Renal Flashcards
Pre-renal causes of acute kidney injury
dehydration haemorrhage sepsis cardio-renal hepato-renal
Renal cause of AKI
glomerulonephtis
interstitial nephritis
acute tubular necrosis
vascular - renal vein thrombosis
post-renal cause of AKI
renal stones
prostate hypertrophy
bladder/cervical/prostate cancer
what is interstitial nephritis typically related too
new medications
e.g. antibiotics, NSAIDs, diruetics
what is a buzzword for interstitial nephritis
urine eosinophilia
what is typical history of acute tubular necrosis
Hx of hypotension, fluid depletion, nephrotoxics
what is common results of acute tubular necrosis
low urine osmolality [due to impairment in concentrating urine]
increased urinary sodium
how does renal vein thrombosis present
flank pain + haematuria
often mistaken for renal calculi
think if patient is at risk i.e. SLE
Mx of AKI
catheterise + accurate fluid balance
causes of chronic kidney disease [6 causes]
hypertension renovascular diabetes reflux glomerulonephritis PCKD
how is secondary hyperparathyroidism Tx
due to Vit D deficiency
i.e. replace Vit D
how is tertiary hyperparathyroidism Tx
phosphate binders
parathyroidectomy
how does hypertensive disease affecting the kidneys present
proteinuria [NOT haematuria]
both kidneys will be similar in size
Mx = control BP
how does renovascular kidney disease present
older patients, M > F
abdominal bruit
majority present with chronic renal failure
what might precipitate someone with renovascular kidney disease presenting with AKI
starting nephrotoxic drug ie. ACEi
Ix for renovascular kidney disease and results
1st line = renal ultrasound (see different size kidneys)
Gold standard = MR Renal Angiography
Mx for renovascular kidney disease
Conservative e.g. statin, manage BP
how does diabetic kidney disease present
microalbuminaemia [NO haematuria]
IX and Mx for diabetic kidney
Ix = Urine albumin to creatinine ratio
Mx = glycaemic control, anti-hypertensives (ACEi)
what is inheritance pattern for PCKD
autosomal dominant
Sx of PCKD
Abdo pain, Haematuria, Hypertension, Abdominal Mass
Typically have a FMHx of sudden death in exam questions
Ix for PCKD
1st line = renal USS
Mx for PCKD
control BP
analgesia - avoid NSAIDs
what is the 2 typical presenting symptoms of nephritic syndrome
haematuria
hypertension
what is the 2 typical presenting symptoms of nephrotic syndrome
proteinuria
oedema
common nephritic syndromes
Rapidly progressive GN
IgA nephropathy
Alport syndrome
common nephrotic syndromes
Minimal change disease
Membranous GN
Focal Segmental Glomerulosclerosis
Amyloidosis
Diabetic Nephropathy
What causes a mixed nephritic and nephrotic picture
Diffuse proliferative GN
Membranoproliferative GN
Post-Strep GN
Presentation, causes, and treatment of Rapidly progressive GN
Presentation = rapid onset, AKI
Causes
- Goodpastures
- ANCA positive vasculitis
Tx
- high dose steroids
- cyclophosphamide
what antibody is associated with Goodpastures
Anti-GBM antibodies
what are the 2 ANCA positive vasculitis that cause Rapidly progressive GN
Granulomatosis with polyangiitis (formerly called Wegener’s)
Eosinophilic granulomatosis with polyangiitis (EGPA) (formerly called Churg Struss)
- associated with pANCA
how does IgA nephropathy present and how is it treated
presentation = young adult, haematuria following URTI
Tx = supportive
how does diffuse proliferative GM present
Post-streptococcal
common in SLE or patients on drugs post-kidney-transplant
hows does membranoproliferative present
following renal transplant
steroids may be effective
who gets minimal change nephrotic syndrome and what is Tx
children
have normal biopsy result
Tx = steroid
what is the commonest cause of nephrotic syndrome in the UK
membranous GN
what are causes of membranous GN
infections
rheumatoid drugs (gold/pencillamine)
malignancy
1/3 resolve
1/3 proteinuric
1/3 CKD
what is the Tx of membranous GN
Mx = steroids + immunosuppressants
what is the commonest cause worldwide of nephrotic syndrome and what is it associated with
focal segmental GM
idiopathic
secondary to HIV, heroin
Mx of focal segmental GM
steroids and immunosuppressants
what are people with nephortic syndrome at increased risk of and why
arterial and venous thrombus
due to lack of anti-thrombin
what is a mnemonic to remember causes of haematuria
TITS tumour infection trauma stones \+ GM/PCKD
what does painless haematuria suggest
GM
Cancer
what does painful haematuria suggest
Infection
Stone
how is macroscopic haematuria investigated
if OVER 50
1st line = cystoscopy
2nd line = CT urography
if UNDER 50
1st line = cystoscopy
2nd line = USS of kidneys
3rd line = only do CT if above Ix are normal
what is the typical presentation of renal cell carcinoma
triad = haematuria, abdo pain, mass
left testicular vein»_space; variocele
Ix of RCC
1st line = USS
Gold standard = CT + biopsy
CXR = shows cannon ball mets
Mx of RCC
Radial Nephrectomy +/- radiotherapy, chemotherapy
