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2a > Renal > Flashcards

Renal Flashcards

1
Q

What is the NICE criteria for AKI?

A
  • Rise in creatinine of >25 micromol/L in 48 hrs
  • Rise in creatinine >50% in 7 days
  • Urine output of <0.5 ml/kg/hr for >6 hrs
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2
Q

What is acute kidney injury?

A

An acute drop in kidney function. Diagnosed by measuring creatinine

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3
Q

How can causes of AKI be classified? Which is most common?

A
  • Pre-renal (most common)
  • Renal
  • Post-renal
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4
Q

What are pre-renal causes of AKI?

A

Due to inadequate blood supply to the kidneys
- Dehydration
- Hypotension
- HF

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5
Q

What are renal causes of AKI?

A

Intrinsic disease leading to reduced filtration of blood
- Glomerulonephritis
- Interstital nephritis
- Acute tubular necrosis

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6
Q

What are post-renal causes of AKI?

A

Obstruction to the outflow of urine causing back-pressure into the kidney
- Kidney stones
- Massess
- Ureter or uretral strictures
- Enlarged prostate or prostate cancer

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7
Q

What is the first step of treating AKI?

A

Correcting the underlying cause:
- IV fluids in pre-renal AKI
- Stop nephrotoxic meds and antihypertensives that reduce filtration pressure
- Relieve obstruction in post-renal AKI

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8
Q

What are complications of AKI?

A
  • Hyperkalaemia
  • Fluid overload
  • Metabolic acidosis
  • Uraemia -> encephalopathy/pericarditis
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9
Q

What are causes of CKD?

A
  • Age related decline
  • Diabetes
  • Chronic HTN
  • Chronic glomerulonephritis
  • PKD
  • Meds
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10
Q

What is required to confirm a diagnosis of CKD?

A

2 eGFR tests 3 months apart

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11
Q

What eGFR would indicate end stage renal failure?

A

eGFR <15

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12
Q

Possible complications of CKD?

A
  • Anaemia
  • Renal bone disease
  • CVD
  • Peripheral neuropathy
  • Dialysis related problems
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13
Q

Why can you get anaemia in CKD?

A

Healthy kidney cells produces erythropoietin which stimulates the production of RBC

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14
Q

General principles of CKD management?

A
  1. Manage cause
  2. General measures - fluid restriction, dietary protein restriction, ACE-In
  3. Treat complications
  4. Dialysis (regular dialysis when GFR <15ml/min and symp/complications of kidney disease)
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15
Q

What are indications for short term dialysis?

A

AEIOU:
- Acidosis (severe and not responding to tx)
- Electrolyte abnormalities (tx resistant Hyperkalaemia)
- Intoxication
- Oedema (severe/unresponsive pulmonary oedema)
- Uraemia (symptoms such as seizures/reduced consciousness)

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16
Q

What is the main indication for long term dialysis?

A

End-stage renal failure (CKD stage 5)

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17
Q

What are the options for long term dialysis?

A
  • Haemodialysis
  • Peritoneal dialysis
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18
Q

How do renal stones present?

A
  • Asymptomatic
  • Renal colic - unilateral loin to groin pain, colicky
  • Haematuria
  • N+V
  • Reduced UO
  • Symptoms of sepsis if infection present
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19
Q

What are the types of renal stones

A
  • Calcium based stones (most common) - hypercalcaemia and low UO are RF, calcium oxalate stones are most common
  • Uric acid - not visible on XR
  • Struvite - produced by bacteria (associated w infection)
  • Cystine
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20
Q

What are two complications of renal stones?

A
  • Obstruction -> AKI
  • Infection -> obstructive pyelonephritis
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21
Q

What is the investigation of choice for renal stones?

A

Non-contrast CT KUB

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22
Q

What is the management of renal stones?

A
  • NSAIDs for pain - IM diclofenac
  • Antiemetics for N+V
  • Abx if infection
  • WW if stone <5mm
  • Tamsulosin - can help aid spontaneous passage of stones
  • Surgical interventions for larger stones/complete obstruction/infection
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23
Q

What advice can you give pts to reduce the risk of recurrent renal stones?

