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Renal Flashcards

1
Q

Causes of AKI

A

Pre- renal (decreased vascular flow)

Renal (damage to glomerulus, intersitium or vessels)

Post-renal- blockage of urinary tract

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2
Q

Pre-renal causes of AKI

A
  • hypovolaemia (dehyd, haemorrhage, D+V, burns, shock)
  • reduced CO- HF, MI, sepsis
  • Meds- ACEI, ARB, NSAIDs, loop diuretics, aminoglycosides
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3
Q

Renal Causes of AKI

A
  • acute tubular necrosis
  • *- vasculitis
  • Glomerulonephritis
  • *- infiltration- amyloidosis, myeloma, renal cancer
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4
Q

Post-renal causes of AKI

A
  • Intrinsic- stones, clot, UT tumour

- Extrinsic- prostate, neurogenic bladder, blocked catheter

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5
Q

Presentation of AKI

A
  • reduced UO
  • colour change of urine (dark, brown)

Fluid overload

  • Peripheral oedema
  • pulm oedema- SOB, orthopnoea, PND, cough, crackles)

Uraemia

  • confusion
  • fatigue
  • drowsiness, GCS
  • N+V
  • seizures
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6
Q

Diagnostic criteria fro AKI

A

1 of:

  • raised Cr >=26 in 48hrs
  • > =50% rise in Cr above baseline
  • UO <0.5ml/kg/hr for at least 6 hours
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7
Q

definition of oliguria

A

<1ml/kg/hr infants

<0.5ml/kg/hr children

Adults:
<400-500ml daily in adults
17-21ml/hour
0.3-0.5ml/kg/hr

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8
Q

ix for ?AKI

A
  • UO
  • FBC, UE, CRP, Coag, LFT, CK
  • *- urinalanysis
  • *- immunology (autoantibs)
  • renals USS
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9
Q

what urinanalysis results would suggest different causes of AKI

A
  • negative- pre-renal
  • blood and protein- glomerular
  • white cell- infection/intersitital nephritis
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10
Q

what clasificaiton is used for AKI (stages)

A
  • KIDGO
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11
Q

complications of AKI

A
  • anaemia (EPO lacking)
  • hyperkalaemia
  • metabolic acidosis
  • pulm oedema
  • uraemia pericarditis
  • total renal failure
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12
Q

Management of AKI

A

Pre-renal cause

  • IV fluids
  • Sepsis 6
  • major haemorrhage protocol

Renal

  • stop meds
  • steroids

Post-renal

  • catherterise
  • surgery

General

  • fluid balance (BP, skin turgor, JVP, fluid chart)
  • monitor Na, K, Ca, Cr, glucose
  • tx hyperkalaemia
  • refer if no ID cause/moderate AKI

severe- haemodialysis

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13
Q

what is acute tubular necrosis

A
  • ischaemic or nephrotoxic injury to tubular epithelial cells causing AKI
  • results in detachment from BM
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14
Q

sx of acute tubular necrosis

A
  • *- hypotension, fluid depletion
  • exposure to nephrotoxic substances- contrast, aminoglycoside, abx, CT
  • oligo/anuria
  • *- poor oral intake, anorexia
  • dizziness, malaise
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15
Q

ix ?acute tubular necrosis

A
  • urinanalysis- muddy brown casts (epithelial cells)

* *****- urine Na conc, urine osmolality (ie conc)– high

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16
Q

management of acute tubular necrosis

A
  • fluid balance

- remove toxic agents

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17
Q

definition of anuria

A

<100ml/day

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18
Q

what is the most common cause of CKD

A

diabetes

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19
Q

causes of CKD

A

diabetes
hypercholesterolaemia
HTN
glomerular disease

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20
Q

presentation of CKD

A
  • asx in stages 1-4
  • N+V, diarrhoea, anorexia, wt loss
  • **- polyuria, nocturia, haematuria
  • oedema, pleural effusions (SOB, cough, chest pain, orthopnoea)
  • HTN
  • *- bone pain, # (Ca, phosphate reab issues)
  • *- prox muscle weakness (Ca, reabs issues)
  • neuro- polyneuropathy, confusion
  • uraemic pericarditis- chest pain worse on insp and lying), coughing
  • skin pigmentation/darkening- pigments that are usually excreted are retained
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21
Q

