Renal / G-U Flashcards
What is the KG+DIGO classification for AKI?
1) Rise in Creatinine >26micromol/L in 48 hours
2) Rise in Creatinine >50% (best figure in last 6 months)
3) Urine output <0.5ml/kg/hr for > 6 consecutive hours
- Only need 1/3 for the diagnosis of AKI
Name 3 pre-renal causes of AKI?
Shock, haemorrhage, Drugs (NSAIDS), sepsis, renal hypo perfusion, DVT
Name 3 renal causes of AKI?
Glomerulonephritis
Vasculitis
Drug Reaction
Name 3 post-renal causes of AKI?
Renal malignancy
Strictures, Stones, pelvic malignancy
What is seen on ECG in a patient with Hyperkalaemia?
Tall T waves, Increase PR interval, widened QRS
Name 3 indications for dialysis in a patient with AKI?
Persistant hyperkalemia
Refractory pulmonary oedema
Severe metabolic acidicosis
Uraemic encephalopathy
Name 6 risk factors to forming urothiliases?
Anatomical factors eg horshoe kidney, obstruction, trauma, hypercalaemia, dehydration, recurrent UTI, diuretics, stents/catheters
Name 4 ways to prevent stone formation?
- Over-hydration
- Low Na diet
- Health protein intake
- Reduced BMI
- Active lifestyle
What is first line treatment/management in urothiliases?
Hydration
Analegesia - pain relief
What treatment is used in larger stones?
Shockwave- Lithotripsy
Which 3 tumour markers are seen in testicular tumour?
AFP. LDH, b-HCG
What are the 3 stages of testicular tumour?
- Confined to testicle
- Spread below the diaphragm
- Above diaphragm or in solid organs
Name 3 difference between chlaymydia and gonorrhoea?
Gonorrhoea implied recent partner change
Chlaymdia longer incubation period
How do you diagnose chlamydia in women?
Vaginal Swab
How do you diagnose chlamydia in men?
First void urine
How do you diagnose gonorrhoea?
Near patient test - culture look for gram negative diplococci
Name 3 causes of nephritic syndrome?
IgA Nephropathy
Goodpastures
Rapidly progressive Gn
Name 3 primary causes of Nephrotic syndrome?
- Minimal change disease
- Membranous nephropathy
- Focal segmental glomerulosclerosis
Name 3 secondary causes of nephrotic syndrome?
- Lupus nephritis
- Diabetes myeloma
- Amyloid
What is detected in serum in membranous GN?
PLA2R
Name 3 complications of nephrotic syndrome?
Thromboembolism
Infection - urine loss of Ig’s
Hyperlipideamia due to hepatic synthesis in respinse to decrease oncotic pressure and defective lipid breakdown
What is first line treatment for ED?
Phosphodiesterase inhibitor eg Sildenfanil
Which medication is contraindicated with phosphodiesterase inhibitors?
Nitrates - unpredictable falls in BP
Name 3 side effects of Sildenfanil (viagra)?
Headache, flushing, dizziness, back pain and myalgia
Name the 3 second line treatments for ED?
- Vacuum constriction device
- Intra-cavernosal injections
- Intra-urethral aloporstdail
Name complication of intra-cavernosal injections?
Priapism (if erection lasts longer than 4 hours)
Name the 3rd line treatment for ED?
Penile prosthesis - malleable or inflatable
What is the definition of UTI?
Defined at >10^5 organisms/ml of fresh-mid stream urine
In what circumstances is a UTI complicated?
Pregnant, male, catheterised, child, structural abnormality of urinary tract, recurrent infection, urosepsis
Name 4 risk factors of UTI?
- Increased bacterial inoculation (sex)
- Increasing binding of url-pathogenic bacteria (post-menopausal)
- Decreased urinary flow (dehydration/obstruction)
- Increased bacterial growth (diabetes, urinary catheter)
Why are you more susceptible to UTI’s post menopause?
Loss of oestrogenisation, normal vagina colonised with lactobacilli, post menopause pH rises and increased colonisation of colonic flora
What are the symptoms of an upper UTI?
Loin pain, fevers, rigors and occasional haematuria
When would you use a urine dipstick to diagnose UTI?
In a woman <65 with less than 3 symptoms
What do red cell casts detect?
Indicate kidney damage
When would you not treat a UTI?
> 65 asymptomatic bacteruria
If it is a complicated UTI what is the GOLD standard diagnosis?
Culture
When should nitrofurantoin be avoided?
