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Belle Phase 2a > Renal > Flashcards

Renal Flashcards

1
Q

Benign prostatic hyperplasia Px

A

Old Age
Nocturia
Hesistancy
Weak stream

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2
Q

Testicular torsion presentation

A

MEDICAL EMERGENCY
Typically teenage male

Acute, severe pain in groin area
Red and swollen scrotum (unilateral)
Cremasteric reflex ABSENT on affected side
Prehns sign NEGATIVE

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3
Q

Epididymitis and testicular torsion differential

A

Prehn’s sign is positive in epididymitis (relief of pain) and negative in testicular torsion (exacerbation of pain)

Cremasteric reflex (stroke thigh = testicle contracts and rises) is negative in testicular torsion

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4
Q

Kidney stone presentation and gold standard investigation

A

Unilateral severe pain down the side of abdomen
Episodic with episodes not lasting too long
“worst pain ever felt”
Nausea with pain

GOLD STANDARD investigation: non-contrast CT of the kidneys, ureter and bladder (NCCT-KUB)

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5
Q

CKD GFR stages

A 
G1: >90 (normal)
G2: 60-90
G3a: 45-59
G3b: 30-44
G4 (severe): 15-29
G5: <15 = dialysis or kidney transplant
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6
Q

IgA nephropathy

A

Haematuria
Hypertension
Urinalysis: mild proteinuria with RBC casts (nephritic)

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7
Q

Nephritic syndrome causes

A

Renal:
IgA nephropathy

Systemic:
Post-streptococcal glomerulonephritis
Goodpasture’s
SLE

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8
Q

Nephrotic syndrome causes

A

Renal disease disrupting kidney function:
Minimal change disease
Focal segmental glomerulosclerosis
Membranous nephropathy

Secondary causes: DDANI (Diabetes, Drugs, Autoimmune, Neoplasia, Infection)

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9
Q

Pyelonephritis (summary)

A

Fever, nausea (systemically unwell)
Unilateral back pain
Dipstick urinalysis: positive for leukocytes, nitrites, blood

Empirical Abx: Ciprofloxacin

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10
Q

AKI secondary to sepsis Tx

A

Insulin + dextrose (HYPERKALAEMIA)
Stop aspirin
Give fluids (dehydration)
Sodium citrate (acidosis)

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11
Q

Gonorrhoea

A

Organism: Neisseria gonorrhoea

Gram stain appearance: Gram negative (pink) diplococci

Presentation: dysuria, discharge

Treatment: ceftriaxone IM

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12
Q

Nephrotoxic drugs contraindicated in AKI

A

NSAIDs: reduce prostaglandin production = vasoconstriction of afferent arteriole = reduced perfusion = decreased GFR

ACEi/ARB: Blood pressure drops = less blood forced into bowman’s capsule = decreased GFR

Aminoglycosides

Loop diuretics

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13
Q

Renal AKI

A

Glomerulonephritis
Small vessel vasculitis
Acute tubular necrosis
Acute interstitial nephritis

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14
Q

Post-renal AKI

A

BPH
Kidney stones
Ureter strictures

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15
Q

Bladder cancer Px and Ix

A

Haematuria
Frequency
Weight loss without pain

Investigation: cytoscopy

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16
Q

Bladder cancer

A

Px: painless haematuria, frequency, weight loss

Ix: flexible cystoscopy

Mx:

surgical: TURBT (low grade, non-muscular), radical cystectomy (severe, muscular)
medical: chemotherapy

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17
Q

Most common cause of glomerulonephritis

A

IgA nephropathy (Berger’s disease)

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18
Q

Oxybutynin in urge incontinence

A

Anti-muscarinic/cholinergic drug

Inhibits PNS - decreases detrusor excitability, preventing symptoms of urgency

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19
Q

Side effects of oxybutynin

A 
SNS:
Constipation
Dry mouth
Dry eyes
Dilated pupils/blurred vision
Tachycardia
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20
Q

Prostate cancer Px and Ix

A

Urgency, nocturia, weight loss, pain

GOLD STANDARD investigation: Transrectal US guided biopsy (Gleason grading)

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21
Q

PSA screening: positives and negatives

A

Non-specific (false positives), over-treatment

Inexpensive, convenient, early detection

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22
Q

Grading vs staging in cancer

A

Grade: microscopic appearance

Staging: size and spread of tumour

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23
Q

Four functions of the kidney

A

Water/hormone homeostasis
Removal of waste/toxins
RBC production (erythropoietin)
Activate Vitamin D

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24
Q

AKI Diagnostic criteria

A

Any one:

  • rise in creatinine of >26 in 48 hours
  • > 50% rise in creatinine in 7 days
  • fall in urine output to less than 0.5 for more than 6 hours (stage 1) or 12 hours (stage 2)
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25
Q

Px: T2DM, HTN, low urine osmolality, high urine Na, hyperkalaemia

Pre-renal, renal, post-renal?

