notes Flashcards
NICE criteria diagnosing AKI
- 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
indications for dialysis
A - acidosis
E - electrolyte imbalance (persistent hyperkalaemia >6.9)
I - intoxication/poisoning
O - oedema
U - uraemia (pericarditis or encephalopathy)
moa tamsulosin for BPH
alpha-1 antagonist
reduces smooth muscle tone of prostate and bladder
moa finasteride for BPH
- 5-alpha reductase inhibitor
- blocks conversion testosterone to dihydrotestosterone
types of bladder malignancy?
- transitional cell/ urothelial - most common
- squamous cell - schistosomiasis
- adenocarcinoma
options after bladder cystectomy
urostomy - ileal conduit
neo-bladder
what is a significant result for urine albumin:creatinine ratio (ACR)
> 3
CKD GFR scoring
- 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
nephrotic syndrome criteria
- peripheral oedema
- proteinuria >3.5g/24 hour
- serum albumin <30g/L
- hypercholesterolaemia + thrombotic disease also seen
findings renal biopsy minimal change disease
- normal glomeruli on light microscopy
- fusion of podocytes and effacement of foot processes on electron microscopy
management minimal change disease
pred
renal biopsy findings in membranous glomerulonephritis
basement membrane thickened with subepithelial deposits (IgG and complement)
spike and dome
management membranous glomerulonephritis
- ACEi or ARB
- immunosuppression
presentation IgA nephropathy
- macroscopic haematuria in young person with recent (1-2 days) history of URTI
- nephrotic range haematuria rare
renal biopsy in post-streptococcal glomerulonephritis
- subepithelial humps caused by immune complex deposits
- granular/starry sky appearance
features anti-glomerular basement membrane disease (goodpastures)
- pulmonary haemorrhage + haemoptysis
- rapidly progressive glomerulonephritis
renal biopsy anti-GBM disease
linear IgG deposits along basement membrane
which disease causes the formation of epithelial crescents in glomeruli
rapidly progressive glomerulonephritis
presentation interstitial nephritis
- AKI + hypertension
- fever
- rash
- arthralgia
- eosinophilia
- sterile pyuria
causes of hyponatraemia in a euvolaemic patient
- SIADH
- hypothyroidism
causes of hyponatraemia in a hypovolaemic patient
renal loss - diuretics (loop, thiazides) + addison’s
extrarenal loss - diarrhoea, vomiting, sweating, burns
what is central pontine myelinolysis
- 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
tumour markers in testicular cancers
seminomas - hCG in 20%
non-seminomas - beta-HCG and/or aFP in 80%
management urinary tract calculi
analgesia = NSAIDs at home, IM diclofenac for patients requiring admission
- small = expulsion therapy e.g. tamsulosin
- medium = shockwave lithotripsy
- big = nephrostomy
hormonal management prostate cancer
- Goserelin - transient increase in testosterone then a blockade
- androgen receptor antagonist e.g. bicalutamide
presentation renal cell carcinoma
- renal mass
- loin pain
- haematuria
- pyrexia
- left sided varicocele
- endocrine effects (erythropoietin, ACTH, PTHrp
ACEi should be stopped if what percentage of creatinine rise is seen within 2 weeks?
> 30%
stage 1 AKI - what increase of creatinine from baseline?
1.5-1.9
stage 2 AKI - what increase of creatinine from baseline?
2-2.9
stage 3 AKI - what increase of creatinine from baseline?
> 3
electrolyte requirements for fluid therapy for adults
sodium, potassium and chloride - 1mmol/kg/day
what is a hydrocele
collection of fluid within tunica vaginalis that surrounds the testes
which side are varicoceles more common on
left side
communicating vs non-communicating hydrocele
communicating - patency of processus vaginalis, in newborns
non-communicating - excess fluid production
features varicocele
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)
what size kidney stones require intervention
> 5mm
requirement CKD diagnosis
GFR < 60 or markers of kidney damage present for > 3 months
medical management stress incontinence
duloxetine - if conservative management fails
management urge incontinence
conservative - bladder retraining
anticholinergic - oxybutinin, solifenacin
intravesical injection botox
sacral neuromodulation
management urge incontinence
conservative
anticholinergic - oxybutinin, solifenacin
intravesical injection botox
sacral neuromodulation
organism which causes UTI associated stones
proteus mirabilis
investigation testicular lump
ultrasound
features inguinal hernia
above and medial to pubic tubercle
strangulation rare
features femoral hernia
below and lateral to pubic tubercle
more common in women
non-reducible typically
high risk of obstruction and strangulation
management femoral hernia
surgical repair necessity given risk of strangulation
management renal stone + systemic features of infection
IV abx and urgent renal decompression due to risk of sepsis
recomendations for maintenance fluids
25-30ml/kg/day of water
1mmol/kg/day of potassium, sodium and chloride
50-100g/day of glucose
features renal cell carcinoma
haematuria
loin pain
abdominal mass
pyrexia of unknown origin
varicocele
common cause of peritoneal dialysis associated peritonitis
staph epidermis
what is stauffer syndrome
paraneoplastic syndrome associated with renal cell cancer
cholestasis/hepatosplenomegaly
why is there an increased risk of thromboembolism in nephrotic syndrome
loss of antithrombin III and plasminogen
most common valvular abnormality seen in polycystic kidney disease
mitral valve prolapse or mitral regurg
features henoch-schonlein purpura
palpable purpuric rash over buttocks and extensor surfaces
abdo pain
polyarthritis
IgA nephropathy
sympathetic nerve to bladder
hypogastric nerve
constriction of neck and urethra
VBG salicylate overdose
1st - resp alkalosis
2nd - metabolic acidosis
