renal Flashcards
indications for urostomy
cystectomy for bladder cancer, pelvic clearance for extensive cancer
→ ileal conduit / indiana pouch (with ileocaecal valve)
complications of renal transplant
immediate: surgical complications (pain, infection, bleeding)
early: rejection
late: failure
immunosupression: opportunistic infections (CMV), malignancy (lymphoma)
nephrotic vs nephritic syndrome
nephrotic: oedema, hypoalbuminaemia, proteinuria (+ hyperlipidaemia)
nephritic: haematuria, proteinuria, oedema (+ HTN)
causes of nephrotic syndrome
primary:
membranous glomerulonephritis (older pts)
minimal change (children)
focal segmental glomerulosclerosis (young adults)
secondary:
diabetes, amyloidosis, SLE, HBV/HCV
causes of nephritic syndrome
primary:
IgA nephropathy: days after URTI / GI infection
mesangiocapillary glomerulonephritis
secondary: post-strep: 2-12wks after throat / skin infection goodpasture's: anti-GBM vasculitis SLE cryoglobulinaemia
differentials for palpable kidneys
bilateral: PKD, RCC (5%), hydronephrosis, amyloidosis
unilateral: PKD + nephrectomy, RCC, simple cyst, hydronephrosis, renal agenesis → hypertrophy of other kidney
presentation of PKD
loin pain haematuria recurrent UTIs renal stones abdo mass / palpable kidneys HTN hepatomegaly (if liver cysts)
investigations PKD
bloods: raised Hb (excess erythrompoeitin) U&Es deranged creatinine genetic testing urine dip → haematuria renal USS (diagnostic for +ve FH) CT abdo + pelvis
management PKD
cons: monitor renal function & for complications
genetic counselling
med: treat HTN
analgesia for renal pain / treat cause (e.g. renal stones)
dialysis for renal failure
surg: CT-guided cyst aspiration
nephrectomy for recurrent bleeds / infection
renal transplant
management PKD
cons: monitor renal function & for complications
genetic counselling
med: treat HTN
analgesia for renal pain / treat cause (e.g. renal stones)
dialysis for renal failure
surg: CT-guided cyst aspiration
nephrectomy for recurrent bleeds / infection
renal transplant
indications for renal replacement therapy
complications refractory to Tx acidosis electrolyte abnormalities: hyperkalaemia intoxicants: salicylates, methanol, lithium overload (fluid) uraemia → encephalopathy
causes of chronic kidney disease
diabetes HTN glomerulonephritis PKD systemic conditions: SLE, vasculitis nephrotoxic drugs: lithium, mesalazine obstruction: recurrent urinary stones
management of chronic kidney disease
cons: diet, exercise, stop nephrotoxic drugs, smoking cessation
med: treat HTN
diuretics → oedema
EPO + vit D replacement
surg: RRT, transplant
RFs for renal cell carcinoma
smoking
HTN
von-hippel lindau
dialysis
presentation of renal cell carcinoma
loin pain / mass
haematuria
varicocele
FLAWS
types of renal cell carcinoma
- clear cell (75%)
- papillary
- chromophobe
- collecting duct
complications of haemodialysis
site infection, sepsis
site stenosis
air embolism
dialysis disequilibrium syndrome (cerebral oedema)
complications of peritoneal dialysis
peritonitis
sepsis
hernias
management renal stones
cons: observation (<5mm → 95% pass spontaneously)
high fluid intake
med: analgesia
tamsulosin (alpha-blocker, promotes expulsion)
treat UTI
surg: extracorporeal shockwave lithotripsy (ESWL)
cystoscopy + JJ stent insertion (to bypass blockage)
percutaneous nephrolithotomy
uretero-renoscopy + laser
types of kidney stones
calcium oxalate (most common) magnesium ammonia phosphate (struvite): assoc w infection (proteus) uric acid (gout) calcium phosphate cysteine
causes of kidney stones
hypercalcaemia
dehydration
gout
urinary tract abnormalities e.g. horse-shoe kidney
management of renal obstruction
requires urgent Tx:
percutaneous nephrostomy
cystoscopy + JJ stent insertion
+ IV ABx + fluids
types of testicular cancer (+ tumour markers)
germ cell (95%):
seminomas (50%)
non-seminoma: teratoma, choriocarcinoma, yolk sac, mixed
non-germ cell: leydig cell, gonadoblastoma
teratoma + seminoma most common
teratoma (all 3 germ cell layers) → younger pts, more aggresive, AFP + bHCG
seminoma (epithelium of seminoferous tubules) → older pts, less aggressive, bHCG only
causes of AKI
pre-renal: reduced perfusion
hypovolaemia: diarrhoea, vomiting, haemorrhage, dehydration, burns
reduced cardiac output: heart failure
renal:
acute tubular necrosis: ischaemia / nephrotoxic agents (e.g. ACEi, gentamicin, contrast media, rhabdomylysis)
glomerulonephritis
vascular: HUS, TTP, DIC, vasculitides
post-renal: obstruction
renal calculi
tumours
prostate enlargement
ABx therapy for acute pyelonephritis
broad-spectrum cephalosporin OR fluoroquinolone (if non-pregnant)