A

Renal

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26
Q

Px: Normal Na, raised urea, raised creatinine, responds well to fluid therapy

Pre-renal, renal, post-renal?

A

Renal

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27
Q

Px: Loin to groin acute colicky pain, microscopic haematuria

Pre-renal, renal, post-renal?

A

Post-renal

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28
Q

AKI Mx

A

Fluid balance
Treat HYPERKALAEMIA
Treat underlying cause

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29
Q

CKD Mx

A

Slow the progression

  • DM Tx
  • HTN Tx
  • Glomerulonephritis Tx

Reduce CVD risk
- Atorvastatin

Manage complications e.g.

  • Mineral bone disease (low Vit D)
  • HTN
  • Proteinuria
  • Anaemia
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30
Q

Lower urinary tract symptoms

A

Storage: frequency, urgency, nocturia, incontinence

Voiding: hesitancy, poor stream, straining, terminal dribble

Haematuria

DDx: UTI, BPH, prostate cancer

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31
Q

BPH Ix

A

DRE (SMOOTH enlarged prostate)
PSA

Mid stream sample (exclude infection)
Biopsy (exclude malignancy)

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32
Q

Prostate cancer treatment

A

Localised: radical prostatectomy
Advanced: GnRh agonist (Zoladex)

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33
Q

Most common type of prostate cancer

A

Adenocarcinoma

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34
Q

Hydrocele

A

Abnormal collection of fluid in the tunica vaginalis

Soft, non-tender swelling

Mx = Conservative (most resolve by 2 years old)

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35
Q

Varicocele

A

Abnormal enlargement of the testicular veins “bag of worms”

Ix: US and Doppler

Mx: Conservative

Note: left testicular vein drains into left renal vein, right testicular vein drains into inferior vena cava

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36
Q

Testicular torsion complication

A

Infarction of the testicle

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37
Q

Ratio used to calculate renal function

A

Urea:creatinine

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38
Q

CKD dietary changes

A 
Low protein (ammonia excretion) 
Low potassium (cardiac arrythmias)
Low sodium (hypertension)
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39
Q

CKD risk factors

A 
Older age
DM
HTN
Progressive AKI
FHx
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40
Q

BPH Tx

A

1st line: Tamsulosin (alpha blocker)

2nd line: Finasteride (5 alpha reductase inhibitor)

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41
Q

Epididymal cyst (summary)

A

Most common cause of scrotal swelling

Lump found in posterior aspect of testicle

Ix: US

Mx: dissolve in 10 days

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42
Q

Testicular cancer (summary)

A

Painless lump
Hydrocele
Gynacomastia

Ix: US

Tx: chemo

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43
Q

Nephritic syndrome

A

INFLAMMATION within the kidney

Defining features:

  • Haematuria
  • Oliguria (due to reduced GFR)
  • Hypertension (due to fluid overload)
  • Proteinuria (but less than nephrotic)
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44
Q

Nephrotic syndrome

A

Issue with the filtration barrier (pOdOcytes = nephrOtic) = leaking of proteins into the urine

Triad of characteristics:

  • Proteinuria
  • Hypoalbuminaemia (due to loss in urine)
  • Oedema (due to loss of oncotic pressure)
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45
Q

Px of nephrotic syndrome

A 
Oedema 
Frothy urine (proteinuria)
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46
Q

Nephrotic syndrome Ix

A

Urinalysis
Urine protein:creatinine ratio (degree of proteinuria)
Blood tests (renal function, elevated lipids)
Renal biopsy (to look for cause)

47
Q

Nephrotic syndrome Mx

A 
Fluid and salt restriction 
Loop diuretics (oedema)
Treat cause
ACEi/ARB (reduce protein loss) 
Manage complications
48
Q

Complications of nephrotic syndrome

A

Hyperlipidaemia: loss of albumin = increased cholesterol formation (Tx = statins)

VTE: due to increased clotting factors (Tx = heparin)

49
Q

Nephritic syndrome Ix

A

Diagnostic test: kidney biopsy

Urinalysis (haematuria)
Bloods (elevated ESR and CRP; anaemia reflecting systemic disease)

50
Q

Nephritic syndrome Mx

A

Treat underlying cause
ACEi/ARB (reduces proteinuria and preserves renal function)
Corticosteroids (reduce inflammation causing damage)

51
Q

Causes of glomerulonephritis

A

IgA nephropathy
Goodpastures disease
Post-streptococcal glomerulonephritis
Henoch Schoenlein purpura

52
Q

IgA nephropathy (summary)

