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TAS > Renal and urology > Flashcards

Renal and urology Flashcards

1
Q

Indications for acute renal failure

A

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

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2
Q

what is the eGFR for dialysis (and in diabetics)

A

<10

<15 if diabetic

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3
Q

Haemodialysis

A

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

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4
Q

Peritoneal dialysis

A

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

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5
Q

Complications of heamodialysis

A

Thrombus
air thrombus
hypotension
anaphylaxis

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6
Q

Complications of PD

A

infection
blockage of catheter
hyperglycaemia and weight gain
hernias

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7
Q

Pathology of HSP

A

Small vascular disease
Immunoglobulin A immune complex deposits in the mesangium

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8
Q

What infection is HSP most commonly preceded by

A

Haemolytic streptococci

Others - mycoplasma, EBV

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9
Q

Presentation of HSP

A

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

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10
Q

Management of HSP

A

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

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11
Q

F/U with HSP

A

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

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12
Q

what type of antibodies are in Goodpasture syndrome

A

antiglomerular basement membrane antibodies

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13
Q

screening for undescended testes

A

72 hours
6-8 weeks
4-5 months age

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14
Q

treatment of undescended testes

A

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

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15
Q

complications of undescended testes

A

bilateral more common of infertility problems
trauma
tumour
torsion

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16
Q

Atypical UTI

A

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

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17
Q

Investigation if uti <6 months

A

Non-complicated - USS in 6 weeks

Atypical or recurrent - USS during infection, DMSA, MSUG

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18
Q

Investigations in UTI in 6months to 3 years

A

non-complicated - nil

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

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

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19
Q

Investigations in UTI in 3 years <

A

Non-complicated - none

Atypical - USS during infection

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20
Q

Goodpastures syndrome triad

A

Glomerulonephritis
Pulmonary haemorrhage
Anti-GBM antibodies

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21
Q

What is SLE associated with

A

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

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22
Q

Most common cause of glomerulonephritis

A

Post-streptococcal

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23
Q

Acute nephritic syndrome

A

presents with haematuria
reduced renal function
oliguria
HTN

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24
Q

Nephrotic syndrome triad

A

Proteinuria
Oedema
Hypoalbumenia

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25
Q

Pathophysiology of nephrotic syndrome

A

Large molecules leaking across the glomerulus

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26
Q

What is the most commonest cause of nephrotic syndrome in children

A

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

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27
Q

What causes secondary NS

A

systemic disease - e.g. lupus
HSP

28
Q

Signs and symptoms of secondary NS / atypical

A

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

29
Q

What is NS’s affect on thrombosis

A

Increases risk

Loss of antithrombin III

30
Q

Treatment of nephrotic syndrome

A

Prednisolone 16 weeks
PPI
Penicillin proph.
fluid monitoring
pneumococcal vaccination

31
Q

Where does Fanconi syndrome affect?

A

Proximal tubular defect

32
Q

Medullary sponge kidney

A

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

33
Q

post-infection GN affect on complements

A

Low C3 and CH 50
Normal C4
Drop within 2 weeks

34
Q

What is a DMSA scan best for?

A

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

35
Q

What is MCUG use for?

A

Assessing for reflux

36
Q

What happens in proximal tubule

A

Glucose transport
Phosphate transport
Amino acid transport

37
Q

What happens in ascending limb of Henley

A

Sodium, potassium and chloride transport

38
Q

What happens in distal tubule?

A

Protein section, sodium chloride transport

39
Q

What happens in collecting duct

A

Water transport
Sodium and potassium transport

40
Q

What happens in primary vesicoureteric reflux

A

Short ureter to bladder
Fails to contract when bladder restricts

41
Q

What happens in secondary VUR

A

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

42
Q

What is the grading for VUR

A

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

43
Q

When do you give prophylactic ABX?

A

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

44
Q

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

A

Hydronephrosis
Oligohydramnios

45
Q

What symptoms seen in duplex kidney?

A

Continuous dribbling

46
Q

What is affected in Bartter Syndrome

A

Disturbance in thick ascending limb of loop of Henle

47
Q

What blood results do you see in Bartter syndrome?

A

Hypokalaemia, hypochloreamic, metabolic alkalosis with salt wasting

Hyperreineami aan hypaldosteronism
Hypercalcemia

48
Q

Where is the defect in Gitelman Syndrome

A

Abnormality in distal consulted tubule

49
Q

How is gitelman syndrome inherited

A

Autosomal recessive

50
Q

What blood results in Gitelman syndrome

A

Hypokalaemia hypochloreamic metabolic alkalosis with salt wasting

Na not include - can be reabsorbed by paracellular route

51
Q

How does furosemide work?

A

Prevents reabsorption of sodium potassium and chloride

52
Q

How does bendroflumethazide work?

A

Affects sodium-chloride transporter in distal convuluted tubule

53
Q

What is idiopathic hyper calciuria

A

high calcium in urine
normal calcium levels in blood

54
Q

What is treatment of idiopathic hypercalciuria

A

thiazide diuretics - promotes calcium reabsorption

55
Q

How is idiopathic hypercalciuria inherited

A

autosomal disorder

56
Q

What would be the histological findings of minimal change disease

A

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

57
Q

When would you do a kidney biopsy in nephrotic syndrome

A

Not responded to steroids in 6 weeks

58
Q

Most common cause of nephrotic syndroome

A

minimal change disease

59
Q

What is the histological finding of membranoproliferazive disease type 1

A

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

60
Q

What is the histological finding of membranous glomerulonephritis

A

deposition of electron-dense material on the capillary basement membrane

61
Q

What are the two stages of descent of the testes

A

trans-abdominal phase
inguinoscrotal phase

62
Q

What hormones are involved in trans-abdominal phase

A

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

63
Q

When would you transfer albumin in nephrotic syndrome

A

If symptomatic hypovolemaia or severe diuretic resistant oedema

e.g. CRT >2 secs

64
Q

Signs of nephritic syndrome

A

HTN
Heamaturia
red cell casts in urine
proteinuria

65
Q

Most common cause of nephritic syndrome

A

post-streptoccocol glomerulonephritis

TAS (18 decks)

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