Renal conditions Flashcards
What organism commonly causes UTIs?
E.coli
Also, proteus mirabalis, klebsiella pneumoniae, staphylococcus saprophyticus (in young women)
In UTI, what would be the likely results of a urinalysis?
+ve nitrites and leucocytes
What is the normal management course for UTI?
What is used for resistant organisms?
Trimethoprim or nitrofurantoin for 3-5 days, modify if culture results indicate. For resistant organisms, co-amoxiclav or ciprofloxacin may be used.
What is the management course for pyelonephritis?
IV cerfuroxime, ciprofloxacin or gentamicin. Switch for further 7 days oral treatment once symptoms improve
Why should asymptomatic bacteriuria be treated in pregnancy?
Frequently leads to acute pyelonephritis.
Amoxicillin, nitrofurantoin and cephalosporins safe to use
What causes hydronephrosis?
Obstruction of the UT, commonly by stones. Also, pregnancy, cancer of bladder/cervix/prostate, BPH, vesicoureteric reflux
How is hydronephrosis managed?
Doesn’t always require treatment. Treat underlying cause i.e. remove kidney stones, stent a narrow ureter, treat tumour
What causes AKI?
- Pre-renal (40-70%): hypoperfusion
- Intrinsic (10-50%): tubular necrosis, glomerular/interstitial/vascular problems
- Post-renal (10-25%): UT obstruction
Commonest are ischaemia, sepsis, nephrotoxins and prostatic disease
What are the symptoms and signs of AKI?
Early stages often asymptomatic. Fatigue, malaise, rash, joint pain, N+V, chest pain, palpitations, SOB, fluid overload, abdo pain, oliguria, hypo/hypertension
O/E: palpable kidneys/bladder/pevlic mass
Why is it important to do an urgent ABG/VBG and ECG in suspected AKI?
To check for hyperkalaemia predisposing to potentially disastrous arrhythmias
How is AKI managed?
Treat underlying cause: replenish fluid in haemorrhage, remove obstruction at least temporarily with catheterisation, dialyse in some cases
How long does it normally take for renal function to recover after AKI?
2-3 weeks
Define chronic kidney disease
Impaired renal function based on abnormal structure or function or GFR <60ml/min/1.73m squared for >3 months
What are the symptoms of CKD?
May not be present til later stages. Weight loss, poor apetite, swollen ankles/feet/hands, SOB, fatigue, haematuria, urgency, nocturia, insomnia, pruritus, muscle cramps, nausea, headaches, impotence
On USS of kidneys, what is often the size of the kidneys in CKD?
<9cm
What 3 things indicate CKD?
Normochromic anaemia, small kidneys and renal osteodystrophy
How is CKD managed?
Aggresively treat underlying cause. Tight glycaemic control, dietry constrictions, blood pressure control, retain Ca and phosphate in normal range, recombinant human EPO for anaemia, sodium bicarbonate for acidosis, furosemide for oedema.
Renal Replacement Therapy.
In which ethnic group is BPH less common?
Asians
What are the typical differences between BPH and prostate carcinoma?
In BPH, inner transitional zone enlarges rather than peripheral layer of prostate in prostate carcinoma.
O/E: BPH - typically, smooth enlargement. Prostate carcinoma - nodular hard enlargement
How is BPH managed?
Mild to moderate disease: Lifestyle changes, avoid caffeine and alcohol, relax when voiding, close monitoring
Moderate: Drugs - alpha blockers such as doxazosin or tamsulosin. 5-alpha reductase inhibitors such as finasteride
Deterioration in renal function: Surgery - TURP, TUIP, retropubic prostatectomy, TULIP
What is the most common male cancer in the UK?
Prostate cancer
What is the name of the scoring system used to grade prostate tumours?
Gleason scoring system
What is the most common form of transitional cell malignancy?
Bladder carcinoma
What are some of the risk factors for bladder carcinoma?
Smoking, industrial exposure (particularly rubber), chronic cystitis, drugs, schistomiasis (SCC likely), pelvic irradiation
In bladder carcinoma, is haematuria typically painful or painless?
Painless
How is bladder cancer managed?
For lower stages: diathermy via transurethral cytoscopy/transurethral resection of bladder tumour (TURBT), also chemo or BCG
Medium stages: Radical cystectomy is gold standard, radio and chemo
Advanced stages: Palliative chemo/radiotherapy
In what autosomal dominant disease are bilateral renal cell carcinomas common?
Von Hippel-Lindau disease
Why can hypertension be a fairly common complication of renal carcinomas?
Tumour secretes renin leading to increased BP. Similarly, anaemia or polycythaemia can develop due to depression/stimulation of EPO production
What kidney tumour is seen typically within the first 3 years of life?
Nephroblastoma or Wilm’s tumour
Lifetime incidence of urinary tract stones?
15%
What is the most common type of urinary tract stones?
Calcium oxolate (75%). Struvite (15%), urate (5%), hydroxyapetite (5%), cysteine
Symptoms of UT stones?
Asymptomatic or renal colic pain with N+V. Writhing about in pain/can’t lie still. Large staghorn calculi may cause loin pain. Pain may radiate to genitals. Microscopic haematuria common. Pyexia if UTI develops
How are UT stones managed?
If <5mm, should pass spontaneously, give analgesia and antibiotics
If >5mm or unresolving, shockwave lithotripsy/medical treatments (nifedipine, tamsulosin)/ureteroscopy/cystoscopy/open surgery
