial nephritis?

A

Renal papillary necrosis, causing haematuria and flank pain

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26
Q

Give 4 causes of renal papillary necrosis other than acute interstitial nephritis

A

Chronic analgesic use
Diabetes mellitus
Sickle cell disease
Pyelonephritis

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27
Q

How would BUN : creatinine ratio appear in intrarenal AKI?

A

Kidney can’t filter, so reabsorption/ secretion is impaired so urea is not reabsorbed
<15 : 1

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28
Q

How is urea sodium affected in intrarenal AKI?

A

Sodium is not reabsorbed so UNa >40mEq/l

% of filtered excreted is > 2%

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29
Q

Describe post-renal AKI

A

Obstruction to outflow due to compression (intra-ado tumours or BPH) or blockage (kidney stones in urea/ urethra)

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30
Q

How does outflow obstruction in post-renal AKI affect GFR?

A

Buildup of urine and pressure in renal tubules, reduces pressure gradient and therefore decreases GFR causing azotemia and oliguria

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31
Q

How does the a high pressure tubule in post-renal AKI affect reabsorption initially and then after a period of time?

A

Increased reabsorption of sodium, water and urea
BUN : creatinine >15 : 1
% sodium filtered excreted is < 1%

Constant pressure leads to cell damage and reduced reabsorption
BUN : creatinine <15 : 1
% sodium filtered excreted is >1-2%

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32
Q

Where do renal cell carcinomas form from and why are the tumours yellow?

A

From epithelial cells in the proximal convoluted tubules and are filled with cytoplasm of carbohydrates and lipids (yellow)

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33
Q

How do renal cell carcinomas form?

A

Mutation on VHL tumour suppressor gene, so IGF-I (growth factor) is increased leading to unregulated cell growth and up regulation of vascular endothelial growth factor and receptor (VEGF) -> angiogenesis

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34
Q

Describe the typical sporadic case of renal cell carcinoma

A

Solitary tumours in the upper pole of the kidney
Older men
Smokers

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35
Q

Give an inherited syndrome that can cause renal cell carcinoma

A

Von Hippel-Lindau disease
Autosomal dominant mutation that causes the formation of cysts and being tumours, often in both kidneys
Younger men/ women

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36
Q

Give 4 symptoms of renal cell carcinoma

A

Flank/ hip pain
Palpable mass (abdomen/ lower back)
Haematuria
Inflammation (fever and weight loss)

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37
Q

Describe the paraneoplastic syndromes associated with renal cell carcinoma

A

Erythropoietin production causing polycythemia, therefore slugding/ slow flow
Renin release increases BP
PTHrP causes hypercalacemia
ACTH (adrenocorticotrophic hormone) causes an increase in cortisol and therefore can cause Cushing’s syndrome

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38
Q

How can a varicocele occur as a result of renal cell carcinoma?

A

If the tumour is of the L kidney it may compress the L renal vein and impede venous drainage of the L testes causing testicular veins to dilate

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39
Q

What is the risk of a renal cell carcinoma invading the renal vein?

A

Spreads to the IVC, there is therefore a high risk of cancer spreading in the blood stream, particularly to the bone and lungs

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40
Q

How would you stage a renal cell carcinoma?

A

T: size/ grown into nearby areas
N: lymph node involvement
M: degree of metastasis
0-4 score

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41
Q

How would you treat renal cell carcinoma?

A

Resistant to chemo/ radiotherapy
If localised may be resection
Sensitive to immune system therefore:
Immunomodulatory agents (chemokines/ antibodies)
Molecular targeted therapy (VEGF) : cut off blood supply

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42
Q

Where does a transitional cell carcinoma most commonly arise?

