Renal Flashcards
Which locations do renal stones classically become lodged?
Pelviureteric junction (ureter joins the kidney), Pelvic brim and Vesicourteric junction (where ureter connects to the bladder)
What are the types of renal stones?
Calcium oxalate, phosphate, urate and cystine stones
Sx of renal stones?
Excruciating spasms of loin to groin pain - patients often can not lie still. Nausea and vomiting - infection may also co-exist. Haematuria, proteinuria, sterile pyuria and anuria.
No tenderness on palpation
Dx and TX of renal stones?
Dx = Non-contrast CT KUB
Treat initially with analgesia e.g. diclofenac, give IV fluids.
Remove stones using nifedipine or alpha-blockers e.g. tamulosin. If these do not work use shockwave lithotripsy or basket removal.
How is AKI defined?
Rise in creatinine >26umol/L within 24 hours
Rise in creatinine >1.5x baseline within 7 days
Urine output <0.5mL/Kg/hr for >6 consecutive hours
How do you stage AKI?
Stage 1: Serum Creatinine = 1.5-1.9 x base line OR Urine Output = <0.5ml/Kg/hr for 6-12 hours
Stage 2: SC = 2-2.9 x baseline OR UO = <0.5ml/kg/hr for > 12 hours
Stage 3: SC = >3 x baseline OR UO = <0.3ml/kg/hr for >24 hours or anuria >12 hrs
Pre-renal causes of AKI?
Decreased vascular volume = haemorrhage, D&V, burns, pancreatitis Decreased CO = cardiogenic shock, MI Systemic vasodilation = sepsis, drugs Renal vasoconstriction (afferant arteriole) = NSAIDs/ACEi/ARB
Renal causes of AKI?
Glomerular = glomerulonephritis Interstitial = drug reaction, infection and infiltration e.g. sarcoidosis Vessels = vasculitis, DIC
Post-renal causes of AKI?
Within the renal tract = stone, renal tract malignancy, stricture and clot
Extrinsic compression = pelvic maligancy, BPH/prostate cancer
Tx of AKI?
Pre-renal = IV fluids
Renal = biopsy and reffer to specialist
Post-renal = catheter
Monitor K+, stop nephrotoxic drugs e.g. NSAIDs, ACE-i, ARB
Define CKD?
Abnormal kidney structure or function present for >3 months with implications for health
How do you classify CKD based on GFR?
G1 = GFR >90 ONLY CKD if other evidence of kidney damage e.g. proteinuria/haematuria G2 = GFR 60-89 " G3a = GFR 45-59 Mild-moderate CKD G3b = GFR 30-44 Moderate-severe CKD G4 = GFR 15-29 Severe CKD G5 = GFR <15 Kidney failure
How do you classify CKD based on albumin:creatinine ratio?
A1 = <3 mg/mmol A2 = 3-30 mg/mmol A3 = >30 mg/mmol
What are the commonest cause of CKD?
Diabetes, glomerulonephritis and hypertension/renovascular disease
Sx of CKD?
Peripheral oedema, weight loss, dyspnoea, pruitus, muscle cramps, nausea, fatigue, bone pain and amenorrhoea and impotence
Tx of CKD?
Antihypertensives, statins, diuretics, EPO injections for anaemia, phosphate binders e.g calcium carbonate, vitamin D supplements e.g. colecalciferol.
Dialysis or transplant may be required
What are the 3 types of dialysis?
Haemodialysis = blood is taken from an AV fistula and passed over a semi-permeable membrane against dialysis fluid
Peritoneal dialysis = Catheter is inserted into the peritoneal cavity to allow dialysis over the peritoneum - CAN BE DONE CONTINUOSLY AT HOME
Haemofiltration = Used in critical care when haemodyalsis is not possible due to low blood pressure
Define nephrotic syndrome?
Proteinuria >3g/24hrs, hypoalbuminaemia (<30g/L) and oedema
Causes of nephrotic syndrome?
Primary = Minimal change disease, Focal segmental glomerulosclerosis and Membranous nephropathy Secondary = DM, lupus nephritis, myeloma
Briefly describe the 3 main primary causes of nephrotic syndrome?
Minimal change disease = abnormally functioning podocytes - give prednisolone
Focal segmental glomerulosclerosis = podocyte injury/death - give ACEi and prednisolone
Membranous nephropathy = immune mediated podocyte damage - give ACEi and immunosuppression
Tx of nephrotic syndrome?
Loop diuretics e.g. furosemide, fluid and salt restriction, ACEi/ARB to reduce proteinuria, treat cause (check with renal biopsy)
Define nephritic syndrome?
Inflammation causing massive decrease in eGFR, haematuria, proteinuria (<1g/24hrs), hypertension and oedema.
Briefly describe the causes of nephritic syndrome?
