R&U placement Flashcards
if a pt has eGFR >90, how can they have CKD?
- may have raised albumin
- underlying kidney disease that has not yet affected GFR e.g. polycystic kidney disease
3 main causes of haematuria
- infection
- stones
- cancers
why is hyperlipidemia seen in nephrotic sydrome
loss of cholesterol binding proteins leading to increased free cholesterol in the blood
why might a pt have proteinuria in the nephrotic range but not be otherwise symptomatic (i.e. no nephrotic syndrome)
liver can compensate well for loss of protein
what is pulmonary-renal syndrome
destruction of both the glomerular and alveolar basement membranes resulting in damage to both organs e.g. in goodpasture’s disease
resistant HTN in a young pt - what should be thought for the underlying diagnosis
phaechromocytoma
what are the 3 main electrolyte abnormalities seen in CKD
- hyperphosphatemia
- hypocalcaemia
- hyperkalaemia
what is uremic frost
a rare manifestation of severe azotemia where tiny, yellow-white urea crystals deposit on the skin, resulting in a frosted appearance as sweat evaporate
mgx for hypovolaemic hyponatremia
isotonic saline
mgx for euvolaemic hyponatremia (4)
- treat underlying cause
consider: - fluid restriction
- hypertonic saline
- tolvaptan (vasopressin V2 receptor antagonists -> increases water excretion)
mgx for oedematous hypovolaemia
- fluid restriction
- salt restriction
- diuretics
causes of SIADH (5)
- malignancy
- non-malignant chest disease
- CNS disease
- drugs
- other e.g. intermittent porphyria, surgery
what investigations should be done post finding an RCC
- triple phase CT -> non contrast KUB, contrast, delayed phase (will provide info on collecting system + bladder)
- CT chest (look for primary or mets)
what 2 things is a CT KUB used to look for
- stones
- hydronephrosis
active surveillance vs watchful waiting
active surveillance - curative, catch before becomes life threatening
watchful waiting - palliative, treat if symptoms
what is the bosniack classification
Bosniak classification system of renal cystic masses - divides renal cystic masses into five categories based on imaging characteristics on contrast-enhanced CT, and helps predict a risk of malignancy and suggests either follow-up or treatment
prostate cancer risk factors
- multiple young first degree relatives w prostate cancer
- age
- ethnicity
what area of the prostate does cancer usually arise
the periphery
visible haematuria investigations
- examine + DRE
- flexible cystoscopy
- USS
- CTU
bladder cancer presentation
- haematuria
- recurrent UTI (in men, ppl prone to bladder inflammation)
- storage symptoms
- systemic (weight loss etc. -> late stage)
bladder cancer mgx
surgical
1. TRUBT
2. radical cystectomy
non surgical
3. BCG
4. Intravesical mitomycin C (chemo)
bladder cancer risk factors
- smoking
- age
- exposure to toxic chemicals
- schistosomiasis
testicular cancer markers (3) !
- LDH (lymphone)
- Alpha-fetoprotein (AFP)
- Human chorionic gonadotrophin (HCG)
risk factors for testicular cancer
- Cryptorchidism
- Hypospadias
- Infertility
- Klinefelter’s syndrome
- Tall men
penile cancer presentation
- painless ulceration
- bleeding/abnormal discharge
3 .chronic phymosis (present w ballonitis)
penile cancer risk factors
- uncircumscised (unless they are obese)
- HPV
- lichen sclerosis
- phymosis
- smoking
penile cancer mgx
surgical
1. glansectomy
2. penectomy
3. local inscision (partial glansectomy)
all get primary surgery + DSNB (look for drainage to lymph nodes and removal of any implicated)
testicular cancer presentation
- Testicular lump
- Testicular pain/discomfort
- Back pain, flank pain (indicative of metastasis)
- Lymphadenopathy
- Gynaecomastia
what is the test of choice in testicular cancer
USS - offers excellent visualisation and identifies likely malignant lesions
what makes a substrate an acceptable surrogate for estimating GFR (3)
- under goes glomerular filtration
- tubular handling
- not excreted elsewhere
what substances can be used to measure GFR as a surrogate marker (5)
- inulin (most accurate, but exogenous so only used in research)
- iohexol
- EDTA
- DTPA
- creatnine (the only one naturally present in the body)
why is creatnine not that accurate a measure of GFR
more creatnine is secreted by the tubules into the filtrate => implies GFR is higher than it actually is
how to calculate creatinine clearance from a 24hr urine collection
Cr clearance = ([creatinine in urine] x Vol of urine)/[Cr in serum]
what must be checked as well as absolute creatinine levels
