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Year 3 Conditions > Renal > Flashcards

Renal Flashcards

1
Q

What is normal GFR

A

over 90ml/min and over 60 in elderly

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2
Q

Kidney extra functions other than excretion

A 
EPO
Ca and PO3
Acid base control
BP
Electrolyte management
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3
Q

What is a cystogram

A

Used to view bladder by giving contrast people urinate out

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4
Q

Symptoms people may describe alongside renal syndromes

A 
Symptoms of UTI
Pain
Oligouria, anuria, polyuria, nocturia
Oedema, SOB
Fatigue
Pain from bone breaks
Headaches from HTN
Muscle weakness
Itching and nausea etc
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5
Q

Where are prostaglandins and bradykinins made

A

Kidney

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6
Q

What is wrong with serum creatinine

A

People with same creatinine can have very different clearing functions

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7
Q

What 2 substances do we use to measure GFR

A

Cystatin C

Creatinine

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8
Q

What is eGFR

A

Equation using serum creatinine that also uses body weight sex etc

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9
Q

Limitations for eGFR

A

Only useful in stable patients so AKI not useful and dependant on muscle mass

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10
Q

What is simplest kidney function test

A

Urine dipstick

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11
Q

What un pathological sources can make urine go red

A

Beetroot
Dyes
Porphyria
Rifampicin

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12
Q

What pathological sources make urine go red

A

Myoglobin

Blood

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13
Q

What does proteinuria normally indicate about site of problem

A

Glomerular problem

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14
Q

What must you always do if dispstick positive

A

Quantitate it- work out protein creatinine ratio

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15
Q

Define AKI- old

A

Rapid decline in renal function over hours or days with accumulation of waste productions with or without change in urine output

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16
Q

AKI research definition

A

Serum creatinine rise by 26umol/L within 24 hrs
Or
Serum creatinine rise by x1.5 from reference value which is presumed to have happened within a week
Or
Urine output of less than 0.5ml/kg/hr for 6 consecutive hours

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17
Q

How are AKI staged

A

1-3

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18
Q

Stage 1 AKI criteria

A

Definition for AKI

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19
Q

Stage 2 AKI criteria

A

SCr increase of 2-3 from baseline or less than 0.5mL/kg/hr for 12 hours

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20
Q

Stage 3 AKI criteria

A

SCr increase of over 3 from baseline or less than 0.3mL/kg/hr for 24 hours, anuria for 12 hours
Or been started on RRT

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21
Q

Why is even slight AKI critical

A

Minor changes in serum creatinine shown to have massive prognostic implications

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22
Q

What is important to do in patients at risk of AKI

A

Ensure hydration
Take off nephrotoxic drugs
More frequent monitoring

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23
Q

Who is at risk of AKI

A

Recent major surgery

Acutely ill

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24
Q

Risk factors for AKI

A 
CKD
Previous AKI
Diabetes
Low BP
Over 75
HF
Liver disease
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25
Q

Categorising cause of AKI

A

Pre renal
Intrinsic
Post renal

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26
Q

How to exclude post renal cause of AKI

A

US

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27
Q

What sort of things cause pre renal AKI

A

Low CO
Hypovolaemia
Renal artery thrombosis
Hypotension

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28
Q

What sort of things cause post renal AKI

A

Bladder tumour
Uereteric or urethral obstruction
Blocked urinary catheter

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29
Q

What sort of things cause renal AKI

A 
ATN
Glomerulonephritis
Vasculitis
Myeloma
Toxins- rhabdomyolysis
Malignant HTN
TTP
Interstitital nephritis
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30
Q

What is ATN

A

Acute tubular nephritis

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31
Q

Difference between AKI and CKD

A

AKI reversible

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32
Q

What is first thing to do when see rediced eGFR or SCr raised

A

Is it acute or chronic

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33
Q

Questions to ask when faced with AKI

A

What is cause and is it treatable

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34
Q

Questions to ask when faced with CKD

A

Cause?
Can we slow progression
How to control and treat complications
Make plan for RRT

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35
Q

How does AKI present

A 
Non specific
Uraemia symptoms
Underlying disease sx
Reduced  output
Systemic features like myalgia, rash, arthralgia
Change in electrolytes, volume pH
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36
Q

Uraemia Sx

A

Anorexia
Nausea
Vomiting

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37
Q

AKI history

A 
Duration
Systemic featurs
PMH- vascular, UTIs, diabetes
Fx- strokes, sudden death
Dx- anything new including herbal, over the counter, recreational drugs
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38
Q

AKI examination

A 
BP, volume status
Systemic disease features
Bladder
Palpable kidneys?
Urinalysis and dispstick
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39
Q

What would you see in urine of someone with glomerular disease

A

Red cells
Red cell casts
Proteinuria

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40
Q

What would you see in urine of someone with tubular disease

A

Minimal blood
Small protein
White cell casts

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41
Q

What would you see in urine of someone with pre renal disease

A

No blood or protein

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42
Q

Investigations for someone with AKI

A 
Previous renal baseline
Electrolytes
US
CXR to see if fluid overload
Urinalysis
CK
Autoimmune screen
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43
Q

Difference in size of kidney between AKI and CKD

A

CKD a lot smaller

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44
Q

What are main complications of AKI

A 
Pulmonary oedema
Potassium variations
Acidosis
HTN
Uraemia affect brain, nerves and heart
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45
Q

What would cause CKD in childhood

A

Congenitally abnormal kidneys

Childhood reflux nephropathy

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46
Q

How is CKD staged

A

1-5 based on GFR

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47
Q

Who is at risk of CKD

A 
Elderly 
HTN
Black people
IHD
Diabetes
Obesity
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48
Q

Causes of CKD

A

Diabetes
Chronic glomerulonephritis
Vacular diseases
Polycystic kidney disease

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49
Q

Preventing CKD progression

A

BP control- ACEi, ARBS
SGLTi drugs
Minimising CVS risk factors- hard to do when have no sx
Encourage hydration

