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4th Year SB > Renal > Flashcards

Renal Flashcards

1
Q

Pre-renal causes of acute kidney injury

A 
dehydration 
haemorrhage 
sepsis
cardio-renal
hepato-renal
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2
Q

Renal cause of AKI

A

glomerulonephtis
interstitial nephritis
acute tubular necrosis
vascular - renal vein thrombosis

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3
Q

post-renal cause of AKI

A

renal stones
prostate hypertrophy
bladder/cervical/prostate cancer

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4
Q

what is interstitial nephritis typically related too

A

new medications

e.g. antibiotics, NSAIDs, diruetics

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5
Q

what is a buzzword for interstitial nephritis

A

urine eosinophilia

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6
Q

what is typical history of acute tubular necrosis

A

Hx of hypotension, fluid depletion, nephrotoxics

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7
Q

what is common results of acute tubular necrosis

A

low urine osmolality [due to impairment in concentrating urine]

increased urinary sodium

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8
Q

how does renal vein thrombosis present

A

flank pain + haematuria

often mistaken for renal calculi

think if patient is at risk i.e. SLE

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9
Q

Mx of AKI

A

catheterise + accurate fluid balance

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10
Q

causes of chronic kidney disease [6 causes]

A 
hypertension 
renovascular 
diabetes 
reflux 
glomerulonephritis 
PCKD
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11
Q

how is secondary hyperparathyroidism Tx

A

due to Vit D deficiency

i.e. replace Vit D

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12
Q

how is tertiary hyperparathyroidism Tx

A

phosphate binders

parathyroidectomy

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13
Q

how does hypertensive disease affecting the kidneys present

A

proteinuria [NOT haematuria]

both kidneys will be similar in size

Mx = control BP

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14
Q

how does renovascular kidney disease present

A

older patients, M > F
abdominal bruit
majority present with chronic renal failure

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15
Q

what might precipitate someone with renovascular kidney disease presenting with AKI

A

starting nephrotoxic drug ie. ACEi

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16
Q

Ix for renovascular kidney disease and results

A

1st line = renal ultrasound (see different size kidneys)

Gold standard = MR Renal Angiography

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17
Q

Mx for renovascular kidney disease

A

Conservative e.g. statin, manage BP

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18
Q

how does diabetic kidney disease present

A

microalbuminaemia [NO haematuria]

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19
Q

IX and Mx for diabetic kidney

A

Ix = Urine albumin to creatinine ratio

Mx = glycaemic control, anti-hypertensives (ACEi)

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20
Q

what is inheritance pattern for PCKD

A

autosomal dominant

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21
Q

Sx of PCKD

A

Abdo pain, Haematuria, Hypertension, Abdominal Mass

Typically have a FMHx of sudden death in exam questions

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22
Q

Ix for PCKD

A

1st line = renal USS

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23
Q

Mx for PCKD

A

control BP

analgesia - avoid NSAIDs

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24
Q

what is the 2 typical presenting symptoms of nephritic syndrome

A

haematuria

hypertension

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25
Q

what is the 2 typical presenting symptoms of nephrotic syndrome

A

proteinuria

oedema

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26
Q

common nephritic syndromes

A

Rapidly progressive GN

IgA nephropathy

Alport syndrome

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27
Q

common nephrotic syndromes

A

Minimal change disease

Membranous GN

Focal Segmental Glomerulosclerosis

Amyloidosis

Diabetic Nephropathy

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28
Q

What causes a mixed nephritic and nephrotic picture

A

Diffuse proliferative GN

Membranoproliferative GN

Post-Strep GN

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29
Q

Presentation, causes, and treatment of Rapidly progressive GN

A

Presentation = rapid onset, AKI

Causes

  • Goodpastures
  • ANCA positive vasculitis

Tx

  • high dose steroids
  • cyclophosphamide
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30
Q

what antibody is associated with Goodpastures

A

Anti-GBM antibodies

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31
Q

what are the 2 ANCA positive vasculitis that cause Rapidly progressive GN

A

Granulomatosis with polyangiitis (formerly called Wegener’s)

