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renal + urology > notes > Flashcards

notes Flashcards

1
Q

NICE criteria diagnosing AKI

A
  • rise in creatinine >25mmol/L in 48 hours
  • rise in creatinine >50% in 7 days
  • urine output <0.5ml/kg/hour for >6 hours = stage 1
  • urine output <0.5ml/kg/hour for 12 hours = stage 2
  • urine urine output <0.3 ml/kg/hour for 24 hours = stage 3
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2
Q

indications for dialysis

A

A - acidosis
E - electrolyte imbalance (persistent hyperkalaemia >6.9)
I - intoxication/poisoning
O - oedema
U - uraemia (pericarditis or encephalopathy)

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3
Q

moa tamsulosin for BPH

A

alpha-1 antagonist
reduces smooth muscle tone of prostate and bladder

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4
Q

moa finasteride for BPH

A
  • 5-alpha reductase inhibitor
  • blocks conversion testosterone to dihydrotestosterone
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5
Q

types of bladder malignancy?

A
  • transitional cell/ urothelial - most common
  • squamous cell - schistosomiasis
  • adenocarcinoma
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6
Q

options after bladder cystectomy

A

urostomy - ileal conduit
neo-bladder

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7
Q

what is a significant result for urine albumin:creatinine ratio (ACR)

A

> 3

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8
Q

CKD GFR scoring

A
  • G1 = eGFR >90
  • G2 = eGFR 60-89
  • G3a = eGFR 45-59
  • G3b = eGFR 30-44
  • G4 = eGFR 15-29
  • G5 = eGFR <15 (known as “end-stage renal failure”)
    only diagnose stage 1 or 2 if markers of kidney disease
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9
Q

nephrotic syndrome criteria

A
  • peripheral oedema
  • proteinuria >3.5g/24 hour
  • serum albumin <30g/L
  • hypercholesterolaemia + thrombotic disease also seen
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10
Q

findings renal biopsy minimal change disease

A
  • normal glomeruli on light microscopy
  • fusion of podocytes and effacement of foot processes on electron microscopy
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11
Q

management minimal change disease

A

pred

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12
Q

renal biopsy findings in membranous glomerulonephritis

A

basement membrane thickened with subepithelial deposits (IgG and complement)
spike and dome

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13
Q

management membranous glomerulonephritis

A
  • ACEi or ARB
  • immunosuppression
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14
Q

presentation IgA nephropathy

A
  • macroscopic haematuria in young person with recent (1-2 days) history of URTI
  • nephrotic range haematuria rare
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15
Q

renal biopsy in post-streptococcal glomerulonephritis

A
  • subepithelial humps caused by immune complex deposits
  • granular/starry sky appearance
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16
Q

features anti-glomerular basement membrane disease (goodpastures)

A
  • pulmonary haemorrhage + haemoptysis
  • rapidly progressive glomerulonephritis
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17
Q

renal biopsy anti-GBM disease

A

linear IgG deposits along basement membrane

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18
Q

which disease causes the formation of epithelial crescents in glomeruli

A

rapidly progressive glomerulonephritis

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19
Q

presentation interstitial nephritis

A
  • AKI + hypertension
  • fever
  • rash
  • arthralgia
  • eosinophilia
  • sterile pyuria
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20
Q

causes of hyponatraemia in a euvolaemic patient

A
  • SIADH
  • hypothyroidism
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21
Q

causes of hyponatraemia in a hypovolaemic patient

A

renal loss - diuretics (loop, thiazides) + addison’s
extrarenal loss - diarrhoea, vomiting, sweating, burns

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22
Q

what is central pontine myelinolysis

A
  • when sodium corrected too quickly
  • myelin sheath damaged by change in osmotic balance
  • causes acute paralysis, speech + swallowing problems
  • only correct hyponatraemia at <10mmol/L/24 hour
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23
Q

tumour markers in testicular cancers

A

seminomas - hCG in 20%
non-seminomas - beta-HCG and/or aFP in 80%

24
Q

management urinary tract calculi

A

analgesia = NSAIDs at home, IM diclofenac for patients requiring admission
- small = expulsion therapy e.g. tamsulosin
- medium = shockwave lithotripsy
- big = nephrostomy