A
  • Increase fluid intake
  • Add fresh lemon juice to water
  • Reduce salt intake
  • Avoid carbonated drinks
  • For calcium stones - reduce intake of oxalate-rich foods (spinach, beetroot, nuts, black tea, rhubarb)
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24
Q

What meds can be used to reduce the risk of recurrence of renal stones?

A
  • Potassium citrate
  • Thiazide diuretics (indapamide)

Both in pts with calcium oxalate stones and raised serum calcium

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25
Q

How do you investigate a man presenting with LUTS?

A
  • Abdo examination
  • DRE
  • Urine dipstick
  • PSA
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26
Q

What is BPH?

A

Hyperplasia of the stromal and epithelial cells of the prostate

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27
Q

What are medical options for managing BPH? What do they do?

A
  • Alpha blockers (tamsulosin) - relax smooth muscle, improving symptoms
  • 5-alpha-reductase-inhibitors (finasteride) - shrink the prostate

Can be used in conjunction, alpha blockers provide more immediate relief

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28
Q

What are side effects of the medications used to manage BPH?

A
  • Tamsulosin = postural hypotension
  • Finasteride = sexual dysfunction (due to reduced testosterone)
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29
Q

What is the most common surgical treatment of BPH?

A

Transurethral resection of the prostate (TURP)

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30
Q

What are risk factors for bladder cancer?

A
  • Smoking
  • Increasing age
  • Aromatic amines exposure in dye and rubber industries (now heavily regulated)
  • Schistosomiasis
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31
Q

What symptom is a red flag for bladder cancer?

A

Painless haematuria

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32
Q

What is used to diagnose bladder cancer?

A

Cystoscopy

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33
Q

What are management options for bladder cancer?

A
  • Transurethral resection of bladder tumour (TURBT)
  • Intravesical chemotherapy - chemo given into bladder via a catheter, after ^ to prevent reoccurrence
  • Intravesical BCG - giving the BCG vaccine into the bladder is thought to stimulate the immune system -> attacks bladder tumours
  • Radical cystectomy
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34
Q

What’s the most common type of bladder cancer?

A

Transitional cell carcinoma

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35
Q

What’s the most common type of renal cell carcinoma?

A

Clear cell

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36
Q

How does renal cell carcinoma present?

A

Triad of:
- Haematuria
- Flank pain
- Palpable mass

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37
Q

Renal cell carcinoma often spreads to the renal vein and then the inferior vena cava. Whats a classic feature of metastatic renal cell carcinoma?

A

’ Cannonball metastases’ in the lungs

38
Q

What are management options for renal cell carcinoma?

A

First line = removal of the tumour:
- Partial nephrectomy
- Radical nephrectomy

Less invasive procedures:
- Arterial embolisation - cutting off blood supply to affected kidney
- Percutaneous cryotherapy - injecting liquid nitrogen to kill tumour cells
- Radiofrequency ablation - putting a needle in the tumour and using an electrical current to kill tumour cells

39
Q

What are risk factors for prostate cancer?

A
  • Increasing age
  • FHx
  • Black African or Caribbean origin
  • Tall stature
  • Anabolic steroids
40
Q

Where does prostate cancer commonly metastasise?

A
  • Bone
  • Lymph nodes
41
Q

What is the issue with PSA testing?

A
  • It is unreliable
  • High rate of false positives and false negatives
42
Q

How does a cancerous prostate feel?

A
  • Firm or hard
  • Asymmetrical
  • Craggy
  • Loss of central sulcus
43
Q

What is the first line investigation for suspected localised prostate cancer?

A

Multiparametric MRI

44
Q

How is prostate cancer diagnosed?

A

Prostate biopsy

45
Q

What is used to look for bony metastases in prostate cancer?

A

Isotope bone scan

46
Q

What grading system is specific to prostate cancer? What does a higher score indicate?

A
  • Gleason Grading System - based on histology from biopsies
  • A higher score indicates the tumour is more poorly differentiate -> worse prognosis
47
Q

What are management options for prostate cancer?

