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Renal Flashcards

1
Q

What is the only protein found in the urine

A

Tam horsfall

- Secreted by thick loop

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2
Q

Nervous control of urine storage

A

Sympathetic - Hypogastric nerve

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3
Q

Nervous control of voiding urine

A

Parasympathetic - Pelvic nerve

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4
Q

Nervous control of voluntary urine passage

A

Pudendal nerve

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5
Q

Criteria for AKI diagnosis

A

Rise in creatnine >26mincrmol/L in 48hrs

Rise in creatnine > 1.5x baseline in 7 days

Decreased urine output <0.5ml/kg/h for 6hrs

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6
Q

AKI risk factors

A 
Age > 65
pre existing CKD
DM 
HF 
Dehydration
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7
Q

AKI

- Pre renal causes?

A 
ARB/ACEi
NSAIDs
Anaphalaxis 
Sepsis 
CCF 
Trauma
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8
Q

AKI

- Renal causes?

A

Glomerulonephritis - SLE / Infection
Vasculitis - SLE
HTN
Acute tubular necrosis

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9
Q

AKI

- Post renal

A

Stone
stricture
BPH
Pelvic malignancy

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10
Q

Causes of acute tubular necorsis

A 
Gentamicin 
NSAIDs
ACEi
Pancreatitis 
MI
Diuretics
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11
Q

AKI signs and sx

A

sx

  • oliguria
  • vomitting
  • nausea
  • weakness

signs

  • tachycardia
  • breathlesness
  • arrhythmias
  • hypocalcaemia
  • dehydration
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12
Q

AKI investigations

A
  • Bloods
  • Urinalysis
  • Rectal US - post renal obstruction
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13
Q

AKI tx

A

Pre - fluids
renal - stop nephrotoxic drug
post - catheter

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14
Q

AKI complications

A
  • Hyperkalaemia
  • Acute pulmonary oedema
  • Metabollic acidosis
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15
Q

Hyperkalaemia ECG findings

A

Tall tented t waves
no p waves
Wide QRS complex

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16
Q

What is BPH

A

Non cancerous growth of prostate gland

Transitional zone enlargement

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17
Q

BPH presentation

A

SHED
FUND

Haematuria
Overflow incontinence

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18
Q

How to spot metabollic acidosis

A

Kussmauls breathing

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19
Q

BPH investigations

A 
PSA 
Urinalysis 
- dipstick 
- MSU
DRE 
Rectal Ultrasound + biopsy
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20
Q

BPH management - lifestyle

A

Avoid caffine / alcohol
relax when voiding
bladder training

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21
Q

BPH medications

A

1st - Tamsulosin
2nd - Finasteride
3rd - surgery

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22
Q

Tamsulosin S/E

A

Postural hypotension
Dizziness
Dry mouth
Ejacualtory failure

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23
Q

Finasteride S/E

A

Impotence

decreased libido

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24
Q

Transurethral resection of prostate complications

A

bleeding
infection
erectiel dysfunction
urethral strictures

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25
Q

CKD causes

  • primary
  • secondary
A

Primary

  • Minimal change disease
  • UTI
  • Pyelonephritis
  • stones

Secondary

  • HTN
  • DM
  • Amyloidosis
  • HF
  • Sarcoidosis
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26
Q

CKD classification stages

A 
1 - > 90
2 - 60- 89
3a - 59 - 45
3b - 44 - 30
4 - 29 - 15
5 - <15
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27
Q

CKD Presentation

A

Protein loss and Na+ retention

  • Polyuria
  • nocturia
  • oliguria
  • S.O.B
  • peripheral oedema

Uraemia

  • Pruritus
  • weightloss
  • paraesthsia
  • confusion
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28
Q

CKD Signs

A

Anaemia
Hypertension
Bone disease - osteomalacia
Pruritus

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29
Q

CKD tx

A

Treat complications

  • EPO
  • Vit D
  • Loop diuretics for oedema

BP control - ACEi

Glycaemic control

Renal replacemnt therapy

Reduce CVS risk - statins

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30
Q

CKD complications

A 
Anaemia 
Bone disease - osteoperosis 
Peripheral neuropathy 
MI/Stroke 
Pericarditis - uraemia 
Pericardial effusion - uraemia
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31
Q