A

Urothelium of the bladder

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43
Q

Describe the structure of the bladder wall

A

Urothelium (3-7 layers)
Basal, intermediate and umbrella layer
Tight junctions in intermediate layer
Plaques over umbrella layer/ umbrella cells give bladder the ability to stretch

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44
Q

Describe the role of P53 in causing transitional cell carcinoma

A

P53 dependent: (mutation) flat tumour, invasive

P53 independent: less aggressive papillary tumour

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45
Q

How would you diagnose a transitional cell carcinoma?

A

Cystoscope (light and camera, can take biopsies)

Haematuria

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46
Q

Why are transitional cell carcinomas difficult to treat?

A

Multifocal, can recur

Tumour cells may detach from one location and implant themselves at another in the bladder

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47
Q

Give 4 risk factors for transitional cell carcinoma

A

Age
Carcinogenesis (phenacetin, smoking, aniline, cyclophosphamide)
Alcohol abuse
Extended dwell times

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48
Q

How would you treat transitional cell carcinoma?

A

Tumours may be resected with a cystoscope/ transurethral resection
Followed with chemo
Aggressive cancer may require removal of the prostate and bladder

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49
Q

Give 3 risk factors for prostate cancer

A

Age
Afro-caribbean
Genetics

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50
Q

How would prostate cancer present?

A 
Raised PSA
Weak stream
Hesitancy
Incomplete emptying
Increased urinary frequency
Urgency
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51
Q

Give 6 possible signs of prostate cancer

A 
General malaise 
Bone pain
Anorexia
Weight loss
Obstructive neuropathy
Paralysis: cord compression
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52
Q

Give 5 features of a malignant prostate on DRE

A 
Lack of mobility
Asymmetrical gland
Nodule with one lobe
Induration of part/ all prostate
Palpable seminal vesicles
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53
Q

Give 4 systemic symptoms of prostate cancer

A

Blood in semen
ED
Pelvic discomfort
Bone pain and stiffness

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54
Q

Give 4 conditions in which you might see an elevated PSA

A

BPE, UTI, prostatitis, prostate cancer

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55
Q

How would you diagnose prostate cancer?

A

LUTS
PSA
Transrectal US
Prostate biopsy

56
Q

How would you stage prostate cancer?

A

TNM

Gleason score

57
Q

How would you manage prostate caner?

A

Localised: acute surveillance
Locally advanced: radial prostatectomy, radiotherapy and androgen deprivation therapy
Metastatic: bilateral orchidectomy, prostatectomy and radiation therapy

58
Q

Give 3 risk factors for testicular cancer

A

Cryptorchidism
FHx
Previous testicular tumour

59
Q

How would testicular cancer present?

A

80% painless lump in the testes (hard/ craggy, lies within testis, can be felt above)
Hydrocele: may contain bloodstained fluid
Pain: unexplained in one testis
Metastases: grows in the lung; abdominal mass due to enlarged para-aortic lymph nodes; cervical nodes

60
Q

How would you diagnose testicular cancer?

A 
USS same day
CXR if resp. symptoms
Staging CT
Tumour markers:
AFP
B-hcg
LDH
61
Q

How would you manage testicular cancer?

A

Orchidectomy if malignant
Seminomas are radiosensitive
Teratomas are treated with cytotoxic chemo.

62
Q

What is the major implication in testicular cancer treatment?

A

Sterility

63
Q

Describe CKD

A

Subtle decreased in kidney function over >3 months

64
Q

Give the value of a healthy GFR

A

100-120ml/min/1.73m3

65
Q

How can HTN cause CKD?

A

Walls thicken in order to withstand the pressure, narrow lumen so less blood is reaching the kidney: Ischaemic injury
Immune cells damage the glomerulus and secrete growth factor such as TGF-B1, this causes mesangial cells to regress to mesangioblasts which secrete extracellular matrix, causing glomerulosclerosis (scarring)

66
Q

How can diabetes cause CKD?

