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Renal > Overview > Flashcards

Overview Flashcards

1
Q

Where are the kidneys located anatomically?

A

Retroperitoneal

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2
Q

Which muscles surround the kidneys?

A

Quadratus lumborum

Psoas major

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3
Q

In relation to the spine where do the kidneys lie

A

Right - L1 -L3

Left T12 -L2

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4
Q

Are the floating ribs anterior or posterior to the kidney?

A

Posterior

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5
Q

Where does renal lymph drain to?

A

Lumbar nodes

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6
Q

Where does ureter lymph drain?

A

Lumbar and iliac nodes

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7
Q

At what level do the ureters turn medially?

A

Ischial spine

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8
Q

What zone of the prostate is felt on DRE?

A

Peripheral

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9
Q

Name the three types of male urethra

A
  • membranous
  • prostatic
  • spongy
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10
Q

Describe the male ejaculation pathway

A 
Seminiferous tubules 
Epididymis 
Vas deferens 
Prostatic urethra 
Spongy urethra
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11
Q

What makes up the spermatic cord?

A 
Purple dicks contribute to a  good sex life 
Pampiniform plexus 
Ducutus deferens 
Cremasteric artery 
Testicular artery 
Artery of ductus deferens 
Genitofemoral nerve 
Sympathetics 
Lymphatics
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12
Q

What is the blood supply to the penis?

A

Internal pudendal artery

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13
Q

What is the lymph drainage of the penis?

A

Superficial inguinal

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14
Q

What is the lymphatic drainage of the testes?

A

Lumbar nodes around abdominal aorta

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15
Q

What cells line the prostate?

A

Columnar secretory epithelium

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16
Q

State the five stages of CKD

A 
Stage 1 >90 
Stage 2 60-89
Stage 3 30-59
Stage 4 15-29
Stage 5 <15 
>3 months
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17
Q

What is the commonest cause of CKD?

A

Diabetes

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18
Q

What is uraemic frost?

A

Urea deposits from sweat crystallise on skin

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19
Q

Describe CKD management

A

ACEi/ARB

Renal replacement therapy

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20
Q

What are the complications of CKD?

A

Anaemia

Renal bone disease

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21
Q

How is CKD anaemia treated?

A

Optimise iron status

EPO weekly injection

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22
Q

How is renal bone disease managed?

A

Reduce phosphate and PTH

  • phosphate binder
  • vitamin D
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23
Q

Describe haemodialysis and the associated risks

A

3 sessions/week
requires a fistula in lower arm
Risks - infection, endocarditis, stenosis, hypotension, arrhythmia, thrombus, air embolus, steal syndrome, disequilibrium

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24
Q

Describe the two types of peritoneal dialysis

A

Continuous - drained every few hours

Automated - drained overnight

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25
Q

What immunosuppression is needed after a kidney transplant?

A

Ciclosporin/tacrolimus
Monoclonal antibody
MMF or sirolimus

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26
Q

What drug is given in acute transplant rejection?

A

Steroids

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27
Q

Name the three types of rejection of renal transplant

A

Hyperacute
Acute
Chronic

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28
Q

What will a biopsy of diabetic nephropathy look like?

A

Kimmelstein Wilson lesions - nodular glomerulosclerosis

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29
Q

What is the most common cause of chronic pyelonephritis?

A

Vesicle-ureteric reflux usually presents in childhood with recurrent infection

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30
Q

What causes renal artery stenosis?

A

Atherosclerosis

Fibromuscular dysplasia

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31
Q

How does renal artery stenosis present?

A

HTN, AKI, flash pulmonary oedema, CKD, renal bruit, different sized kidneys

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32
Q

How do you treat renal artery stenosis?

A

Statin
ACE inhibitor
Anti-platelet

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33
Q

What is the appearance of fibromuscular dysplasia on angiography?

A

String bean

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34
Q

How does endothelial or mesangial cell damage present?

A

Haematuria

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35
Q

How does podocyte damage present?

A

Proteinuria

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36
Q

Describe nephrotic syndrome

A

Proteinuria
Hypo-albuminaemia
Oedema

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37
Q

Describe nephritic syndrome

A

Oliguria
Haematuria - red cell casts
Hypertension

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38
Q

Describe IgA nephropathy

A

Most common
Haematuria in young males post URTI
HSP and coeliac
IgA and C3 deposits

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39
Q

How do you treat IgA nephropathy?

A

BP control - ACEi/ARB

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40
Q

Describe minimal change nephropathy

A

Children with nephrotic syndrome
T cell damage - podocytes
Podocyte fusion

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41
Q

How do you treat minimal change nephropathy ?

