RENAL SYSTEM Flashcards
are urinary tracts more common in males or females?
females
in elderly men, UTIs are most commonly caused by what other condition?
prostatitis
what is the most common causative organism for UTIs?
e coli
give 3 other organisms that could cause UTIs
proteus iribalis
klebsiella
e. faecalis
staph saprophyticus
what is the name for bladder and urethral inflammation?
cystitis
how many infective organisms must be present in the urinary tract for it to be classed as an infection?
over 10^5
give 6 symptoms of a UTI
frequency urgency nocturia foul smell suprapubic pain tenderness haematuria confusion (if elderly)
What are risk factors for UTI?
Female long term catheter Sexual intercouse Malformations and obstructions Spermicide Pregnancy Menopause
what is a relapse UTI?
recurrence of symptoms caused by same organism within a week of finishing antibiotics
what is a reinfection UTI?
recurrence of symptoms after 14 days of finishing antibiotics, can be caused by a different organism
give 2 causes of sterile pyuria
TB
chlamydia
how long would you recommend giving antibiotics for a UTI?
3-5 days
suggest 3 antibiotics you could give for UTI treatment
trimethoprim
nitrofurantoin
amoxicillin
what antibiotic would you use for resistant bacteria UTI?
co-amoxiclav
give 2 complications of UTIs
calculi
pyelonephritis
what two symptoms would you use to distinguish a UTI from pyelonephritis
loin pain
fever
what percentage of 80 year old men have benign prostatic hypertrophy?
a) 10%
b) 20%
c) 50%
d) 80%
d) 80%
is BPH more or less common in asians?
less
give 4 common symptoms of BPH
frequency
nocturia
dribbling
overflow incontinance
give 3 causes of haematuria in BPH
bacteraemia
stones
venous rupture
what medical imaging test is important to rule out cancer in BPH?
transrectal ultrasound (maybe + biopsy)
what treatment would you recommend for acute retention in BPH?
catheter
what 2 surgical procedures can be used in BPH?
prostatectomy
TURP
suggest 2 drugs that could be used in BPH
tamsulosin= alpha blocker finasteride= 5 alpha reductase inhibitor
why is tamsulosin used in BPH?
alpha blocker, lowers smooth muscle tone of prostate and bladder necker
why is finasteride used in BPH?
Prevents the conversion of testosterone to adrogen DHT
give 2 complications of BPH
incontinance
retention
SEVERELY renal failure
is AKI more or less common than CKD?
less
what is acute kidney injury defined generally by?
significant decrease in renal function over hours to weeks
is AKI reversible?
yes
what blood markers would rise during AKI?
urea
creatinine
What are the signs and symptoms of AKI?
Weakness Fatigue Confusion Skin pallor Hypertension Abdominal pain Tachycardia Oliguria Fever Rash
what blood test specifically would be very reduced in AKI?
eGFR
What scan should you do in the first 24 hours of a patient having suspected AKI and why?
Renal tract ultrasound to see if their is any obstruction and the size of the kidneys
what signs on an ECG might you see in hyperkalaemia caused by AKI?
tall tented T waves
what is the cause of pre-renal AKI?
Kidney usually gets 20% of normal cardiac output
So caused by hypovolemia or reduced cardiac output
give 4 causes of hypo perfusion in pre-renal AKI
Haemorrhage= loss of blood hypovolaemia and hypotension sepsis= vasodilation Over diuresis with diuretics Diarrhea and vomiting Severe burns CCF liver cirrhosis renal artery stenosis
What is the most common cause of intrinsic AKI?
acute tubular necrosis
How can pre renal AKI lead to acute tubular necrosis?