A

Excess glucose in the blood sticks to proteins
(Non-enzymatic glycation, causes hyaline arteriosclerosis of efferent arteriole)
Difficult for blood to leave the glomerulus and increases pressure causing hyper filtration
Mesangial cells secrete extracellular matrix, increasing glomerular size and causing sclerosis

67
Q

Give a systemic, infective, medicinal and toxin cause of CKD

A

Lupus/ rheumatoid arthritis
HIV
NSAIDs
Tobacco

68
Q

Describe the consequences of decreased urea excretion as a result of CKD

A

Buildup in blood causing nausea, loss of appetite, encephalopathy: asterixis (tremor of the hand) : coma and death
Can also cause uraemic frost, pericarditis and bleeding

69
Q

Describe the consequences of decreased potassium excretion as a result of CKD

A

Buildup in blood causing cardiac arrhythmias

70
Q

Describe the consequences of less activated vitamin D as a result of CKD

A

Less calcium absorbed causing PTH release so the bones lose calcium causing renal osteodystrophy

71
Q

How can CKD cause anaemia?

A

Reduced erythropoietin levels

72
Q

How would you diagnose CKD?

A

Changes in GFR over time ( <90ml/min/1.73m3)
Irreversible damage ( <60ml/min/1.73m3)
Biopsy: look for glomerulosclerosis

73
Q

How would you treat CKD?

A

Manage underlying cause
Dialysis
Transplant

74
Q

Describe benign prostate hyperplasia

A

Non-cancerous increase in size of the prostate

75
Q

Give 3 storage symptoms of BPH

A

Increased frequency
Nocturia
Involuntary urination

76
Q

Give 5 voiding symptoms of BPH

A 
Urinary hesitancy
Intermittency
Weak stream
Incomplete emptying sensation
Terminal dribbling
77
Q

Give 5 symptoms of bladder outlet obstruction secondary to BPH

A 
Abdo pain
Feeling of a full bladder
Frequent urination
Acute urinary retention
Dysuria
Urinary hesitancy
78
Q

How can BPH cause an increased risk of UTI?

A

Incomplete voiding results in urinary stasis

79
Q

How would you diagnose BPH?

A

History of LUTS
DRE
Exclusion of other causes of similar symptoms
Urinalysis

80
Q

Describe the medicinal management of BPH

A

Alpha blockers: Alfuzosin, tamulosin (relax smooth muscle in prostate and bladder neck, reducing the blockage of flow)
5-alpha reductase inhibiters: Finasteride (Inhibits 5-alpha reductase which inhibits DHT- hormone responsible for prostate enlargement)

81
Q

Describe the lifestyle changes suggested to manage BPH

A

Physical activity
Moderate alcohol and caffeine consumption
Avoid meds with anti-cholinergic properties
Elderly men: seated voiding position

82
Q

Describe acute pyelonephritis

A

Inflammation of the renal pelvis, usually unilateral

83
Q

Describe the causes of acute pyelonephritis

A

Ascending infection
Vesicoureteral reflux if vericoureteral orifice fails and urine moves up the urinary tract, creating a one way valve from the ureter to the bladder
This may be caused by a primary congenital defect or bladder outlet obstruction

84
Q

Give 5 risk factors for acute pyelonephritis

A 
Female
Sexual intercourse
Indwelling catheter
Diabetes
Urinary tract obstruction
85
Q

Give 3 types of bacteria that commonly cause ascending infection in acute pyelonephritis

A

E. coli
Proteus
Enterobacter

86
Q

Give 3 ways in which a haematogenous infection can cause acute pyelonephritis

A

Septicaemia
Bacteremia
Infective endocarditis

87
Q

Why are dead neutrophils and WBC casts found in the urine of a patient with acute pyelonephritis?