ix ?CKD

A
  • UE
  • FBC- anaemia
  • HbA1c, lipids
  • PTH, Ca, Phosphate, vit D
  • urinanalysis- proteinuria, haematuria
  • urine albumin-Cr ratio– >3mg/mmol clinically relevant pronteinuria
  • renal USS- obstruction, FH PCKD
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22
Q

Classification of CKD

A 
1- eGFR >90 plus kidney damage (strctural/haematuria/proteinuria >3m)
2- eGFR 60-89 plus kidney damage
3a- eGFR 45-59 
3b- eGFR 30-44
4- eGFR 15-29
5- eGFR <15
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23
Q

management of CKD

A
  • monitor eGFR and alb-Cr ratio
  • smoking, alcohol, wt/diet
  • avoid NSAIDs and other nephrotoxics
  • pneumococcal and flu jabs
  • bisphos, vit D and Ca supplements
  • PO iron, IV iron, recombinant EPO/erythropoietic stimulatign agent
  • manage HTN
  • statins
  • antiplatelets
  • renal replacement
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24
Q

indications for renal replacement therapy

A

Severe AKI

  • unresponsive acidosis
  • unreposnsive electrolyte abnormalities, esp hyperkalaemia
  • oedema
  • uraemia, seizure, GCS, encephalopathy
  • pericarditis