In final trimester of pregnancy and poor renal function eGFR<45
How do you diagnose a UTI for a catheter sample?
Send fresh sample not from bag
Name 3 prevention methods to prevent UTI from catheter samples?
- Intermittent catheterisation or suprapubic catheritse, keep catheter clean and remove as soon as possible, don’t treat if asymptomatic
What is the pathophysiology of pyelonephritis?
Ascending bacterial infection from bladder to renal parenchyma
What would be present on abdominal investigation in a patient with pyelonephritis?
Renal angle tenderness
How do you treat pyelonephritis?
Oral ciprofloxain or oral co-amoxiclav
How do you diagnose urinary tract tuberculosis?
Early morning urine sample
Name 2 complications of pyelonephritis?
Renal abscess, emphysematous pyelonephritis (rare, gas accumulation in tissues)
Name 5 causes of CKD?
- Diabetes Melltius
- Glomerulonephritis
- Hypertension
- Vasculitis
- SLE
- PKD
- Nephrotoxic Drugs
- Urinayr tract obstruction
Why is there increased PTH in stage 3 CKD?
Renal phosphate retention and impaired 1,25-dihydroxy vitamin D production leads to a fall in serum Calcium and thus a compensatory increase in PTH which can result in skeletal decalcification leading to bone disease
Name 4 complications of CKD?
- Anaemia - decreased EPO production
- Bone disease due to increased PTH
- Postural hypotension, depressed cerebral function
- Hypertension, hyperlipidaemia and vascular calcification –> CVD
Name 3 complications fo peritoneal dialysis.?
Peritonitis, abdominal wall herniation, intestinal perforation
Name 3 complications fo haemodialysis.?
Hypotension, fevers, infection, chest pain, nausea
Name 4 differences between AKI and CKD?
- CKD- small kidney AKI = normal
- No anaemia in AKI, Anaemia in CKD
- Low BP in AKI, high BP in CKD
- Oliguria present in AKI, oliguria only present in advanced disease in CKD
- rapid onset AKI, gradual onset CKD
In which disease would you see bilateral kidney enlargement?
PKD polycystic kidney disease
What are the storage symptoms?
Frequency, urgency, urgency incontinence, nocturia
What are the voiding symptoms?
Dysuria, dribbling, hesitancy, straining, haematuria, incomplete emptying, poor stream
What lifestyle advice would you suggest in a man with BPH?
Avoid caffeine, alcohol Relax when voiding. Void twice in a row to aid emptying. Control urgency by practising distraction methods (eg breathing exercises). Train the bladder by ‘holding on’ between voiding.
Name 3 methods to diagnose BPE?
- DRE
- Renal Biochem - PSA
- Frequency volume chart
If patient presents with nocturnal enuresis (bed wetting) and pain loin to groin. What would you suspect?
Interactive obstructive uropathy, diagnose by checking standing and lying blood pressures to see if patient can cope with diuresis
What is acute retention of urine caused by?
Prostatic obstruction, urethral strictures, alcohol
How do you treat acute retention of urine?
Catheterisation and alpha 1 blocker
When should you think about surgery in a patient with LUTS?
Retention, UTI, Stones, Haematuria, Elevated creatinine, Symptoms progression
What is the GOLD standard surgery in LUTS?
Trans-urethral resection of prostate (TURP)
Give two side effects of finesteradide?
Incompetence and decreased libido
When should you not prescribe Tamulosin and name 3 other side effects ?
Postural hypotension
dizzy, depression, dry mouth, dec. BP
What is the equation for renal blood flow?
aortic pressure- renal venous pressure renal vascular resistance
Name 3 renal causes of urinary obstruction?
PKD, TB infection, renal cell carcinoma
Name 3 causes of urinary obstruction in ureters?
Stricture, schistosomiasis, pregnancy
Name 3 causes of urinary obstruction in the bladder?
Urethral stricture, TCC, prostatitis
What is hydoureterhonehrosis?
Dilatation of the renal pelvis, calyces and ureter caused by the obstruction to free flow of urine from the kidney, leading to progressive atrophy of the renal cortex
Which investigation for renal stones is safe in pregnancy?
Ultrasound
How do you treat metastatic prostate cancer?
- Surgical castration
2. Medical androgen deprivation therapy with GNrH analogues and LH antagonists
Name 3 possible methods to treat localised prostate cancer?
- Watch and wait
- brachytherapy - radioactive beads placed in prostate
- Radical prostatectomy
What is the definition of overactive bladder?