A

Steroids

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42
Q

Describe focal segmental glomuerulosclerosis

A

Young adults with nephrotic syndrome
Primary
Secondary - HIV, reflux/IgA, heroin, Alports, sickle cell
Sclerosis and complement

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43
Q

Describe membranous nephropathy

A

Adults with proteinuria and nephrotic
Anti-PlA2
Secondary - infection, malignancy, NSAIDs, systemic disease
Thick BM with sub-epithelial deposits

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44
Q

How is focal segmental glomerulosclerosis treated?

A

Steroids
Immunosuppression
50% ESRF

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45
Q

How is membranous nephropathy treated?

A

ACEi/ARB
Immunosuppression - steroids, mab, cyclophosphamide
30% ESRF

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46
Q

Describe rapidly progressive glomerulonephritis

A

Granular casts AKI
Nephritic syndrome
ANCA or goodpastures/SLE

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47
Q

How is RPG treated?

A

Immunosuppression
Plasmaphoresis
RRT

48
Q

Describe post strep GN

A

Young children 7-14 days post strep
Immune complex deposition in glomeruli
Headache, malaise, haematuria, proteinuria, HTN, low C3
‘starry sky’

49
Q

Which chromosomes are linked to polycystic kidney disease?

A

Autosomal dominant - 16 and 4

Recessive - 6

50
Q

Describe autosomal dominant kidney disease

A

Presents with HTN, recurrent UTI, abdominal pain, stones, CKD, berry aneurysms, cysts, valve prolapse

51
Q

What drug can be used in PCKD?

A

Tolvaptan

52
Q

Describe Alport’s

A

X linked dominant type IV collagen

Microscopic haematuria, renal failure, sensorineural hearing loss (bilateral), ocular manifestations

53
Q

What will biopsy of Alports show?

A

Longitudinal splitting of lamina dense

54
Q

Name the stages of AKI

A

1 -
2-
3-

55
Q

How does AKI present?

A

Reduced urine output
Oedema
Uraemia
Arrhythmias

56
Q

State the indications for dialysis in AKI

A

Hyperkalaemia >7
Severe acidosis
Fluid overload
Urea >40

57
Q

Name the pre-renal causes of AKI

A

Hypovolaemia
Hypotension
Renal hypo perfusion

58
Q

What can untreated AKI lead to?

A

Acute tubular necrosis

- muddy brown casts

59
Q

How do you treat pre-renal AKI?

A

Fluid bolus

60
Q

Name the renal causes of AKI

A

Vascular - vasculitis
Glomerular - GN, systemic
Interstitial nerphritis
Tubular injury

61
Q

What causes interstitial nephritis?

A

Drugs
Infection -TB
Systemic - sarcoidosis

62
Q

What causes tubular injury?

A

Ischaemia
Drugs - gentamicin
Contrast
Rhabdomyolysis

63
Q

Describe interstitial nephritis

A

Penicillin, NSAIDs, allopurinol, furosemide, PPI

Fever, rash, eosinophilia, renal impairment , hypertension

64
Q

What causes post renal AKI?

A

Obstruction

  • calculi
  • stricture
  • cancer
  • extrinsic
65
Q

How do you treat hyperkalaemia?

A

ECG and IV
Calcium gluconate
Insulin/nebulised salbutamol

66
Q

How does hypokalaemia present?

A

Muscle weakness, hypotonia

67
Q

What is the antidote to ethylene glycol?

A

Ethanol

68
Q

What drugs should be avoided in AKI?

A 
ACEi/ARB
Diuretics 
NSAIDs
Gentamicin 
Trimethoprim 
Contrast
69
Q

What bug usually causes prostatitis?

A

E.coli

70
Q

How is bacterial prostatitis treated?

A

Quinolones

71
Q

What is balanitis?

A

Inflammation of the glans

72
Q

What infections can cause balanitis?

A

Candida

Staph

73
Q

How do you treat BPH?

A

Alpha 1 antagonists - tamsulosin
5 alpha reductase inhibitor -finesteride
TURP surgery

74
Q

What can cause acute urinary retention?

A

BPH
Obstruction
Anticholinergic drugs
Neurological cause

75
Q

What is the most common type of prostate cancer?

A

Adenocarcinoma

76
Q

How is prostate cancer investigated?

A

PSA and DRE

MRI and biopsy

77
Q

What grading scale is used in prostate cancer?

A

Gleason’s

78
Q

How do you treat prostate cancer?