LT
- CKD stage 5

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25
types of renal replacement therapy
Intermittent haemodialysis- - AV fistula * *- 3-4 times p/w, 3-4 hours - infection, thrombosis, aneurysm in fistula, stenosis, STEAL syndrome (distal limb ischaemia), **high output HF (increased venous retrun to heart) Peritoneal dialysis - pt can do in own time, independence - bacterial peritonitis, peritoneal sclerosis, wt gain, **LT ascites Continuous- - on ward, more unwell pts - no toxin build up
26
what would suggest O/E of a renal transplant
- mass palpable in iliac fossa (usually R) - Rutherford Morrison (reverse hockey stick ie long curved scar, usually in RIF). - may have palpable AV fistula - may have mutiple abdo scars due to dialysis insertion/exit sites (peritnoeal)
27
pathopysiology of renal arteyr stenosis
- atherosclerosis - impaired renal BS - juxtaglom apparatus detects - renin released - RAAS activated - HTN
28
RAAS system
- low BP detected by juxtoglomerulus apparatus - renin released - angiotensinogen--> angiotensin I - ACEI causes angio I--> II - angio II causes aldosterone from adrenals plus vasoconstriction - alosterone-- reabs Na and water
29
where is angiotensinogen released from
liver
30
sx of renal artery stenosis
* **Flash pulm odema (recurrent) - dyspnoea - orthopnoea - cough- frothy, blood - wheezing - weak, thirst, confusion, irritable (hypernatraemia) - twitches, cramps, paralysis, arrhythmias (hypokalaemia) * *- confusion, tremor (metabolic alkalosis) - double vision, headaches
31
signs of renal artery stenosis
- sudden onset HTN - tx resistant HTN - worsening eGFR (ischaemia)- esp after starting ACEI deranged U&Es - metabolic alkalosis - HTN retinopathy on fundocscopy
32
ix ?renal artery stenosis
- UE, aldosterone to renin ratio - renal USS - duplex/doppler US - CT/MRI angiography
33
tx renal artery stenosis
- diuretics - angioplasty, stenting - lifestyle - manage diabetes - antiplatelets, statins
34
presentation of glomerulonephritides
- asx - nephritic or nephrotic syndromes - chronic/end-stage- anaemia, bone disease
35
ix ?glomerulonephrtides
- bloods- inflam markers, protein levels, antibodies | - renal biopsy
36
What is Nephrotic Syndrome
- large proteinuria (>=3.5g/day) AND - hypoalbuminaemia (<=30g/L) - cause by non-proliferative glomerulonephritis - also has hyperlipidaemia- liver compensates fro reduces albumin by also increasing lipid production - loss of Ig proteins - loss of antithrombotic proteins
37
sx nephrotic syndrome
- oedema- ascites, effusion - immunosupression, recurrent infections - clotting (urinary loss of antithrombotic proteins, increased prod of prothombotic factors)- renal vein thromb, PE, DVT - frothy urine (proteinuria)
38
What is nephritis syndrome
- small proteinuria - haematuria (micro or macro) - reduced renal function-- reduced UO-- HTN +- oedema - caused by proliferative glomerulonephritis - red cell casts in urine (indicate glomerular damage)
39
Name some non-proliferative glomerulonephritis
- focal segmental glomerulosclerosis - minimal change - membranous glomerulonephritis
40
what type of renal syndrome do non-proliferative glomerulonephritides cause
- nephrotic
41
who does focal segmental glomerulosclerosis affect
adults
42
pathophysio of focal segmental glomerulosclerosis
- non proliferative - segmental scarring of glomeruli and fusion of foot processes - idiopathic - HIV, lupus, reflux nephro
43
who does minimal changes disease tend to affect
2-6yo
44
causes of minimal change disease
- idiopathic - paraneoplastic- Hodgkins - drugs
45
sx of minimal change disease
- oedema / wt gain | - in a child
46
pathophysio of membranous glomerulonephritiis
- non-proliferative - IgG deposition, thickening of glomerular cap wall - glomerular PLA2R antigen targetting - mostly caused by autoimmune disease - can also be caused by infection, drugs, tumour
47
presentation of focal segmental glomerulosclerosis and membranous glomerulonephritis
- facial swelling - oedema - HTN - renal failure (reduced UO)
