Renal and urology Flashcards by kate de

Indications for acute renal failure

Severe ECF volume overload - severe HTN, pulmonary oedema
Severe hyperkaelmia
Severeve symptoms uremia - urea >40, hypothermia, seizures
Hypo and hyper natraemia

How well did you know this?

Not at all

Perfectly

what is the eGFR for dialysis (and in diabetics)

<10

<15 if diabetic

How well did you know this?

Not at all

Perfectly

Haemodialysis

Synthetic material to surround blood with an eelctroylte solution
Differing concentrations of solutes across the membrane facilitate movement from a high concentration (Blood) to a lower
Blood taken from fistula or central venous line

How well did you know this?

Not at all

Perfectly

Peritoneal dialysis

Peritoneal vessels are source of blood and dialyste
ultrafiltration regualted by osmolality
can be done during day or over night

How well did you know this?

Not at all

Perfectly

Complications of heamodialysis

Thrombus
air thrombus
hypotension
anaphylaxis

How well did you know this?

Not at all

Perfectly

Complications of PD

infection
blockage of catheter
hyperglycaemia and weight gain
hernias

How well did you know this?

Not at all

Perfectly

Pathology of HSP

Small vascular disease
Immunoglobulin A immune complex deposits in the mesangium

How well did you know this?

Not at all

Perfectly

What infection is HSP most commonly preceded by

Haemolytic streptococci

Others - mycoplasma, EBV

How well did you know this?

Not at all

Perfectly

Presentation of HSP

Kidneys - nephritis, microscopic haematuria
Skin - erythematous rash on back on legs, buttocks changes to purpuric lesions
Arthritis - transient, affects more joints
GI - abdominal pain

How well did you know this?

Not at all

Perfectly

Management of HSP

Self-limiting
Refer to renal specialist for biopsy
Can use steroids +/- azathioprine or MMF

How well did you know this?

Not at all

Perfectly

F/U with HSP

Dependent on abnormalities In urinanalysis
Absence of proteinuria - BP and urinanalysis at 7 days, 14 days and one three six and twelve months
Presence of proteinuria - 7 and 14 days, every month until 6 months and 12 months

How well did you know this?

Not at all

Perfectly

what type of antibodies are in Goodpasture syndrome

antiglomerular basement membrane antibodies

How well did you know this?

Not at all

Perfectly

screening for undescended testes

72 hours
6-8 weeks
4-5 months age

How well did you know this?

Not at all

Perfectly

treatment of undescended testes

delay until at least 6 months
treatment should be performed max. 18 months

How well did you know this?

Not at all

Perfectly

complications of undescended testes

bilateral more common of infertility problems
trauma
tumour
torsion

How well did you know this?

Not at all

Perfectly

Atypical UTI

Not responded to ABX in 48 hours
Raised Cr
Sepsis
Non-ecoli
abdomen mass

How well did you know this?

Not at all

Perfectly

Investigation if uti <6 months

Non-complicated - USS in 6 weeks

Atypical or recurrent - USS during infection, DMSA, MSUG

How well did you know this?

Not at all

Perfectly

Investigations in UTI in 6months to 3 years

non-complicated - nil

atypical - USS during infection, DMSA 4-6 months after

recurrent - USS in 6 weeks, DMSA 4-6 months after

How well did you know this?

Not at all

Perfectly

Investigations in UTI in 3 years <

Non-complicated - none

Atypical - USS during infection

How well did you know this?

Not at all

Perfectly

Goodpastures syndrome triad

Glomerulonephritis
Pulmonary haemorrhage
Anti-GBM antibodies

How well did you know this?

Not at all

Perfectly

What is SLE associated with

prolific formation of auto antibodies from immune complexes deposited within mesangium and sub endothelial

How well did you know this?

Not at all

Perfectly

Most common cause of glomerulonephritis

Post-streptococcal

How well did you know this?

Not at all

Perfectly

Acute nephritic syndrome

presents with haematuria
reduced renal function
oliguria
HTN

How well did you know this?

Not at all

Perfectly

Nephrotic syndrome triad

Proteinuria
Oedema
Hypoalbumenia

How well did you know this?

