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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
List the triad seen in nephrotic syndrome
Proteinuria Hypoalbuminaemia Oedema
26
List the types of nephrotic syndrome
1. Minimal change disease 2. Membranous nephropathy 3. Focal segmental glomerulosclerosis
27
Discuss the features and treatment of IgA nephropathy
Post URTI High IgA IgA deposits in the mesangium Treatment with steroids or cyliphosphamide
28
Discuss the features and treatment of thin BM disease
Auto-dominant Asymptomatic haematuria No treatment
29
Discuss the features and treatment of Alport's syndrome
X-linked inheritance | Haematuria and progressive renal failure
30
Discuss the features and treatment of minimal change disease
Associated with URTI Fusion of the podcytes Rx steriods
31
Discuss the features and treatment of membranous nephropathy
Associated with Ca (lung, colon, breast) Infection (HBV) Immune complex deposits on biopsy Rx immunosuppression
32
Discuss the features and treatment of focal segmental glomerulosclerosis
Seen in Afro-Carb Focal scarring IgM deposition Rx Steriods and cyclophosphamide
33
Define CKD
Proteinuria and/or haematuria with kidney damage, decreased GFR (<60mL) over 3 months or more
34
List the primary and secondary prevention of CKD
PRIMARY - Diabetic control - HTN control - Smoking cessation - Weight loss SECONDARY - As above - Fluid and salt restriction
35
List the complications of CKD
``` Anaemia Renal osteodystrophy CV disease Protein malnutrition Metabolic acidosis Hyperkalamia Pulmonary oedema ```
36
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
37
List the types of bladder cancer
Transitional cell carcinoma | Squamous cell carcinoma
38
Risk factors for developing bladder cancer
``` Smoking Occupational - Amines (rubber dye) - Hydrocarbons (coal) - Age >65 - Pelvic radiation for prostate ca - Male - HNPCC ```
39
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 ```
40
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
41
List the types of testicular tumours
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
Risk factors for developing testicular cancer
Undescended testicles Family hx of cancer Kleinfleters Infertility
43
Presentation of testicular cancer
``` Painless testicular lump Haemospermia Hydrocele Bone pain Gynaecomastia Venous occlusion Back pain ```
44
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
45
Management of testicular cancer
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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