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Core Conditions > Renal > Flashcards

Renal Flashcards

1
Q

UTIs more common in men or women

A

Women

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2
Q

main causative organism of UTI

A

E.coli (75-95%) - first line treatment nitrofurantoin/trimethoprim

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3
Q

Pathology of acute pyelonephritis

A

Streaks of pus in renal medulla, small renal cortical abscesses, infiltration of polymorphonuclear leucocytes and polymorphs in the tubular lamina

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4
Q

Reflux nephropathy causes…?

A

Chronic pyelonephritis - common in childhood

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5
Q

Relapse UTI

A

Recurrence of bacteriuria of same organisms within 7 days of completing treatment

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6
Q

Signs of UTI

A

Fever, abdo. pain, foul smelling urine, distended bladder, enlarged prostate

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7
Q

Symptoms of acute pyelonephritis

A

High fever, rigors, vomiting, loin pain, tenderness, oliguria (if AKI), pain radiating along flank towards back, often vomiting
Develop over hours

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8
Q

Symptoms of cystitis

A

frequency, dysuria, urgency, haematuria, suprapubic pain

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9
Q

Symptoms of prostitis

A

Flu-like sx, low back ache, few urinary sx, tender/swollen prostate

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10
Q

Inflammation of kidney tissue, calyx and renal pelvis

A

Pyelonephritis

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11
Q

Most common cause of pyelonephritis

A

E.coli

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12
Q

Untreated pyelonephritis can lead to…

A

urosepsis, kidney failure and death

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13
Q

Symptoms and signs of chronic pyelonephritis

A

persistent flank/abdo. pain, signs of infection (fever, wt. loss, malaise), lower UTI Sx, blood in urine

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14
Q

condition where one or both kidneys become stretched and swollen as the result of a build-up of urine inside them

A

Hydropnephrosis

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15
Q

Symptoms of upper urinary tract obstruction in hydronephrosis

A

loin pain, exacerbated by increased urinary volume, anuria (bilateral obstruction), polyuria (onstruction of renal capacity), fever, sepsis

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16
Q

Symptoms of bladder outflow obstruction in hydronephrosis

A

hesitancy, narrowing and diminished stream, sensation of incomplete voiding, overflow incontinence, increased frequency, irgency, incontinence and dysuria

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17
Q

Investigative signs of hydronephrosis

A

Increased creatinine
Increased K+
Stones/calcification on X ray
Blood in urine

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18
Q

Surgical treatment of hydronephrosis

A

Nephrostomy, removal of calculi

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19
Q

Period of onset of AKI

A

hours to days

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20
Q

Pathology of AKI

A

Failure of renal excretory function due to depression of eGFR, failure of EPO production, vit. D hydroxylation, regulation of acid-base balance and regulation of salt and water balance and BP

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21
Q

Abrupt deterioration in parenchymal renal function, usually reversible over a period of days or weeks

A

AKI

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22
Q

Criteria for diagnosis of AKI

A

rise in creatinine >26 micromol/L in 48h
rise in creatinine >1.5 x baseline
urine output <0.5L/kg for >6h

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23
Q

3 commonest causes of AKI

A

Nephrotoxins
Sepsis
Ischaemia

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24
Q

Pre-renal causes of AKI

A

Renal hypo-perfusion e.g. hypotension and renal a. stenosis

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25
Q

Intrinsic causes of AKI

A

tubular, glomerular, intersticial or vascular pathology

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26
Q

Post-renal causes of AKI

A

urinary tract obstruction

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27
Q

Investigations for AKI

A

Urinalysis, volume status, microscopy, culture for infection, U&Es, FBC, LFT, clotting, CK, ESR, CRP, consider ABG, renal USS

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28
Q

Treatment for pre-renal AKI

A

correct volume depletion with fluids, treat sepsis with ABx

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29
Q

Treatment for post-renal AKI

A

Catheterise, CT of renal tract, investigate obstruction

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30
Q

Treatment for intrinsic AKI

A

Refer to nephrology

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31
Q

Complications fo AKI

A

Hyperkalaemia - arrhythmias
Pulmonary oedema
Uraemia and acidaemia - may require dialysis

32
Q

Types of renal replacement therapy

A

Haemodialysis and haemofiltration

33
Q

Definition of CKD

A

Impaired renal function for >3 months based on abnormal structure/function, or GFR <60ml/min/1.73m2 for >3m with/without evidence of kidney damage

34
Q

Stage 1 kidney disease

A

GFR >90ml/min

35
Q

GFR 60-89ml/min

A

Stage 2 kidney disease

36
Q

Stage 3A CKD

Stage 3B CKD

A

GFR: 45-59ml/min

30-44 ml/min

37
Q

GFR 15-29 ml/min

A

Stage 4 CKD

38
Q

Stage 5 CKD

A

GFR <15ml/min - established renal failure

39
Q

Main causes of CKD

A

Type 2 diabetes, glomerulonephritis, hypertension, renovascular disease, pyelonephritis, adult polycystic kidney disease (commonest inherited cause)

40
Q

Treatment of CKD

A

Treat symptoms, then renal replacement therapy/kidney transplant

41
Q

Hyperplasia of glandular elements of the prostate

A

Benign prostatic hyperplasia

42
Q

Sx of BPH

A

Frequent urination, nocturia, difficulty starting urination, variability and reduced stream, dribbling, acute retention or overflow incontinence

43
Q

What does BPH feel like on PR exam?

