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FINALS > Renal and urology > Flashcards

Renal and urology Flashcards

1
Q

Criteria for AKI

A
  • Rise in creatinine >26micromol/l in 48hrs
  • Rise in creatinine of >50% in 7 days
  • UO < 0.5ml/kg/hr in 6 hours
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2
Q

RF AKI

A
  • age
  • sepsis
  • CKD
  • HF
  • DM
  • Liver disease
  • COgnitive impairement
  • Meds
  • radiocontrast
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3
Q

pre renal causes AKI

A
  • dehydration
  • shock
  • HF
  • renal artery stenosis
    Insufficient blood supply to kidneys (hypoperfusion/ischaemia)
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4
Q

Renal causes AKI

A

Intrinsic disease
- glomerulonephritis
- nephritis
- HUS
- rhabdomyolysis
- acute tubular necrosis = death of epithelial cells in rt
- renal artery stenosis

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5
Q

post renal causes AKI

A

Obstruction to outflow
- stones
- tumours
- strictures
- BPH
- neurogenic bladder

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6
Q

Tx AKI

A
  • IV fluids
  • Withhold nephrotoxic meds
  • relive obstruction
  • dialysis if severe
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7
Q

assessment of AKI patient

A
  • current sx, fluid intake, output, RF, meds
  • volume status = urological obstruction
  • renal function and K level
  • Urine dipstick
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8
Q

Ix AKI

A
  • urinalysis
  • USS urinary tract
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9
Q

causes CKD

A
  • DM
  • HTN
  • Meds
  • Glomerulonephritis
  • PCKD
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10
Q

Presentation CKD

A
  • Asymptommatic
  • Fatigue
  • Pallor
  • Proteinuria, polyuria
  • Pruritis
  • oedema
    Diagnose = chronic reduction in kidney function >3 months
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11
Q

Ix CKD

A
  • eGFR = serum creatinine, age, gender
  • early morning urine to measure ACR
  • Proteinuria
  • Haematuria = dip or micro
  • Renal USS
  • BMI, HbA1c and lipids
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12
Q

Diagnosis CKD

A
  • eGFR <60 sustained
  • ACR >3 mg/mmol sustained
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13
Q

Mx CKD

A
  • kidney failure risk equation for 5yr risk dialysis
    Refer when
  • eGFR <30
  • Urine ACR >70
  • Accellerated progression
  • 5yr risk >5%
  • uncontrolled HTN despite 4+ meds
    Meds
  • ACEi
  • SGLT2 inhib
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14
Q

stage 1 CKD

A
  • > =90
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15
Q

stage 2 ckd

A

60-89

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16
Q

stage 3a ckd

A

45-59

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17
Q

stage 3b ckd

A

30-44

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18
Q

stage 4 ckd

A

15-29

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19
Q

stage 5 ckd

A
  • <15
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20
Q

BP target CKD

A

<130/80 if under 80 with ACR >70

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21
Q

drug to reduce complications CKD

A

Statin 20mg

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22
Q

when to offer ACEi in CKD

A
  • DM plus ACR >3
  • HTN plus ACR >30
  • ACR >70
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23
Q

renal bone disease

A
  • high serum phosphate
  • low vit D activity
  • Low serum calcium
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24
Q

Assessment of patient with LUTS

A
  • DRE
  • Abdo exam
  • Urine output chart
  • Urine dipstick
  • PSA
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25
Q

Common causes raised PSA

A
  • prostate cancer
  • BPH
  • Prostatitis
  • UTI
  • Exercise
  • Recent ejaculation
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26
Q

Medical Mx BPH

A
  • Alpha blockers = tamsulosin
  • 5 alpha reductase inhibitors = finasteride
  • combination
  • antimuscarinic
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27
Q

surgical mx BPH

A
  • TURP
  • TEVAP
  • HoLEP
  • Prostatectomy
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28
Q

RF bladder cancer

A
  • smoking
  • Age
  • Aromatic amines = dye and rubber
  • Schistosomiasis
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29
Q

most common type of bladder cancer

A
  • transitional cell carcinoma 90%
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30
Q