A

Bacteria adheres to tubules epithelium which attracts neutrophils to infiltrate

88
Q

Give 5 symptoms of acute pyelonephritis

A 
Fever 
Nausea and vomiting 
Chills
Leukocytosis 
Flank pain @ costo-vertebral angle
89
Q

Give the treatment for acute pyelonephritis

A

Abx

Hydration

90
Q

Describe the complications which may occur as a result of acute pyelonephritis

A

Renal abscess

Recurrent infections: from anatomic problem, chronic pyelonephritis, papillary necrosis

91
Q

Give 5 general causes of cystitis

A 
Bacterial infection
Fungal infection 
Chemical irritants
Foreign bodies
Trauma
92
Q

Give 3 gram negative bacteria that may colonise the bladder mucosa in cystitis

A 
E. coli
Klebsiella 
Proteus
Enterobacter
Citrobacter
93
Q

Give 2 gram positive bacteria that may colonise bladder mucosa in cystitis

A

Enterococcus

Staph. saprophyticus (second most common, esp. in sexually active young women)

94
Q

Give 5 risk factors for cystitis

A

Sexual intercourse
Female (short urethra, post-menopausal: decrease in oestrogen, loss of protective vaginal flora)
Foley catheter
Diabetes: hyperglycaemia inhibits phagocytosis
Infant boys with foreskin
Impaired bladder emptying

95
Q

Give 4 symptoms of cystitis

A

Suprapubic pain
Dysuria
Frequent urination
Urgency

96
Q

Give 3 signs of cystitis found on urinalysis

A

Pyuria- cloudy
Leukocyte esterase
Positive for nitrites (if caused by gram -ve since gram -ve bacteria convert nitrates to nitrites)

97
Q

Describe the results of a urine culture in cystitis

A

Positive if >100,000 CFU/ml

98
Q

What might be suspected if a urine sample was positive for pyuria but gave a negative urine culture?

A

Sterile pyuria
Suggests urethritis, may be due to:
Neissariae gonorrhoea
Chlamydia tricomitis

99
Q

How would you treat cystitis?

A

Abx
Pain medication
Prevention: lots of fluid and good hygiene

100
Q

Give 5 acute symptoms of prostatitis

A 
Pain in/ around penis, testicles, anus, lower abode
Urinary symptoms
Acute urinary retention
General malaise
Fever
Discharge
101
Q

Give 3 chronic symptoms of prostatitis

A

Englarged/ tender prostate on DRE

ED, pain when ejaculating, pelvic pain after sex

102
Q

What is the cause of prostatitis?

A

Bacteria from the urinary tract enters the prostate

103
Q

Give 5 risk factors for prostatitis

A 
Having a UTI in the recent past
Catheter
Prostate biopsy
STI
HIV/ AIDS
Anal sex
Pelvic injury
104
Q

How would you treat acute prostatitis?

A

2 week course of Abx

105
Q

How does nephritic syndrome occur in glomerulonephritis?

A

Damage means that small pores in the podocytes become large enough to allow proteins and RBCs into the urine

106
Q

Give 3 causes of nephritic syndrome in children/ adolescents

A

IgA nephropathy
Post-strep glomerulonephritis
Haemolytic ureic syndrome

107
Q

Give 4 causes of nephritic syndrome in adults

A

Good pasture syndrome
SLE
Rapidly progressing glomerulonephritis
Infective endocarditis

108
Q

Give 5 signs/ symptoms of nephritic syndrome

A 
Haematuria
Proteinuria
HTN
Blurred vision
Azotemia
Oliguria
109
Q

How would you diagnose nephritic syndrome?

A 
Blood electrolytes
BUN
K+
Protein in urine
Urinalysis
Kidney biopsy
110
Q

How would you treat nephritic syndrome?

A

Anti-hypertensives
Anti-inflammatory meds
Low potassium and salt diet

111
Q

Describe nephrotic syndrome

A 
A collection of symptoms due to kidney damage:
Proteinuria
Hypoalbuminemia
Hyperlipidaemia
Oedema
Lipiduria
112
Q

Why would nephrotic syndrome present with hyperlipidaemia?

