Renal Flashcards

Question

Nephrolithiasis: Dx

Answer 1

Pain pattern - analgesia delayed to allow dx US CT (faster) Urinalysis (hematuria?, infection, pH, crystals) IVP - Intravenous pyelogram - not used anymore- iv contrast medium

Answer 2

Supportive > address pain and N&V Narcotics (morphine) and antispasmodics (buscopan) Most passed/voided sponteously (<5mm) Identify stone to id cause (diet change & increase fluid intake)

Answer 3

acute loss of renal failure - abrupt onset typically reversible Decreased GFR (hr or days) Fluid & electrolyte imbalance & azotemia Progression to anuria if no fx oliguria: 100-400mL/day anuria: <100mL minimum of 400mL/day avoids azotemia

Answer 4

Mostly caused by ischemia, hypotension & hypovolemia Pre-renal Intra-renal Post-renal

Answer 5

Pre-renal: dehydration- hypovolemia & hypotension; decreased renal perfusion Intra-renal: eg. glomerulonephritis acute renal damage > necrosis - initiating phase -tubular damage -Maintenance phase - problem persists - decreased GFR, oliguria, azotemia, edema, pulmonary congestion - recovery phase - repair with gradual increase of GFR Post-renal: obstruction of urine flow (eg. BPH)

Answer 6

oliguria or anuria fluid-electrolyte imbalance - pH azotemia edema, HTN, proteinuria, hematuria

Answer 7

``` (BUN, *Creatinine, *GFR & *urinary output) RIFLE categories: Risk of renal Fx Injury in the kidney Failure of kidneys Loss of renal fx End stage of renal failure (ESRF) ``` Depends on measurements of * RIFLE helps to understand what tx or management NEW MARKERS: IL18 - mediator released by proxima tubule in early renal ischemia

Answer 8

``` Stat intervention to reverse Fluids & lytes (caution d/t renal failure - risk of exacerbation) renal diet - cautions about proteins intermittent dialysis - hemodialysis - peritoneal dialysis ``` CRRT ( continuous renal replacement therapy) - hemodynamic instability - usually in ICU

Answer 9

Long term - progressive - gradual - stages dictated by GFR levels Irreversible damage 1) Diminished renal reserve:GFR < 50% (N= 120-130) no mfts of renal failure 2) Renal insufficiency: GFR -20%-50% not adequate, but kidneys still working 3) Renal failure: GFR <20% End-stage <5%

Answer 10

Most common primary neoplasms of younger children May occur in one or both kidneys Histologically the tumour resembles normal fetal tissue Association with other congenital abnormalities WT1 gene in Ch. 11

Answer 11

Stage 1: tumour is limited to kidney; can be excised with renal capsular intact Stage 2: extension of the tumour into renal capsule; can be excised Stage 3: extension of tumour but confined to the abdomen Stage 4: hematogenous metastasis (involves lung commonly)

Answer 12

Asymptomatic Large abdominal mass HTN (d/t increased renin secretion) Some children may present with abdominal pain, vomiting or both

Answer 13

Sx Chemotherapy Radiation Tx

Answer 14

Onset: 55yo-84yo Approx. 90-95% of renal tumours Idiopathic Possible correlation with heavy smoking and renal CA, obesity in women, environmental exposure (heavy metals, asbestos, ..)

Answer 15

``` Clear cell carcinoma Papillary tumours Chromophobic Oncocytomas Collecting duct tumours ```

Answer 16

``` Silent disorder in early stages When advanced: -hematuria -flank pain -presence of palpable mass ```

Answer 17

US CT Scan MRI

Answer 18

Sx - radical nephrectomy with lymph node dissection 5 year survival rate - 90% If tumour has not extended the renal capsule If so it drops to 30% survival rate

Answer 19

``` Most common cause of UT CA Fall into 2 major groups - Low grade non invasive - High grade invasive (worse prognosis) Idiopathic Evidence suggests carcinogens excreted (eg. Smoking, chronic bladder stones, infections, ..) ```

Answer 20

``` Painless hematuria (may be intermittent) Frequent, urgency, dysuria ```

Answer 21

Cytologic studies Excretory urography Cystoscopy Biopsy

Answer 22

``` Depends on extent of lesion Endoscopic resection Diathermy for removal of tumours Segmental Sx resection External beam radiation ```