48
who does membranous glomerulonephritis tend to affect
adults, slow
49
ix of non-proliferative glomerulonephritides/nephrotic syndromes (focal segmental glomerulosclerosis, minimal change, membranous)
- urinanalysis- large proteinuria - PLAR2 ab in urine (membranous) - renal biopsy
50
management of non-proliferative glomerulonephritides/nephrotic syndromes (focal segmental glomerulosclerosis, minimal change, membranous)
- prednisolone cyclophosphamide/ciclosporin - salt/fluid restriction - correct cause (infection, drug, autoimmune disease)
51
what would yuo see on renal biopsy of the different non-proloferative glomerulonephritides
focal segmental glomerulosclerosis - segmental scarring of glomeruli - fusion of foot processes minimal changes - no changes on light micro - effacement of podocyte foot process on electrone - no deposits or ig complements Membranous - Ig deposits on immunofluoresent staining - thickened BM
52
Name proliferative glomerulonephritis
- IgA (berger's) - post- strep - anti-glomerular BM - rapidly progressive
53
what renal syndrome do proliferative glomerulonephritides tend to cause
nephritic
54
what is igA nephropathy
- igA deposits - proliferative glomerulonephritis - occurs post- URTI
55
sx of igA nephropathy
- frank haematuria - after URTI - can cause henoch-schonlein purpura in children- deposits in skin, GI tract
56
management f igA nephropathy
- ARB, ACEI (BP control) - low cholesterol diet - immunosupresison- steroids, cyclophosphamide, azathioprine for remission
57
most common proliferative glomerulonephritis
igA nephropathy/Berger's
58
most common non-proliferative glomerulionephritis
adult- focal segmental glomerulosclerosis children- minimal change
59
ix for any cause of ?nephritic syndrome/proliferative glomerulonephritis (frank haematuria)
- dipstick - renal biopsy- to find cause - serology for autoab
60
what is post-strep glomerulonephritis
- proliferative glomerulonephritis - immune glomerular injury triggered by strep infection (2w following) - generally self limiting
61
what is the specific antibody found in post- strep glomerulonephritis
anti-streptococcal antibody titres
62
management of post-strep glomerulonephritis
fluid balance supportive self limiting
63
what is anti-glomerular basement membrane disease
- autoimmune attack of basemement membrane antigens located in glomeruli and alveoli
64
sx anti-glomerular BM disease
- nephritic syndrome- haematuria, HTN, oedema | - haemoptysis, cough, SOB- Goodpasture's syndrome!
65
what is a sepcific antibody found in anti-GBM disease
- anti-GBM antibodies
66
renal biopsy findings of the different nephritic, proliferative diseases
IgA- mesangial cells and matrix, crescents, igA deposits Post-strep- exudative and proliferative, subepithelial humps anti-GBM- igG deposits along basement membrane
67
What vasculitic diseases can affect the kidneys?
- necrotising small vessel vasculitis | - granulomatosis with polyangitis (wegner's)
68
sx of necrotising small vessel vasculitis
rash sinusitis malaise, fever, wt loss
69
tx of necrotising small vessel vasculitis/ granulomatosis with polyangiitis
- steroids - cyclophosphamide - metho, azathioprine
70
sx of granulomatosis with polyangitis (wegner's)
sinusitis glomerulonephritis- proteinuria, haematuria cough, haemoptysis purpura, arthritis, scleritis/episcleitis fever, malaise, weakness, wt loss
71
What is haemolytic uraemic syndrome
shiga toxin /verotoxin producing e.coli - thrombin and fibrin deposition in renal, GI and CNS microvasculature - haemolysis - plts sequestered
72
sx of haemolytic uraemic syndrome
- after e.coli infection- gastroeneritis - bloody diarrhoes, pain, vomiting - haematuria - oliguria - jaundice - anaemia sx
73
ix for haemolytic uraemic syndrome
- low plt, low Hb, elevated LDH, raised WCC - red cell fragments on blood film - rise in Ur and Cr - LFTs to ddx HELLP - CRP - clotting- reduced values - stool PCR, urine culture - urinanalysis- haematuria, proteinuria
74
tx haemolytic uraemic syndrome