Urgency with frequency, with or without nocturia, then appearing in the absence of local pathology
Name 5 methods to treat OAB?
- behavioural therapy
- Anti-muscanics
- B3 agonist
- Botox
- Sacral neuromodulation
- Surgery
Name two treatment methods in stress incontinence in women post pregnancy?
Pelvic floor physiotherapy
Surgery – (Sling, bulking agents, artificial sphincter)
Name two methods of bladder management in paraplegic patients?
- Suprapubic catheter
2. Convene drainage
When should you refer a patient with haematuria to have an appointment within two weeks?
- > 45, unexplained visible haematuria or visible haematuria that perisists after UTI treatment
- > 60 non-visible haematuria, dysuria and raised WCC
- > 60 with recurrent or persistent unexplained urinary tract infection
Name 4 investigations in a patient with visible haematuria?
- FBC
- MSU- microscopy and culture
- Cytology
- Flexible cystoscopy
- Imaging: Ultrasound/CT
What is stage 3 or renal cancer?
Above diagram and towards right atrium
Name 5 risk factors for bladder cancer?
- Paraplegic
- Smoking
- Occupation eg dye
- Drugs eg cyclophosphamide
- Bladder stones
- Schistosomiasis
How do you confirm the diagnosis of bladder cancer?
Trans-urethral resection of bladder tumour (TURB)
What complication arises during TURB?
Perforate bladder, due to obturator kick
What are the 4 stages of bladder cancer?
Ta- Surface of bladder
T1- Through lamina propria but not muscle
T2-T4- Through muscular layer
How do you grade non-muscular invasive bladder cancer?
G1 - low grade bladder tumour
G2. moderate differentiation
G3- poorly differentiated
Name 6 differential diagnosis of testicular tumour?
- Epididymal orchitis
- Hydrocele
- Variocele
- Haematocele
- Epididymal - cysts
- Testicular torsion
What class of drug is oxybutynin?
Anti-muscarinic
How does oxybutin work?
Inhibits acetylchloine by blocking muscarinic receptors on M3 and promoting bladder relaxation
What are the side effects of oxybutinin?
Dry cough, tachycardia, constipation and blurred vision
How does primary syphillis present?
Maculole - papuole - painless ulcer
How does secondary syphillis present?
Rash (70%), common on hands and soles of feet, fever, myalgia, lymphadenopathy
Give 2 signs and 2 symptoms of AKI?
Symptoms = dehydration, confusion, fever Signs = Postural hypotension, peripheral oedema, raised JVP, pallor
Give 5 investigations you would do into AKI?
- Urinalaysis - bloods, leukocytes
- Bloods - eg vasculitis, IgG
- Urine electrophoresis
- Skeletal survey for myeloma
- Doppler US of renal artery and veins
What are the complications of AKI?
- Hyperkalaemia
- Bleeding
- Pulmonary oedema
- Metabolic Acidosis
What components make up the eGFR?
Creatinine, age, gender, race
What lifestyle advice would you give a patient with CKD?
Encourage exercise health weight, stop smoking and patient education on CKD
Give 4 medications to manage the complications of CKD?
Bone disease (calcitriol), anaemia (epo/iron supplements), Decreases BP (ace), oedema (furosemide) and CVD (statins
Name 4 problems with using eGFR?
Creatinine is secreted and filtered, drugs eg trimethorprom inhibit creatinine secretion so make function look worse, extremes of muscle mass can be misleading and requires a steady state
Where is IgA commonly found?
Breast milk, respiratory tract, GI tract, saliva, tears and GU
Give 2 management steps for a patient with IgA nephropathy?
- Reduce BP = ACE and lifestyle changes
2. Steroids to stop deposition
What is the pathophysiology of IgA nephropathy?
Type 3 hypersensitivity, immune complexes deposit in the mesangium –> glomerular injury
Give 2 methods of diagnosis of IgA nephropathy?
- Biopsy to show mesangial deposits
2. Immunoflouresence IgA
Give 4 features of nephritic syndrome?
Haematuria (cola-coloured) Red cell casts Proteinuria Hypertension Low urine volume <300ml/day
What are the 3 features of nephrotic syndrome?
- Proteinuria
- Hypoalbuminaemia
- Oedema
Which 3 geoups of patients commonly have bacteruria?
> 65, catheterised and pregnant women
Give 3 times with PSA will be raised?
UTI, exercise, prostatitis, ejaculation