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50
Q

What do you get with nephrotic syndrome

A

Heavy proteinuria
Oedema
Hypoalbuminaemia

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51
Q

Sx of nephrotic syndrome

A

Swollen legs
Limited walking
Painful legs

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52
Q

Normal protein in urine

A

Up to 300mg/day

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53
Q

What is nephrotic syndrome threshold for proteinuria

A

Over 3g/day

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54
Q

What is main indication of proteinuria

A

Glomerular disease

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55
Q

What are common glomerular pathologies

A

Diabetes
Membranous nephropathy
Amyloid
SLE

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56
Q

How to control oedema

A

Low salt diet

Diuretics

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57
Q

Proteinuria management

A

Control odema
ACEi/ARB
Treat cause

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58
Q

Haematuria with pain investigations

A

Stones and cancer likely so imagining

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59
Q

Haematuria age considerations

A

Over 40 must rule out cancer

Under 40 most likely IgA nephropathy

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60
Q

Investigation for renal stones

A

CT KUB

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61
Q

What is a CT KUB

A

Kidney

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62
Q

Findings of nephrotic syndrome

A

Hypoalbuminaemia
Oedema
Proteinuria

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63
Q

What is nephrotic syndrome

A

Increased permeability of GBM

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64
Q

What is active urinary sediment

A

Protein and blood in urine

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65
Q

Categories of AKI

A

Pre renal
Renal
Post renal

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66
Q

Pre renal causes of AKI

A

Hypovolaemia

Sepsis

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67
Q

Renal causes of AKI

A

Drugs

Glomerulonephritis

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68
Q

Post renal causes of AKI

A

Obstruction

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69
Q

How to diagnose renal artery stenosis

A

Magnetic Resonance Angiogram and will see unequal perfusion bilaterally

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70
Q

What is treatment of hyperkalaemia

A

Calcium chloride (calcium gluconate also) followed by insulin and dextrose- calcium chloride stabilises the myocardium and glucose important to open cellular trasnporters to shift potassium into cells

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71
Q

What are 4 indications for urgent haemodialysis

A

Uraemic encepaholopathy(over40)
Hyperkalaemia resistant to treatment after 4 hours of insulin/dextrose
Metabolic acidosis that doesnt respond to IV fluids
Pulmonary oedema with oligouria
Can be drugs

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72
Q

Treatment for metabolic acidosis

A

IV NaCl

IV sodium bicarb

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73
Q

Why can pulmonary oedema occur with oligouria

A

After fluid resus post AKI it is possible to not regain urine output ability leading to fluid overload

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74
Q

What presents with shortness of breath, haemoptysis and renal issues

A

Goodpastures

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75
Q

What is goodpastures syndrome

A

Presence of autoantibodies to the alpha-3 chain of type IV collagen

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76
Q

What causes pulmonary renal syndrome with rapid degeneration of glomerulonepthritis

A

Goodpastures

ANCA vasculitis

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77
Q

What does pulmonary renal syndrome consist of

A

Haemoptysis and glomerulnephritis

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78
Q

What blood findings suggest chronic renal failure as opposed to AKI

A

Low Hb
Elevated phosphate
Low calcium

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79
Q

Differences between chronic and acute presentation of bladder outflow obstruction

A

Bladder smaller in acute- chronic obstruction gives time for bladder to grow
Acute very painful

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80
Q

Treatment of bladder outflow obstruction

A

Put in a catheter

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81
Q

What cant be done before checking PSA

A

Catheter be put in

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82
Q

Important investigations in outflow obstruction

A

US

Then CT to see if ant mets

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83
Q

What causes itching from kidney pathology

A

Hyperphosphataemia

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84
Q

How does high phosphate from kidney failure lead to hypocalcaemia and hypoparathyroidism

A

Negative feedback directly on PT gland

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85
Q

Additional treatments of hyperkalaemia

A

Salbutamol nebs
Haemodialysis if required
Haemofiltration

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86
Q

What does epistaxis, skin rash and unilateral deafness imply

A

Vasculitis

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87
Q

How does nephrotic syndrome present

A

Leg oedema
Facial swelling
Scrotal swelling
Ascites

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88
Q

When does nephrotic syndrome only cause pulmonary oedema and raised JVP

A

Renal or cardiac failure is present

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89
Q

What gives frothy urine

A

Proteinuria

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90
Q

What is most common cause of nephrotic syndrome in men

A

Membranous glomerulonephritis

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91
Q

Can diabetes cause nephrotic syndrome

A

Yes but only after a few years of disease

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92
Q

What tends to cause nephrotic syndrome in women

A

SLE

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93
Q

Causes of nephrotic syndrome

A

Membranous glomerulonephritis
Minimal change glomerulonephritis- common in children
SLE
Diabetes

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94
Q

Why must avoid contrast CT in renal patients

A

Contrast can be nephrotoxic

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95
Q

Symptoms of chronic renal disease

A 
Impotence
Pruritus
Weight loss
Pleural effusion
Bone pain
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96
Q

Why do you check PTH in kidney patients

A

Can get secondary hyperparathyroidism due to renal failure

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97
Q

What are US findings of outflow obstruction

A

Smaller kidneys with cortical thickness

Thick walled bladder

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98
Q

Why get bone pain in renal failure

A

Osteodystrophy

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99
Q

Bloods to look out for in chronic kidney disease

A

Phosphate
Calcium
Potassium
PTH

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100
Q

Nephrotic syndrome triad

A

Oedema
Hypoalbuminaemia(less than 30)
Heavy protein loss (more than 3g/24hrs urine collection or PCR over 300)

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101
Q

Different ways to determine protein loss

A

PCR

24hr urine collection

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102
Q

What is normally associated with heavy protein loss

A

Hypercholesterolaemia due to increased hepatic synthesis

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103
Q

Most common cause of nephrotic syndrome

A

Diabetes

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104
Q

What happens to INR in nephrotic syndrome

A

Clotting factors are protein bound so these are lost into urine making patient hypercoagulable

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105
Q

What are people with nephrotic syndrome more susceptible to

A

DVT due to loss of clotting factors

Infection due to loss of Ig

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106
Q

Differentials for elevated urea

A

Dehydration
Upper GI bleed
High protein diet

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107
Q

Pre renal causes of AKI

A 
Hypoperfusion from:
Sepsis
Hypovolaemia
HF
Renal artery stenosis
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108
Q

Renal causes of AKI

A 
Glomerulonephritis
Acute intersitial nephritis
Nephrotoxic drugs
Vasculitis
Nephrotoxic drugs
Rhabdomyolysis
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109
Q

