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2B - GRIND > Renal > Flashcards

Renal Flashcards

1
Q

Which locations do renal stones classically become lodged?

A

Pelviureteric junction (ureter joins the kidney), Pelvic brim and Vesicourteric junction (where ureter connects to the bladder)

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2
Q

What are the types of renal stones?

A

Calcium oxalate, phosphate, urate and cystine stones

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3
Q

Sx of renal stones?

A

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

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4
Q

Dx and TX of renal stones?

A

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.

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5
Q

How is AKI defined?

A

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

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6
Q

How do you stage AKI?

A

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

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7
Q

Pre-renal causes of AKI?

A 
Decreased vascular volume = haemorrhage, D&amp;V, burns, pancreatitis
Decreased CO = cardiogenic shock, MI
Systemic vasodilation = sepsis, drugs
Renal vasoconstriction (afferant arteriole) = NSAIDs/ACEi/ARB
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8
Q

Renal causes of AKI?

A 
Glomerular = glomerulonephritis
Interstitial = drug reaction, infection and infiltration e.g. sarcoidosis
Vessels = vasculitis, DIC
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9
Q

Post-renal causes of AKI?

A

Within the renal tract = stone, renal tract malignancy, stricture and clot
Extrinsic compression = pelvic maligancy, BPH/prostate cancer

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10
Q

Tx of AKI?

A

Pre-renal = IV fluids
Renal = biopsy and reffer to specialist
Post-renal = catheter
Monitor K+, stop nephrotoxic drugs e.g. NSAIDs, ACE-i, ARB

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11
Q

Define CKD?

A

Abnormal kidney structure or function present for >3 months with implications for health

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12
Q

How do you classify CKD based on GFR?

A 
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
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13
Q

How do you classify CKD based on albumin:creatinine ratio?

A 
A1 = <3 mg/mmol
A2 = 3-30 mg/mmol
A3 = >30 mg/mmol
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14
Q

What are the commonest cause of CKD?

A

Diabetes, glomerulonephritis and hypertension/renovascular disease

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15
Q

Sx of CKD?

A

Peripheral oedema, weight loss, dyspnoea, pruitus, muscle cramps, nausea, fatigue, bone pain and amenorrhoea and impotence

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16
Q

Tx of CKD?

A

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

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17
Q

What are the 3 types of dialysis?

A

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

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18
Q

Define nephrotic syndrome?

A

Proteinuria >3g/24hrs, hypoalbuminaemia (<30g/L) and oedema

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19
Q

Causes of nephrotic syndrome?

A 
Primary = Minimal change disease, Focal segmental glomerulosclerosis and Membranous nephropathy
Secondary = DM, lupus nephritis, myeloma
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20
Q

Briefly describe the 3 main primary causes of nephrotic syndrome?

A

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

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21
Q

Tx of nephrotic syndrome?

A

Loop diuretics e.g. furosemide, fluid and salt restriction, ACEi/ARB to reduce proteinuria, treat cause (check with renal biopsy)

22
Q

Define nephritic syndrome?

A

Inflammation causing massive decrease in eGFR, haematuria, proteinuria (<1g/24hrs), hypertension and oedema.

23
Q

Briefly describe the causes of nephritic syndrome?

A

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

24
Q

What drugs can be used to reduce proteinuria and protect renal function

A

ACEi or ARB (they inhibit efferent arteriole vasoconstriction so decrease the pressure in the glomerulus)

25
Q

Sx of ADPKD?

A

Loin pian, visible haematuria, cyst infection, renal stones, hypertension, progressive renal failure, cysts elsewhere e.g. liver or ovaries

26
Q

What is the diagnostic criteria for ADPKD?

A

15-39 yrs >= 3 cysts, 40-59 yrs >2 cysts on each kidney.

Mutation seen in PKD1 or PKD2

27
Q

Sx of ARPKD?

A

Renal cysts presenting very early in life, congenital hepatic fibrosis and portal hypertension

28
Q

Which layers of the prostate enlarge in BPH and cancer?

A 
BPH = inner transitional zone
Cancer = peripheral layers
29
Q

Sx of BPH?

A

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

30
Q

Dx and treatment of BPH?

A

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)

31
Q

Sx of epididymal cyst?

A

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

32
Q

Sx of a hydrocele?

A

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.

33
Q

Causes of a hydrocele?

A

Fluid fills the tunica vaginalis
Primary = patent processus vaginalis - most common and seen in young men
Secondary = trauma, tumour or infection

34
Q

Sx of a varicocele?

A

The scrotum feels like a bag of worms (due to dilation of the panpiniform plexus), dull ache, more commonly seen in the left testis

35
Q

Sx of epididymo-orchitis?

A

Sudden onset tender swelling of the scrotum and fever. May be dysuria and discharge depending on the cause

36
Q

Causes of epididymo-orchitis?

A

STI and UTI are the main ones (Chlamydia, N. gonorrhoea, E.coli) and mumps/TB

37
Q

Sx of bladder cancer? What is the most common type?

A

Transitional cell carcinoma

Painless haematuria, reccurrent UTIs, voiding irritability

38
Q

Dx and Tx of bladder cancer?

A

Cystoscopy and biopsy

Surgical resection and chemotherapy. Palliative care if metastasized

39
Q

Sx of testicular cancer?

A

This is the commonest malignancy in males ages 15-44

Painless testicular lump, secondary hydrocele, may cause pain, abdominal mass

40
Q

Dx and Tx of testicular cancer?

A

Beta-hCG and alpha-Fetoprotein are markers of disease

Radical orchidectomy, chemo/radiotherapy

41
Q

Sx of testicular torsion?

A

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

42
Q

Tx of testicular torsion?

A

Rapid surgery is required (<6 hours to save the testis)

43
Q

Sx of prostate cancer?

A

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

44
Q

Dx and Tx of prostate cancer?

A 
Raised PSA, transurethral US and biopsy, DRE = hard and irregular prostate
Radical prostatectomy (if <70),  radical radiotherapy, hormone therapy e.g. goserelin, active surveillance
45
Q

Sx of renal cell carcinoma?

A

Haematuria, loin pain, abdominal mass, anorexia, malaise, weight loss, fever, hypertension (increased renin secretion)

46
Q

What are the most common causes of UTI?

A

Klebsiella spp., E. coli (most common), Enterococci, Proteus spp., Staphylococcus spp.

47
Q

Sx of pyelonephritis?

A

Fever, loin pain/tenderness, pyuria, frequency, urgency, dysuria, rigors, nausea and vomiting

48
Q

Sx of cystitis?

A

Frequency, dysuria, urgency, suprapubic pain, polyuria, haematuria, cloudy/smelly urine

49
Q

Sx of prostatitis?

A

Pain in the perineum/rectum/scrotum/penis/bladder/lower back. Fever, malaise, nausea, urinary symptoms, pain on ejaculation.
DRE = hot, swollen and tender prostate

50
Q

Tx of UTIs?

A

Trimethoprim, nitrofurantoin, ciprofloxacin

2B - GRIND (11 decks)

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