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CP3 Medicine > RENAL - Infections, Stones and Malignancy > Flashcards

RENAL - Infections, Stones and Malignancy Flashcards

1
Q

PS Acute pyelonephritis (6)

A 
High fever
Loin pain w/ tenderness 
Bacteruria 
Rigors
Vomiting 
Oliguria
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2
Q

Complications of pyelonephritis (3)

A

Sepsis
Abscess
Papillary necrosis

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3
Q

What does chronic pyelonephritis lead to

A

Scarring + progressive renal impairment –> ESRD

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4
Q

Appearance of kidney chronic pyelonephritis

A

Shrunken
Scarred
Capsule thickened and internal plumbing distorted and distended

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5
Q

What does chronic pyelonephritis occur in the presence of

A

Vesicoureteric reflux

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6
Q

Cystitis S+s (7)

A 
Freq + nocturia 
Dysuria 
Urgency 
Haematuria 
Smelly urine
Suprapubic pain/tenderness 
Strangury
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7
Q

What is Strangury

A

Painful frequent urination of small volume, expelled only by straining despite a severe sense of urgency

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8
Q

What specific Sx do older pt w/ cystitis present with?

A

Confusion

+/- incontinence

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9
Q

What specific Sx do children w/ cystitis present with (3)

A

FTT
Fever
Poor feeding

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10
Q

Predisposing factors cystitis (6)

A 
Female
Pregnancy
Menopause
Obstructive/tract malformation 
Catheter
Diabetes
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11
Q

Most common causative agent cystitis

A

E.Coli (75%)

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12
Q

Ix cystitis (5)

A 
Urine dipstick 
Midstream urine MCS
USS
CT/IV urography 
MSU
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13
Q

Causes of sterile pyuria (5)

A 
Recently Tx UTI
Appendicitis 
TB
Chlamydia 
Bladder Cancer
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14
Q

Tx cystitis

A

Nitrofurantoin 100mg BD 3 days

+ lifestyle advice

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15
Q

Tx pyelonephritis

A

IV Tazocin 4.5g tds for at least 7 days

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16
Q

Recurrent UTI’s advice + Tx (5)

A 
High fl intake 
Freq voiding (esp after sex)
Avoid spermicidal jellies 
Avoid constipation 
Prophylactic Abx at night
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17
Q

3 Tx outcomes of UTI

A

Eradication
Elapse - rec infection within 7 days
Reinfection - bacteria absent 14 days then reoccur

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18
Q

What does acute ureteric obstruction lead to

A

Enlargement of UT superior to obstruction

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19
Q

Sx of upper ureteric obstruction (3)

A

Loin pain
Palpable kidney (hydronephrosis)
Infection due to stasis

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20
Q

Sx lower ureteric obstruction (5)

A 
Suprapubic pain 
Palpable bladder 
Frequency 
Slow to start 
Slow to finish
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21
Q

Luminal causes ureteric obstruction (5)

A 
Calculus 
SLoughed renal papilla 
Blood clot 
TCC renal pelvic/ureter 
Bladder. tumour
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22
Q

Mural causes ureteric obstruction (3)

A

Ureteric stricture
Congenital pelviureteric NM dysfunction
Congenital megaureter

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23
Q

Extramural causes ureteric obstruction (4)

A 
Compression due to
External tumours 
Diverticulitis 
AAA
Retroperitoneal fibrosis
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24
Q

Ix ureteric obstruction (5)

A 
Urine MCS
USS confirm dilatation 
Abdo XR
Non-contrast CT 
Retrograde pyelogram
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25
Q

Medical Mx ureteric obstruction

A 
A-E
75mg diclofenac IM 
IM metocloperamide if severe N/V
Iv ABx if severe infections 
Assess whether admission is req
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26
Q

When to admit - ureteric obstruction (4)

A

Still severe pain after 1hr
Risk of AKI
Signs shock/infection
Uncertainty over diagnosis

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27
Q

Indications for active Tx ureteric obstruction (5)

A 
Low chance spontaneous passage
Persistent pain 
Ongoing obstruction 
Signs infection 
Renal insufficiency
28
Q

