Renal Medicine Core Conditions ALL Flashcards

1
Q

Epidemiology of UTI

A
Most common type of infection
Most common form: infectious cystitis
20% of all UTIs in men
Risk in men increases w/age
Rarely develop in men <50
10% of >18yo will have 1 every 12 months
20-40% of women develop recurrent UTI problems
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2
Q

Most common causative agent of UTIs

A

E. coli

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3
Q

Other causative agents of UTIs in men

A

Klebsiella
Proteus
Enterococcus
Staphylococcus

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4
Q

Other causative agents of UTIs in women

A
Staphylococcus
Saprophyticus
Proteus
Klebsiella
Pseudomonas
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5
Q

Pathophysiology of UTIs in men

A

<50 - possible due to sexual intercourse or alteration to host defence

> 50 - due to structural or functional abnormalities of the urinary tract or alteration to host defence

  • prostate disease
  • stones
  • external/intrinsic devices
  • catheters
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6
Q

Pathophysiology of UTIs in women

A

Ascending pathway vagina>urethral meatus>urethra

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7
Q

Classification of UTIs

A

Nosocomial or comment acquired
Complicated or uncomplicated
Recurrent
Relapse

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8
Q

Who should be tested for asymptomatic bacteriuria?

A

pregnant women

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9
Q

RFs for UTI in men

A
Prostate hypertrophy
Stones
Urological surgery
Age >50
Catheterisation
Previous UTI
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10
Q

RFs for UTI in women

A
Sexual activity
Use of spermicide
Positive FHx
Post menopause
Previous UTI
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11
Q

Clinical presentation of UTIs

A
Dysuria
Urgency
Frequency
In men: suprapubic pain
In women: back/flank pain
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12
Q

Investigations to consider in UTI

A

Urine dipstick + MCS

Imaging to rule out obstruction

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13
Q

Management of UTIs

A

Trimethoprim or quinolone such as cipro/levofloxacin

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14
Q

What is acute pyelonephritis?

A

Inflammatory disease of the renal parenchyma, chalices and pelvis, caused by enteric bacteria that ascend from the lower urinary tract or haematogenous spread

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15
Q

Aetiology of pylenophritis

A

Major causative pathogen = gram -ve bacteria

  • E.coli 60-80%
  • Others: proteus, klebsiella, enterobacter, pseduo
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16
Q

RFs for pyelonephritis

A
Frequent sexual intercourse
Prev/ongoing UTI
DM
Occlusion to urinary tract
Anatomical/functionaal abnormality
Immunosuppressed state
Pregnancy
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17
Q

Clinical presentation of pyelonephritis?

A

Flank/costovertebral angle pain + fever

18
Q

Investigations to order in pyelonephritis

A
Urine MCS
FBC
ESR
CRP
Imaging
Cultures
19
Q

Management of pyelonephritis

A

Cephalosporin such as Cefiximine

20
Q

What is hydronephrosis?

A

Dilation of the renal pelvis with or with our obstruction. Obstructions can be obstructive nephropathy or uropathy

21
Q

Epidemiology of hydronephrosis

A

Increasing prev. in whites

Peak 30-50yo

22
Q

Aetiology

A

Anything that can interrupt urine flow by narrowing or blocking the tract:

  • stones
  • BPH
  • Ca
  • Bladder tumours
23
Q

Pathophysiology of hydropnephrosis

A

Obstructive condition > back pressure on kidney > decreased renal blood flow = decreased GFR = increased RAS pathway = atrophy and apoptosis of renal tubule cells

24
Q

RFs for hydronephrosis

A
BPH
Constipation
Medication: antichols., narcotics, alpha recap. agonists
Spinal cord injury
Malignancy
25
Clinical presentation of someone with hydronephrosis
``` Flank pain Fever Lower urinary fact symptoms inability to urinate costovertebral angle tenderness haematuria palpable bladder Hypertensive ```
26
Investigations to consider in hydronephrosis
``` urine dipstick renal use urea and creating abc CT pyelogram ```
27
Mx of hydronephrosis
Depends on the underlying cause: - Stones < 10mm - medical management + ?lithotrip - Stones >10mm - surgery - Obstruction: surgery + Abx - Bilateral obstruction: catheter and Abx
28
Causes of AKI
Pre renal: reduced renal perfusion Intrinsic: - Acute tubular necrosis due to ischaemia - Acute TIN - Nephritic syndrome Post renal: SNIPPIN - Stones - Neoplasm - Infection - Prostate - Posterior urethra valves - Inflammation - Neuropathic
29
Mnemonic for causes of AKI
patients can't VOID RIGHT ``` Vasculitis Obstruction Infection Drugs Renal artery stenosis Interstitial nephropathy Glomerular nephropathy Hypovolemia Thromboembolism ```
30
What is the most common cause of AKI
Ischemia causing acute tubular necrosis
31
RFs for AKI
``` Increased age underlying renal disease malignant HTN DM Trauma Haemorrhage Sepsis Pancreatitis Drug overdose Surgery HF ```
32
Clinical presentation of AKI
``` Uraemia/Azotaemia Acidosis Hyperkal Fluid overload signs Vomitting Dizziness Orthopnea Tachycardia ```
33
Investigations to consider in AKI
``` Basic metabolic profile Urea:Cr ratio FBC ABG Renal USS CXR ECG changes ```
34
Mx of AKI
ABG/VBG to asses K+ status ECG to assess K+ status (Tents on flat Plains) -proceed to treat if needed Assess volume status: BP - low: fluids until BP>100 - high: diuretics Catheterise to assess hourly output
35
Definition of CKI
Diseased kidney state where GFR <60 for >3 months
36
Most common causes of CKI
1. DM 2. HTN Others: RAS, GN, Polycystic disease, SLE
37
Preventative values for CKI
HbA1c <7% BP <140/90 Stop smoking BMI <27
38
RFs for CKI
DM HTN Age >50
39
Clinical presentation of CKI
``` Fatigue Oedema Nausea Anorexia Enlarged prostate Pruritus ```
40
Investigations in CKI
``` Serum Cr Urinalysis Urine mucroalbumin Renal USS eGFR ```
41
Mx of CKI
Stage 1-2 uncomplicated: ACEi + satin Stage 3-4 uncomplicated: increased dose ACEi + statin Stage 5 or uraemia: Dialysis or transplant
42
Complications of CKI
CRF HEALS ``` CVD Renal osteodystrophy Fluid HTN Electrolyte disturbance Anaemia Leg restlessness Sensory neuropathy ```