- fluid and electrloytes - anti-HTNs - dialysis - plasma exchange - liver, kidney transplants
75
what is lupus nephritis, sx
- lupus (fever, malaise, joint pain, malar rash) | - haematuria, proteinuria (forthy), HTN, oedema
76
tx lupus nephritis
- BP ctornol - electrolyte and fluid - steroids, cyclophosphamide
77
what is fanconi syndrome
- inadequate reabs in the Prox renal tubules | - caused by hypoxia, drugs, genetics, infiltration (myelome, wilsons)
78
sx of fanconi
- polyuria, polydipsia, dehydration - rickets and osteomalacia (loss of phosphate) - electrolyte disturbances-- hypokalaemia
79
tx fanconi syndrome
- replace electrolytes and fluids | - kidney transplant
80
what inheritance pattern is PCKD
dominant OR recessive!
81
presentation of autosomal dominant PCKD
asx unless cysts large/haemorrhagic - loin pain - haematuria - stones - HTN - cyst infection- fever, pain, sepsis - UTI, pyelonephritis
82
management of dominant PCKD
- annual monitoring USS< BP, UE - drink water - HTN control - tx infections - CT guided cyst aspiration - tolvaptan- slows growth - renal replacement therapy
83
sx of recessive PCKD
- affects fetus - oligohydramnios - underdeveloped lungs infance - abdominal mass - resp failure - portal HTN (cirrhosis) - underdeveloped ear cartiliage, low set ears, flat nasal bridge
84
tx recessive PCKD
- tx renal failure, portal HTN | - renal replacement- most will dies in childhood if dont have this
85
what is alport syndrome
x linked - defect in type IV collagen - affects glomerular BM, cochlea, eyes
86
sx alport
- haematuria, proteinuria - sensorineural deafness - cataracts, corneal erosion later in life
87
management of alport syndrmoe
ACEI renal replacement therpay renal transplant
88
ix for inhertied renal disease (PCKD, alport)
UE, urinanalysis USS genetic testing renal biopsy
89
cell type of renal cancer
95% RCC
90
sx renal cancer
2/3 are asx - haematuria - flank pain - abdo mass - HTN - anorexia, wt loss
91
ix ?renal cancer
- HTN- aggressive (renin) - FBC- polycythemia due to EPO - ESR, UE - ALP (bony mets) - renal USS - CT/MRI
92
what is the 2ww criteria for ?RCC
>=45 yo and unexplained frank haematuria without UTI OR frank haematuria that perissts/recurs after successful tx of UTI
93
tx RCC
- surgical- nephrectomy | - CT/RT resistant
94
what is a wilms tumour
nephroblastoma - children - embryonal tumour of the kidney
95
sx wilm's tumour
- abdo mass - otherwise well child - haematuria - HTN
96
ix ?wilms tumour
- US/CT/MRI abdo | - assess function of contralateral kidney
97
tx wilms tumour
CT excision, nephrectomy RT
98
what is rhabdomyolysis
- breakdown of damage skeletal muscle - causes myoglobin release - kidney damage
99
causes of rhabdomyolysis
- trauma (crush, burns, ischaemia) - heat (lightning, heat stroke) - exertion (long lie, shivering, seizures) - genetic disorders in metabolism - hypothyroidism - DKA - electrolyte imbalances - DUchenne - infection - inflammation - drugs
100
what drugs may cause rhabdomyolysis
- statin (safety net muscle pain) - cyclosporin - erythro - colchicine - cocaine, ampehtamines, ecstasy, LSD
101
sx rhadomyolysis
- weakness - soreness - bruising - dark urine - fatigue, malaise, fever, N+V, - confusion, agitation
102
ix ?rhabdomyolysis
- CK - myoglobin- serum and urine - K- may leak from injured tissue - Cr
103
tx rhadomyoloysis
- IV fluids stat - sodium bicarbonate meds- binds to myoglobin and alkalanises the urine - diuretics - tx and monitor for hyperkalaemia, hypocalacaemia - dialysis
104
sx acute retention
- urgency, but cannot urinate - lower abdo pain.discomfort - normal renal function
105
sx chronic retention
- polyuria (8x p/d) - hesitancy - weakn/intermittent stream - feeling need to urinate post-mic - nocturia - leakage - urge incontinence - cant tell when bladder is full - mild discomfort lower abdo/pelvis
106
ix to differentiate acute and chronic retention
Residual volume >1L in chronic <1L in acute Kidney function deranged in chronic normal in acute
107
what is high pressure urinary retention