A

Smooth, enlarged

44
Q

Investigation of BPH

A

PSA, trans-rectal USS and biopsy - rule out cancer

Mid-stream urine (MSU), U&Es, USS

45
Q

Lifestyle treatment of BPH

A

reduce coffee, relax when voiding, reduce alcohol intake, train bladder by increasing time between voiding, catheterise is retention is painful

46
Q

Pharmacological treatment of BPH

A

Analgesics
Alpha-blockers (doxazosin)
5alpha-reductase inhibitors (finasteride)

47
Q

Prostate cancer is responsible for what percentage of cancers in men?

A

7%

48
Q

What % of men have malignant foci within the prostate gland at 80yo?

A

80%

49
Q

What zone of the prostate does prostate carcinoma usually develop in?

A

Peripheral zone

50
Q

Most common sites of metastasis of prostate carcinoma

A

Bones, LNs, rectum, bladder, lower ureter

51
Q

genetic pathology of prostate cancer

A

Loss of cancer suppressor genes - p53 and cadherin loss

52
Q

Treatment of prostatic cancer confined to the prostate

A

Depends on prognosis, patient preference and comorbidities:
Radical prostectomy
Radical radiotherapy
Hormone therapy - delays progression if unfit for surgery
Active surveillance - if over 70 and low-risk

53
Q

Treatment of metastatic prostatic cancer

A

Hormonal therapy
Symptom relief - analgesia, treat hypercalcaemia, radiotherapy for bony mets
Prognosis: 10% die in 6months, 10% live >10yrs

54
Q

Types of bladder carcinoma

A

Squamous cell carcinoma
Adenocarcinoma
Transitional cell carcinoma (>90% in UK)

55
Q

Presenting symptoms of bladder carcinoma

A

Painless haematuria, recurrent UTIs, voiding irritability

56
Q

Risk factors of bladder carcinoma

A

Aromatic amines (runner industry), smoking, chronic cystitis, schistosomiasis, pelvic irraditaion

57
Q

Complications of cystectomy

A

May result in sexual and urinary malfunction

58
Q

cell lineage of renal carcinoma

A

proximal renal tubular epithelium

59
Q

90% of renal cancers are

A

renal carcinomas

60
Q

Mayo Prognostic Risk Score for Renal carcinoma

A

SSIGN:

Stage, Size, Grade, Necrosis

61
Q

Classical distribution of renal stones

A

Pelviureteric junction
Pelvic brim
Vesicoureteric junction

62
Q

Types of renal stone

A

Calcium oxalate (75%)
Magnesium ammonium phosphate (15%)
Urate (5%)
Hydroxyapatite (5%)

63
Q

Rx of renal stones

A

Encourage passing (usually within 48h) - nifedipine and alpha-blockers promote expulsion
Analgesia
Antibiotics if infection apparent
Can operate if stones are large, multiple or complex
Urgent removal if obstructed and infected

64
Q

First line Rx of BPH and in resistant hypertension

A

Alpha blockers

65
Q

Alpha blocker

A

Doxazosin

66
Q

Side effects of doxazosin

A

Postural hypotenion
Dizziness
Syncope

67
Q

MoA of Doxazosin

A

Highly selective alpha1-adrenoceptor antagonism, inducing relaxation - vasodilation and reduces resistance to bladder outflow

68
Q

Metabolism of doxazosin

A

Hepatic

69
Q

Interaction of doxazosin with anti-hypertensives

A

Postural hypotension - omit during doxazosin therapy

70
Q

5alpha-reductase inhibitor

A

Finasteride

71
Q

Second-line treatment for BPH, relief of urinary tract symptoms

A

Finasteride

72
Q

Side effects of finasteride

A

Impotence, hair growth (use in male-pattern baldness), reduced libido, breast tenderness/enlargement - can affect patient adherence

73
Q

Contraindications of finasteride

A

Pregnancy - exposure of male foetus to finasteride may cause abnormal development of external genitalia - pregnant women must not be exposed

74
Q

MoA of finasteride

A

Inhibit enzyme 5alpha-reductase which converts testosterone to dihydrotestosterone, which stimulates prostatic growth
Inhibition reduces prostatic enlargement and improves urinary flow

75
Q

Finasteride metabolism

A

Hepatic

76
Q

Finasteride excretion

A

57% faecal, 39% urine

Core Conditions (5 decks)

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