S+S bladder cancer and when 2ww

A
  • painless haematuria
    2ww when
  • 45 or over with unexplained visible haematuria
  • 60 or over with microscopic haematuria PLUS dysuria or raised WCC
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31
Q

diagnosis and mx of bladder cancer

A
  • cystoscopy to diagnose
  • tx = TURBT, chemo, BCG, cystectomy
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32
Q

causes of epididymo orchitis

A
  • E coli
  • Chlamydia
  • Gonorrhoea
  • Mumps
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33
Q

S+S epididymo-orchitis

A
  • testicular pain
  • dragging sensation
  • swelling testicle
  • tender palpation
  • discharge
  • systemic
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34
Q

Ix epididymo orchitis

A
  • urine MC&S
  • STI screen and charcoal swab
  • saliva swab if suspect mumps
  • serum abs for mumps
  • USS
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35
Q

Mx epididymo orchitis

A
  • treat STI
    E coli
  • Ofloxacin 14d, levofloxacin for 10 or co amox for 10
    empirical tx
  • IM ceftriaxone
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36
Q

SE of quinolone abx

A

= ofloxacin, levofloxacin
- Tendon damage and rupture = acilles
- lowers seizure threshold

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37
Q

features of nephritic syndrome

A
  • Haematuria
  • Oliguria
  • Proteinuria
  • FLuid retention
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38
Q

nephrotic syndrome features

A

BM becomes highly permeable
- proteinuria
- low serum albumin
- peripheral oedema
- hypercholesterolaemia
= present with oedema and frothy urine

39
Q

most common cause nephrotic syndrome n children

A

minimal change disease
- successfully treated with steroids

40
Q

most cmomon nephrotic in adults

A
  • membranous nephropathy
  • focal segmental glomerulosclerosis
41
Q

diagnosis glomerulonephritis

A
  • renal biopsy
  • supportive care
  • steroids
42
Q

nephritic syndrome features

A
  • haematuria
  • oliguria
  • proteinuria
  • fluid retention
43
Q

triad of HUS

A
  • microangiopathic haemolytic anaemia
  • AKI
  • Thrombocytopenia
44
Q

HUS presentation

A
  • following gi upset = e coli or shigella
  • bloody diarrhoea in 3 days
  • fever
  • abdo pain
  • lethargy
  • oliguria
  • haematuria
  • bruising
45
Q

Mx HUS

A
  • IV fluids
  • Treat HTN
  • Blood transfusions
  • Haemodialysis
46
Q

Ix kidney stones

A
  • AXR
  • Non contract CT KUB
47
Q

Mx kidney stones

A
  • NSAIDs = diclofenac
  • antiemetics
  • ABx
  • surgery = ESWL, ureteroscopy
48
Q

Mx renal stones

A
  • <5mm and no sx = WW
  • 5-10mm = shockwave lithotripsy
  • 10-20 mm = shockwave or ureteroscopy
  • > 20mm = percutaneous nephrolithotomy
49
Q

Mx ureteric stones

A
  • <10mm = shockwave lithotripsy +/- alpha block
  • 10-20mm = ureteroscopy
50
Q

2 meds to reduce risk recurrence stones

A
  • potassium citrate
  • thiazide diuretics = increase distal tubule Ca resorption
51
Q

RF testicular cancer

A
  • undescended
  • infertility
  • FHx
  • increased height
52
Q

Ix testicular cancer

A
  • USS
  • Alpha fetoprotein
  • Beta hCg
  • CT
53
Q

S+S prostate cancer

A
  • lower back or bone pain
  • Lethargy
  • erectile dysfunction
  • haematuria
  • anorexia
  • LUTS
54
Q

most common type prostate cancer

A
  • Adenocarcinoma
55
Q

prostate cancer ix

A
  • multiparametric mri
  • ## prostate biopsy
56
Q

prostate cancer mx

A
  • external beam radiotherapy
  • brachytherapy
  • hormone therapy
  • surgery
57
Q

Goserelin is..

