Nephrology/urology Flashcards
How does nephroblastoma (Wilma tumour) develop
Usually in 2-4 y/o
When glomeruli is forming in the embryo sometimes some cells are left over and they can turn into a tumour
Most common sites of metastasis for nephroblastoma?
Bones
Lungs
Lymph nodes
Liver
Brain
What values of creatinine and urea are characteristic of an AKI
Increase in serum creatinine by >26.5mol/l in 48 hr
OR
increase in serum creatinine by >1.5x the baseline within the last 7 days
OR
Urine volume <0.5ml/kg/h for 6 hours
Which medications should be stopped during an AKI?
DAMN drugs
Diuretics
Ace inhibitors/ARB
Metformin/ methotrexate
NSAIDS
ACE inhibitors prevent angiotensin 2 from forming which vasoconstricts the efferent areteriole more than the afferent leading to increased GFR pressure
What is the first line treatment for minimal change disease
Prednisolone as it has anti inflammatory properties and reduced the inflammation and permeability of the epaffected podocytes
What commonly causes primary hyperparsthyroidism
A problem with the gland itself e.g.
Parathyroid gland adenoma
Hyperplasia (enlargement or increased cell reproduction rate) of all 4 glands
Parathyroid carcinoma
What commonly causes secondary hyperparathyroidism
Vitamin D deficiency (as vit D exerts negative feedback on PTH)
Loss of extra cellular ca
Ca malabsorption
Abnormal parathyroid activity
Inadequate ca intake
Tertiary occurs after prolonged secondary or after conditions like CKD
What is the relationship between phosphate and parathyroid
PTH decreases phosphate re absorption at the Pct
Phosphate ions in serum form insoluable salts with calcium causing decreased serum ca
Therefore the reduction of phosphate ions results in more ionised ca in blood
What is type 1 renal tubular acidosis
RTA is a series of disorders characterised by impaired acid handling which manifests as a normal anion gap metabolic acidosis with maintained renal function
Type 1 ( distal) is characterised by the collecting ducts inability to excrete H+ ions leading to hypokalaemia hyperchloraemic metabolic acidosis
Management with urine alkalisation with potassium citrate or sodium bicarbonate
What is the most common type of prostate cancer
Adenocarcinoma
Smoking, exposure to aniline dyes, rubber manufacture and cyclophosphamide are risk factors for what type of cancer
Transitional cell carcinoma of the bladder
What is the management of protein urea in CKD patients
ACE inhibitors or ARBs - first line in patients with coexist at hypertension and CKD I’d albumin:creatinine >30/3
If >70 they are indicated regardless of BP
SGLT-2 inhibitors - block reabsorption of glucose in PCT
What test is performed in a diabetic review to test for diabetic nephropathy
Early morning specimen albumin:creating ration (ACR)
In patients with ADPKD what medication is said to help slow the progression of CKD and renal insufficiency
Tolvaptan - a vasopressin receptor 2 antagonist is first line
When is nephrostomy tube insertion indicated for renal stones over shockwave lithotripsy
Patients with obstructive urinary calculus (hydronephresis) and signs of infection require urgent renal decompression and I’ve antibiotics.
Hydroneohresis is dilation of the renal pelvis due to obstruction of urine
What is the initial management for renal colick and further management
IM diclofenac (an NSAID), if contraindicated e.g. upper GI bleed then IV paracetamol is indicated
Then if stone is <5mm and asymptomatic then watch and wait
Then shockwave if <10
10-20 - shockwave or uteroscopy
If >20 mm percutaneous nephrolithotomy
Why do are you more susceptible to clots when you have nephrotic syndrome
You are peeing out all your proteins including the ones that help to make blood clots e.g. antithrombin III
Also loosing IGs proteins so at risk of infections also
How to manage nephrotic syndrome?
Manage symptoms first e.g. If fluid overloaded manage with it furisomide
But always biopsy to see what’s causing it and the give steroids after x
What are the 2 week wait guidelines for haematuria?
Ages >45 AND unexplained visible haematuria without UTI/ persistent visible haematuria post UTI
Aged >60 AND unexplained visible haematuria with dysuria/ raised WCC
RAISED PSA in men with visible haematuria
What does aldosterone do and what does is cause to be excreted
It works on your DCT to reabsorb Na Cl from solute to blood to help retain water and increase blood pressure
By doing this is excretes water therefore when giving antihypertensives you will retain potassium
What is a common side effect if CCB
Leg swelling thought to be due to CCBs dilating the arteries which then causes intracapillary hypertension and fluid retention
What is a common side effect of aldosterone antagonist
Hyperkalaemia
Gynacoemastia
What is th equation for an anion gap? And what is considered high
Positive ions - negative ions
(Na+ + k+) - (cl- + HCO3)
> 18 is high below that is normal
What are the causes of a high anion gap (acidosis)
M ethanol
U remia
D KA
P aracetamol
I Ron, isoniazid - (potent antibiotic used to treat TB)
L actate
E thanol
S alicylate e.g. aspirin
Causes of normal anion gap acidosis ( bicarbonate loss)
H yperchloraemia
A ddisons ( adrenal insufficiency/ low cortisol)
R TA (renal tubular acidosis )
D iarrhoea
A cetazolamide (glaucoma treatment by excreting bicarbonate)
S piro (potassium sparing diuretic)
S Aline
What is associated with IGA nephropathy
Happens few days after URTI
associated with Cole is disease and henloch- shonlein purpura ( condition that causes small blood vessels to become inflamed and bleed)
What are some causes of membranous glomeruloneohritis
Presents with protinuria, nephrotic syndrome, ckd
Causes can be primary, infections such as hep b, drugs, autoimmune but commonly associated with malignancy
What is rhabdomylisis and how can you tell if this is indicated
Serums condition where damage to your muscles occur and the tissues release it’s proteins and electrolytes into the blood which can damage the heart and kidneys
If patient is lying on floor for hours like 12 hours it’s usually rhapsodic in exam but CK has to be in the thousands >5000
AKI, anaemia and low platelets are characteristic of what 2 kidney conditions
HUS - haemolytic ureamic syndrome- inflammation of blood vessels which can damage and form clots that damage heart and kidneys. Typically occurs after someone has had diarrhoea or infection with E. coli
TTP- thrombotic thrombocytopenia with purpura - rare blood coagulation disorder typically affecting women in 40s
All supportive management don’t give platelets !!!
What’s an example of anticholinergics/ antimuscarinks and what are their side effects
Oxybutinin
Side effects include: dry mouth , dilated pupils/ blurred vision
