Renal Flashcards
What is AKI + how to treat
Reduced GFR in 24 hrs Reduced output (<0.5/ 6hrs) Increased creatinine (>50%)
Management:
Give saline
Ca gluconate, insulin and dextrose to protect heart
CKD: define and treat
Decrease in GFR over 90 days I: >90 w damage II: 60-90 w damage III: 30-60 IV: 15-30
Manage: Lifestyle (salt and fluid restriction) ACEis/ARBs NaHCO3 Phosphate binders ferrocarboxylase
Indications for dialysis
K+ >7 or 6.5 w treatment
Pericardial rub/effusion
pH < 7.15
Whats the risk with peritoneal dialysis?
Peritonitis
Treat with vancomycin and gentamicin
Why is haemodialysis considered safer?
Avoids dysequilibrium syndrome
Acute loin to groin pain
Colicky pain
Sweating
Renal stones
Investigate:
CT-KUB
Management:
-Diclofenac
small: Tamsulosin
Large: Percutaneous nephrostomy
Whats the most common form of renal stone?
Caclium oxalate
What does a ‘staghorn’ calculi indicate?
UTI
Proteinuria (1-3g)
Oedema
albumin <30
Nephrotic syndrome
Investigate:
Lipid in urine
Management:
- Fluid and salt restriction
- Diuretics
- Albumin if decreased volume
Hamaturia
Nephritic syndrome
Treat cause
Kids
EM shows podocytes
Minimal change
Steroids and cyclophosphamides
Adults
C3 on immunofluorescence
loss of loops and sclerotic membrane
Focal segmental
Steroids
Infections
PLAR2
Thickened GBM
Basement membrane complexes
Membranous
6 months ACEis
Steroids and cyclophosphamide
IgA deposits
Macroscopic haematuria
Increasesd cells and matrix
Incrased BP
IgA nephropathy
Steroids and cyclophosphamide
ANCA +ve/-ve
nephritic
Rapidly progressive: c-ANCA: Steroids and cyclophosphamide p-ANCA: MPA anti-GBM + linear immuno: GPS Steroids and cyclophosphamide
Haematuria following strep infection
Smoky urine
oedema
lumpy bumpy complex
Post strep
Massive bilateral enlargement
Renal symptoms and polycythemia
AD polycystic kidney disease
PKD1 gene
Investigate: US then CT/MRI
Management:
tolvaptan
lithotripsy for stones
Children
Bilateral enlargement
Slow decline in eGFR
AR kidney disease
PK1HD
US at pregnancy @ 20 weeks
Transplant
Renal symptoms
Sensorineural deafness
anterior lens dislocation
Allports syndrome
X-linked 4 collagen
Biopsy shows thickened membrane
Manage symptoms
Angiokeratomas
Cardio and neuro problems
Anderson-Fabrys
X-lined a galactosidase
Fabryzyme
Fibrosis of tubules of imaging
family history
Medullary cystic kidney
Transplant
Sponge appearance on imaging
Medullary sponge kidney
Excretion nephropathy
Tumour
Fluffy
Stellate central scar
Oncocytoma
Tumour
Bright echo on USS
Angiomyolipoma
Embolise/partial nephrectomy
Bright yellow surface
Heterogenous
VHL loss
Renal vein and PNPS association
Clear cel
Finger like
multifocal
Papillary
Raisinoid nuclei
Perinuclear halo
Chromophobe
Desmoplastic stroma
Collecting duct
Young
Sickle cell
Medullary
Gross haematuria following abdo trauma
Bladder injury
Investigation: CT cystography
If blood at meatus/no catheter (retrograde urethrogram)
How to investigate urethral injury
retrograde urethrogram
Loin pain
haematuria
mass
Suspect cancer
Small: watch/ablate
>3cm: Nephrectomy
Bloods and imaging as follow up
Suprapubic pain
Increased urine frequency
Haematuria
Been on honeymoon/cathetr in
UTI
Tends to be coliforms (E.Coli)
‘staghorn/foul smell: proteus
Investigate:
Dipstick shows WBCs and nitrites
Midstream culture
kAss > 105 in childbearing
Treament: Uncomplicated; Nitrofuratoin/trimethoprim Complicated llower/ pyelo: GP/catheter: Co trimox/co-amox Hospital; Amox + gent
Peeing on sneezing coughing
Stress incontinence (increased pressure)
Investigations: Urodynamic
Management:
Exercises and lifestyle
Always needing to go
Incompleteness
Fullness
Urge incontinence
Pelvic floor
Oxybutin
Mirabegnon
Pain
Hard to urinate
History of BPH
Acute retention Investigation: urogram and cystoscopy Management: Catheterise Tamsulosin If clots: 3 way catheter
Man who worked in dye industry and smoked a lot
Suprapubic pain
painless haematuria
recurrent UTIs
Bladder cancer
(Usually transitional cell but can be squamous)
Investigations: CT halo sign
Management:
lower: cystectomy
Upper: intravesical chemo
Bell clapper deformity
Adolescent
Pain at night
Testicular torsion
-ve cremasteric reflex
D-US
2/3 point fixation
Undescended testes, HIV
Slow growing mass in balls
Testicular cancer Seminoma: potato non-seminomatous: More aggressive Increased PLAP a feto if yolk sac Bhcg if trophoblast
Treatment: Orchidectomy
Radio if semino, chemo if not
Hard painless lump on dick
SCC/BCC appearance
Penile cancer
Imaging of lower abdomen
circumcise/resurface/glansectomy/penilectomy lymphadenectomy
Swelled foreskin following catherisation
Paraphimosis
Iced glove
Granulated sugar
puncture skin
Erection > 48 hrs
Priaprism
Isch: Compartment syndrome
NI: trauma
Investigations:
Aspirate blood and colour duplex
Management:
aspirate
Phenylephrine (NI)
‘Bag of worms’ in balls
Valsalva makes it pulsate
Variocoele
US to check further up as could be malignancy sign
Incomplete dribbling
weak stream
Straining
BPH (hormonal imbalances increases central and peripheral zones)
Investigate:
PR
PSA
Rx:
Tamsolusin
finasteride
TURP
Asymptomatic
Raised PSA
Craggy mass on PR
Prostate cancer
(adenocarcinoma thats mutlifocal and affects peripheries)
TRUS biopsy
Management:
Conservative
5 a reductase
Cancer treatment