25
Q

hormonal management prostate cancer

A
  • Goserelin - transient increase in testosterone then a blockade
  • androgen receptor antagonist e.g. bicalutamide
26
Q

presentation renal cell carcinoma

A
  • renal mass
  • loin pain
  • haematuria
  • pyrexia
  • left sided varicocele
  • endocrine effects (erythropoietin, ACTH, PTHrp
27
Q

ACEi should be stopped if what percentage of creatinine rise is seen within 2 weeks?

A

> 30%

28
Q

stage 1 AKI - what increase of creatinine from baseline?

A

1.5-1.9

29
Q

stage 2 AKI - what increase of creatinine from baseline?

A

2-2.9

30
Q

stage 3 AKI - what increase of creatinine from baseline?

A

> 3

31
Q

electrolyte requirements for fluid therapy for adults

A

sodium, potassium and chloride - 1mmol/kg/day

32
Q

what is a hydrocele

A

collection of fluid within tunica vaginalis that surrounds the testes

33
Q

which side are varicoceles more common on

A

left side

34
Q

communicating vs non-communicating hydrocele

A

communicating - patency of processus vaginalis, in newborns
non-communicating - excess fluid production

35
Q

features varicocele

A

throbbing pain
dragging sensation
associated with sub-fertility or infertility
bag of worms
disappears when lying down (if it doesn’t = concern for retroperitoneal tumours)

36
Q

what size kidney stones require intervention

A

> 5mm

37
Q

requirement CKD diagnosis

A

GFR < 60 or markers of kidney damage present for > 3 months

38
Q

medical management stress incontinence

A

duloxetine - if conservative management fails

39
Q

management urge incontinence

A

conservative - bladder retraining
anticholinergic - oxybutinin, solifenacin
intravesical injection botox
sacral neuromodulation

40
Q

management urge incontinence

A

conservative
anticholinergic - oxybutinin, solifenacin
intravesical injection botox
sacral neuromodulation

41
Q

organism which causes UTI associated stones

A

proteus mirabilis

42
Q

investigation testicular lump

A

ultrasound

43
Q

features inguinal hernia

A

above and medial to pubic tubercle
strangulation rare

44
Q

features femoral hernia

A

below and lateral to pubic tubercle
more common in women
non-reducible typically
high risk of obstruction and strangulation

45
Q

management femoral hernia

A

surgical repair necessity given risk of strangulation

46
Q

management renal stone + systemic features of infection

A

IV abx and urgent renal decompression due to risk of sepsis

47
Q

recomendations for maintenance fluids

A

25-30ml/kg/day of water
1mmol/kg/day of potassium, sodium and chloride
50-100g/day of glucose

48
Q

features renal cell carcinoma

A

haematuria
loin pain
abdominal mass
pyrexia of unknown origin
varicocele

49
Q

common cause of peritoneal dialysis associated peritonitis

A

staph epidermis

50
Q

what is stauffer syndrome

A

paraneoplastic syndrome associated with renal cell cancer
cholestasis/hepatosplenomegaly

51
Q

why is there an increased risk of thromboembolism in nephrotic syndrome

A

loss of antithrombin III and plasminogen

52
Q

most common valvular abnormality seen in polycystic kidney disease

A

mitral valve prolapse or mitral regurg

53
Q

features henoch-schonlein purpura

A

palpable purpuric rash over buttocks and extensor surfaces
abdo pain
polyarthritis
IgA nephropathy

54
Q

sympathetic nerve to bladder

A

hypogastric nerve
constriction of neck and urethra

55
Q

VBG salicylate overdose

A

1st - resp alkalosis
2nd - metabolic acidosis

renal + urology (2 decks)

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