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Renal/GU > Renal > Flashcards

Renal Flashcards

1
Q

Classify UTI

A

Uncomplicated: Normal GU tract and function
Complicated: Abnormal GU tract, outflow obstruction, decreased renal function, impaired host defence, virulent organism
Recurrent: further infection with new organism

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2
Q

List the organisms that cause UTI

A

E.coli
Staphy saprophyticus
Proteus
Klebsiella *more common in DM

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3
Q

List the risk factors for a complicated UTI

A 
Age 
Anatomical abnormality 
Foreign body 
Impaired renal function 
Immunocompromised 
Instrumentation 
Male sex 
Obstruction 
Pregnant
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4
Q

What is the triad seen in pyelonephritis

A
  1. Loin pain
  2. Fever
  3. Renal tenderness
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5
Q

What investigation is recommended in patients presenting with recurrent pyelonephritis?

A

Renal USS
Contrast CT of kidneys
DMSA scan to look for renal scarring

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6
Q

Outline the treatment of the following UTIs

  • Cystitis
  • Pyelonephritis (uncomplicated)
  • Pyelonephritis (complicated)
A

CYSTITIS

  • Nitrofurantoin 100mg BD for 3 days
  • Trimethoprim 200mg BD for 3 days

PYELONEPHRITIS (uncomplicated)
- ciprofloxacin 500mg PO BD 7-14 days

PYELONEPHRITIS (complicated)

  • Admit
  • IV ceftriaxone
  • IV fluid
  • IV paracetamol
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7
Q

List the causes of AKI

A

Pre renal

  • Shock
  • Renovascular collapse

Renal

  • Acute tubular necrosis
  • HTN
  • DM
  • Nephritis
  • Infection
  • Tumour

Post renal

  • Mechanical obstruction
  • Tumour
  • Fibrosis
  • Prostate hyperplasia
  • Renal calculi
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8
Q

List the drugs which can be damaging to the kidney

A

Diuretics
NSAIDs
ACEi
Metformin

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9
Q

Outline the broad management of AKI

A
  1. Stop nephrotoxic drugs
  2. ABCDE (fluid challenge if hypotensive)
  3. Catheterise for low urine output
  4. Treat hyperkalamia
  5. Urgent USS KUB
  6. Dialysis
    - Hyperkalamia not treatable
    - Pulmonary oedema
    - Uraemia
    - pH <7.2
    - Poisoning
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10
Q

Name the two types of polycystic kidney disease

A
  1. ADPKD
    - 2 genes PKD1 (polycystin 1) and PKD2 (polycystic 2)
  2. ARPKD very high mortality
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11
Q

Clinical features of PKD

A 
Flank/abdominal discomfort 
Lumbar discomfort 
Haematuria 
HTN 
Palpable kidneys 
Headaches
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12
Q

Investigations in patients presenting with PKD

A
  1. Renal USS (Ravine’s criterai)
  2. Genetic testing for the PKD1 and PKD2
  3. CT abdo pelvis

May need MR angiography

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13
Q

Management of patients with PKD

A
  1. Treat HTN
    - ACEi/ARB
  2. If UTI use ciprofloxacin and same for infected cyst
  3. Pain
    - Analgesia
    - Cystectomy
    - Nephrectomy
  4. ESRD
    - target fluid secretion
    - target cell proliferation
    - genetic counselling
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14
Q

List the types of renal cell carcinoma

A
  1. Clear cell renal carcinoma

2. Papillary tumour

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15
Q

Outline how renal cell carcinomas present

A

Often asymptomatic

  • Abdo mass
  • Haematuria
  • Loin pain
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16
Q

What are the risk factors for developing renal cell carcinoma

A
  1. Smoking
  2. Obesity
  3. HTN
  4. Age
  5. +ve family history (Von Hippel Lindau syndrome )
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17
Q

List the investigations you would carry out in a patient with suspected renal cell carcinoma

A
  1. Tight BP controll
  2. Renal biopsy
  3. Bloods
    - FBC
    - LDH
    - Calcium
    - LDH
    - Cr
  4. CT abdo/pelvis
  5. abdo/pelvis USS
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18
Q

What is Stauffer’s syndrome

A

Cholestasis in the absence of liver metastasis

  • elevated bilirubin
  • alkaline phosphatase
  • gamma Gt
  • elevated PT
  • thrombocytosis
  • hepatosplenomegaly
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19
Q

Outline the management of renal cell carcinoma

A

s1/s2:

  • surgical resection
  • local ablation

s3: radical nephrectomy
s4: targeted molecular therapy

20
Q

Causes of renal artery stenosis

A

Artherosclerosis
Fibromuscular dysplasia
Thromboembolism

Beware it can cause pul flash oedema

21
Q

Define renal tubular acidosis

A

Excretion of acid or reabsorption of bicarbonate is absorbed disproportionately to the GRF

=
HYPERCHLORAEMIC METABOLIC ACIDOSIS + HYPOBICARBONATAEMIA + DECREASED ARTERIAL pH + NORMAL ANION GAP

22
Q

List the types of renal tubular acidosis

A 
Type 1: (Distal)
inability to excrete H+ 
- marafn's, ehler's danlos 
- AI: SLE, thryroididits 
- drugs

urine pH = 5.5

Type 2 (Proximal) 
Defect in the HCO3 reabsorption in PCT 
Can do slight acidification of the urine in systemic acidosis

urine pH >5.5

Fanconi’s syndrome
Disturbance of the PCT function, generalised impaired reabsorption

