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YR3 Core Conditions > Renal Medicine Core Conditions ALL > Flashcards

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
Q

Clinical presentation of someone with hydronephrosis

A 
Flank pain
Fever
Lower urinary fact symptoms
inability to urinate
costovertebral angle tenderness
haematuria
palpable bladder
Hypertensive
26
Q

Investigations to consider in hydronephrosis

A 
urine dipstick
renal use
urea and creating
abc
CT pyelogram
27
Q

Mx of hydronephrosis

A

Depends on the underlying cause:

  • Stones < 10mm - medical management + ?lithotrip
  • Stones >10mm - surgery
  • Obstruction: surgery + Abx
  • Bilateral obstruction: catheter and Abx
28
Q

Causes of AKI

A

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
Q

Mnemonic for causes of AKI

A

patients can’t VOID RIGHT

Vasculitis
Obstruction
Infection
Drugs
Renal artery stenosis
Interstitial nephropathy
Glomerular nephropathy
Hypovolemia
Thromboembolism
30
Q

What is the most common cause of AKI

A

Ischemia causing acute tubular necrosis

31
Q

RFs for AKI

A 
Increased age
underlying renal disease
malignant HTN
DM
Trauma
Haemorrhage
Sepsis
Pancreatitis
Drug overdose
Surgery
HF
32
Q

Clinical presentation of AKI

A 
Uraemia/Azotaemia
Acidosis
Hyperkal
Fluid overload signs
Vomitting
Dizziness
Orthopnea
Tachycardia
33
Q

Investigations to consider in AKI

A 
Basic metabolic profile
Urea:Cr ratio
FBC
ABG
Renal USS
CXR
ECG changes
34
Q

Mx of AKI

A

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
Q

Definition of CKI

A

Diseased kidney state where GFR <60 for >3 months

36
Q

Most common causes of CKI

A
  1. DM
  2. HTN
    Others: RAS, GN, Polycystic disease, SLE
37
Q

Preventative values for CKI

A

HbA1c <7%
BP <140/90
Stop smoking
BMI <27

38
Q

RFs for CKI

A

DM
HTN
Age >50

39
Q

Clinical presentation of CKI

A 
Fatigue
Oedema
Nausea
Anorexia
Enlarged prostate
Pruritus
40
Q

Investigations in CKI

A 
Serum Cr
Urinalysis
Urine mucroalbumin
Renal USS
eGFR
41
Q

Mx of CKI

A

Stage 1-2 uncomplicated: ACEi + satin
Stage 3-4 uncomplicated: increased dose ACEi + statin
Stage 5 or uraemia: Dialysis or transplant

42
Q

Complications of CKI

A

CRF HEALS

CVD
Renal osteodystrophy
Fluid
HTN
Electrolyte disturbance
Anaemia
Leg restlessness
Sensory neuropathy

YR3 Core Conditions (32 decks)

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