Not at all

Perfectly

Pathophysiology of nephrotic syndrome

Large molecules leaking across the glomerulus

What is the most commonest cause of nephrotic syndrome in children

Primary idiopathic ns Minimal change disease - most likely steroid responsive focal-segmental glomerulosclerosis - likely to be resistant to steroids membranoproliferazive glomerulonephritis

What causes secondary NS

systemic disease - e.g. lupus HSP

Signs and symptoms of secondary NS / atypical

>10 years Hypertensive Family Hx systemic features - rash abnormal renal function abnormal complement C3 or autoantibody

What is NS's affect on thrombosis

Increases risk Loss of antithrombin III

Treatment of nephrotic syndrome

Prednisolone 16 weeks PPI Penicillin proph. fluid monitoring pneumococcal vaccination

Where does Fanconi syndrome affect?

Proximal tubular defect

Medullary sponge kidney

Cysts 1-5mm in collecting system Bilateral in 75% cases often presents in adulthood Not considered inherited disorder Hypercalcemai MSK leads to stones

post-infection GN affect on complements

Low C3 and CH 50 Normal C4 Drop within 2 weeks

What is a DMSA scan best for?

it is a static radio-isotope taken up by proximal tubules good for assessing scars

What is MCUG use for?

Assessing for reflux

What happens in proximal tubule

Glucose transport Phosphate transport Amino acid transport

What happens in ascending limb of Henley

Sodium, potassium and chloride transport

What happens in distal tubule?

Protein section, sodium chloride transport

What happens in collecting duct

Water transport Sodium and potassium transport

What happens in primary vesicoureteric reflux

Short ureter to bladder Fails to contract when bladder restricts

What happens in secondary VUR

Abnormally high intravescile pressure Posterior urethral valves, neurogenic bladder (spina bifida), uterecele

What is the grading for VUR

I = urine tracts into non-dilated ureter II = urine tracts into renal pelvis without any dilatation III = mild to moderate dilatation to ureter only IV = urethral touristy with pelvic dilatation V = gross dilatation and urethral torisity with blunted fornices

When do you give prophylactic ABX?

I - I I = if recurrent UTIs or not toilet trained III - V = all

What features might you see in antenatal scans for concerns regarding VUR

Hydronephrosis Oligohydramnios

What symptoms seen in duplex kidney?

Continuous dribbling

What is affected in Bartter Syndrome

Disturbance in thick ascending limb of loop of Henle

What blood results do you see in Bartter syndrome?

Hypokalaemia, hypochloreamic, metabolic alkalosis with salt wasting Hyperreineami aan hypaldosteronism Hypercalcemia

Where is the defect in Gitelman Syndrome

Abnormality in distal consulted tubule

How is gitelman syndrome inherited

Autosomal recessive

What blood results in Gitelman syndrome

Hypokalaemia hypochloreamic metabolic alkalosis with salt wasting Na not include - can be reabsorbed by paracellular route

How does furosemide work?

Prevents reabsorption of sodium potassium and chloride

How does bendroflumethazide work?

Affects sodium-chloride transporter in distal convuluted tubule

What is idiopathic hyper calciuria

high calcium in urine normal calcium levels in blood

What is treatment of idiopathic hypercalciuria

thiazide diuretics - promotes calcium reabsorption

How is idiopathic hypercalciuria inherited

autosomal disorder

What would be the histological findings of minimal change disease

Loss/ fusion of podocyte foot processes and growth of vili on the visceral epithelial cells = allowing proteins to be loss = ON ELECTRON MICROSCOPY NOTE IT IS NORMAL IN LIGHT MICROSCOPY

When would you do a kidney biopsy in nephrotic syndrome

Not responded to steroids in 6 weeks

Most common cause of nephrotic syndroome

minimal change disease

What is the histological finding of membranoproliferazive disease type 1

splitting of capillary basement membrane with deposits in intra-glomerular mesangium

What is the histological finding of membranous glomerulonephritis

deposition of electron-dense material on the capillary basement membrane

What are the two stages of descent of the testes

trans-abdominal phase inguinoscrotal phase

What hormones are involved in trans-abdominal phase

insulin-like 3 protein and mulliarn inhibiting hormone Thickening of gumernaculum (attached to caudal end of testis) - this is controlled by insulin-like 3 protein and considered most important stage

When would you transfer albumin in nephrotic syndrome

If symptomatic hypovolemaia or severe diuretic resistant oedema e.g. CRT >2 secs

Signs of nephritic syndrome

HTN Heamaturia red cell casts in urine proteinuria

Most common cause of nephritic syndrome

post-streptoccocol glomerulonephritis