A

Prosatectomy
Radiotherapy
Hormone treatment

79
Q

What hormone therapy can be used in prostate cancer?

A

Synthetic GnRH agonist
Anti-androgen
Bilateral orchidectomy

80
Q

What is the most common bladder cancer?

A

Transitional cell

81
Q

What is the biggest risk factor for bladder cancer?

A

Smoking

Occupation risk - hydrocarbon dyes

82
Q

What is schistosomiasis infection associated with?

A

Squamous cell carcinoma

83
Q

How does bladder cancer present?

A

Painless macroscopic haematuria

LUTS

84
Q

How is bladder cancer investigated?

A

Flexible cystoscopy and biopsy
MRI
CT
PET

85
Q

How is bladder cancer treated?

A

Chemo
Cystectomy
Radiotherapy

86
Q

What are the red flags in terms of bladder cancer?

A

Age >45
- visible haematuria
Age >60
- visible haematuria and dysuria/raised WCC
- recurrent or persistent unexplained UTI

87
Q

How do you investigate macroscopic haematuria?

A

> 50 - CT urography flexible cystoscopy
<50 USS and flexible cystoscopy then CT urography
Pregnancy - MR urography

88
Q

Name benign renal tumours

A

Cysts
Oncocytoma
Angiomyolipoma

89
Q

Name three malignant tumours of the kidney

A

Transitional cell - renal pelvis
Renal cell carcinoma - parenchyma
Embyrogenic - nephroblastoma

90
Q

What is the common renal cell carcinoma?

A

Clear cell

91
Q

Who gets renal cell carcinoma?

A

Middle aged men

Smokers

92
Q

What genetic disease is renal cell carcinoma associated with?

A

Von Hippel Lindau

93
Q

State the features of renal cell carcinoma

A 
Haematuria
Loin pain 
Abdo mass 
Pyrexia 
Paraneoplastic syndrome 
Stauffer syndrome
94
Q

What is the typical mets of renal cell carcinoma?

A

Haem spread to lungs causing cannot ball mets

95
Q

How do you assess renal cell carcinoma?

A

USS
CT
Biopsy

96
Q

How is renal call carcinoma treated?

A

Nephrectomy
Ablative
Abjuvant therapy

97
Q

What is nephroblastoma called?

A

Wilm’s tumour

98
Q

Describe nephroblastoma

A

Present in first 4 years of life with a mass, haematuria, pyrexia

99
Q

How is wilm’s treated?

A

Nephrectomy

100
Q

How does colic present?

A

Loin to groin pain with associated nausea, vomiting, haematuria/dysuria

101
Q

What are the common sites of calculi?

A

Pelvic ureteric junction
Pelvic brim
Vesicoureteral junction

102
Q

How do you investigate colic?

A

CT KUB

USS/MRI if pregnancy

103
Q

How is colic treated?

A 
NSAIDs
<5mm pass spontaneously 
alpha blocker - tamsulosin 
Shock wave Lithotripsy 
Ureteroscopy - pregnancy 
Nephrolithotomy
104
Q

How is colic treated in an emergency?

A

Nephrostomy and ureteric catheter and stent

105
Q

What do struvite stones look like?

A

Stag horn calculi - proteus bacteria

106
Q

What is the commonest cause of urethral stricture?

A

Catheterisation

107
Q

How is hydronephrosis investigated and treated?

A

Ix - USS, CT KUB,

Nephrostomy

108
Q

Describe hydrocele

A

Fluid in tunica vaginalis
Soft non tender swelling confined to scrotum
Transluminates
USS and conservative

109
Q

What causes hydrocele in newborns?

A

Patent processus vaginalis

110
Q

Describe varicocele

A

Bag of worms, usually on the left USS and conservative.

Blockage of renal vein can be a cause

111
Q

What type of cancer are most common in the testes?

A

Germ cell tumours

112
Q

How do you investigate testicular cancer?

A

USS

CT

113
Q

How is testicular cancer treated?

A

Surgery
Seminoma - radiosensitive and surgery
Orchidectomy

114
Q

What are the tumour markers in testicular cancer?

A

PLAP - seminoma

AFT and HCG in teratoma

115
Q

What are the two types of priapism and how are they managed?

A

Non-ischaemic - conservative

Ischaemic - emergency aspiration and phenylephrine then surgery

116
Q

What is the most common penile cancer?

A

Squamous cell carcinoma

117
Q

How does penile SCC present?

A

Red, raised, fumigating, foul smelling mass requires penectomy and reconstruction

Renal (20 decks)

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