Renal Flashcards
Classify UTI
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
List the organisms that cause UTI
E.coli
Staphy saprophyticus
Proteus
Klebsiella *more common in DM
List the risk factors for a complicated UTI
Age Anatomical abnormality Foreign body Impaired renal function Immunocompromised Instrumentation Male sex Obstruction Pregnant
What is the triad seen in pyelonephritis
- Loin pain
- Fever
- Renal tenderness
What investigation is recommended in patients presenting with recurrent pyelonephritis?
Renal USS
Contrast CT of kidneys
DMSA scan to look for renal scarring
Outline the treatment of the following UTIs
- Cystitis
- Pyelonephritis (uncomplicated)
- Pyelonephritis (complicated)
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
List the causes of AKI
Pre renal
- Shock
- Renovascular collapse
Renal
- Acute tubular necrosis
- HTN
- DM
- Nephritis
- Infection
- Tumour
Post renal
- Mechanical obstruction
- Tumour
- Fibrosis
- Prostate hyperplasia
- Renal calculi
List the drugs which can be damaging to the kidney
Diuretics
NSAIDs
ACEi
Metformin
Outline the broad management of AKI
- Stop nephrotoxic drugs
- ABCDE (fluid challenge if hypotensive)
- Catheterise for low urine output
- Treat hyperkalamia
- Urgent USS KUB
- Dialysis
- Hyperkalamia not treatable
- Pulmonary oedema
- Uraemia
- pH <7.2
- Poisoning
Name the two types of polycystic kidney disease
- ADPKD
- 2 genes PKD1 (polycystin 1) and PKD2 (polycystic 2) - ARPKD very high mortality
Clinical features of PKD
Flank/abdominal discomfort Lumbar discomfort Haematuria HTN Palpable kidneys Headaches
Investigations in patients presenting with PKD
- Renal USS (Ravine’s criterai)
- Genetic testing for the PKD1 and PKD2
- CT abdo pelvis
May need MR angiography
Management of patients with PKD
- Treat HTN
- ACEi/ARB - If UTI use ciprofloxacin and same for infected cyst
- Pain
- Analgesia
- Cystectomy
- Nephrectomy - ESRD
- target fluid secretion
- target cell proliferation
- genetic counselling
List the types of renal cell carcinoma
- Clear cell renal carcinoma
2. Papillary tumour
Outline how renal cell carcinomas present
Often asymptomatic
- Abdo mass
- Haematuria
- Loin pain
What are the risk factors for developing renal cell carcinoma
- Smoking
- Obesity
- HTN
- Age
- +ve family history (Von Hippel Lindau syndrome )
List the investigations you would carry out in a patient with suspected renal cell carcinoma
- Tight BP controll
- Renal biopsy
- Bloods
- FBC
- LDH
- Calcium
- LDH
- Cr - CT abdo/pelvis
- abdo/pelvis USS
What is Stauffer’s syndrome
Cholestasis in the absence of liver metastasis
- elevated bilirubin
- alkaline phosphatase
- gamma Gt
- elevated PT
- thrombocytosis
- hepatosplenomegaly
Outline the management of renal cell carcinoma
s1/s2:
- surgical resection
- local ablation
s3: radical nephrectomy
s4: targeted molecular therapy
Causes of renal artery stenosis
Artherosclerosis
Fibromuscular dysplasia
Thromboembolism
Beware it can cause pul flash oedema
Define renal tubular acidosis
Excretion of acid or reabsorption of bicarbonate is absorbed disproportionately to the GRF
=
HYPERCHLORAEMIC METABOLIC ACIDOSIS + HYPOBICARBONATAEMIA + DECREASED ARTERIAL pH + NORMAL ANION GAP
List the types of renal tubular acidosis
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
List the potential causes of asymptomatic haematuria
- IgA nephropathy
- Thin BM disease
- Alport’s syndrome
List the types of nephritic syndromes
- Proliferative
Young people post sore throat
High ASOT
High C3
2. Crescentic TI: Goodpastures TII: Immune complex deposition TIII: Pauci Immune cANCA/pANCA
List the triad seen in nephrotic syndrome
Proteinuria
Hypoalbuminaemia
Oedema
List the types of nephrotic syndrome
- Minimal change disease
- Membranous nephropathy
- Focal segmental glomerulosclerosis
Discuss the features and treatment of IgA nephropathy
Post URTI
High IgA
IgA deposits in the mesangium
Treatment with steroids or cyliphosphamide
Discuss the features and treatment of thin BM disease
Auto-dominant
Asymptomatic haematuria
No treatment
Discuss the features and treatment of Alport’s syndrome
X-linked inheritance
Haematuria and progressive renal failure
Discuss the features and treatment of minimal change disease
Associated with URTI
Fusion of the podcytes
Rx steriods
Discuss the features and treatment of membranous nephropathy
Associated with Ca (lung, colon, breast)
Infection (HBV)
Immune complex deposits on biopsy
Rx immunosuppression
Discuss the features and treatment of focal segmental glomerulosclerosis
Seen in Afro-Carb
Focal scarring IgM deposition
Rx Steriods and cyclophosphamide
Define CKD
Proteinuria and/or haematuria with kidney damage, decreased GFR (<60mL)
over 3 months or more
List the primary and secondary prevention of CKD
PRIMARY
- Diabetic control
- HTN control
- Smoking cessation
- Weight loss
SECONDARY
- As above
- Fluid and salt restriction
List the complications of CKD
Anaemia Renal osteodystrophy CV disease Protein malnutrition Metabolic acidosis Hyperkalamia Pulmonary oedema
Management of CKD
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
List the types of bladder cancer
Transitional cell carcinoma
Squamous cell carcinoma
Risk factors for developing bladder cancer
Smoking Occupational - Amines (rubber dye) - Hydrocarbons (coal) - Age >65 - Pelvic radiation for prostate ca - Male - HNPCC
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?
Bladder cancer
Urine dip: Haematuria Urine Mc&S: KUB USS Bimanual staging EUA Flexible cystoscopy + biopsy CT urogram with contrast Bone scan
Management of bladder cancer
- non invasive/ superficial
- invasive
- metastic
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
List the types of testicular tumours
GERM CELLS
- Pure seminomas
- high BHCG
- high ALP
- normal AFP
- radiosenstive - Non seminomas
- mixed
- teratoma (high BHCG, AFP)
- yolk sac
- choriocarcinoma (very high BHCG)
SEX CORD STROMAL
- Leydig cells
- secrete androgens and oestrogens - Sertoli cells
- Secrete oestrogens
Risk factors for developing testicular cancer
Undescended testicles
Family hx of cancer
Kleinfleters
Infertility
Presentation of testicular cancer
Painless testicular lump Haemospermia Hydrocele Bone pain Gynaecomastia Venous occlusion Back pain
Investigation in suspected testicular cancer
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
Management of testicular cancer
Radical orchidectomy
Early stage summons
- external beam radiation
- carboplatin chemotherapy
Early stage non seminoma
- Chemo (BEP)
- Lymph dissection
