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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
Common causes raised PSA
- prostate cancer - BPH - Prostatitis - UTI - Exercise - Recent ejaculation
26
Medical Mx BPH
- Alpha blockers = tamsulosin - 5 alpha reductase inhibitors = finasteride - combination - antimuscarinic
27
surgical mx BPH
- TURP - TEVAP - HoLEP - Prostatectomy
28
RF bladder cancer
- smoking - Age - Aromatic amines = dye and rubber - Schistosomiasis
29
most common type of bladder cancer
- transitional cell carcinoma 90%
30
S+S bladder cancer and when 2ww
- painless haematuria 2ww when - 45 or over with unexplained visible haematuria - 60 or over with microscopic haematuria PLUS dysuria or raised WCC
31
diagnosis and mx of bladder cancer
- cystoscopy to diagnose - tx = TURBT, chemo, BCG, cystectomy
32
causes of epididymo orchitis
- E coli - Chlamydia - Gonorrhoea - Mumps
33
S+S epididymo-orchitis
- testicular pain - dragging sensation - swelling testicle - tender palpation - discharge - systemic
34
Ix epididymo orchitis
- urine MC&S - STI screen and charcoal swab - saliva swab if suspect mumps - serum abs for mumps - USS
35
Mx epididymo orchitis
- treat STI E coli - Ofloxacin 14d, levofloxacin for 10 or co amox for 10 empirical tx - IM ceftriaxone
36
SE of quinolone abx
= ofloxacin, levofloxacin - Tendon damage and rupture = acilles - lowers seizure threshold
37
features of nephritic syndrome
- Haematuria - Oliguria - Proteinuria - FLuid retention
38
nephrotic syndrome features
BM becomes highly permeable - proteinuria - low serum albumin - peripheral oedema - hypercholesterolaemia = present with oedema and frothy urine
39
most common cause nephrotic syndrome n children
minimal change disease - successfully treated with steroids
40
most cmomon nephrotic in adults
- membranous nephropathy - focal segmental glomerulosclerosis
41
diagnosis glomerulonephritis
- renal biopsy - supportive care - steroids
42
nephritic syndrome features
- haematuria - oliguria - proteinuria - fluid retention
43
triad of HUS
- microangiopathic haemolytic anaemia - AKI - Thrombocytopenia
44
HUS presentation
- following gi upset = e coli or shigella - bloody diarrhoea in 3 days - fever - abdo pain - lethargy - oliguria - haematuria - bruising
45
Mx HUS
- IV fluids - Treat HTN - Blood transfusions - Haemodialysis
46
Ix kidney stones
- AXR - Non contract CT KUB
47
Mx kidney stones
- NSAIDs = diclofenac - antiemetics - ABx - surgery = ESWL, ureteroscopy
48
Mx renal stones
- <5mm and no sx = WW - 5-10mm = shockwave lithotripsy - 10-20 mm = shockwave or ureteroscopy - >20mm = percutaneous nephrolithotomy
49
Mx ureteric stones
- <10mm = shockwave lithotripsy +/- alpha block - 10-20mm = ureteroscopy
50
2 meds to reduce risk recurrence stones
- potassium citrate - thiazide diuretics = increase distal tubule Ca resorption
51
RF testicular cancer
- undescended - infertility - FHx - increased height
52
Ix testicular cancer
- USS - Alpha fetoprotein - Beta hCg - CT
53
S+S prostate cancer
- lower back or bone pain - Lethargy - erectile dysfunction - haematuria - anorexia - LUTS
54
most common type prostate cancer
- Adenocarcinoma
55
prostate cancer ix
- multiparametric mri - prostate biopsy -
56
prostate cancer mx
- external beam radiotherapy - brachytherapy - hormone therapy - surgery
57
Goserelin is..
- GnRH agonist = lower LH levels by causing overstimulation
58
RCC S+S
- haematuria - loin pain - non specific cancer features - palpable renal mass on examination
59
when 2ww for rcc
- >45 - unexplained visible haematuria without UTI or persisting after treatment
60
paraneoplastic syndromes associated with rcc
- polycythaemia - hypercalcaemia - htn - stauffers syndrome
61
most common cause pyelonephritis
- e coli = gram -ve anaerobic rod shaped bacteria
62
pyelonephritis triad
- fever - loin pain - nausea/vomiting
63
mx pyelonephritis
- ciprofloxacin 500mg BD for 7 days - cefalexin, co amox and trim as well - pregnant = cefalexin 500mg 2-3 x day
64
uti mx
- nitrofurantoin or trim for 3 days - 5-10 days if immunosuppressed or abnormal anatomy - 7 days for men, pregnant or catheter
65
hydrocele
- fluids within tunica vaginalis - painless - soft and fluctuant - irreducible - transilluminated
66
varicocele
- swollen veins in pampiniform plexus - pain worse standing - dragging sensation - mass, goes when lying - asymmetry - uss
67
epididymal cysts
- head of epididymis - soft round lumo - top of testicle - separate from testicle - may transilluminate
68
torsion
- firm, swollen, elevated, no reflex - acute pain, unilateral, vomiting mx - nbm - analgesia - surgical exploration
69
chronic prostatitis s+s
- pelvic pain - LUTS - sexual dysfnction - tender prostate
70
acute prostatitis s+s
- fever - myalgia - nausea - fatigue - sepsis
71
mx acute bacerial prostatitis
- admit - abx - analgesia - laxatives
72
mx chronic prosttitis
- alpha blockers -analgesia - psychological tx - abx
73
causes hyperkalaemia
- aki - ckd - rhandomyolysis - adrenal insufficiency - aldosterone antagonists - acei - arbs - nsaids
74
hyperkalaemia ecg
- tall peaked t waves - flat p waves - prolonged pr and broad qrs
75
mx hyperkalaemia
- insulin and dextrose infusion - iv calcium gluconate salbutamol nebs
76
affected genes in ADPCKD
- PKD1 gene on csome 16 - PKD2 gene on csome 4
77
affected genes in ARPCKD
- PKHD1 gene on csome 6
78
stress incontinence def
leaking when coughing, laughing etc
79
urge incontinence def
urge to urinate quickly followed by uncontrollable leakage
80
urge mx
- bladder retrain 6 weeks - oxybutynin - mirabegron if concerns re anticholinergic sx
81
stress incontinence mx
- pelvic floor training 3 months - surgery - duloxetine
82
why does ckd cause high phosphate
kidneys normally excrete phosphate
83
what effect foes high phosphate have on calcium
- draws calcium from bones = osteomalacia - low calcium
84
mx high phosphate
1st line = reduced dietary intake 2nd line = phosphate binders
85
stage 1 aki
- creatinine increase 1.5-1.9 X baseline - increase creatinine by >26.5
86
stage 2 aki
- increase creatinine 2-2.9X baseline
87
stage 3 aki
- increase creatinine 3X baseline - increase >353.6
88
when to watchful wait renal stones
<5mm and asymptomatic
89
what tx if stones 5-10mm
ESWL
90
what txif stones 10-20mm
shockwave lithotripsy or ureteroscpy
91
TNM RCC
T1 = <7cm and confined T2 = >7 cm and confined T3 = major veins or tissues T4 = beyond gerotas fascia
92
causes and features of acute tubular necrosis
- Ischaemia = shock, sepsis - Nephrotixins Features - AKI and muddy brown casts
93
Acute interstitial nephritis
- Drugs = penicillin, NSAIDs, Furosemide - Fever, rash, arthralgia, eosinophilia - Sterile pyuria and WC casts

FINALS (32 decks)

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