Post renal causes of AKI

A

Stone
Protastatic hypertrophy
Cancer

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110
Q

Management of renal problems according to the renal pathology

A

Modify risk factors such as antihypertensives
Fluid balance with salt and fluid restriction
EPO stimulating agents for anaemia
Phosphate binders and vit d supplements for hypocalcaemia

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111
Q

When is renal replacement therapy used

A

Stage 5 kidney disease

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112
Q

Problems for patients with haemodialysis

A

Have to go into hopsital 4/7

Complications include infection, cardiovascular disease, fluid balance irregularities

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113
Q

Problem for patients with peritoneal dialysis

A

Massive risk of infection

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114
Q

Benefit of peritoneal dialysis for patients

A

Done at home

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115
Q

Benefit of renal transplant for patients

A

Lasts 10-20 years no hospital trips

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116
Q

Problems of renal transplant for patients

A

Rejection
Massive operation
Immunosuppression
Recurrence

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117
Q

Difference between nephrotic and nephritic

A

In nephritic get blood and protein in urine but in nephrotic just protein

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118
Q

Definition of nephritic

A

Related to inflammation of glomerulus and nephrons

Definition of nephrotic syndrome

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119
Q

Definition of nephrotic syndrome

A

Urinary protein loss of over 3.5g/day

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120
Q

Causes of nephritic syndromes

A 
IgA nephropathy
Post streptococcal glomerulonephritis
Henoch-schonlein purpura
Haemolytic uraemic syndrome
SLE
Goodpastures syndrome
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121
Q

Causes of nephrotic syndrome

A

Minimal change disease
Focal segment glomerulosclerosis
Membranous glomerulonephritis
Diabetes nephropathy

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122
Q

When do you get IgA nephropathy

A

Few days post URTI

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123
Q

When do you get post streptococcal glomerulonephritis

A

4-6 weeks post strep infection

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124
Q

When do you get HUS

A

Post E coli infection (0157)

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125
Q

What is henoch-schonlein purpura

A

IgA vasculitis that commonly affects children

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126
Q

Triad of symptoms for henoch schonlein purpura

A

Purpura on buttocks
Abdo pain
Arthritis

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127
Q

Way to remember Sx of SLE

A

SOAP BRAIN MD

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128
Q

What is an urinary tract calculi

A

Crystal deposition within UT

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129
Q

Presentation of UTC

A

Severe loin to groin pain

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130
Q

What are 4 types of UTC stones

A 
Calcium oxalate- most common!!
Calcium phosphate
Magnesium ammonium phosophate
Uric acid
Cysteine
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131
Q

Bedside investigations for UTC

A

Urine dispstick

Bloods for U&Es

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132
Q

Urine dipstick finding of UTC

A

Haematuria

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133
Q

Gold standard diagnosis for UTC

A

CT KUB

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134
Q

Management of UTC

A

First determine if its infected or obstructed- nephrostomy
Then determine if stone smaller or greater than 5mm.
If smaller allow to pass spontaneously and retain it for analysis. If larger intervention needed

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135
Q

Interventional methods for UTC

A

Uteroscopic lithotripsy
Extracorporeal shockwave lithotripsy
Percutaneous nephrolitomy

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136
Q

What happens in uteroscopic lithotripsy

A

Camera put through urethra and stone is crushed

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137
Q

What happens in extracorporeal shockwave lithotripsy

A

Ultrasound shockwaves used to break up stone

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138
Q

What happens in percutaneous nephrolitomy

A

Hole made in back under general anaesthetic and stone removed or cut up

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139
Q

What happens in nephrostomy

A

Drain put in to drain urine that cant pass

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140
Q

What is way to remember symptoms relating to lower UT

A

FUND- to do with storage

HIPS- to do with voiding

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141
Q

FUND symptoms of LUT

A

Frequency
Urgency
Nocturia
Dsyuria

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142
Q

HIPS symptoms relating to LUT

A

Hesitancy
Incomplete emptying
Poor stream
Straining

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143
Q

What is benign prostatic hyperplasia

A

Slowly progressive hyperplasia of periurethral zone of prostate gland

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144
Q

Management of benign prostatic hyperplasia

A

If in acute retention immediately catheterise

Then have conservative, medical and surgical options

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145
Q

Conservative management of benign prostatic hyperplasia

A

Watchful waiting

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146
Q

Medical management of BPH

A

Alpha blocker- tamsulosin
5a-reductase inhibitor- finasteride
Anti-cholinergic

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147
Q

Surgical management of BPH

A

TURP
Incision into prostate
Open prostatectomy

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148
Q

What is TURP

A

Transurethral resection of prostate

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149
Q

When feeling scrotal mass first question ask

A

Can you feel above the mass- no then is inguinal hernia

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150
Q

If can feel above a scrotal mass what is next question to ask

A

Can the swelling be separated from the testicle

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151
Q

What is implied if mass can be separated from the testicle

A

Epididymal cyst

Varicocele

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152
Q

If cant separate testicle from mass what is next thing to ask

A

Is it tender

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153
Q

What does tender scrotal mass suggest

A

Epididymitis

Orchitis

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154
Q

What does non tender mass that cant be separated from testicle suggest

A

Hydrocele

Tumour

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155
Q

How to differentiate between tumour and hydrocele

A

Is it transilluminable

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156
Q

What is a hydrocele

A

Collection of serous fluid in tunica vaginalis

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157
Q

Investigations for scrotal mass

A

Consider secondary causes
US
Testicular tumour markers
Urine cultures

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158
Q

Causes of hydrocele

A

Primary- congenital patent vaginalis

Secondary- trauma, malignancy, infection/inflammation

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159
Q

What is a varicocele

A

Distended veins of pampiniform plexus

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160
Q

Where are varicoceles normally found

A

Left testicle

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161
Q

What complications are there for varicocele

A

Renal cancer risk

Infertility risk

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162
Q

What does swelling on lying down suggest with scrotal mass

A

Varicocele

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163
Q

What re the tumour markers for testicular cancer

A

Afp
B-hCG
LDH

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164
Q

Important investigations for testicular cancer

A

CT for staging

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165
Q

What is most common malignancy in males aged 20-40

A

Testicular

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166
Q

Where does testicular cancer normally metastasize

A

Para-aortic nodes

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167
Q

What can hydrocele be a sign of

A

Cancer in testicle

Epididymo orchiditis

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168
Q

What testicular mass will transilluminate

A

Hydrocele

Epididymal cyst

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169
Q

Where would pain be in LUT infection

A

Suprapubic

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170
Q

Management of renal colic

A

IV fluids and anti-emetics

PR diclofenac or IV paracetamol

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171
Q

In which sex are renal colics more common

A

Men

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172
Q

Are AXR good for renal stones

A

80% picked up

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173
Q

Which renal stones are radio-opaque on AXR

A

Calcium oxalate
Calcium phosphate
URATE IS NOT

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174
Q

Specifity of CT KUB for stones

A

97%

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175
Q

AXR findings of renal colic

A

Pelvicalcyeal dilation

Dilation of ureter

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176
Q

Where are common points for renal stone to be stuck

A

Pelvi-uteric junction (at start of ureter)
Vesicourteric junction (where ureter enters bladder or ureter inside bladder)
Where urter crosses iliac vessels