CKD investigations

A
  • Bloods
  • Urinalysis
    A:C > 3mg/mmol
    Dipstick - Haematuria
  • US
    Small kidneys
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32
Q

CKD Management

A

Conservative

  • excercise/ diet / weight control
  • stop smoking

Medical

  • Optomise DM and HTN control
  • dialysis

Surgical
- transplant

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33
Q

Why does metabollic acidosis occur in CKD and tx

A

Decreased H+ secretion and HCO3- reabsorption

Tx - sodium bicarbonate

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34
Q

Main cause of Cystitis infection

A

E coli

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35
Q

Cystitis presentation

A 
cloudy urine 
haematuria
suprapubic pain 
urgency 
dysuria
frequency 
abdo tenderness
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36
Q

Cystitis investigations

A

Urine dipstick

MSU sample
- MC&S

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37
Q

Cystitiis tx

A

1st - Trimethorpim

2nd - Co-amoxiclav

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38
Q

Prostatitis presentation

A 
fever
malaise 
voiding luts - SHED 
pelvic pain 
perianal oain 
pain on ejacualtion
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39
Q

prostatitis investigations

A

Dipstick
- lecoytes + nitrites positive

DRE - tender and hot

MSU - MC&S

STI screen

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40
Q

Prostatitis tx

A

1st - Gentamicin + co-amoxiclav

2nd - Trimethoprim

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41
Q

Nephritic syndrome features

A 
Oedema 
HTN 
Proteinuria 
Haematuria - red cell casts 
Oliguria
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42
Q

Nephritic syndrome causes

A 
ANCA positive vasculitis 
SLE 
Post strep glomerulonephritis 
IgA nephropathy 
Anti-GBM disease (Good pasture's disease)
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43
Q

Nephritic syndrome presentation

A 
Haematuria 
Sterile pyuria 
HTN 
Oedema 
Oliguria 
Uraemia
- pruritus 
- lethargy
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44
Q

Nephritic syndrome Ix

A

Dipstick - protein/hamaturia

Urine - MC&S

  • RBC casts
  • Bence jones proteins

Bloods

Renal biopsy

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45
Q

Nephritic syndrome tx

A

Tx underlying cause

Reduce proteinuria
- ACEi/ARB

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46
Q

Common features of diseases causing glomerulonephritis

A 
Haematuria
Proteinuria 
Diagnosed on renal biopsy
Can cause CKD 
Deteriorating kidney function
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47
Q

Minimal change disease

  • common in
  • observation on electron microscopy
  • tx
A

Common in children

loss of large amounts of protein lost due to podocyte damage - fused podocytes

Tx - Prednisolone

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48
Q

IgA nephropathy

  • Pathophysiology
  • presentation
  • tx
A

IgA deposition in mesangium

HTN
High creatnine
haematuria
proteinuria

BP control - ACEi

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49
Q

Nephrotic syndrome causes

- primary

A

Primary

  • Focal glomerular sclerosis
  • Minimal change disease
  • Membranous nephropathy]
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50
Q

Nephrotic syndrome triad

A 
Proteinuria - frothy urine 
Hypoalbuminaemia 
Oedema -
- peripheral 
- periorbital 
- ascites

Hyperlipidaemia

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51
Q

Nephrotic syndrome causes - secodnary

A 
DDANI 
D - DM
D - Drugs (NSAIDs)
A - AI - SLE 
N - Neoplasia - Myeloma 
I - Infection - Hep B/C
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52
Q

Nephrotic syndrome investigations

A

Bloods

  • U+E
  • Creatnine - elevated
  • Increased clotting factors
  • Hyperlipidaemia
  • Hypoalbuminaemia

Urinalysis

  • Proteinuria
  • A:C ratio RAISED
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53
Q

Nephrotic syndrome differential dx

A

CCF

  • oedema
  • raised JVP

Cirrhosis

  • hypoalbuminaemia
  • Oedema
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54
Q

Nephrotic syndrome management

A
  • High dose oral steroids
  • Tx underlying cause
  • Rampiril
    Reduce proteinuria
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55
Q