- chronic retention with high intra-vesical pressure | - back up to kidneys- BL hydronephrosis
108
causes of retention
Obstruction - stones - strictures - constipation - mass in pelvis/GI - blood clot - foreigh bodies - urethritis, cystitis, balanitis, prastatitis Meds - amphetamines - Anticholinergics - sypathomimetics - muscle relaxants - MSADs - antipsychotics - tricyclics - opioids Neuro- CNS damage, diabetes, MS, parkisons Iatrogenic- spinal, joint surgery BPH, prostate cancer, penile cotnriction bands, meatal stenosis, paraphimosis/phimosis Gynae cancers, prolapse
109
name some antimuscarinic/anticholinergic drugs
- Antihistamines- promethazine, hydoxyzine, chlorpheniramine - oxybutynin, solifenacin - procyclidine (parkinsons) - tiotropium/irpatropium - atropine
110
anticholinergic drug mechanism
block the parasympathetic nervous system: - block cholinergic or acetylecholin receptors - antimuscarinics block muscarinic receptors - antinicotinics block nicotinic receptors
111
effects of anticholinergic drugs on the body
- decreased smooth muscle motility in UT and increase tone of sphincters contorlling urination - increase the heart rate, - minimize vestibular issues - help with motor sx in parkinsonss - decrease gastric acid secretion - relax muscles in airways
112
SE anticholinergics
Can't pee, can't see, can't spit, can't shit - dry mouth, sore throat - urinary retention - mood changes, hallucinations, confusion - above are sx of an overdose too
113
ix for retention
- genital and rectum - urinanalysis - post void residual volume, urodynamic testing - cystoscopy - USS, CT
114
tx retention
- 2 way catheter - surgical dilatation - analgesia - acute- alpha-adrenoreceptor blocker (doxazosin, tamsulosin) - chronic- intermittent catheterisation, indwelling Men - alpha adrenoceptor blocker (alfuzosin, doxazosin, tamulosin-- selective alppa1) - bethanechol chloride - 5alpha reductase inhib- finasteride - surgery
115
post obstructive diuresis
- UO >200ml/hr over 2 hours | - can cause electrloyte disurbance and hypotension
116
management of post obstructive diuresis
- monitor (bloods, wt, ABG, obs) - USS renal - CT KUB - IV fluid relplacement, hartmans 50% of UO - catheter- indwelling - never TWOC
117
Hydronephrosis- what is it?
UT obstruction cause increased pressure in the kidneys - kidney distension - damage and loss of function
118
sx hydronephrosis
- flank/back pain- can be dull if chronic - N+V - fever - infants- listelessness, FTT
119
ix ?hydronephrosis
- USS- distended - urogram - CT/MRI if ?cancer - creatinine - urinanalysis- ??infection
120
tx hydronephrosis
- watch and wait if mild - preventative abx - anatomical correction - surgery to unobstruct
121
sx of renal vein thrombosis
- loin/flank pain - oliguria - haematuria - N+V - may also have PE - asymmetrical lower leg oedema- back flow of venous blood - frothy urine if due to nephrotic syndrmoe
122
signs of renal vein thromb
- - lef variocele if L renal vein thrombosed - dilated abdo veins - peripheral oedema - proteinuria
123
ix ?renal vein thrombosis
``` Cr, urinary protein doppler USS IV urogram CT/MRI ?cancer biopsy if ?nephrotic syndrome ```
124
management of renal vein thrombosis
- warfarin - streptokinase to lyse if acute - statin - ACEI/ARBC or proteinuria - tx underlying cause - thrombectomy - surgery- IVC filters, nephrectomy
125
Where to loop diuretics act in the kidneys, how do they work
- loop of henle- thick ascending - inhibit NKCC2 transporter - stop Na, K and Cl reabs - reduced water reabs
126
SE loop diuretic
- hypokalaemia- stops K reabs
127
Where do thiazide- like diuretics act in the kidney, mechanism of action
DCT NaCa cotransporter inhibition- less Cl ions and Na reabs from tubule into blood Less water reabs
128
SE thiazide like diuretics
- gout flare | - hyperglycaemia
129
egs of thiazide like diuretics
indapamide | bendroflumethiazide
130
EGs of aldosertone antagonsists
spironolactone | eplerenone
131
location of action of aldosterone anatgonsists
DCT- inhibit aldosterone from binding | prevents water and Na reabs