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177
Q

What is pyonenephrosis

A

Backing up of septic pus and sediment into kidney

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178
Q

Management of pyonephrosis

A

IV paracetamol
IV abx
IV fluids

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179
Q

Why is stone removal not indicated in pyonephrosis

A

Uretal wall very fragile

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180
Q

What are staghorn renal stones

A

Branched stones that fill the renal pelvis

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181
Q

What is urgency urinary continence

A

Pressing desires to go to toilet and can lead to leakage of urine if dont make it in time

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182
Q

What is overactive bladder syndrome

A

Urinary urgency without or without urinary incontinence associated withincreased frequency and nocturia

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183
Q

What is stress urinary incontinence

A

Leaking or dribbling of urine post sneeze or cough that arises from increased abdo pressure

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184
Q

What is post-micturition dribble

A

When small amounts of urine in bulbar urethra pass leak out when moving post urination

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185
Q

Who is post-micturition dribble very common in

A

Elderly men

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186
Q

How is diagnosis of overactive bladder syndrome made

A

Bladder diary

187
Q

What is treatment of OAB

A

Fluid advice
Bladder training
Anti-cholinergics like oxybutinin

188
Q

What can happen to inguinal hernia when patient lies down

A

Will disappear

189
Q

Features of testicular torsion

A

Excruciating sudden onset pain

High lying testicles

190
Q

What normally causes epididymo orchiditis

A

UTI

Medical instruments

191
Q

What are 2 most common testicular cancers

A

Seminoma

Testicular teratoma

192
Q

What do seminomas produce

A

Placental ALP

193
Q

What does raised PALP suggest

A

Seminoma

194
Q

What do only teratomas produce

A

AFP

195
Q

Peak age differences between seminoma and teratoma

A

Teratoma- 20-30

Seminoma 30-40

196
Q

Differences between teratoma and seminoma in preferred met route

A

Seminoma- lymphatics

Teratoma- blood

197
Q

What metastases do seminomas often cause

A

Cannonball lung mets

198
Q

In a young man what is a testicular mass until proven otherwise

A

Tumour

199
Q

If diagnosis of testicular tumour is made what further investigations should be made

A

CT abdo

CXR

200
Q

What do germ cell tumours of testes produce

A

hCG

201
Q

What HcG is measured for testicular cancer marker

A

Beta as the alpha chain is very similar to that of pituitary hormones

202
Q

Tumour markers for testicular cancer

A

AFP
LDH
Beta HCG
PALP

203
Q

Side effect of ectopic HCG production

A

Gynaecomastia

204
Q

Gold standard diagnosis for kidney cancers

A

CT urogram

205
Q

Most common group for testicular torsion

A

11-30

206
Q

Management of testicular torsion

A

Analgesia then surgery immediately with potential orchidectomy

207
Q

What can be done to further engorge the veins in varicocele

A

Valsalva

208
Q

What can make varicocele disappear

A

Lying supine

209
Q

Gold standard investigation for varicocele

A

Scrotal US

210
Q

What is rare association of varicocele

A

Renal carcinoma

211
Q

Associations of renal cell carcinoma

A

Smoking
Von-hippel Lindau disease
Industrial dyes

212
Q

What happens to magnesium in CKD

A

Elevated as reduced excretion

213
Q

What are 5 types of incontinence

A 
Stress
Overflow
Urge
Neuropathic
Mixed
214
Q

What is most common cause of stress incontinence in men

A

BPH

215
Q

What is most common cause of stress incontinence in women

A

Hypermobility of sphincter

216
Q

What causes hypermobility of sphincter in women

A

Pregnancy and labour can cause damage to connective tissue surrounding bladder that doesnt support them in cases of extreme pressure
Or damage to nerve affects sphincter control

217
Q

Investigations you would do for stress incontinence

A

Stress test where ask to cough
PAD test
Urodynamics

218
Q

What happens in pad test

A

Person wheres pad then weigh how much it is after from how much urine has been leaked into it

219
Q

What are 2 categories causing overflow incontinence aand examples

A

Outflow obstruction- BPH, cystocele, organ prolapse, urethral stricture
Reduced detrusor action- medication, long standing distension

220
Q

Investigation for overflow obstruction

A

Post voiding US

221
Q

What are 2 categories causing neuropathic incontinence

A

Spasticity of detrusor muscle- stroke, MS

Inability to control external sphincter- cauda equina or anything affecting S2-S4

222
Q

Main symptoms of BPH

A

Hesitancy
Poor flow
Post micturition drip
Pis en deux

223
Q

What is pis en deux

A

Incomplete voiding so need to go again just after have been

224
Q

Investigations for BPH in order

A

Take blood for PSA
Then do DRE
Dipstick
Cystoscopy

225
Q

Why are UTIs more common in women

A

Their urethra is much shorter so less distance for bacteria to travel

226
Q

What does acute urinary retention lead to increased risk of

A

Hydronephrosis
UTI
Renal stones

227
Q

How does rhabdomyolysis present

A

Muscle pain and weakness

Dark urine

228
Q

What does nephrtic syndrome consist of

A

HTN
Haematuria
Proteinurea
Oedema

229
Q

Extreme signs of nephritic syndrome

A

Oligouria

Uraemia

230
Q

Presentation of renal cell carcinoma

A

Pain
Haematuria
Mass in flank
FLAWS

231
Q

Where do renal cell carcinomas originate from

A

Proximal tubular epithelium

232
Q

What is other name for a renal cell carcinoma

A

Von Grawitz tumour

233
Q

Which antibiotic should be especially avoided in pregnant women with UTI

A

Trimethoprin as a folic acid antagonist
Fluoroquinalones
Tetracyclines- these both teratogens