A
  • Watch and wait
  • External beam radiotherapy - directed at prostate
  • Brachytherapy - radioactive seeds implanted into prostate -? delivers targeted continuous radiotherapy
  • Hormone therapy - to reduce level of androgens (prostate cancer is almost androgen dependant)
  • Radial prostatectomy
48
Q

What do most testicular cancers arise from?

A

Germ cells in the testes

49
Q

What age group is testicular cancer most prevalent?

A

15-35

50
Q

What are risk factors for testicular cancer?

A
  • Undescended testes
  • Male infertility
  • FHx
  • Increased height
51
Q

How does testicular cancer present?

A

Painless lump on the testicle

52
Q

What investigation is used to diagnose testicular cancer?

A

Scrotal ultrasound

53
Q

What staging system is used to stage testicular cancer?

A

Royal Marsden Staging System

54
Q

What are management options for testicular cancer?

A
  • Radical orchidectomy +/- prosthesis insertion
  • Chemo
  • Radiotherapy
  • Sperm banking as treatment can cause infertility
55
Q

How can the types of testicular cancer be categorised?

A
  • Seminomas
  • Non-seminomas (mostly teratomas)
56
Q

What are tumour markers for testicular cancer?

A
  • Alpha-fetoprotein (not raised in seminomas)
  • Beta-hCG - may be raised in both types
  • Lactate dehydrogenase (LDH) - non-specific tumour marker
57
Q

What are causes of epididymo-orchitis?

A
  • E. Coli
  • Chlamydia trachomatis
  • Neisseria gonorrhoea
  • Mumps
58
Q

How does epididymo-orchitis present?

A
  • Testicular pain
  • Dragging/heavy sensation
  • Swelling of testicle and epididymis
  • Tenderness on palpation
  • Urethral discharge (think STI cause)
  • Systemic symptoms
59
Q

What is the management of epididymo-orchitis?

A
  • Acutely unwell -> hosp for IV abx
  • Local guidelines for choice of abx
  • If likely enteric organism (e.g. E. coli) -> quinolone abx (e.g. oflaxacin)
60
Q

What are complications of epididymo-orchitis?

A
  • Chronic pain
  • Chronic epididymitis
  • Testicular atrophy
  • Sub-fertility
  • Scrotal abscess
61
Q

What are the most common causes of UTIs?

A
  • E. coli (most common) - found in faeces and spread to the bladder
  • Klebsiella pneumoniae
  • Enterococcus
  • Pseudomonas aeruginosa
62
Q

What at RF for UTIs?

A
  • Sexual activity - spread bacteria around the perineum
  • Incontinence
  • Poor hygiene
  • Urinary catheters
63
Q

What should you look at on urine dipstick if suspecting a UTI?

A
  • Nitrates
  • Leukocytes
  • RBCs

Nitrates are a better indication of infection than leukocytes. NICE indicate nitrates or leukocytes AND RBCs suggest a UTI

64
Q

Which pts with a UTI require a MSU?

A
  • Pregnant pts
  • Pts w recurrent UTI
  • Atypical symptoms
  • No improvement with abx
65
Q

What antibiotics are commonly used in community to treat UTIs?

A
  • Trimethoprim
  • Nitrofurantoin
66
Q

What is the duration of abx for UTIs?

A
  • 3 days - UTI in women
  • 5-10 days - immunosuppressed women, impaired renal function
  • 7 days - men , pregnant women, catheter-related UTIs
67
Q

How does pyelonephritis present?

A
  • Fever
  • Loin pain
  • N+V
  • Systemic illness
  • LOA
  • HAematuria
  • Renal angle tenderness
68
Q

What is the management of pyelonephritis?

A
  • 7-10 abx
  • Cefalexin
  • Co-amox if culture results avaliable
  • Trimethoprim of culture results available
69
Q

How can prostatitis be classified?

A
  1. Acute bacterial
  2. Chronic - >3 months
    - Chronic prostatitis/chronic pelvic pain syndrome (no infection)
    - Chronic bacterial prostatitis (infection)
70
Q

How does prostatitis present?

A
  • Pelvic pain
  • LUTS
  • Sexual dysfunction
  • Pain with bowel movements
  • Tender, enlarged prostate
71
Q

What is the management of acute prostatitis?