23
Q

List the potential causes of asymptomatic haematuria

A
  1. IgA nephropathy
  2. Thin BM disease
  3. Alport’s syndrome
24
Q

List the types of nephritic syndromes

A
  1. Proliferative
    Young people post sore throat
    High ASOT
    High C3
2. Crescentic 
TI: Goodpastures 
TII: Immune complex deposition 
TIII: Pauci Immune 
cANCA/pANCA
25
Q

List the triad seen in nephrotic syndrome

A

Proteinuria
Hypoalbuminaemia
Oedema

26
Q

List the types of nephrotic syndrome

A
  1. Minimal change disease
  2. Membranous nephropathy
  3. Focal segmental glomerulosclerosis
27
Q

Discuss the features and treatment of IgA nephropathy

A

Post URTI
High IgA
IgA deposits in the mesangium
Treatment with steroids or cyliphosphamide

28
Q

Discuss the features and treatment of thin BM disease

A

Auto-dominant
Asymptomatic haematuria
No treatment

29
Q

Discuss the features and treatment of Alport’s syndrome

A

X-linked inheritance

Haematuria and progressive renal failure

30
Q

Discuss the features and treatment of minimal change disease

A

Associated with URTI
Fusion of the podcytes
Rx steriods

31
Q

Discuss the features and treatment of membranous nephropathy

A

Associated with Ca (lung, colon, breast)
Infection (HBV)
Immune complex deposits on biopsy
Rx immunosuppression

32
Q

Discuss the features and treatment of focal segmental glomerulosclerosis

A

Seen in Afro-Carb
Focal scarring IgM deposition
Rx Steriods and cyclophosphamide

33
Q

Define CKD

A

Proteinuria and/or haematuria with kidney damage, decreased GFR (<60mL)
over 3 months or more

34
Q

List the primary and secondary prevention of CKD

A

PRIMARY

  • Diabetic control
  • HTN control
  • Smoking cessation
  • Weight loss

SECONDARY

  • As above
  • Fluid and salt restriction
35
Q

List the complications of CKD

A 
Anaemia 
Renal osteodystrophy 
CV disease 
Protein malnutrition 
Metabolic acidosis 
Hyperkalamia 
Pulmonary oedema
36
Q

Management of CKD

A 
Treat any reversible causes 
Treat BP and CV risk 
- ACEi and ARB 
Statins 
Smoking
Treat anaemia 
Renal bone disease 
- phosphate binding drugs 
Metabolic acidosis 
- sodium bicarbonate 
Oedema 
- Loop diuretics

Haemodialysis
Peritoneal dialysis
Renal transplant

37
Q

List the types of bladder cancer

A

Transitional cell carcinoma

Squamous cell carcinoma

38
Q

Risk factors for developing bladder cancer

A 
Smoking 
Occupational 
- Amines (rubber dye) 
- Hydrocarbons (coal) 
- Age >65
- Pelvic radiation for prostate ca 
- Male 
- HNPCC
39
Q

A 67 year old gentleman presents complaining of painless haematuria, voiding difficulty. On reviewing his notes you notice that he has been prescribed abx twice in the last month for a UTI.
What are you worried about?
What investigations would you order?

A

Bladder cancer

Urine dip: Haematuria 
Urine Mc&amp;S: 
KUB USS
Bimanual staging EUA
Flexible cystoscopy + biopsy 
CT urogram with contrast 
Bone scan
40
Q

Management of bladder cancer

  • non invasive/ superficial
  • invasive
  • metastic
A

NON INVASIVE

  • Transurethral resection of the bladder
  • Invasive chemo (mitomycin)
  • Intravesicular immunotherapy (BACILLE CALMETT-GUERIN)

INVASIVE

  • radical cystectomy with illegal conduit
  • radiotherapy

METASTIC

  • Palliative chemo
  • Long term catertherisation
41
Q

List the types of testicular tumours

A

GERM CELLS

  1. Pure seminomas
    - high BHCG
    - high ALP
    - normal AFP
    - radiosenstive
  2. Non seminomas
    - mixed
    - teratoma (high BHCG, AFP)
    - yolk sac
    - choriocarcinoma (very high BHCG)

SEX CORD STROMAL

  1. Leydig cells
    - secrete androgens and oestrogens
  2. Sertoli cells
    - Secrete oestrogens
42
Q

Risk factors for developing testicular cancer

A

Undescended testicles
Family hx of cancer
Kleinfleters
Infertility

43
Q

Presentation of testicular cancer

A 
Painless testicular lump 
Haemospermia 
Hydrocele 
Bone pain 
Gynaecomastia 
Venous occlusion 
Back pain
44
Q

Investigation in suspected testicular cancer

A

Tumour markers

  • High AFP
  • High BHCG

Scrotum USS

Staging CXR/CT

Do not perform a percutanous biopsy as can cause seeding along the needle tract

45
Q

Management of testicular cancer

A

Radical orchidectomy
Early stage summons
- external beam radiation
- carboplatin chemotherapy

Early stage non seminoma

  • Chemo (BEP)
  • Lymph dissection

Renal/GU (2 decks)

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