Prolonged reduced perfusion of the kidney can damage the tubular cells
give 3 vascular causes of acute tubular necrosis
vasculitis hypotension Reduced cardiac output Sepsis haemolytic uraemia syndrome cholesterol emboli
give an example of an exogenous nephrotoxin which could cause acute tubular necrosis in AKI
radio contrast drugs
give 2 examples of endogenous nephrotoxins which could cause acute tubular necrosis in AKI
pigments
crystals (urate)
immunoglobulins
Post renal AKI is caused by renal tract obstruction from the renal pelvis to the urethra. Give examples of causes of obstructions
BPH Bladder carcinoma Cervical carcinoma Retroperitoneal fibrosis Renal stone disease
What is the initial treatment for AKI?
Iv fluids for fluid loss
Stop nephrotoxic drugs
Treat the underlining cause
when should acute dialysis be considered for AKI? (3 instances)
persistant hyperkalaemia
metabolic acidosis
uraemic encephalopathy
pericarditis
give 3 risk factors for the development of AKI into CKD
diabetes
hypertension
Small kidneys
Chronic kidney disease is 4 times more common in what race?
afro-carribean
what is the most common cause of CKD in the uk?
Diabetes= secondary cause of glomerular disease
give 4 other causes of CKD
urinary tract obstruction= Renal stone disease and prostatic disease
Autosomal dominant polycystic kidney disease
Membranous Glomerulonephritis
Atherosclerosis of renal arteries
malaria nephropathy
Hypertension
Residual injury from AKI
Drugs causing tubular interstital disease
give 3 skin symptoms of CKD
epistaxis
skin pigmentation
pruritis
give a blood symptom of CKD
anaemia
give 2 genital/sexual symptoms of CKD
amenorrhoea
erectile dysfunction
give 2 circulatory/cardiovascular symptoms of CKD
heart failure
pericarditis
give 2 renal symptoms of CKD
nocturia
oedema
give 3 infective risk factors for CKD
TB, malaria, schistosomiasis
give 4 systemic disease risk factors for CKD
SLE wegener's amyloidosis polycystic kidney disease sickle cell disease thrombotic thrombocytopenia purport
would these blood tests be raised, lowered or normal in CKD?
a) urea
b) creatinine
c) ALP
d) eGFR
e) calcium
f) phosphate
g) Hb
a) high
b) high
c) high
d) low
e) low
f) high
g) low= anaemia
in which two conditions that can lead to CKD would you suggest immunosuppression?
systemic vasculitis
goodpastures
give 3 risk factors for the development of hydronephrosis
pregnancy
cancer
Urinary tract obstruction
the incidence of hydronephrosis is 1 in 300 ____ per year and 1 in 600 ____ per year
unilateral
bilateral
what type of hydronephrosis is characterised by loin pain that radiates to the groin, with an enlarged kidney?
acute upper
what type of hydronephrosis is characterised by flank pain, renal failure and polyuria?
chronic upper
what kind of hydronephrosis is characterised by suprapubic pain, distension, dullness and retention?
acute lower
what type of hydronephrosis is characterised by freq, hesitancy, overflow incontinence and distension?
chronic lower
give 10 causes of hydronephrosis
Obstruction Back flow from bladder to the kidney strictures of the ureter BPH Pregnancy = enlarged womb Cancer of the prostate, cervical, colon, bladder, womb, kidney and ovarian Kidney stones clots/tumour schistosomiasis
why are neonates given a routine kidney ultrasound?
can get hydronephrosis
normally self limiting
what is hydronephrosis?
Caused by urinary tract obstruction preventing outflow of urine from the kidney or abnormal flow of urine up the tract causing build up of urine in the kidney.
Leading to stretching and swelling of the kidney.
Dilation above blockage and renal pelvis
what treatment would you recommend for a stricture in hydronephrosis?
stent or pyeloplasty
give 2 complications of hydronephrosis?
kidney scarring
kidney failure
what is the second most common cancer death cause of males in the UK?
prostate cancer
what percentage of over 80s have dormant malignant changes in their prostate?
a) 10%
b) 20%
c) 50%
d) 80%
d) 80%
On PR what would a cancerous prostate feel like?
hard, irregular
symptoms of what other physiological condition present with prostatic cancer?
lower urinary tract obstruction symptoms: Increase frequency and urgency, haematuria, cannot fully empty etc
What factors in a diet are risk factors for developing prostate cancer?