Eosinophilic granulomatosis with polyangiitis (EGPA) (formerly called Churg Struss)
- associated with pANCA

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32
Q

how does IgA nephropathy present and how is it treated

A

presentation = young adult, haematuria following URTI

Tx = supportive

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33
Q

how does diffuse proliferative GM present

A

Post-streptococcal

common in SLE or patients on drugs post-kidney-transplant

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34
Q

hows does membranoproliferative present

A

following renal transplant

steroids may be effective

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35
Q

who gets minimal change nephrotic syndrome and what is Tx

A

children
have normal biopsy result

Tx = steroid

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36
Q

what is the commonest cause of nephrotic syndrome in the UK

A

membranous GN

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37
Q

what are causes of membranous GN

A

infections
rheumatoid drugs (gold/pencillamine)
malignancy

1/3 resolve
1/3 proteinuric
1/3 CKD

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38
Q

what is the Tx of membranous GN

A

Mx = steroids + immunosuppressants

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39
Q

what is the commonest cause worldwide of nephrotic syndrome and what is it associated with

A

focal segmental GM

idiopathic
secondary to HIV, heroin

40
Q

Mx of focal segmental GM

A

steroids and immunosuppressants

41
Q

what are people with nephortic syndrome at increased risk of and why

A

arterial and venous thrombus

due to lack of anti-thrombin

42
Q

what is a mnemonic to remember causes of haematuria

A 
TITS
tumour 
infection 
trauma 
stones 
\+ GM/PCKD
43
Q

what does painless haematuria suggest

A

GM

Cancer

44
Q

what does painful haematuria suggest

A

Infection

Stone

45
Q

how is macroscopic haematuria investigated

A

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

46
Q

what is the typical presentation of renal cell carcinoma

A

triad = haematuria, abdo pain, mass

left testicular vein&raquo_space; variocele

47
Q

Ix of RCC

A

1st line = USS
Gold standard = CT + biopsy

CXR = shows cannon ball mets

48
Q

Mx of RCC

A

Radial Nephrectomy +/- radiotherapy, chemotherapy

49
Q

what is the typical presentation of bladder cancer, most common type and risk factors

A

haematuria, recurrent UTIs

Transitional cell carcinoma

smoking, dye industry

50
Q

Ix for bladder cancer

A

cystoscopy and biopsy

51
Q

Mx for bladder cancer

A

TIS/Ta/T1 = resection of bladder tumour

T2-3 = radial cystectomy

T4 = palliative chemo/radiotherapy

52
Q

what is the typical presentation of prostate cancer and most common type

A

Haematuria, LUTS, bone pain

adenocarcinoma

53
Q

how do you investigate prostate cancer

A

PSA and Digital Rectal Exam

TRUS and biopsy

54
Q

Mx of prostate cancer

A

organ confined = radiotherapy, prostatectomy, watching

locally advanced = radiotherapy + hormonal therapy

mets = hormonal therapy, orchidectomy

55
Q

what are the two types of testicular cancer and what age groups do they present in

A

teratoma
= 20-30 y/o

seminoma
= 30 + y/o

56
Q

RF for testicular cancer

A

undescended testis

infant hernia

57
Q

Ix for testicular cancer and tumour markers

A

USS + biopsy

Teratoma = AFP, HCG

Seminoma = PLAP, HCG

58
Q

Mx of testicular cancer

A

Teratoma = chemo

Seminoma = orchidectomy

59
Q

buzzwords for hydrocele

A

on USS it transilluminates

“can’t get above it” on examination

need to exclude tumour as hydrocele can develop secondary

60
Q

what is a varicocele and how does it present

A

Dilated scrotal venous plexus

Feels like sac of worms

Left side more commonly affected

61
Q

where is an epididymal cyst found and what is Ix

A

Found separate from the body of the testicle
Usually posterior
U/S main Ix

62
Q

what is typical presentation of testicular torsion

A

Puberty

Spontaneous – sudden onset

O/E: Tender, swollen testis, reddening of skin, lifting testis increases pain

Lack of cremastic reflex

63
Q

what is seen on USS of testicular torsion

A

avascular

64
Q

Mx of testicular torsion

A

Emergency surgery - orchidopexy

65
Q

what does “blue dot” sign on upper pole of testis suggest

A

Torsion of appendage

66
Q

what is presentation of Epididymitis

A

Hx of UTI/Catheterisation
Cremastic reflex present
Elevation of testis helps pain

