renal and uro SBAs Flashcards
A 17 year old male presents with a 1 week history of fever, malaise, pain on swallowing + has found lumps in the neck. On examination a tender scrotal swelling is also noted.
Mumps - parotitis and swelling of parotid gland(s) which is present in 95% of symptomatic mumps. Mumps epididymo-orchitis is also a common feature shown as a tender scrotal swelling. Treatment of this viral infection involves isolation and supportive care with paracetamol or ibuprofen.
Acute features of kidney failure
Oliguria & acute rise in Cr/urea
Electrolyte imbalance (hyperK+)
Nausea and vomiting
Drowsiness (malaise)
Chronic features of kidney failure
Oedema Poor appetite Drowsiness (malaise) Anaemia Bone weakness (high phosphate, renal osteodystrophy, low calcitriol, high oestrogen)
Renal colic medical Rx (suitable for <10mm calculi)
Analgesia e.g. diclofenac IV fluids to rehydrate Drugs to reduce ureteric spasm: -Tamsulosin (a-blocker) -Nifedipine (CCB) Active stone removal if stone >7mm
Long-term diet changes, hydration, allopurinol
Which pathogens are most likely to cause epididymo-orchitis in patients <35 years and >35 years?
<35years = STIs (Chlamydia trachomatis and Neisseria gonorrhoeae) >35years = UTIs (E coli)
Commonest cause of nephrotic syndrome in children is
Minimal change glomerulonephritis
Commonest causes of nephrotic syndrome in adults
Diabetes mellitus
Membranous glomerulonephritis
n.b. any type of glomerulonephritis can cause nephrotic syndrome but these are just the most common.
Nephrotic syndrome
Hypoalbuminaemia
Oedema
Proteinuria
(hypercholesterolaemia)
SLE can cause glomerulonephritis. What would you test for to confirm this?
ANA
Anti-dsDNA
Goodpasture’s syndrome can cause glomerulonephritis. What would you test for to confirm this?
Anti-GBM antibodies
Wegener’s polyangiitis antibody
cANCA
Main causes of renal artery stenosis
Atherosclerosis (older) Fibromuscular dysplasia (younger)
Fibromuscular dysplasia resembles a string of beads on angiography. What conditions is it associated with?
Causes RAS in the young.
Associated with collagen disorders, neurofibromatosis, Takayasu’s disease, and microaneurysms in renal arteries.
Renal artery stenosis gold standard investigation
Digital subtraction angiography
Types of renal calculi
Calcium oxalate (65%) Calcium phosphate (15%) Magnesium ammonium phosphate (10%) Uric acid (5%) Cysteine (1%)
Renal calculi risk factors
Dehydration
UTIs
Changes in urinary pH
HyperCa2+, hyperoxaluria, hyperuricaemia, cystinuria
Kidney functions
Maintains fluid compartments (ECF Na+ and ICF H2O)
Electrolyte/acid-base balance (K+ and pH)
Excretion of waste products (urea)
Hormone production (erythropoietin and vit D)
Causes of pre-renal AKI
40-70% of AKI
Renal hypoperfusion
e.g. hypotension:
hypovolaemia, sepsis
Renal artery stenosis ±ACEi
Causes of intrinsic renal AKI
(10-50%) These may require renal biopsy for diagnosis.
Tubular - ATN (pre-renal damage, nephrotoxic drugs, rhabdomyolysis, myeloma)
Glomerular - autoimmune
Interstitial - acute interstitial nephritis (drugs, infiltration)
Vascular - vasculitis, thrombus
Causes of post-renal AKI
10-25%
Urinary tract obstruction
e.g. stones, blood clots, malignancy, retroperitoneal fibrosis
Pulmonary oedema Rx
Sit up, give O2 ±CPAP
IV GTN
IV furosemide
IV diamorphine
Complications of AKI that need to be treated
HyperK+
Metabolic acidosis
Pulmonary oedema
Acute kidney injury Rx
after complications have been treated
IV fluids Treat infection - Abx Stop nephrotoxic drugs (ACEi and NSAIDs) Treat intrinsic renal disease Relieve obstruction Optimise nutrition Consider future dialysis
Epidydimo-orchitis
<35years Chlamydia: doxycycline/ azithromycin Gonorrhoea: + ceftriazone >35years UTIs: ciprofloxacin/oflaxacin
Antibiotics should be used for 2-4weeks
Analgesia, scrotal support, drainage of abscess