Reduce vitamin D intake
High calcium intake
What are the risk factors for prostate cancer?
Infections:chlamydia, gonorrhoea, syphillis
Age >50
Fhx (especially if they have Prostate cancer under 60)
Ethnicity= ^ African/African-carribean
Low amount of exercise
Obesity
What are the signs of prostate cancer has metastasised?
Weight loss
Anaemia
Back pain
what kind of cancer is prostate cancer?
adenocarcinoma
what medical imaging might you suggest in suspected prostate cancer?
transrectal ultrasound
what staging is used for prostate cancer?
Gleason score = the most common grade + the highest other grade in the samples
Grade is 1-5
when would you perform an orchidectomy (removal of testicles) in prostate cancer?
if metastatic
Testosterone is involved in the growth of the prostate cancer.
What hormonal therapy is recommended for treatment with radiotherapy to slow down the growth of the cancer?
(LHRH + anti adrogen treament ) with radiotherapy
what surgery would you recommend in prostate cancer?
radical prostatectomy
give 2 complications of prostate cancer
metastasis
urinary incontinence
sexual dysfunction
Who is most at risk of pyelonephritis?
Women and children
What is the pathology of pyelonephritis?
Same organism that cause LUTI= E.coli, Klebsiella, Pseudomonas, enterococcus travel up the ureter and cause infection of the kidneys
what 2 signs may you expect in the kidneys in pyelonephritis?
renal cortical abscesses
pus in medulla
What are the symptoms of pyelonephritis?
1-2 days onset Loin/flank pain unilaterally or bilaterally fever Nausea and vomiting Tenderness Haematuria \+/- LUTI symptoms
How do you diagnose pyelonephritis?
A patient with proven UTI infection + loin pain and or fever
What are the risk factors for pyelonephritis?
Catheter Immunosuppression (DM2) Female and sexually activity Urinary obstruction Age >65 Pregnant Prostatitis Prostate enlargement Renal structural abnormalities
What test are done to identify pyelonephritis?
Urine dip stick test to confirm UTI= leucocytes, protein, nitrates and blood
Mid urine stream= culture
CT
What is the treatment for pyelonephritis?
Oral ciprofloxacin/ co-amoxiclav or trimethoprim if sensitive for 7-14 days
Fluids
Painkillers
what is the name for chronic pyelonephritis?
reflux nephropathy
reflux nephropathy is caused by what?
vesicoureteric reflux (back flow from valve between ureter and bladder)
give an example of a situation where asymptomatic bacteraemia in urine should be treated
pregnancy
why should tetracycline, trimethoprim, sulphonamides and quinolone be avoided in treating pyelonephritis in pregnancy?
teratogenic
Suggest a antibiotics that could be used to treat pyelonephritis in pregnancy
Cefalexine (cephalosporins)
give 3 features of bladder carcinoma
Painless haematuria = most common
Burning sensation wheen peeing
frequency
urgency
give 2 symptoms of advanced bladder cancer
referred boneand pelvic pain oedema flank pain palpable mass Weight loss
what type of cancer accounts for 90% of bladder cancer
transitional cell carcinoma/ urepithelial cells
name 3 other types of cancer which make up the remaining 10% of bladder cancers
squamous cell
adenocarcinoma
sarcoma
name 2 common causes of bladder cancer
smoking
occupational carcinogen exposure
genetic mutation
what medical imaging might you use to diagnose bladder cancer?
cytoscopy and take biopsy
What is the treatment for non muscle invasive bladder cancer?
TURBT (transurethral resection of bladder tumour) via cystoscopy and then chemotherapy
Depends on staging and grading
When is cystectomy done for bowel cancer?