67
Q

Ix for Epididymitis

A

USS = shows increased blood flow

Can be related to STI, so send urine for chlymadia

68
Q

Mx for Epididymitis

A

Doxycycline < 35 (covers STI)

Ofloxacin >35

69
Q

what anti-hypertensive drug is shown to slow the rate of decline in renal function in diabetics

A

ACEi - ramipril

70
Q

Recent sore throat + nephritic syndrome = ?

A

IgA Nephropathy

71
Q

Patient prescribed Amoxicillin + present later with nausea, SOB, diffuse rash + HTN + elevated eosinophil count = ???

A

Acute interstitial nephritis secondary to amoxicillin.

72
Q

what is Cryoglobulinaemia

A

causes membranoproliferatuve glomerulonephritis
i.e. presents as a mixed Nephritic/Nephrotic pic

associated with Hep C

73
Q

how does Cryoglobulinaemia present

A

gangrene = large leg ulcers

purpura = multiple purpuric rashes

SOB = due to PE. Increased risk of thrombus.

74
Q

common nephritic syndromes

A

Rapidly Progressive GN
IgA nephropathy
Alport Syndrome

75
Q

common nephrotic syndrome

A

Minimal change - kids
Membranous GN - commonest cause in UK
Focal segmental GN = commonest worldwide
Diabetic nephropathy

76
Q

common mixed nephrotic and nephritic syndromes

A

Diffuse proliferative GN
Membranoproliferative GN
Post-Strep GN

77
Q

which test is useful when determining whether there is prerenal uraemia or acute tubular necrosis?

A

urinary sodium

78
Q

what are the eGFR variables

A

CAGE

= creatinine, age, gender, ethnicity

79
Q

what do you see on microscopy in nephritis syndromes

A

red cast cells

80
Q

what do “muddy brown casts” in the urine suggest

A

acute tubular necrosis

81
Q

Ix for TCC

A

1st line = cystoscopy + biopsy
2nd line = CT urogram
3rd line = CT/MRI

82
Q

Mx of BPH

A

1st line = alpha blocker e.g. doxazozin, tamsulosin

2nd line = 5 alpha reductase inhibitor
e.g. dutasteride, finasteride

83
Q

what are the most common types of renal stones

A

calcium oxalate

84
Q

mx of renal stones

A

analgesia = IM or IV diclofenac

stone < 5mm will pass spontanteously

stone > 5mm requires medical explusion i.e. nifidipine or shockwave lithrotripsy

85
Q

tumour markers for seminoma and teratoma

A

seminoma = PLAP and bhcg

teratoma = AFP

86
Q

patient with proteinuria + HTN = ?

A

ACE i

87
Q

patient with AKI and hyperkalaemia = diagnosis

A

goodpastures

88
Q

RA with GN

A

amyloidosis

89
Q

HTN + IHD = ?

A

renal artery stenosis

90
Q

what passes through cell membrane readily

A

cations

91
Q

1st line Ix for hydrocele

A

doppler USS with colour

92
Q

how do TZD work and what are there side effects

A

work by inhibiting sodium reabsorption at distal convoluted tubule

s,e, = low na and potassium, high calcium, gout, impaired glucose tolerance, impotence

93
Q

how do loop diuretics work and what are there side effects

A

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

94
Q

how do potassium sparing diuretics work and what are there side effects

A

sodium channel blockers or aldosterone antagonist

s.e. = hyperkalaemia, gynaecomastia, metabolic acidosis

95
Q

where does acetazolamide work on kidneys

A

proximal tubular and increases secretion of K, Na, and H2O

4th Year SB (22 decks)

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