what is the typical presentation of bladder cancer, most common type and risk factors
haematuria, recurrent UTIs
Transitional cell carcinoma
smoking, dye industry
Ix for bladder cancer
cystoscopy and biopsy
Mx for bladder cancer
TIS/Ta/T1 = resection of bladder tumour
T2-3 = radial cystectomy
T4 = palliative chemo/radiotherapy
what is the typical presentation of prostate cancer and most common type
Haematuria, LUTS, bone pain
adenocarcinoma
how do you investigate prostate cancer
PSA and Digital Rectal Exam
TRUS and biopsy
Mx of prostate cancer
organ confined = radiotherapy, prostatectomy, watching
locally advanced = radiotherapy + hormonal therapy
mets = hormonal therapy, orchidectomy
what are the two types of testicular cancer and what age groups do they present in
teratoma
= 20-30 y/o
seminoma
= 30 + y/o
RF for testicular cancer
undescended testis
infant hernia
Ix for testicular cancer and tumour markers
USS + biopsy
Teratoma = AFP, HCG
Seminoma = PLAP, HCG
Mx of testicular cancer
Teratoma = chemo
Seminoma = orchidectomy
buzzwords for hydrocele
on USS it transilluminates
“can’t get above it” on examination
need to exclude tumour as hydrocele can develop secondary
what is a varicocele and how does it present
Dilated scrotal venous plexus
Feels like sac of worms
Left side more commonly affected
where is an epididymal cyst found and what is Ix
Found separate from the body of the testicle
Usually posterior
U/S main Ix
what is typical presentation of testicular torsion
Puberty
Spontaneous – sudden onset
O/E: Tender, swollen testis, reddening of skin, lifting testis increases pain
Lack of cremastic reflex
what is seen on USS of testicular torsion
avascular
Mx of testicular torsion
Emergency surgery - orchidopexy
what does “blue dot” sign on upper pole of testis suggest
Torsion of appendage
what is presentation of Epididymitis
Hx of UTI/Catheterisation
Cremastic reflex present
Elevation of testis helps pain
Ix for Epididymitis
USS = shows increased blood flow
Can be related to STI, so send urine for chlymadia
Mx for Epididymitis
Doxycycline < 35 (covers STI)
Ofloxacin >35
what anti-hypertensive drug is shown to slow the rate of decline in renal function in diabetics
ACEi - ramipril
Recent sore throat + nephritic syndrome = ?
IgA Nephropathy
Patient prescribed Amoxicillin + present later with nausea, SOB, diffuse rash + HTN + elevated eosinophil count = ???
Acute interstitial nephritis secondary to amoxicillin.
what is Cryoglobulinaemia
causes membranoproliferatuve glomerulonephritis
i.e. presents as a mixed Nephritic/Nephrotic pic
associated with Hep C
how does Cryoglobulinaemia present
gangrene = large leg ulcers
purpura = multiple purpuric rashes
SOB = due to PE. Increased risk of thrombus.
common nephritic syndromes
Rapidly Progressive GN
IgA nephropathy
Alport Syndrome
common nephrotic syndrome
Minimal change - kids
Membranous GN - commonest cause in UK
Focal segmental GN = commonest worldwide
Diabetic nephropathy
common mixed nephrotic and nephritic syndromes
Diffuse proliferative GN
Membranoproliferative GN
Post-Strep GN
which test is useful when determining whether there is prerenal uraemia or acute tubular necrosis?
urinary sodium
what are the eGFR variables
CAGE
= creatinine, age, gender, ethnicity
what do you see on microscopy in nephritis syndromes
red cast cells
what do “muddy brown casts” in the urine suggest
acute tubular necrosis
Ix for TCC
1st line = cystoscopy + biopsy
2nd line = CT urogram
3rd line = CT/MRI
Mx of BPH
1st line = alpha blocker e.g. doxazozin, tamsulosin
2nd line = 5 alpha reductase inhibitor
e.g. dutasteride, finasteride
what are the most common types of renal stones
calcium oxalate
mx of renal stones
analgesia = IM or IV diclofenac
stone < 5mm will pass spontanteously
stone > 5mm requires medical explusion i.e. nifidipine or shockwave lithrotripsy
tumour markers for seminoma and teratoma
seminoma = PLAP and bhcg
teratoma = AFP
patient with proteinuria + HTN = ?
ACE i
patient with AKI and hyperkalaemia = diagnosis
goodpastures
RA with GN
amyloidosis
HTN + IHD = ?
renal artery stenosis
what passes through cell membrane readily
cations
1st line Ix for hydrocele
doppler USS with colour
how do TZD work and what are there side effects
work by inhibiting sodium reabsorption at distal convoluted tubule
s,e, = low na and potassium, high calcium, gout, impaired glucose tolerance, impotence
how do loop diuretics work and what are there side effects
work by inhibiting Na-K-Cl co transporter in the thick ascending loop of henle, reducing reabsorption of Na-Cl
s.e. = low sodium, low potassium, low magnesium, low calcium, ototoxic, hyperglycaemia, gout
how do potassium sparing diuretics work and what are there side effects
sodium channel blockers or aldosterone antagonist
s.e. = hyperkalaemia, gynaecomastia, metabolic acidosis
where does acetazolamide work on kidneys
proximal tubular and increases secretion of K, Na, and H2O