A
  • Hosp admission if systemically unwell
  • Oral abx - typically for 2-4 weeks
  • Analgesia
  • Laxatives for pain during bowel movements
72
Q

What is the management of chronic prostatitis?

A
  • Alpha-blockers - relax smooth muscle, help with symptoms
  • Analgesia
  • Antibiotics - if <6 months of symptoms (e.g. trimethoprim/doxycycline for 4-6 wks)
  • Laxatives for pain during bowel movements
73
Q

What are complications of acute bacterial prostatitis?

A
  • Sepsis
  • Prostate abscess
  • Acute urinary retention
  • Chronic prostatitis
74
Q

How does upper urinary tract obstruction present?

A
  • Loin to groin pain
  • Reduced/no UO
  • Non specific symptoms e.g. vomiting
  • Impaired renal function on bloods (raised creatinine)
75
Q

How does lower urinary tract obstruction present?

A
  • Difficulty/inability to pass urine
  • Urinary retention (w an increasingly full bladder)
  • Impaired renal function on bloods (raised creatinine)
76
Q

What is neurogenic bladder?

A

Abnormal function of the nerve innervating the bladder and urethra

77
Q

What are management options for urinary tract obstruction?

A
  • Upper - nephrostomy
  • Lower - urethral/suprapubic catheter
78
Q

What is hydronephrosis? What is the cause?

A
  • Swelling of the kidney (renal pelvis and calyces)
  • Urinary tract obstruction -> back-pressure into the kidneys
79
Q

What is renal tubular acidosis (RTA)?

A

Metabolic acidosis due to pathology in the tubules of the kidneys

80
Q

What are the types of RTA?

A
  • Type 1 - distal tubule cannot excrete H+
  • Type 2 - proximal tubule cannot reabsorb HCO3
  • Type 3 - mixed
  • Type 4 - low aldosterone/impaired aldo function

Type 4 is most common. Know 1/4 for exams

81
Q

What are the features of type 1 RTA?

A
  • High urinary pH
  • Metabolic acidosis
  • Hypokalaemia (failure of H+/K+ exchange)
82
Q

What is the treatment of type 1 RTA?

A

Oral bicarbonate - corrects acidosis and electrolyte imbalances

83
Q

What are the features of type 4 RTA?

A
  • Metabolic acidosi
  • Hyperkalaemia
  • Low urinary pH
84
Q

Why is urinary pH low in types 4 RTA?

A
  • Normally ammonia is produced in the distal tubules to buffer H+ ions and prevent the urine from becoming to acidotic
  • Hyperkalaemia suppresses ammonia production -> urine becomes acidotic
85
Q

What are causes of type 4 RTA?

A

Reduced aldosterone:
- Adrenal insufficiency
- Diabetic nephropathy
- Meds (ACE-In, spironolactone, eplerenone)

86
Q

What is the management of type 4 RTA?

A
  • Manage underlying cause
  • Fludrocortisone for aldosterone deficiency
  • Oral bicarbonate
  • Treatment of hyperkalaemia
87
Q

What is PKD?

A

A genetic condition where healthy kidney tissue is replaced with fluid-filled cysts

88
Q

What are the two types of PKD? Which is more common?

A
  • AD (more common)
  • AR
89
Q

What genes are affected in ADPKD?

A
  • PKD1 gene on chromosome 16
  • PKD2 gene on chromosome 4
90
Q

What are complications of ADPKD?

A
  • Chronic loin pain
  • Hypertension
  • Gross haematuria (when cyst rupture)
  • Recurrent UTI
  • Renal stones
  • End-stage renal failure (occurs at mean age of 50)
91
Q

What are extra-renal manifestations of ADPKD?

A
  • Cerebral aneurysms
  • Hepatic/splenic/pancreatic/ovarian/prostatic cysts
  • MR
  • Colonic diverticula
92
Q

What is the management of PKD?

A
  • Tolvaptan - slow the dev of cyst and progression of renal failure in ADPKD
  • Treat complications e.g. HTN, pain, infections
  • Drainage if symptomatic
  • Dialysis/transplant for end-stage renal failure

Advice:
- Avoid contact sport (cyst rupture)
- Avoid NSAIDs and anticoagulants
- Genetic counselling

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