234
Q

When would phosphate deficiency be suggested

A

Signs of osteoporosis
Anorexis
Weight loss

235
Q

Signs of acute renal failure

A 
Uraemia
Hyperventilation
Easy bruising
SOB due to increased fluid
Oligouria
236
Q

How does uraemia present

A

Nausea and vomiting

Confusion in extreme cases

237
Q

How does acidosis present in renal failure

A

Hyperventilation

238
Q

How can a kidney patient be SOB

A

Fluid in lungs

Anaemia from EPO dysfunction

239
Q

How do kidney patients present woth easy bruising

A

Haemostasis impaired

240
Q

What is criteria used to determine whether kidney injury is chronic, acute or acute on chronic

A

RIFLE

241
Q

How can teratomas be classified

A

Mature or immature

242
Q

Difference in teratoma between men and women

A

Malignant in men but normally benign in women

243
Q

Difference in malignancy between mature and immature teratomas

A

Mature normally benign

Immature malignant

244
Q

What can see in immature teratomas

A

Immature nerual tissue containing skin and teeth etc

245
Q

How are mature teratomas classified

A

Cystic and solid

246
Q

What is different about solid teratomas

A

Can undergo transformation to carcinoma

247
Q

Complications of renal colic that would make you consider fast tracking management

A

Infection
Cant keep fluids down where nauseous
AKI
Constant pain

248
Q

Haematuria ddx

A 
Kidney
- cancer
- glomerulonephritis
- pyelonephritis
Bladder
- cancer
Prostate
- BPH
- prostatits
- cancer
Ureter and urethra
- UTI
-stone
249
Q

Physiological causes of microscopic haematuria

A

Vigorous exercises

Sex recently

250
Q

Signs of bladder cancer urinalysis

A

Blood

WCC

251
Q

Sx bladder cancer

A

Dysuria
Polyuria
Blood in urine

252
Q

Investigations for bladder cancer

A

Urinalysis
Urine cytology
Cystoscopy
CT urogram

253
Q

What does blood in urine throughout voiding suggest

A

Kidney or bladder problem

254
Q

What does blood at end of urinating suggest

A

Prostate or distal bladder problem

255
Q

What does blood at beginning of urinating suggest

A

Urethral problem

256
Q

What can give fake positive for blood on dipstick

A

Hb

Myoglobin

257
Q

What is another name for IgA nephropathy

A

Bergers disease

258
Q

What is urine blood in Bergers

A

Macroscopic

259
Q

In daibetic nephropathy what is proportions on dipstick

A

Protein> blood

260
Q

Post surgery what is cause of hyponatraemia

A

Poor fluid control

261
Q

What happens in diabetic nephropathy

A

Initially increased GFR and GBM hypertrophy -> glomerulosclerosis due to ECM buildup-> BM destruction so protein loss

262
Q

What happens when give too much insulin in blood

A

Hypo

Hypokalaemia

263
Q

How does excess insulin present

A

Sweating

Irritable

264
Q

What tends to cause acute tubulointerstitial nephritis

A

Drug hypersensitivity from NSAIDS and penicillin commonly

265
Q

How does acute tubulointerstitial nephritis present

A

Painful joint
Fever
Rash
Nephritic syndrome

266
Q

Blood findings of acute tubulointerstitial nephritis

A

Eosinophilia

267
Q

What is problem of using MRI for UTC

A

Cant differentiate between stones, tumours and clots

268
Q

How does TB affecting kidney present

A

Pain in flank going to back
Nocturia
Polyuria

269
Q

How is TB affecting kidney found

A

Pyuria that wont colonise

270
Q

Main risk factor for bladder cancer

A

Dyes

Inks

271
Q

Triad of renal cancer

A

Haeamturia
FLAWS
Flank pain and mass

272
Q

Hypercalcaemia symptoms of kidney

A

Polyuria
Nocturia
Polydipsia

273
Q

Vasculitides affecting kidney

A

Henoch schonlein purpura
Granulomatosis with polyangiitis
Microscopic polyangiitis
Eosinophilic granulomatosis with polyangiitis

274
Q

What is BPE

A

Benign prostate enlargement that is common as grow older

275
Q

What is BPH

A

Enlargement of prostate with histological diagnosis of hyperplasia

276
Q

What is BOO

A

Bladder outflow obstruction

277
Q

From the prostate where does BPH occur

A

Transition zone

278
Q

From the prostate where does cancer occur

A

Peripheral zone

279
Q

What is significance of prostate cancer growing from peripheral zone

A

Tumour is already quite big by time it reaches the urethra

280
Q

Difference between voiding and storage problems

A

Strong flow in storage symptoms

281
Q

What causes voiding symptoms

A

Obstruction

282
Q

What causes storage symptoms

A

Detrusor overactivity

283
Q

What investigations would do for BOO

A 
DRE
Dipstick 
Flow rate and post voiding scan
PSA, U&Es bloods
Renal US
Flexi cystoscopy
284
Q

Why do you always do bladder scan post flow rate test

A

Chronic urinary retention common in elderly

285
Q

How can prostate cancer present

A 
LUTS 
Haematuria
Dysuria
Pain
Bone pain
FLAWS
286
Q

Grading scale for prostate cancer

A

Gleason

287
Q

What is best imagine for prostate cancer

A

MRI

288
Q

When person is doing urology history what should be filled out

A

IPSS

289
Q

In DRE how do you describe size of prostate

A

According to objects- walnut, ping pong ball, golf ball, clementine

290
Q

How does renal failure increase risk of heart problems

A

Long QT from hypocalcaemia

Hyperkalaemia

291
Q

What can lead to orcitis or epididymitis

A

STI
UTI
Post op

292
Q

What is concern of patient who has varicocele

A

Slight chance of kidney cancer

293
Q

What gene is linked to prostate cancer

A

BRCA2

294
Q

What is used to pick up uric acid stones

A

CTKUB

295
Q

What is main danger of stones

A

Can go into gram neg septicaemia

296
Q

What would suggest uric acid stone on urinalysis

A

Low pH

297
Q

Treatment for uric acid stones

A

Alkylysing the urine

298
Q

What is NMP22 associated with in urine cytology

A

Bladder cancer

299
Q

What is most commonl cause of PCKD

A

Mutation on PKD1 chromosome 16

300
Q

How can PCKD present

A

Loin pain or diffuse abdo pain as kidneys hypertrophy
Symptoms of kidney failure as disease progresses
Bleeding or infection of cysts