In muscle invasive bladder caner
what are 5 year survival rates for bladder cancer?
a) 5%
b) 25%
c) 50%
d) 75%
d) 75%
what is the most common (80%) type of renal carcinoma?
renal cell carcinoma = mainly clear cell type
what type of cancer makes up 20% of renal carcinoma cases?
transitional cell carcinoma
what type of renal carcinoma is rare and occurs mainly in infants?
Wilm’s
give 4 risk factors for development for renal cancer
Age affects 60-70s olders rare to affect 50s Smoking NSAIDs obesity CKD (dialysis) Hypertension hepatitis C FHx
what are 5 year survival rates for renal cancer?
a) 5%
b) 25%
c) 50%
d) 70%
d) 70%
What are the symptoms of urinary tract stones?
Usually asymptomatic Lower abdo/back pain Pain and difficulty urinating Fever haematuria stagnant urine
what are whewellite and weddellite urinary calculi made of?
calcium oxalate
Gout can cause what type of renal stone to develop?
Urate (uric acid)
how can concentrated urine cause calculi
dehydration of urine causing minerals to crystallise into stones
Give risk factors for the development of renal calculi?
Fhx Recurrent UTI Gout Hypertension Drugs= aspirin, NSAIDS, Diuretics Bed bound High protein low fibre diet Hyperparathyroidism Hypercalciuria Renal structural abnormalities Dehydration
what surgical treatment might you recommend for urinary calculi?
cytolithotomy
fragmentation using cystoscope
In a urine dipstick test what would be positive for UTI?
Nitrates and leukocytes
What is sterile pyuria?
Elevated WCC count even though standard culture techniques indicate the urine is sterile
What is stage 1 AKI?
1.5-1.9 fold from baseline serum creatinine level
Urine output = <0.5ml/kg/hr for >6 hours
What is stage 2 AKI?
2-2.9 fold from baseline serum creatinine level
Urine output= <0.5ml/kg/hr for >12 hours
What is stage 3 AKI?
> 3 fold from baseline SCR level or started renal replacement therapy (regardless of level)
Urine output <0.3ml/kg/hr for >24 hours or anuria for >12hrs
What happens in intrinsic AKI?
Damage structurally to the kidney tissue causing leakage of blood and protein through the kidney.
Can be detected by urine dipstick test
What is more common Pre renal AKI or renal AKI?
Pre renal AKI
What muscle condition can lead to intrinsic AKI?
Rhabdomylsis
What are other causes of intrinsic AKI other than Acute tuberculosis necrosis?
Acute glomerulonephritis
Acute interstitial nephritis (AIN)= caused by NSAIDS
Nephrotoxic medication such as contrast
What are the risk factors for AKI?
Age >75 years as GFR reduces with age DM Cardiac failure Liver disease CKD Nephrotoxic drugs Hypovolemia Sepsis
What are systemic presentation of AKI caused by vasculitis?
Rash
Fever
Joint pain
What are the early signs of AKI?
Usually asymptomatic with only reduction in urine output
What are the complications of AKI?
Hyperkalaemia–> lead to arrhythmia
Pulmonary oedema–> see on Cxray
Metabolic acidosis
Uraemia = pericarditis, neuropathy and encephalopathy
What are the stages of CKD?
Stage 1= >90 GFR= Normal kidney function but urine finding or abnormal structure indicate kidney disease
stage 2= 60-90GFR= Mild reduction in kidney function plus abnormal finding
Stage 3a= 45-59= moderate reduction in kidney function
stage 3b= 30-44GFR= moderate reduction in kidney function
stage 4= 15-29 GFR= severely reduced kidney function
stage 5= <15 or dialysis= end stage
What are 3 neurological symptoms of CKD?
Insomnia
Restless leg
Paraesthesia of legs
How common is it for the presentation of symptoms in CKD?
Symptoms don’t present until late stage CKD
Usually asymptomatic
What general systemic symptoms do you get in CKD?
Lethargy and nausea
What MSK symptoms you get with CKD due to being a metabolic bone disease?
Osteomalacia and general joint and bone pain
Why do you do urinalysis for CKD?