Nephrotic syndrome symptomatic tx

A

Oedema

  • furosemide
  • fluid and salt restriction

Prophylactic LMWH

Simvastatin

Pneumococcal vaccinations

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56
Q

Nephrotic syndrome complications

A

Thromboembolism

Infection

  • decreased IgG
  • decreased compliment activity

Hyperlipidaemia

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57
Q

Why is someone with nephritic syndrome at risk of sepsis

A

Immunoglobulins lost in urine

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58
Q

What is prostate cancer

A

Peripheral zone prostate neoplasia - Adenocarcinoma

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59
Q

Risk factors for prostate cancer

A 
Increasing age 
Black - increased testosterone 
Family hx 
Genetics 
- HOXB13 gene 
- BRCA2 gene
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60
Q

Location of metastatic spread of prostate cancer

A

Bone - sclerotic bone lesions

Lymph nodes

  • para aortic
  • inguinal
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61
Q

Prostate cancer presentation

A

SHED
FUND

Visiable haematuria
weight loss
Anaemia
Urinary retention - obstruction

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62
Q

Prostate cancer investigations

A

PSA

DRE

  • nobbly
  • hard irregular lump

Transrectal US + biopsy

63
Q

Why must multiplebiopsies be taken in prostate cancer

A

Multi focal tumour

64
Q

What grading is used in prostate cancer

A

Gleason grading

65
Q

Radical tx complications of prostate cancer

A

erectile dysfunction
urianry incontinece
urethral strictures

66
Q

Causes of increases PSA

A

BPE
Prostate cancer
UTI
Prostatitis

67
Q

Organisms that cause pyelonephritis

A

E.coli - tranurethral
Klebsiella
Enterococcus
S.aureus - haemotogenous from IE

68
Q

Pyelonephritis presentation

A

Loin pain + fever + Pyuria

  • Loin to groin pain
  • Dysuria
  • Frequency
  • Haematuria
  • Vomitting
  • Pain on palpation over kidney
69
Q

Pyelonephritis Investigations

A 
Urine dipstick 
MSU culture 
Bloods 
Imaging 
- Contrast enhanced CT
70
Q

Pyelonephritis tx

A

Abx - Co-amoxiclav
Analgesia
Hydration
Blood + urinary cultures

71
Q

What cells does renal cell carcinoma arise from

A

Proximal convoluted tubular epithelium

72
Q

Renal cell carcinoma risk factors

A 
Smoking 
Obesity 
Von hippel lindau syndrome 
Long term dialysis 
Leather tanners 
Asbestos
73
Q

Renal cell carcinoma presentation

A

Haematuria + flank pain + mass

weight loss
night sweats
fatigue

74
Q

Renal cell carcinoma investigations

A

Urinalysis

  • Dipstick
  • MSU
  • Cytology

US - cyst or tumour

CT with contrast - Sensitive for mass detection

MRI - Staging

Bloods

75
Q

Renal cell carcinoma metastases

A

Lung - Cannon ball mets

Bone

76
Q

Renal cell carcinoma complications

A
  • Left sided varicoceles
  • IVC invasion
  • Paraneoplastic syndromes
77
Q

Renal cell carcinoma paraneoplastic syndromes

A

EPO –> Polycythaemia

Renin –> HTN

PTHrp –> Hypercalcaemia

ACTH –> Cushings

78
Q

3 locations where a stone can lodge

A

Pelviureteric junction
pelvic brim
vesicoureteric junction

79
Q

types of stone

A 
Calcium oxalate 
calcium phosphate 
struvite 
uric acid 
cystine
80
Q

what are the 2 stone forming inhibitors

A

citrate

mg

81
Q

Stone composition

- calcium oxalate

A

High dietary oxalate intake

  • tea
  • rhubarb
  • spinach

chronic intestinal malabsorption - chrons

Primary hyperoxaluria

82
Q

Stone composition

- calcium phosphate

A

Hyperparathyroidism

excess Ca2+ intake

PCKD

83
Q

Stone composition

- struvite

A

Magnesium
Ammonium

Assosciation with UTIs

84
Q

Renal colic presentation - sx

A

Loin to groin pain - stabbing
nausea
vomitting
sweating

85
Q

Renal colic presentation - signs

A 
can;t lie still 
nausea
haematuria 
stranguary 
dysuria
86
Q

How can you tell the difference between a bladder stone and a urethral stone

A

Bladder -
Increased urinary frequqency
Haematuria

Urethral
- bladder outflow obstruction
Anuria + painful bladder distension

87
Q

Renal colic investigations

A

Urine dipstick - haematuria

MSU sample

  • MC&S
  • Measure electrolytes

Abdo X-ray

Non contrast CT - Dx

88
Q

What is the diagnostic Ix for Renal colic

A

Non contrast CT

89
Q

Renal colic tx

A
  • Diclofenac
  • fluids
  • Tamsulosin
90
Q

Stone composition

- uric acid

A

Hyperuricaemia

acidic urine

91
Q

Prevention methods for recurrent stones

A

Hydration
normal dietary calcium
Thiazide diuretic - reduces urine calcium levels