301
Q

What are some associations of PCKD

A

Mitral valve prolapse

Berry aneurysms

302
Q

Best first line imaging for PCKD

A

US

303
Q

Best imaging for PCKD

A

MRI

304
Q

In question what is loin pain with mid systolic click

A

PCKD

305
Q

Mainstay first line treatment of new onset proteinuria in daibetics

A

ACEi or ARBs

306
Q

What are Kimmelstiel wilson nodules seen in

A

Diabetes nephropathy- nodular glomerulosclerosis

307
Q

What is medullary sponge kidney

A

Congenital disorder of the kidneys that
is characterized by the formation of cystic sacs within the papillary zone of the kidney creating a sponge-like appearance

308
Q

Presentation of medullary sponge kidney

A

Cysts obstruct the outflow predisposing to UTIs, stones and haematuria

309
Q

Associations of medullary sponge kidney

A

Hypercalciurua
Hypertrophy
Renal tubular acidosis

310
Q

Effects of excessive NSAID use

A

Papillary necrosis

Tubulointerstitial nephritis

311
Q

What does papillary necrosis and tubulinterstitial nephritis from NSAID use lead to

A

Anaemia
UTIs
Haematuria

312
Q

What is best way to visualise papillary necrosis and tubulinterstitial nephritis from NSAID use

A

MRI

313
Q

How do calcium oxalate stones appear on urinalysis microscopy

A

Envelope shaped

314
Q

What is a healthy adult urinary rate

A

1ml/kg/hour

315
Q

What is defined as oligouria

A

Less than 0.5mL/kg/hour

316
Q

What can cause reduced local perfusion of kidneys

A

Stenosis
Thrombosis
Aneurysm

317
Q

How can renal causes of AKI be classified

A 
Vascular
Tubular
Glomerular
Interstitial 
Complex
318
Q

Vascular causes of AKI

A 
TTP
HUS
DIC
Malignant HTN
Vasculitides
Scleroderma
319
Q

Glomerular causes of AKI

A

Glomerulonephritis

320
Q

Complex causes of kidney damage

A

Amyloid

Myeloma

321
Q

Interstitial causes of AKI

A

Interstitial nephritis from drugs

322
Q

Infectious causes of AKI

A

Malaria
Legionnaires
Leptospirosis

323
Q

How can post renal causes of renal failure be classified

A

Ureter
Bladder
Urethra

324
Q

Ureteric causes of renal failure

A

Abdominal mass
Bilateral stones
Pelvic surgery complication
Retroperitoneal fibrosis

325
Q

Bladder causes of renal failure

A

Neuropathic bladder
Anticholinergic or sympathomimetic drugs
Bladder stones or tumour
Uterovaginal prolapse in women

326
Q

Urethral causes of renal failure

A 
BPH
Prostate cancer
Urethral stricture
Infection meaning too painful to urinate
Blocked catheter
327
Q

What is rate of required fluid

A

30-50ml/kg/day

328
Q

What is volume of fluid required each day by body

A

3L

329
Q

How much more fluid is needed per day in febrile patients per degree of body temp

A

500ml/ 1^C

330
Q

What class of abx cause interstitial nephritis

A

Aminoglycosides

Glycopeptides

331
Q

What are things to assess on examination of oligouria

A

If catherised check bag
Signs of volume status- JVP, BP, lips, cap refill, narrow pulse pressure
Signs of heart failure
Palpable and dull on percussion bladder

332
Q

What would cause post operative bilateral creps

A

Atelectasis

333
Q

What is difference between acute and chronic retention on presentation

A

Chronic is painless

334
Q

Management of acute urinary retention

A 
Catheterise 
Measure how much is voided
Fluids to replenish those lost in diuresis
Assess renal function
Assess cause of obstruction
Do a TWOC if possible
335
Q

What is a TWOC

A

Trial without catheter

336
Q

What does over 1L being voided on catheterisation of acute retention

A

That it is an acute on chronic cause

337
Q

What test cant you do when assessing cause of urinary retention

A

PSA as this will definetely be raised

338
Q

When is only time people are eligible for TWOC following acute retention

A

If under 1L was voided upon catheterisation and has normal renal function

339
Q

What happens in a TWOC

A

Given an alphablocker and a dose of ABx (to prevent UTI following catheterisation)
Wait to see if actually urinates

340
Q

If patient fails TWOC what happens to them

A

Given finasteride too with an indwelling catheter and booked in for a TWOC outpatient clinic

341
Q

If patient urinates more than 1L on presentation or their renal function was raised on presentation what is management

A

they are immediate candidates for TURP

342
Q

What causes urethral strictures

A

Repeated trauma to urethra often after cystoscopies

343
Q

How can surgery lead to AKI

A

Fluid loss during surgery may have caused hypovolaemic perfusion of kidney

344
Q

Management of renal cause oligouria patient

A 
Stop fluids
Assess need for dialysis
Check drug chart and stop any drugs
Blood tests to assess U&Es, Ca and PO to determine if chronic
Renal US
Urinalysis
345
Q

What causes focal segmented glomerulosclerosis

A

Heroine

HIV

346
Q

What is gold standard measurement of GFR

A

Inulin

347
Q

What influences blood urea levels

A

Nutritional state
Hepatic function
GI bleed

348
Q

What is renal function a measure of

A

Flow from the glomerulus to the bowmans capsule

349
Q

What causes nausea and vomiting in AKI

A

Uraemia

350
Q

Difference in whats used to measure AKI vs CKD

A

Creatinine in AKI

eGFR in CKD

351
Q

What is defined as CKD

A

An eGFR of less than 60 for more than 3 months

352
Q

What is an AKI a failure to manage

A

Fluid- oligouria leading to hypervolaemia
Electrolytes- hyperkalaemia
Acid base- metabolic acidosis