A

Hypoproteinuria stimulates protein synthesis in the liver leading to the overproduction of lipoproteins
There is also a decrease in lipid catabolism due to the low lipase levels

113
Q

Give 5 symptoms of nephrotic syndrome

A 
Anaemia
Dyspnoea
High ESR
Frothy urine
Puffiness around the eyes
114
Q

Give 5 causes of nephrotic syndrome

A 
Minimal change disease
Focal segmental glomerulosclerosis
Membrane glomerulonephritis
Membranoproliferative glomerulonephritis
Rapidly progressive glomerulonephritis
115
Q

Describe polycystic kidney disease

A

Genetic disease causing the cortex and medulla of the kidneys to become filled with hundreds of cysts

116
Q

How might polycystic kidney disease cause HTN?

A

Blood vessels of neighbouring nephrons can be compressed by cysts causing ischaemia
RAAS activation leads to HTN

117
Q

How can polycystic kidney disease cause kidney stones?

A

Expanding cysts can compress the collecting system, this causes urinary stasis which is a risk factor for developing kidney stones

118
Q

Give 2 general symptoms of PKD

A

Flank pain

Haematuria

119
Q

Give the two possible mutations for PKD and state which is more severe and earlier onset

A

Both autosomal dominant
PKD1: More severe and earlier onset
PKD2

120
Q

What is the result of the absence of a normal PKD1 or PKD2 protein?

A

Signal to inhibit cell growth won’t be received

Cells proliferate abnormally and express proteins that allow water into the lumen of the cysts

121
Q

Give 4 parts of the body in which cysts can form in PKD other than the kidneys

A

Liver
Seminal vesicles
Pancreas
Vasculature (aortic root dilation/ berry aneurysm)

122
Q

How does autosomal recessive PKD differ from autosomal dominant PKD?

A

ARPKD
Renal failure before birth, less foetal urine, oligohydraminos (low amniotic fluid)
Can cause Potter’s syndrome (developmental abnormalities) such as clubbed feet, flattened nose, pulmonary hypoplasia

123
Q

How would you diagnose PKD?

A

Prenatal US
Bilaterally large kidneys
Cysts
Oligohyraminos

124
Q

What is the result of congenital hepatic fibrosis in ARPDK?

A 
Portal HTN:
Oesophageal varices
Upper GI bleeds
Haemorrhoids
Splenomegaly
125
Q

How would you treat PKD?

A

HNT: ACE inhibitors, angiotensin receptor blockers
Cholestasis: Ursodiol
Renal failure: Dialysis, transplant
Portal HTN: Portocaval shunt, transplant

126
Q

Describe a spermatocele

A

Retention cyst of a tubule of the rete testis/ head of epididymis, distended with fluid, containing spermatozoa

127
Q

Give 3 causes of a spermatocele

A

Epididymitis
Physical trauma
Vasectomy

128
Q

How would you diagnose a spermatocele

A

US to rule out malignancy

129
Q

When might a spermatocele be removed?

A

If cysts are causing discomfort/ are enlarging in size

130
Q

Describe a hydrocele

A

Accumulation of serous fluid around a testicle

131
Q

Give 3 causes of a hydrocele

A

Fluid secretion from the tunica vaginalis
Defective absorption of fluid
Interference of lymphatic drainage

132
Q

How would you diagnose a hydrocele?

A

Transillumination +ve
Fluctuation +ve
Impulse on coughing -ve

133
Q

Describe a varicocele

A

Abnormal enlargement of the pampiniform venous plexus in the scrotum

134
Q

How might a varicocele present?

A

Noticed as soft lumps, usually above the testicle, most commonly on the left, can sometimes be painful/ felt as heaviness

135
Q

What is the main risk/ complication of a varicocele?

A

Male infertility

136
Q

How would you diagnose and treat a varicocele?

A

US: dilation of the vessels
Treatment: microscopic surgery, percutaneous embolism

Medicine Phase 2A (OWN) (10 decks)

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