92
Q

Uric acid stone preventiol

A

Allopurinal

93
Q

Oxalate stone prevention

A

Pyridoxine

94
Q

Scrotal disease

testicular + cystic

95
Q

Scrotal disease

Testicular + solid

A

Tumour
Orchititis
Haematocele

96
Q

Scrotal disease

Separate + solid

A

Epididymitis

varicocle

97
Q

Scrotal disease

Separate + cystic

A

Epididymal cyst

98
Q

What is an epididymal cyst

A
  • contains clear milky fluid
  • soft lump
  • fluctuance
  • well defined
  • transilluminate
99
Q

What is a hydrocele

A
  • transilluminate
  • soft
  • fluctuant
  • Lies anterior and below testis
  • due to patent proccesus vaginalis
  • testis palpable
100
Q

Which scrotal disease is associated with testicualr disease

101
Q

What is a varicocele

A

Abnormal dilatation of testicular veins in pampiniform plexus due to venous reflux

  • Left sided more common
  • Bag of worms
  • dulla ache
  • scrotum hangs lower on affected side
102
Q

What is testicualr torsion

A

Urological emergency - twisting of spermatic cord leading to ischaemia and infarction

  • Sudden onset testicualr pain
  • Pain on walking
  • pain during physical acitvity
  • Testes - hot / tender / swollen
  • abdo pain
  • nausea
  • vomitting
103
Q

STI

- Organisms that cause discharge

A
  • Chlamydia

- Gonorrhoea

104
Q

STI -

- Organisms that cause genital ulcers

A
  • Syphillis

- Herpes

105
Q

STI investigations

A
  • Nucleic acid amplification test
  • MC&S

Male -
First void urine

Female -
Vaginal swabs

106
Q

Management

  • Chlamydia
  • Gonorrhoea
  • Syphillis
A
  • Azithromycin
  • Ceftriaxone
  • Penicillin
107
Q

Risk factors for testicular tumour

A

Undesecended testes

108
Q

Testicualr tumour presentation

A 
Painless lump in testicle 
Haemospermia 
Hydrocele 
Back pain 
Lymphadenopathy
109
Q

Testicular tumour Ix

A

Scrotal US

  • non tender
  • no fluctuace
  • no transillumination

Bloods
- Tumour markers

110
Q

Tumour markers for testicualr cancer

A

Alpha fetoprotein - Raised in teratomas

Beta - hCG
Raised in both teratomas and seminomas

111
Q

Transitional cell carcinoma investigations

A

Urinalysis

  • MC&S
  • Cytology

Fexible cystoscopy with biopsy

CT urogram - staging

112
Q

Transitional cell carcinoma risk factors

A
  • smoking
  • Aromatic amines
  • aldehydes
  • family hx
  • schistomiasis infection
113
Q

Who is at risk of bladder cancer

A

hairdressers
painers
rubber industry

114
Q

Transitional cell carcinoma presentation

A

Painless haematuria
frequency
urgency
dysuria

115
Q

Transitional cell carcinoma tx

A

No muscular invasion - TURB

Muscle invasion
Radical cystectomy with ileal conduit

116
Q

What is urgency incontinece

A

Sudden urge to void due to detrusor instability - Overactive bladder

117
Q

Urge incontinence Tx

A

Bladder diary

  • Bladder retraining
  • Increase intervals between urination
  • Cut out caffine and alcohol
  • Severe - Oxybutynin
118
Q

What is stress incontinence

A

Urine leakage with increases in abdominal pressure

  • cough
  • sneeze
  • standing up
  • laughing
119
Q

What is overflow incontinence

A

Leakage of small amounts of urine - voiding issue

120
Q

Causes of overflow incontience

A

BPH
Urethral stricture
Mass

121
Q

Neurological causes of imcontinence

A 
DM - Autonomic neuropathy causing decreased detrusor excitability 
Parkinsons 
Multiple sclerosis 
Prostatectomy 
Hysterectomy
122
Q