Surgical Mx options ureteric obstruction (4)

A 
ESWL
Uterscopy 
Percutaneous nephrolithotomy 
Nephrostomy 
Stenting
29
Q

Which drugs incr rate of expulsion in ureteric obstruction

A

Tamulosin

Nifedipine

30
Q

What % of stones pass naturally

A

80%

31
Q

Follow up ureteric obstruction

A

send 1st stone for analysis

Rx urology within 1 week

32
Q

Where are the 3 classic sites of renal stones

A

Pelvicoureteric jct = renal pelvis
Pelvic brim
Vesicoureteric jct

33
Q

What is the most common composition of renal stones

A

Calcium oxaolate (75%)

34
Q

Peak age of kidney stones

A

20-40 y/o

35
Q

M:F kidney stones

A

3:1

36
Q

What are the 3 types of kidney stones

A

Staghorns
Renal pelvis stone
Ureteric stone

37
Q

PS kidney stones

A

Renal colic - loin to groin spasms
Pt can’t lie still
N/V
UTI

38
Q

When does renal colic occur w/ kidney stones

A

If stone impacted in ureter

39
Q

When does a dull loin pain occur w/ kidney stones

A

If stone in major/minor calyx

40
Q

RF KIDNEY STONES (4)

A

Obesity
Dehydration
FHx/PHx
Anatomical abnormalities

41
Q

When are stones are emergency

A

If there is both obstruction and infection

42
Q

Ix kidney stones

A 
Bloods - Ca,PO4, gluc, HCO3, urate
Urine dip -95% blood
bHCG
MCS + pH 
AXR 
Non contract CT
43
Q

What % of kidney stones are visible on AXR

A

80%

44
Q

What % of kidney stones are visible on non-contrast CT

A

99%

45
Q

Mx kidney stones (4)

A

Analgesia
PCNL/lithotripsy
Diet advise - high fl, low salt, low animal protein, drink citrus. fruit juice
Exercise + W loss

46
Q

Causes of bladder calculi (3)

A

Bladder flow obstruction
Presence of FB
Upper UT stone passing down

47
Q

Sx bladder calculi

A

Sx UTI; signif bacturia, poor flow, terminal dribble
+ Haematuria + pain gen at end of micturition as bladder contracts
Male - pain at tip penis
Perineal pain

48
Q

When is there perineal pain w/ a bladder calculi

A

If = trigonitis

49
Q

Ix bladder calculi

A

As per upper UT stone

50
Q

Mx bladder calculi

A

Medical expulsive therapy
ESWL (lithotripsy if large)
Immediate analgesia

51
Q

Complications bladder calculi

A

Predispose to SCC

52
Q

What is a renal cell carcinoma

A

Vascular tumour from PCT

53
Q

What % of renal tumours are renal cell carcinomas

A

90%

54
Q

Main RF RCC

A

Prolonged haemodyalysis

55
Q

PS RCC

A

50% incidential
10% - Haematuria, loin pain, abdo pass, B Sx
Signs polycythaemia or HTN (if EPO secretion)

56
Q

Ix RCC (5)

A 
Urine cytology 
USS
CT/MRI 
CXR 
REnal angiography
57
Q

Why do CXR for renal cell carcinoma

A

Assess for cannon ball mets in the lungs

58
Q

Mx renal cell carcinoma (2)

A

Radical / partial nephrectomy

Post op chemo

59
Q

What is a Wilms tumour

A

Undifferentiated mesodermal mass

60
Q

What age to Wilms tumours PS

A

3.5y

61
Q

Sx Wilms tumour (2)

A

Flank pain

Abdo mass

62
Q

What must you NOT do w/ a WIlms tumour

A

Biopsy

63
Q

Mx Wilms tumour

A

Nephrectomy

Post-op chemo

64
Q

What % of 50 y/o have renal cyst

A

50%

65
Q

Sx renal cysts (3)

A

Asymp

Or cause haematuria + pain

66
Q

What are the 3 most common causes of renal cysts

A

PKD
Medullary cystic disease
Medullary spongy disease

CP3 Medicine (29 decks)

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