353
Q

What are common symptoms of an AKI

A 
N&V
Confusion from uraemia
SOB
Dehydration
Oligouria/anuria
354
Q

What does an abrupt anuria suggest

A

Post renal cause whereas insidious suggest renal

355
Q

What causes ATN

A 
Toxins:
Paracetamol
Contrast
Rhabdomyolysis
NSAIDS
Abx
Hypoperfusion
356
Q

What is ATN

A

Death of epithelial cells but wis reversible as cells can regro

357
Q

What is pathognomonic for ATN

A

Muddy brown casts

358
Q

What is seen on urinalysis ATN

A

Muddy brown casts

Epithelial cells

359
Q

What is different about AKI in acute interstitial nephritis

A

Non oligouric

360
Q

Causes of AIN

A

Drugs- often Abx, NSAIDS, PPIs, diuretics
Infections- Ecoli, campylobacter, syphillis, measles, mumps, EBV, histoplasmosis
Infiltration- lupus, sarcoid, sjogrens

361
Q

Urinalysis findings of AIN

A

WC casts
Sterile pyuria
Proteinuria

362
Q

Categorising causes of pre renal AKI

A

Hypovolaemia
Systemic vasodilation
Reduced cardiac output
Intrarenal vasoconstriciton

363
Q

How does myoglobin affect kidney

A

Acute tubular necrosis

364
Q

Endogenous causes of ATN

A

Myoglobin
Uric acid crystals
Light chains in myeloma

365
Q

Urine findings of rhabdomyolysis

A

Muddy brown casts

Myoglobinuria

366
Q

What is urea:creatinine ratio in pre renal cause

A

Over 100:1

367
Q

What is urea:creatinine ratio in post renal cause

A

40:1-100:1

368
Q

What is urea:creatinine ratio in renal cause

A

Under 40:1

369
Q

What is normal urea:creatinine ratio

A

40:1-100:1

370
Q

Blood findings of rhabdomyolysis AKI

A

Hypocalcaemia
Hyperphosphataemia
Raised CK

371
Q

Histopathological finding of ATN

A

Tubular necrosis

372
Q

Primary causes of nephrotic syndrome

A

FSGS
Minimal change disease
Membranous nephropathy

373
Q

Secondary causes of nephrotic syndrome

A

DM
Amyloid
SLE

374
Q

What happens to renal function and complement levels in minimal change disease

A

Normal

375
Q

What disease is associated with minimal change disease

A

Hodgkins lymphoma

376
Q

What is primary cause of membranous nephrotic syndrome

A

Autoimmune

377
Q

What are secondary causes of membranous nephrotic syndrome

A

Cancer- lung/colon adenoarcinoma
SLE
Hep B/C

378
Q

Which ethnicity is normally affected by membranous nephrotic syndrome

A

Afro carribeans

379
Q

Histopatholoical findings of diabetic nephropathy

A

Kimmelstiel wilson nodules

Nodular glomerulosclerosis

380
Q

Histopathological findnigs of FSGS

A

Focal scarring

IgM deposits

381
Q

Stain done for amyloid nephrotic syndrome and result

A

Congo red

Apple green birefringence

382
Q

What is special about mesangiocapillary GN

A

A mix of both nephritic and nephrotic syndrome

383
Q

Histopathological findings of MSCGN

A

Tram tracking

Mesangial proliferation

384
Q

What conditions are assocaited with MSCGN

A

Hep C
End stage renal failure
C3 nephritic factor

385
Q

What types of infection cause post strep GN

A

Lung

Skin- remember!!!

386
Q

Blood findings of post strep GN

A

High anti-strep titres

Low C3

387
Q

What is smoky urine seen in

A

Post streptococcal GN- described as cola like

388
Q

What is primary cause of GN

A

Rapidly progressive glomerulonephritis

389
Q

What are the 3 types of RPGN

A

Type 1- Anti- GBM
Type 2- immune coplex deposition
Type 3- Pauci immune

390
Q

What causes type 1 anti GMN RPGN

A

Goodpastures

391
Q

What causes type 2 immune complex deposition RPGN

A

SLE
IgA
Henoch schnolein purpura

392
Q

What causes type 3 pauci immune RPGN

A

Wegners
Granulomatosis with microscopic polyangiitis
Churg strauss

393
Q

Differnece in presentation of 3 causes of type 3 RPGN

A

Wegners- nose and lung
Churg strauss- eosinophilia, asthma, mononeuritis multiplex
Microscopic polyangiitis- purpuric rash

394
Q

What would be done in renal workup of patient

A

Bedside- urinalysis with microscopy
Bloods- urea:creatinine ratio, complement levels, autoimmune screen (ANCA, GBM), EBV and hep C serology, serum free light chains
Imaging- renal USS and biopsy histology and immunofluorescence

395
Q

Use of ACR vs PCR

A

Albumin creatinine ration used more for DM

PCR used more for nephrotic syndrome generally

396
Q

Causes of proteinuria

A 
Nephrotuc syndromes
Amyloid
HTN
DM
Myeloma
397
Q

Causes of glucose in urine

A

DM
Pregnancy
Sepsis
Tubular damage

398
Q

Most common causes of CKD

A 
DM
HTN
Atherosclerosis
Chronic glomerulonephritis
Stones/infection
399
Q

Most common congenital cause of CKD

A

PCKD

400
Q

What do you see on examination of CKD patient

A 
AV fistula
Finger BM
Half and half nails
Tremor- on immunosuppresion tacrolimus
Gum hypertrophy from ciclosporin
Parathyroidectomy scar
Dialysis line
Kidney transplant scar and mass (hockey stick scar)
Uraemic fetor
Pruritus
401
Q

What are half and half nails also called

A

Lindsay nails

402
Q

What must do if see AV fistula on examination

A

Examine for thrills and bruits- if blood flowing through then is active bruit

403
Q

Consequences of CKD

A 
Anaemia from EPO deficiency
Renal bone disease
Acidosis
Hyperkalaemia
Vascular calcifcation
Uraemic pericarditis
404
Q

How are CKD patients at greater risk of pericarditis

A

Uraemia

405
Q

What investigations will do for CKD patient

A 
Bedside
Obs- looking at HTN in particular
Urinalysis- haematuria and proteinuria
Fundoscopy for HTN changes
ECG for hyperkalaemia and LVH
Bloods
FBC- normocytic anaemia
LFTs- albumin
U&Es- eGFR, potassium, urea creatinine ratio
VBG- metabolic acidosis from retention of acid or loss of bicarb
Hba1c- likely to be on steroids
Bone profile
Blood tacrolimus 
Imaging
CXR- pulmonary oedema or pericardial effusion
USS check perfused
Histology to check disease progression if getting worse
406
Q