A

Deposition of IgA into the mesangium of the kidney = activates complement pathway = glomerular injury
Develops during infection of mucosal lining (IgA mediated)
Presents asymptomatically with microscopic haematuria
Diagnosis: biopsy

53
Q

Minimal change disease

A

Makes up 25% of adult cases of nephrotic syndrome
Most common type seen in children

Normal appearance on microscopy but abnormal function
Diagnosis: biopsy
Tx: high dose steroids (prednisolone)

54
Q

Focal segmental glomerulosclerosis (summary)

A

Aetiology: can be idiopathic or secondary to HIV, heroin, lithium
Diagnosis: biopsy (presence of scarring of the glomeruli i.e. focal sclerosis)
Tx: steroids in idiopathic, ACEi/ARB for BP control

55
Q

Membranous nephropathy

A

25% of adult nephrotic syndrome

Immunologically mediated (IgG)

Diagnosis: renal biopsy (thickened glomerular basement membrane)
- Antiphospholipase A2 receptor antibody found in 70-80% of patients

Tx: ACEi/ARB, in patients with high risk of progression: prednisolone and cyclophosphamide

56
Q

Bladder cancer risk factors

A

Smoking (increases risk 2-4 times) - accounts for HALF of male cases
Age >55
Pelvic radiation
Exposure to occupational carcinogens
Bladder stone (due to chronic inflammation)

57
Q

Most common cause of nephritic syndrome in high income countries

A

IgA nephropathy

58
Q

Henoch Schoenlein purpura

A

Small vessel vasculitis that affects the kidney and joints due to IgA deposition

More common in males post upper resp tract infection

PURPURIC RASH on legs, NEPHRITIC symptoms, and joint pain

Diagnosis: kidney biopsy

Mx: corticosteroids and ACEi/ARB

59
Q

Post-streptococcal glomerulonephritis

A

Nephritic syndrome following an infection (3-6 weeks prior, impetigo or strep throat)
Usually affects children
Deposition of strep antigen complexes in the glomeruli = inflammation and damage
Dx: evidence of strep infection + haematuria
Tx: Abx and supportive care

60
Q

Bladder cancer Px

A

PAINLESS HAEMATURIA
Pelvic mass
UTI symptoms without bacteriuria

61
Q

Bladder cancer Ix

A

Urinalysis (sterile pyuria)
Diagnostic: cystoscopy and biopsy
CTT urogram: allows staging

62
Q

1st line Tx bladder cancer

A

Transurethral resection or local diathermy

63
Q

Renal cancer

A

90% = proximal tubular epithelium (renal cell carcinomas)
Age 55, F > M
Spread to bone, liver, lungs

64
Q

RF Renal Cell Carcinoma

A

Haemodialysis
Smoking
Hypertension

65
Q

Px Renal Cell Carcinoma

A

Haematuria
Flank pain
Palpable abdominal mass

66
Q

Renal Cell Carcinoma Ix

A

CT/MRI
Bloods: polycythaemia (erythropoietin secretion)
Raised BP (increased renin secretion)
Ultrasound

67
Q

Bladder cancer parasite

A

Schistosomiasis

68
Q

Score to predict survival in RCC

A

Mayo score
stage 1: partial or radical nephrectomy
stage 3: radical nephrectomy and adrenalectomy

69
Q

5 most common pathogens in UTIs

A 
KEEPS:
Klebsiella (PREGNANT WOMEN) 
E. coli (MOST COMMON CAUSE) 
Enterococci
Proteus
Staphylococcus coagulase -ve
70
Q

UTI Px

A

Voiding: FUND

- Frequency, Urgency, Nocturia, Dysuria

71
Q

Pyelonephritis

A

Infection and inflammation of the kidney

Most often due to ASCENDING UTI

72
Q

Pyelonephritis Px

A

Triad:
Loin pain
Fever
Polyuria

73
Q

Gold standard for Dx of causative agent in UTIs

A

Mid stream urine and culture

74
Q

Pyelonephritis Ix

A

Urinalysis (WCC and microscopic haematuria)
Mid stream urine and culture
Bloods (elevated CRP)
Renal USS (rule out urinary tract obstruction/stones)

75
Q

Pyelonephritis Tx

A

Cefalexin (7-10 days)

Trimethoprim or amoxicillin if sensitive

76
Q

Cystitis Tx

A

Trimethoprim or nitrofurantoin (3 days)
AVOID trimethoprim in pregnancy
- Avoid nitrofurantoin at term in pregnancy

77
Q

Cystitis

A

Urinary bladder infection

Most common in young sexually active women

78
Q

Cystitis RFs

A

History of UTI
Diabetes
Frequent sexual intercourse
Pregnancy

79
Q

Prostatitis

A

Inflammation and swelling of the prostate gland

Most common causative agent: E. Coli

80
Q

Prostatitis Px

A

DRE: VERY TENDER prostate
Systemic Sx: fever, chills, malaise
VOIDING symptoms

81
Q

Prostatitis Ix

A

Urinalysis and culture (blood, WBCs, bacteria)