Common organisms causing UTIs

A

E.Coli
Proteus mirabilis
Klebsiella pneumonia

123
Q

Lower UTI presetation

A 
Cloudy smelly urine 
Dysuria 
haematuria 
suprapubic pain 
frequency 
tenderness
124
Q

Upper UTI presentation

A 
Loin pain 
tenderness - costavertebral angle 
N+V 
Oliguria 
Fever 
Systemically unwell
125
Q

UTI investigations

A

Urinalysis - dipstick
+ve = Emperical tx
-ve but pt has sx = MSU for MC&S

Bloods

Imaging

  • bladder scan
  • Renal US
126
Q

Urinary tract obstruction investigations

A

Bloods

Urinalysis

Ultrasound

CT - hydronephrosis

127
Q

What is polyuria

A

Partial blockage and loss of concetration mechanisms - Excess urination

128
Q

What is anuria

A

Complete bilateral blockage - no urination

129
Q

Upper urinary tract obstruction sx

A

Loin to groin pain
worse with fluids
Enlarged kidneys

130
Q

4 complications of peritoneal dialysis

A

Infection
peri catheter leak
abdominal wall herniation
Intestinal perforation

131
Q

Name 3 isotonic solutions

A

5% Dextrose
0.9% Sailine
Hartmans solution

132
Q

Signs of ADPCKD

A 
HTN 
haematuria 
polyuria 
abdo/loin pain
palpable massess
133
Q

ADPCKD tx

A

Treat HTN - Target = 130/80

Dialysis

Increase H20

Reduce salt

134
Q

ARPCKD Assosciated mutation

A

PKHD1 - chromosome 6

135
Q

PCKD complications

A

Mitral valve prolpase
Liver cysts
SAH

136
Q

What classification helps differentiate between benign cystic lesions and cancerous cystic lesiosn

A

Bozniak classification

137
Q

4 causes og haematuria

A

Kidney

  • tumour
  • trauma
  • stones
  • cysts

Urethral stones

Bladder

  • Infection
  • Stones
  • Tumour

BPH

Prostate cancer

138
Q

Trimethoprim MOA

A

Affects folic acid metabolism

139
Q

Descibe the action of aldosterone

A
  • Acts on the collecting ducts
  • Increases ENaC and H+/K+ pumps
  • Increases sodium absoprtion
  • K+ secretion
  • H20 retention
  • BP rise
140
Q

3 functions of ANP

A

Renal vasodialtor
Inhibits aldosterone
Closes ENaC - decreases Na+ reabsorption

141
Q

3 factors stimulate renin release

A

Sympathetic stimualtion
Decreased BP
Macula densa cells

142
Q

Function of calcitrol

A

Suppression of PTH (-ve feedback)

Increases Ca2+ and Phosphate absorption from the gut

143
Q

How does PTH increases serum calcium levels - 3

A
  • Increases bone resorption
  • Increases Ca2+ reabsorption from the kidneys
  • Stimulates alpha -1 hydroxylase activity so increases Ca2+ absorption from gut
144
Q

which part of the loop of henle is water permeable

A

thick ascending limb

145
Q

What is fanconi’s syndrome

A

Failure of nephron to reabsorb essential ions

Sugars / a.a. / bicarbonates appear in urine

146
Q

2 signs of fanconi’s syndrome

A

Sugar in the urine

Acidosis

Rickets / osteomalacia

147
Q

2 Causes of Fanconi’s syndrome

A

Myeloma

Cystinosis

148
Q

Name a drug that inhibits creatinine secretion and its effects on eGFR

A

Trimethoprim

Increased eGFR

149
Q

Equation for GFR

A

(Um X urine flow rate) / Pm.

  • Um = concentration of marker substance in urine.
  • Pm = concentration of marker substance in plasma.
150
Q

What cancer does schistomiasis cause

A

SCC of bladder

151
Q

What are LUTS sx in a male aged 50 likely to be

152
Q

Describe tx for sepsis

A 
Give high flow O2
Take blood cultures
Give IV abx
Give IV fluids 
Check lactate 
Monitor hourly urine output
153
Q

How are urate stones visualised

A

Non contrast CT

Radiolucent

Disease summaries (9 decks)

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