Limiting complications management of CKD

A

Control BP and glucose strongly- ACEi ideal

Diet- avoid high phosophate foods mainly dairy

407
Q

Symptoms control CKD

A

Human EPO
Sodium bicarb if acidotic
Loop diuretics and restrict fluid for oedema
Phosphate binders for hyperphosophataemia
Vit D supplements
Parathyroidectomy if tertiary parathyroidectomy

408
Q

What is management of tertiary hyperparathyroidism

A

Parathyroidectomy

409
Q

Why is BP control important if recently had renal transplant

A

Affects grafts ability to hold

410
Q

Why is peritoneal dialysis not good for diabetics

A

Fluid used is full of glucose

411
Q

Who is peritoneal dialysis contraindicated in

A

Diabetics

412
Q

What bacteria is indicated in UTI from catheters

A

Proteus as very good at swimming up

413
Q

Atypical organisms causing UTI typically in immunocompromised

A

Candida albicans
Pseudomonas
Klebsiella

414
Q

What is presentation of PCKD

A

Often clincally silent for many years
Acute loin pain
Haematuria
Stone formation

415
Q

Examination findings of PCKD

A

Enlarged kidney
HTN
Haematuria

416
Q

Investigations for PCKD

A

Obs
FBC- raised Hb
Deranged U&Es
USS or could do MRI if positive fx or SAH or PCKD

417
Q

What causes varicocele in renal cancer

A

Invasion of renal vein

418
Q

Investigations for renal cancer

A 
BP-obs showing HTN from increased renin
FBC- polycythaemia sometimes
ALP- bone mets
Urinalysis- haematuria
CXR- canonball mets
CT/MRI IVU
419
Q

What is IVU

A

Intravenous urogram

420
Q

What flank pain can radiate to back

A

Pyelonephritis
AIN
TB affecting kidney

421
Q

What presents following abx for CAP with pain radiating to back

A

AIN

422
Q

Differentials for haematuria and a rash

A

SLE
Vasculitide
HSP

423
Q

Rfs for UTC

A 
Idiopathic
Hypercalcaemia
Hyperuricaemia
Low water
Lots of meat
Structural kidney defects- medullary sponge kidney, PCKD
424
Q

Which kidney stones can especially be seen on AXR

A

Uric acid

425
Q

What forms staghorn kidney stones

A

Struvite

426
Q

Which infection is often linked to struvite staghorn stones

A

Proteus

427
Q

What tends to cause cysteine stones

A

Congenital defects- homocyteinuria

428
Q

Investigations going to do for UTC

A

Bloods- renal damage
Urine dip/MSU- blood
Non contrast CT-KUB

429
Q

What looking for on CT KUB for UTC

A

Where are stones
How big
Evidence of obstruction leading to hydronephrosis

430
Q

When do you do US KUB instead of CT KUB for UTC

A

Pregnant

Under 16

431
Q

Which stone gives microscopy shows crystals having a “coffin-lid” shaped appearance

A

Struvite

432
Q

When do you do AXR for UTC

A

To track recovery

433
Q

Conservative management of UTC

A

Lifestyle advice- more water

Modify RFs

434
Q

Medical management of UTC

A

Diclofenac
Anti-emetics
Tamsulosin

435
Q

What is done if UTC stone 5-10mm

A

Medical management using tamsulosin

436
Q

What are indications for surgical management of UTC

A 
Renal dysfunction
Previous renal disease
Infection
Pain for over 48hrs
Bilateral stones
437
Q

What to do if stone 10-20mm

A

Uteroscopy lithotripsy

438
Q

What to do if stone over 20mm

A

Percutaneous nephrolithotomy

439
Q

Management of infected stone leading to pyonephrosis

A

Sepsis 6- co amox and gent

Nephrostomy

440
Q

What is seen on US of varicocele

A

Dilated pampiniform plexus

441
Q

Investigations for varicocele

A

US
Colour doppler
CT

442
Q

Causes of epidiymitis and orchitis

A

In sexually active people is normally gonorrhoea or chlamydia
In over 35s tends to be klebsiella or enterococcus from UTI
In children is mumps orchitis

443
Q

What causes orchitis in sexually active people

A

gonorrhoea or chlamydia

444
Q

What causes orchitis in over 35s

A

klebsiella or enterococcus from UTI

445
Q

What causes orchitis in very young

A

Mumps

446
Q

What age group is orchitis mainly found in

A

Male 20-30

447
Q

Symptoms of orchitis

A

Slow onset testicular pain
Tender to touch
LUTS sx
Discharge from penis

448
Q

O/E epididymitis

A

Testicular tenderness

Positive prehns sign

449
Q

Investigations for orchitis and epididymitis

A

Urinalysis- mc&s
Bloods- WBC, CRP
Mumps serology

450
Q

Management of orchitis

A

Abx and analgesia
Scrotal support pants
GUM referral with tracing of partners

451
Q

Complications of orchitis

A

Reactive hydrocele
Abscess
Infertility

452
Q

Risk factors for testicular cancer

A

Cryptorchidism, Klinefelter syndrome, hypospadias

453
Q

What is cryptochordism

A

When one or two of testicles fail to descend

454
Q

Symptoms of testicular cancer

A

Dullness in testes
Ache
Back ache from met spread
Inguinal lymph nodes

455
Q

How are testicular cancers classified

A

Germ cell tumour

Non germ cell

456
Q

Examples of germ cell testicular cancer

A 
Seminoma
Teratoma
Choriocarcinoma
Yolk sac
Embryonal carcinoma
457
Q

Examples of non germ cell testicular cancer

A

Sertoli cell tumours

Leydig cell tumours

458
Q

What is the marker very raised in choriocarcinoma

A

bHcG

459
Q

What marker is very raised in yolk sac tumours

A

AFP

460
Q

What testicular cancer has fried egg appearnce

A

Seminoma

461
Q

What is most common testicular cancer

A

Seminoma

462
Q

Management of testicular torsion

A

Analgesia
Antiemetics
Urgent orchidectomy and contralateral fixation

463
Q

DDx for testicular torsion

A

Epididymo orchitis

Incarcerated inguinal hernia

Year 3 Conditions (33 decks)

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