A
  • GnRH agonist
    = lower LH levels by causing overstimulation
58
Q

RCC S+S

A
  • haematuria
  • loin pain
  • non specific cancer features
  • palpable renal mass on examination
59
Q

when 2ww for rcc

A
  • > 45
  • unexplained visible haematuria without UTI or persisting after treatment
60
Q

paraneoplastic syndromes associated with rcc

A
  • polycythaemia
  • hypercalcaemia
  • htn
  • stauffers syndrome
61
Q

most common cause pyelonephritis

A
  • e coli = gram -ve anaerobic rod shaped bacteria
62
Q

pyelonephritis triad

A
  • fever
  • loin pain
  • nausea/vomiting
63
Q

mx pyelonephritis

A
  • ciprofloxacin 500mg BD for 7 days
  • cefalexin, co amox and trim as well
  • pregnant = cefalexin 500mg 2-3 x day
64
Q

uti mx

A
  • nitrofurantoin or trim for 3 days
  • 5-10 days if immunosuppressed or abnormal anatomy
  • 7 days for men, pregnant or catheter
65
Q

hydrocele

A
  • fluids within tunica vaginalis
  • painless
  • soft and fluctuant
  • irreducible
  • transilluminated
66
Q

varicocele

A
  • swollen veins in pampiniform plexus
  • pain worse standing
  • dragging sensation
  • mass, goes when lying
  • asymmetry
  • uss
67
Q

epididymal cysts

A
  • head of epididymis
  • soft round lumo
  • top of testicle
  • separate from testicle
  • may transilluminate
68
Q

torsion

A
  • firm, swollen, elevated, no reflex
  • acute pain, unilateral, vomiting
    mx
  • nbm
  • analgesia
  • surgical exploration
69
Q

chronic prostatitis s+s

A
  • pelvic pain
  • LUTS
  • sexual dysfnction
  • tender prostate
70
Q

acute prostatitis s+s

A
  • fever
  • myalgia
  • nausea
  • fatigue
  • sepsis
71
Q

mx acute bacerial prostatitis

A
  • admit
  • abx
  • analgesia
  • laxatives
72
Q

mx chronic prosttitis

A
  • alpha blockers
    -analgesia
  • psychological tx
  • abx
73
Q

causes hyperkalaemia

A
  • aki
  • ckd
  • rhandomyolysis
  • adrenal insufficiency
  • aldosterone antagonists
  • acei
  • arbs
  • nsaids
74
Q

hyperkalaemia ecg

A
  • tall peaked t waves
  • flat p waves
  • prolonged pr and broad qrs
75
Q

mx hyperkalaemia

A
  • insulin and dextrose infusion
  • iv calcium gluconate
    salbutamol nebs
76
Q

affected genes in ADPCKD

A
  • PKD1 gene on csome 16
  • PKD2 gene on csome 4
77
Q

affected genes in ARPCKD

A
  • PKHD1 gene on csome 6
78
Q

stress incontinence def

A

leaking when coughing, laughing etc

79
Q

urge incontinence def

A

urge to urinate quickly followed by uncontrollable leakage

80
Q

urge mx

A
  • bladder retrain 6 weeks
  • oxybutynin
  • mirabegron if concerns re anticholinergic sx
81
Q

stress incontinence mx

A
  • pelvic floor training 3 months
  • surgery
  • duloxetine
82
Q

why does ckd cause high phosphate

A

kidneys normally excrete phosphate

83
Q

what effect foes high phosphate have on calcium

A
  • draws calcium from bones = osteomalacia
  • low calcium
84
Q

mx high phosphate

A

1st line = reduced dietary intake
2nd line = phosphate binders

85
Q

stage 1 aki

A
  • creatinine increase 1.5-1.9 X baseline
  • increase creatinine by >26.5
86
Q

stage 2 aki

A
  • increase creatinine 2-2.9X baseline
87
Q

stage 3 aki

A
  • increase creatinine 3X baseline
  • increase >353.6
88
Q

when to watchful wait renal stones

A

<5mm and asymptomatic

89
Q

what tx if stones 5-10mm

A

ESWL

90
Q

what txif stones 10-20mm

A

shockwave lithotripsy or ureteroscpy

91
Q

TNM RCC

A

T1 = <7cm and confined
T2 = >7 cm and confined
T3 = major veins or tissues
T4 = beyond gerotas fascia

92
Q

causes and features of acute tubular necrosis

A
  • Ischaemia = shock, sepsis
  • Nephrotixins
    Features
  • AKI and muddy brown casts
93
Q

Acute interstitial nephritis

A
  • Drugs = penicillin, NSAIDs, Furosemide
  • Fever, rash, arthralgia, eosinophilia
  • Sterile pyuria and WC casts

FINALS (31 decks)

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