Renal and Urology Flashcards
Recall 3 pre-renal causes of AKI
Hypovolaemia
Renal hypoperfusion
Heart failure
How does hypovolaemia cause AKI?
Decreased renal BP causes reduced GFR
Give 2 intrinsic renal causes of AKI
Glomerulonephritis
Interstitial nephritis
Other than thrombi and emboli, what might cause vessel obstruction leading to AKI?
Haemolytic microangiopathy (HUS or TTP)
Which type of cancer is most strongly associated with AKI and with what investigation might it be detected/ excluded?
Myeloma
Microscopy: looking for Bence-Jones protein
What ECG sign shows hyperkalaemia?
Tented T waves
What is the first line of management for hyperkalaemia?
10mls of calcium gluconate 10%
Recall 3 common complications of AKI
Hyperkalaemia
Metabolic acidosis
Pulmonary oedema
Recall the 4 principles of management for AKI
- Protect against hyperkalaemia
- Optomise fluid balance
- Stop any nephrotoxic drugs
- Consider for dialysis
Which part of the prostate is hypertrophic in BPH?
Periurethral (transitional) zone
What would be the main DRE finding in BPH?
Palpable midline groove
What is the option for medical management of BPH and why?
Alpha blockers - relax SMCs
What is the eGFR diagnostic of CKD?
<60
What is the eGFR diagnostic of established renal failure?
<15
Give 2 skin signs of CKD
Pigmentation
Excoriation
Recall 3 non-skin signs of CKD
Anaemia
Leuconychia
Kussmaul breathing due to acidosis
Are CKD patients acidotic or alkalotic?
Acidotic
What sort of diet should be fed to CKD patients?
High energy, low potassium
Recall 2 autoimmune conditions that can cause CKD
SLE
Goodpasture’s
With what comorbidity does orchitis always present?
Epidydimitis
What are the most likely infective causes of epidydimitis/orchitis in <35s?
Gonorrhoea/ chlamydia
What are the most likely infective causes of epidydimitis/orchitis in >35s?
Klebsiella/ enterobacter
How do you distinguish epidydmitis/orchitis from testicular torsion?
Testicular torsion has very sudden onset of symptoms
What is the most likely complication of epidydimitis?
Testicular abscess
What are the complications of mumps orchitis?
Testicular atrophy
Infertility
Define glomerulonephritis
Immunologically-mediated inflammation of the renal glomeruli
What is the nephrotic syndrome?
Triad of proteinuria, low albumin and oedema
What is the nephritic syndrome?
Triad of hypertension, proteinuria and haematuria
What is the main difference in the symptoms of nephrotic syndrome and nephritic syndrome?
Nephrotic: proteinuria
Nephritic: haematuria
Define hydrocele
Excessive collection of serous fluid within the tunica vaginalis
When is hydrocele most common?
First year of life
What is the main sign of hydrocele?
Scrotal swelling
Recall 2 tumour markers for testicular cancer
Beta-HCG
Alpha-fetoprotein
What is the usual composition of urinary tract calculi?
Calcium oxalate
Describe the pain produced by urinary tract calculi
Severe loin to groin
Recall the symptoms of urinary tract calculi
Severe loin to groin pain
Nausea and vomiting
Urinary symptoms may be frequency or retention
What is the main differential to consider in suspected urinary tract calculi when the patient is an elderly man?
Leaking AAA
What blood tests outside of the usual would you order in urinary tract calculi?
Calcium
Phosphate
Urate
What % of urinary tract calculi are radio-opaque?
80%
Stones of what size in the urinary tract will pass spontaneously?
<5mm
What would make a urinary tract stone an acute presentation?
Obstructed or infected kidney
What is the most commonly-implicated pathogen in UTI?
E coli
Recall the symptoms of cystitis
Frequency and urgency
Dysuria
Suprapubic pain
WBCs in urine
Recall the symptoms of pyelonephritis
Flank pain
High fever
Malaise
WBCs in urine
Under what group of conditions does prostatitis fall?
UTIs
Describe the symptoms of prostatitis
Lower backache
Obstructive urinary symptoms
Flu-like symptoms
What is the first choice of antibiotic for uncomplicated UTI in women and men?
Women: nitrofurantoin
Men: flucloxacillin
What are the typical abnormalities seen on urine dip in UTI?
Raised WBC
Nitrites
On which side does varicocele usually present?
Left
What is the cause of varicocele?
Venous incompetence in the pamphiniform plexus
What are the usual symptoms of varicocele?
Scrotal heaviness but no pain
What is the best investigation to do for varicocele?
Colour doppler ultrasound
