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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
Intrinsic causes of AKI
tubular, glomerular, intersticial or vascular pathology
26
Post-renal causes of AKI
urinary tract obstruction
27
Investigations for AKI
Urinalysis, volume status, microscopy, culture for infection, U&Es, FBC, LFT, clotting, CK, ESR, CRP, consider ABG, renal USS
28
Treatment for pre-renal AKI
correct volume depletion with fluids, treat sepsis with ABx
29
Treatment for post-renal AKI
Catheterise, CT of renal tract, investigate obstruction
30
Treatment for intrinsic AKI
Refer to nephrology
31
Complications fo AKI
Hyperkalaemia - arrhythmias Pulmonary oedema Uraemia and acidaemia - may require dialysis
32
Types of renal replacement therapy
Haemodialysis and haemofiltration
33
Definition of CKD
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
Stage 1 kidney disease
GFR >90ml/min
35
GFR 60-89ml/min
Stage 2 kidney disease
36
Stage 3A CKD | Stage 3B CKD
GFR: 45-59ml/min | 30-44 ml/min
37
GFR 15-29 ml/min
Stage 4 CKD
38
Stage 5 CKD
GFR <15ml/min - established renal failure
39
Main causes of CKD
Type 2 diabetes, glomerulonephritis, hypertension, renovascular disease, pyelonephritis, adult polycystic kidney disease (commonest inherited cause)
40
Treatment of CKD
Treat symptoms, then renal replacement therapy/kidney transplant
41
Hyperplasia of glandular elements of the prostate
Benign prostatic hyperplasia
42
Sx of BPH
Frequent urination, nocturia, difficulty starting urination, variability and reduced stream, dribbling, acute retention or overflow incontinence
43
What does BPH feel like on PR exam?
Smooth, enlarged
44
Investigation of BPH
PSA, trans-rectal USS and biopsy - rule out cancer | Mid-stream urine (MSU), U&Es, USS
45
Lifestyle treatment of BPH
reduce coffee, relax when voiding, reduce alcohol intake, train bladder by increasing time between voiding, catheterise is retention is painful
46
Pharmacological treatment of BPH
Analgesics Alpha-blockers (doxazosin) 5alpha-reductase inhibitors (finasteride)
47
Prostate cancer is responsible for what percentage of cancers in men?
7%
48
What % of men have malignant foci within the prostate gland at 80yo?
80%
49
What zone of the prostate does prostate carcinoma usually develop in?
Peripheral zone
50
Most common sites of metastasis of prostate carcinoma
Bones, LNs, rectum, bladder, lower ureter
51
genetic pathology of prostate cancer
Loss of cancer suppressor genes - p53 and cadherin loss
52
Treatment of prostatic cancer confined to the prostate
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
Treatment of metastatic prostatic cancer
Hormonal therapy Symptom relief - analgesia, treat hypercalcaemia, radiotherapy for bony mets Prognosis: 10% die in 6months, 10% live >10yrs
54
Types of bladder carcinoma
Squamous cell carcinoma Adenocarcinoma Transitional cell carcinoma (>90% in UK)
55
Presenting symptoms of bladder carcinoma
Painless haematuria, recurrent UTIs, voiding irritability
56
Risk factors of bladder carcinoma
Aromatic amines (runner industry), smoking, chronic cystitis, schistosomiasis, pelvic irraditaion
57
Complications of cystectomy
May result in sexual and urinary malfunction
58
cell lineage of renal carcinoma
proximal renal tubular epithelium
59
90% of renal cancers are
renal carcinomas
60
Mayo Prognostic Risk Score for Renal carcinoma
SSIGN: | Stage, Size, Grade, Necrosis
61
Classical distribution of renal stones
Pelviureteric junction Pelvic brim Vesicoureteric junction
62
Types of renal stone
Calcium oxalate (75%) Magnesium ammonium phosphate (15%) Urate (5%) Hydroxyapatite (5%)
63
Rx of renal stones
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
First line Rx of BPH and in resistant hypertension
Alpha blockers
65
Alpha blocker
Doxazosin
66
Side effects of doxazosin
Postural hypotenion Dizziness Syncope
67
MoA of Doxazosin
Highly selective alpha1-adrenoceptor antagonism, inducing relaxation - vasodilation and reduces resistance to bladder outflow
68
Metabolism of doxazosin
Hepatic
69
Interaction of doxazosin with anti-hypertensives
Postural hypotension - omit during doxazosin therapy
70
5alpha-reductase inhibitor
Finasteride
71
Second-line treatment for BPH, relief of urinary tract symptoms
Finasteride
72
Side effects of finasteride
Impotence, hair growth (use in male-pattern baldness), reduced libido, breast tenderness/enlargement - can affect patient adherence
73
Contraindications of finasteride
Pregnancy - exposure of male foetus to finasteride may cause abnormal development of external genitalia - pregnant women must not be exposed
74
MoA of finasteride
Inhibit enzyme 5alpha-reductase which converts testosterone to dihydrotestosterone, which stimulates prostatic growth Inhibition reduces prostatic enlargement and improves urinary flow
75
Finasteride metabolism
Hepatic
76
Finasteride excretion
57% faecal, 39% urine

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