82
Q

Prostatitis Tx

A

Ciprofloxacin or levofloxacin (14 days)

83
Q

Most common bacterial STI and causative organism

A

Chlamydia trachomatis

84
Q

Chlamydia symptom in men

A

Testicular pain

50% are ASx

85
Q

Chlamydia symptom in women

A

Vaginal discharge and dysuria

70% are ASx

86
Q

Chlamydia diagnostic test

A

Nucleic acid amplification testing

87
Q

Chlamydia Mx

A

1st line: DOXYCYCLINE
Breastfeeding, pregnancy, allergy: AZITHROMYCIN

Avoid sex until Tx finished
Contact tracing

88
Q

Second most common STI in UK and causative organism

A

Neisseria gonorrhoea (Gram -ve diplococci)

89
Q

Gonorrhoea Ix

A

Nucleic acid amplification testing (NAAT)

Microscopy and culture (G-ve diplococci)

90
Q

Gonorrhoea Tx

A

1st line: Ceftriaxone IM dose

2nd line: azithromycin

91
Q

Syphilis Tx

A

Benzanthine penicillin + azithromycin

92
Q

Urolithiasis

A

The presence of crystalline stones in the urinary tract

OKA: renal calculi, nephrolithiasis

93
Q

Three places where you find renal stones

A

Where the ureter narrows:

  • Pelvicoureteric junction
  • Pelvic brim
  • Vesicoureteral junction
94
Q

Composition of renal stones

A

Crystals in supersaturated urine = CALCIUM oxylate (80% of cases)

95
Q

Renal stones RFs

A

Think anything that increases calcium, oxalate or phosphates

Dehydration 
High salt intake 
Hypercalcaemia
Obesity (lowers pH)
Oxalate rich diet
Gout (Uric acid stones)
Thiazide (Uric acid reabsorption)
96
Q

Diclofenac

A

NSAID

97
Q

Adrenal gland layers

A
98
Q

Renal stones Px

A 
Most are asymptomatic 
SEVERE COLICKY UNILATERAL PAIN from LOIN to GROIN
Writhing around in pain
Associated with nausea and vomiting
ASSUME AAA until proven otherwise!
99
Q

Renal stone 1st line diagnostic imaging technique

A

KUB X-Ray (diagnostic for 80% of cases)

100
Q

Renal stone Gold standard imaging technique

A

Non-contrast CT KUB

101
Q

Renal stones Mx

A

STRONG analgesia: diclofenac
Antibiotics
Tamsulosin: relaxes smooth muscle and helps expulsion
Percutaneous nephrolithotomy: used to expel stones over 10mm

Prevention:

  • thiazide diuretics (helps with recurrent stones by reducing calcium levels)
  • hydration, reduce salt and oxalate intake
102
Q

AKI stages

A 
Stage 1: risk
Stage 2: injury
Stage 3: failure
Loss
ESKD
103
Q

CKD Px

A

Pruritis
Fatigue
Oedema
Polyuria

104
Q

2nd line to ACEi due to cough SE

A

Angiotensin II receptor blockers E.g. candesartan

105
Q

Post-strep glomerulonephritis Ix

A

Blood tests (renal function + eGFR)
Urinalysis (blood + protein)
Biopsy (dead bacterial cell + antibodies)
USS

106
Q

Granulomatosis with polyangiitis Px

A

Nasopharynx: saddle nose
Lung: Dyspnoea, Haemoptysis
Kidneys: decreased urine output

107
Q

Goodpastures Px

A

Reduced urine output
Haemoptysis
Oedema
Dyspnoea

108
Q

Testicular seminoma

A

Germ cell tumour

Seminoma cancers NEVER secrete alpha-fetoprotein (AFP)

109
Q

Radiolucent vs radiopaque

A

Radiolucent: allow X-Rays to penetrate through them and expose the receptor

Radiopaque: bony in origin (absorb/stop the penetration of the X-Rays and therefore do not reach the receptor)

110
Q

Uric acid stones on X-Ray

A

Radiolucent

111
Q

Treatment with prognostic benefit in prostate cancer

A

Finasteride: inhibits conversion of testosterone to dihydrotestosterone

112
Q

Uncomplicated UTI

A

Non-pregnant women

Children over 3 months

113
Q

Autosomal dominant polycystic kidney disease mutations

A

PKD1 mutation

PKD2 mutation

114
Q

ADPKD complications

A

Kidney stones
Renal insufficiency
Berry aneurysms
Heart failure (aortic root dilation)

Belle Phase 2a (14 decks)

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