change from prior result e.g. increase for 60 to 90 can be fatal for a pt, despite 90 being in the ref range
when should eGFR be not taken as actual GFR (6)
- AKI
- children
- pregant women
- extremes of body size
- amputees
- malnutrition
how do the triad of nephrotic syndrome relate to each other
GN leads to filtration disruption -> proteinuria -> decrease in circulating protein -> hypoalbuminuria -> decreased oncotic pressure resulting in oedema as water exits the bvs
what are some complications of nephrotic syndrome (3)
- DVT (loss of anti thrombotic factors e.g. antithrombin III)
- infection
- hypercholesterolaemia (increase cholesterol produciton by the liver as it tries to upreg protein synth to compensate for loss)
why should children with a FH of polycystic kidney disease not have an US
high chance of false -ve as cysts only tend to develop later
what is the scar for a kidney transplant
hockey stick scar in illiac fossa
what lifethreatening arrythmia is most common to occur from hyperkalaemia
asystole
what lifethreatening arrythmia is most common to occur from hypokalaemia
VF
hyperkalaemia ECG changes (4)
- tall tented T waves
- broad QRS
- prolonged PR
- “sine wave pattern”
what can be done other than calcium gluconate to increase K+ uptake into the cells (reducing hyperkalaemia)
- Beta 2 stimulation (salbutomol)
- insulin (+dextrose)
what is calcium resonin and what can it be used for
an ion-exchange resin that can be used to increase excretion of K+ -> works slowly so not in emergency situ
pulmonary oedema with AKI mgx
- consider NIV/intubation (after A-E)
- sit up
- loop diuretics (much higher dose than usual)
- nitrates/opiates
- venesection
relation of uremia to pericarditis/pericardial effusion
accumulation of toxic metabolites within the pericardial sac leads to fluid within the pericardial sac
standard bicarbonate vs total bicarbonate
standard - bicarb measured under standard conditions, adjusted for body conditions -> USE STANDARD if given both
total - total HCO3- in blood
what is base excess on ABG
the titratable acidity (or base) of the blood sample -> It is defined as the amount of acid or base that must be added to a sample of oxygenated whole blood to restore the pH to 7.4 at standard conditions
e.g. -2 means 2 mol of alkali needed to make neutral
anion gap on ABG
difference between anion and cations -> helps establish cause of metabolic acidosis/alkalosis
3 functions of the kidneys
- excretory/regulatory (uraemic toxins, fluid, acid/base, electrolytes)
- metabolic function (vit D hydroxylation)
- synthetic function (EPO)
what is renal osteodystrophy
a consequence of CKD when bones become weaker due to increased phosphate, decreased vit D etc.
what might small vessel vasculidities present as initially
pulmonary-renal syndrome
-> if lung and kidney problems seen this indicates a rapidly deteriorating condition that need mgx
what is micro angiopathic haemolytic anaemia
a subgroup of hemolytic anemia where there is fragmentation and hemolysis due to damage of erythrocytes in the small blood vessels -> It is characterized by the presence of red cell fragments or schistocytes on blood film review
what is DIC
Disseminated intravascular coagulation - a widespread hypercoagulable state that can lead to micro- and macrovascular clotting and compromised blood flow
how can DIC lead to the presence of schistocytes
fibrin stands form which can slice RBCs leading to schistocytes
what is haemolytic uremic syndrome
combination of :
1. microangiopathic haemolytic anaemia
2. thrombocytopenia
3. renal failure
polymerisation of clotting components that are released in such large quantities they can’t be broken down in time
usually due to E.coli (be careful of giving abx as death of the bacteria in this case can cause massive release of pre formed toxins into the body)
what is TTP
Thrombotic Thrombocytopenia Purpura -> clotting disorder where thrombi arise in small bvs
assoc w ADAMS13 deficency leading to lack of vWF or ADAMS13 auto-antibody
HUS treatment
supportive - emergency dialysis, treat HTN
why is alkilisation of the urine a treatment for rhabdomyolysis
Administration of Sodium Bicarbonate to increase urine pH is done as this alkalotic conditions reduces the precipitation of myoglobin
what are bence-jones proteins
free light chains that may appear in the urine - seen in multiple myeloma
(now historical test)
primary vs secondary hypertension
how might renal artery stenosis present
- hypertension
- salt and water retention
- “flash pulmonary oedema”
- renal impairment (particularly following ACEi -> should be advised to stop for a few days if unwell)