132
SE of alosetrone anatgonsists
Hyperkalaemia | agranulocytosis
133
SE of ACEI
dry cough | hyperkalaemia
134
SE ARB
hyperkalaemia
135
eg of ACEI
ramipril | - pril
136
eg of ARB
losartan candesartan - sartan
137
CCBs mechanism of action
block Ca channels on BV and heart | relaxes smooth muscle
138
eg of CCBs
amlodipine | verapamil
139
SE CCBs
- peripheral oedema - flushing - constipation
140
Sx of pyelonephritis
- fever, N+V, aching, fatigue, confusion - abdo/flank pain - dysuria - cloudy urine, haematuria, pyuria - urgency/frequency - fishy odour
141
organisms that commonly cause pyelonephritis
Gram -ve - e.coli - proteus - klebsiella - enterbacter
142
ix ?pyelonpehritis
- urinanalysis - if catheter- check - bloods, culture - -> can make dx if loin/flank pain and confirmed UTI diagnostic uncertainty: - CTKUB ?stone - kidney USS if recurrent, voiding custourethrography - DMSA- radionucleotide
143
tx pyelonephritis in non pregnant women, men, indwelling catheters
1st line - cefalexin 500mg BD 7 days - coamox 500/125mg TDS 7 days - trimethoprim 200mg BD 14 days - cipro 500mg BD 7 days
144
tx pyelonephritis in pregnant women
cefalexin 500mg BD 7 days
145
what are kidney stones often made up of
- Ca oxalate - Ca phosphate - uric acid- dont show on XR - struvite (mg, ammon, phos) - cysteine - Xanthine- dont show on XR
146
sx kidney stone
- flank pain - becomes severe - renal colic- spasmodic - loin to groin - haematuria
147
ix kidney stone
CT KUB | urinanalysis- blood
148
tx stone
- <5mm- can pass (CCBs, alpha adrenergic eg tamsulosin) - hydration - analgesia - potassium citrate reduce formation - lithotripsy - surgery and stent
149
sx stress incontinence
- physical stress - coughing, sneezing, laughing, bending. lifting, jumping, running, having sex - muscles that support urethra are weak
150
sx of urgency incontinence/OAB
- sudden urge to urinate due to bladder contracting
151
sx overflow incontinence
- dribbling after micturition | - due to obstruction
152
medications that can cause incontinence
- diuretics - antihypertensives - sleeping tablets - sedatives - muscle relaxants
153
food,drink that can cause incontinence
- caffeine - fizzy drinks - chocolate, - chillis, spice - citrus, vit c - alcohol
154
conditions/diseases that can cause incontinence
- neuro - stones, UTI - obstruction (tumour, constipation, prostate - cauda equina - retention (nocturnal) - prolapse
155
ix incontinence
- bladder diary - physical exam- pelvic floor, PR - diptick - USS bladder (overflow, retention) - cystoscopy - urodynamics
156
tx stress incontinence
- pelvic floor exercises - topical oestrogen - pessary/urethral insert - bulking agents injected - surgery- sling - catheter - absorbent pads
157
tx overactive bladder
- bladder training - anticholinergics- oxybutynin, solifenacin - mirabegron- beta-3-adrenergic agonist - topical oestrogen - imipramine- tricyclic - botox catheter - absorbent pads
158
tx cystitis
- trimethoprim 200mg BD 3 days OR - nitro 100mg BD for 3 days If recurrent - trimethoprim 200mg within 2 hours of sex - 6m course of trimethoprim or nitro 100mg at night
159
what is interstitial cystitis, sx
chronic, mech unknwn - urgency, frequency, nocturia - suprapubic/pelvic pain - may rdiate to groin, sacrum, vagina - pain worse when bladder full - dysuria - pain better post void - sx worse during menstruation - dyspareunia - often coincides with functional issues, SLE, asthma, TMJ
160
ix ?intersitial cystitis
rule out other causes: - urinanalysis - cervical swab (STI) - urodynamics - men- urethral swabs, prostatic secretion cultures-- chronic prostatits - cystoscopy with biopsy for diagnosis
161
tx intersitial cystitis
- reduce caffeine, alcohol, acidic foods and drink - stress - analgesia - amytriptyline,. cimetidine - pentosan - polysulfate sodium - oxybutynin - gabapentin - ciclosporin - intravescical lidocaine, botulinum toxin - surgical ablaiton, augmentation cystoplasty

Finals (15 decks)

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