Haematuria or proteinuria indicate glomerular disease
What scan do you do for CKD?
renal tract US for obstruction
What screening do you do for CKD?
Myeloma screen
What is the duration of deterioration in
a) AKI
b) CKD
a) days to weeks
b) months to years
What is the main treatment for CKD?
BP under control and lowered
Treat the underlining cause
Prevent complications
What are the common complications of CKD and how do you treat them?
Hyperkelaemia = reduce dietary intake
Anaemia = subcutaneous erythropoietin therapy
Metabolic bone disease = Vitamin D and phosphate binders
Acidosis= sodium bicarbonate
Heart disease
What is treatment for end stage CKD?
Dialysis and transplant
What are the two types of bladder cancer?
1) When the cancer cells are in the lining of the bladder= Non-muscle invasive bladder cancer
2) Cancer wells have spread across the lining= Muscle invasive bladder cancer
How do you diagnose renal cancer?
Various scan
Cystoscopy and biopsy
What is the treatment for renal carcinoma?
Surgery and removal of whole or part of kidney
Ablation = freeze and death of cancer cells
Embolisation= cutting of the blood supply
Biological therapy
Radio/Chemo not effective
What is the treatment for Wilms tumour?
Radiotherapy and chemotherapy
What are general symptoms of hydronephrosis?
UTI symptoms of fever and pain
Haematuria
Loin pain
Increase frequency to urinate
What is the initial treatment of hydronephrosis?
Treat underlining cause
Surgical drainage
Catheter to drain the urine
What is the initial response to prostate canecer?
Unless very symptomatic to watch and wait
Active surveillance
How is prostate cancer diagnosed?
PSA= very unreliable
Digitial rectam exam
Biopsy
MRI and CT
What are the NICE staging of prostate cancer?
1) Local prostate cancer= within the prostate glands
2) Local advance PC= Attached to the prostate capsule but has advance outside the gland
3) Relapse after treatment or mets
In who is risk of renal abscess complication from pyelonephritis increased?
Patient with DM2
What is the rarest type of renal stones
Cysteine
What is the formation of struvite stones?
Mg/AL/CA phosphate stones
They occur after UTI and common in females
What is the most common type of renal stones?
Calcium oxolate
Why does hyperparathyroidism increae risk of calcium stone development?
Parathyroid involved in regulation of calcium
What is
a) Nephrotic syndrome
b) Nephritic syndrome?
a) Loss of a lot of protein in the urine
b) Loss of a lot of blood in the urine
What is the criteria for nephrotic syndrome?
1) Loss of 3.5 grams of protein/24 hrs
2) oedema= around legs and eyes
3) Hypoalbuminemia –> loss via urine
How does the liver compensate for Hypoalbuminemia in nephrotic syndrome?
Increase the production of lipids and cause hyperlipidaemia
What affect does nephrotic syndrome have on the urine output and the state of urine?
Urine is foamy and urine output is reduced due to the lack of oncotic pressure
What is the main cause of nephrotic syndrome in
a) children
b) adults
A) Minimal change disease
b) Diabetes
What are the two differentials for oedema?
Heart failure
Nephrotic syndrome
What test should you immediately do regarding kidney function if a patient has oedema?
Urine dip stick test
What is the criteria for nephritic syndrome?
1) Haematuria
2) Slight loss of protein
3) Mild hypertension
4) Urine output <300ml/day
What is the cause of nephritic syndrome?
Post-streptococcal glomerulonephritis–> appears weeks after a URTI
What surgery is done to treat urinary problems ascoiated with BPH?
Transuretheral resection prostate= trim away the excess prostate blocking the ureter
Why is pyelonephritis more common in females?
Due to the shorter ureter and because the anus and bladder are closer so easier for bacteria to travel between the two
Having AKI with jaundice can be indication of what cause?
Hepatorenal failure
Build up of what chemicals in the body lead to renal stones?
Ammonia
Cysteine
Calcium
uric acid