IgA nephropathy = an autoimmune disease where build up of IgA in the kidney leads to inflammatory damage
Post-streptococcal glomerulonephritis = recent throat or skin infection causes streptococcal antigens to deposit in the kidneys
Anti-GBM disease/Goodpastures syndrome = autoantibodies to type 4 collagen cause renal disease and lung disease
What drugs can be used to reduce proteinuria and protect renal function
ACEi or ARB (they inhibit efferent arteriole vasoconstriction so decrease the pressure in the glomerulus)
Sx of ADPKD?
Loin pian, visible haematuria, cyst infection, renal stones, hypertension, progressive renal failure, cysts elsewhere e.g. liver or ovaries
What is the diagnostic criteria for ADPKD?
15-39 yrs >= 3 cysts, 40-59 yrs >2 cysts on each kidney.
Mutation seen in PKD1 or PKD2
Sx of ARPKD?
Renal cysts presenting very early in life, congenital hepatic fibrosis and portal hypertension
Which layers of the prostate enlarge in BPH and cancer?
BPH = inner transitional zone Cancer = peripheral layers
Sx of BPH?
Nocturia, frequency, urgency, post-micturition dribble, poor stream/flow, hesitancy, overflow incontinence, haematuria, bladder stones and UTI.
There will be an enlarged bladder on palpation and the prostate will be enlarged but smooth
Dx and treatment of BPH?
PSA will be raised, transurethral US and biopsy, DRE = enlarged and smooth prostate
Alpha-blockers e.g. tamulosin, 5-alpha-reductase inhibitors e.g. finasteride, surgery (TURP or TUIP)
Sx of epididymal cyst?
Lump (may be multiple and bilateral) which will transiluminate. The testis are palpable seperatley from the lump and large lumps may cause pain.
Lump lies behind the testis
Sx of a hydrocele?
Scrotal enlargement with non-tender, smooth, cystic swelling which will transiluminate. It will be painless unless infected.
Lump lies infront of and below the testis.
Causes of a hydrocele?
Fluid fills the tunica vaginalis
Primary = patent processus vaginalis - most common and seen in young men
Secondary = trauma, tumour or infection
Sx of a varicocele?
The scrotum feels like a bag of worms (due to dilation of the panpiniform plexus), dull ache, more commonly seen in the left testis
Sx of epididymo-orchitis?
Sudden onset tender swelling of the scrotum and fever. May be dysuria and discharge depending on the cause
Causes of epididymo-orchitis?
STI and UTI are the main ones (Chlamydia, N. gonorrhoea, E.coli) and mumps/TB
Sx of bladder cancer? What is the most common type?
Transitional cell carcinoma
Painless haematuria, reccurrent UTIs, voiding irritability
Dx and Tx of bladder cancer?
Cystoscopy and biopsy
Surgical resection and chemotherapy. Palliative care if metastasized
Sx of testicular cancer?
This is the commonest malignancy in males ages 15-44
Painless testicular lump, secondary hydrocele, may cause pain, abdominal mass
Dx and Tx of testicular cancer?
Beta-hCG and alpha-Fetoprotein are markers of disease
Radical orchidectomy, chemo/radiotherapy
Sx of testicular torsion?
Sudden onset of pain in one testis which makes walking uncomfortable, testis is very hot, tender and swollen, testis lies high and transversely.
Abdo pain, nausea and vomiting
Tx of testicular torsion?
Rapid surgery is required (<6 hours to save the testis)
Sx of prostate cancer?
COMMONEST MALE MALIGNANCY
Nocturia, hesitiancy, poor stream, terminal dribbling or obstruction = frequency, urgency and overflow incontinence. Hard irregular prostate
Weight loss, bone pain and anaemia = metastases
Dx and Tx of prostate cancer?
Raised PSA, transurethral US and biopsy, DRE = hard and irregular prostate Radical prostatectomy (if <70), radical radiotherapy, hormone therapy e.g. goserelin, active surveillance
Sx of renal cell carcinoma?
Haematuria, loin pain, abdominal mass, anorexia, malaise, weight loss, fever, hypertension (increased renin secretion)
What are the most common causes of UTI?
Klebsiella spp., E. coli (most common), Enterococci, Proteus spp., Staphylococcus spp.
Sx of pyelonephritis?
Fever, loin pain/tenderness, pyuria, frequency, urgency, dysuria, rigors, nausea and vomiting
Sx of cystitis?
Frequency, dysuria, urgency, suprapubic pain, polyuria, haematuria, cloudy/smelly urine
Sx of prostatitis?
Pain in the perineum/rectum/scrotum/penis/bladder/lower back. Fever, malaise, nausea, urinary symptoms, pain on ejaculation.
DRE = hot, swollen and tender prostate
Tx of UTIs?
Trimethoprim, nitrofurantoin, ciprofloxacin
