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Y3 CORE CONDITIONS > RENAL SYSTEM > Flashcards

RENAL SYSTEM Flashcards

1
Q

are urinary tracts more common in males or females?

A

females

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2
Q

in elderly men, UTIs are most commonly caused by what other condition?

A

prostatitis

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3
Q

what is the most common causative organism for UTIs?

A

e coli

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4
Q

give 3 other organisms that could cause UTIs

A

proteus iribalis
klebsiella
e. faecalis
staph saprophyticus

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5
Q

what is the name for bladder and urethral inflammation?

A

cystitis

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6
Q

how many infective organisms must be present in the urinary tract for it to be classed as an infection?

A

over 10^5

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7
Q

give 6 symptoms of a UTI

A 
frequency
urgency
nocturia
foul smell
suprapubic pain
tenderness
haematuria
confusion (if elderly)
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8
Q

What are risk factors for UTI?

A 
Female
long term catheter
Sexual intercouse
Malformations and obstructions
Spermicide
Pregnancy 
Menopause
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9
Q

what is a relapse UTI?

A

recurrence of symptoms caused by same organism within a week of finishing antibiotics

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10
Q

what is a reinfection UTI?

A

recurrence of symptoms after 14 days of finishing antibiotics, can be caused by a different organism

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11
Q

give 2 causes of sterile pyuria

A

TB

chlamydia

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12
Q

how long would you recommend giving antibiotics for a UTI?

A

3-5 days

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13
Q

suggest 3 antibiotics you could give for UTI treatment

A

trimethoprim
nitrofurantoin
amoxicillin

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14
Q

what antibiotic would you use for resistant bacteria UTI?

A

co-amoxiclav

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15
Q

give 2 complications of UTIs

A

calculi

pyelonephritis

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16
Q

what two symptoms would you use to distinguish a UTI from pyelonephritis

A

loin pain

fever

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17
Q

what percentage of 80 year old men have benign prostatic hypertrophy?

a) 10%
b) 20%
c) 50%
d) 80%

A

d) 80%

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18
Q

is BPH more or less common in asians?

A

less

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19
Q

give 4 common symptoms of BPH

A

frequency
nocturia
dribbling
overflow incontinance

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20
Q

give 3 causes of haematuria in BPH

A

bacteraemia
stones
venous rupture

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21
Q

what medical imaging test is important to rule out cancer in BPH?

A

transrectal ultrasound (maybe + biopsy)

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22
Q

what treatment would you recommend for acute retention in BPH?

A

catheter

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23
Q

what 2 surgical procedures can be used in BPH?

A

prostatectomy

TURP

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24
Q

suggest 2 drugs that could be used in BPH

A 
tamsulosin= alpha blocker
finasteride= 5 alpha reductase inhibitor
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25
Q

why is tamsulosin used in BPH?

A

alpha blocker, lowers smooth muscle tone of prostate and bladder necker

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26
Q

why is finasteride used in BPH?

A

Prevents the conversion of testosterone to adrogen DHT

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27
Q

give 2 complications of BPH

A

incontinance
retention
SEVERELY renal failure

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28
Q

is AKI more or less common than CKD?

A

less

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29
Q

what is acute kidney injury defined generally by?

A

significant decrease in renal function over hours to weeks

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30
Q

is AKI reversible?

A

yes

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31
Q

what blood markers would rise during AKI?

A

urea

creatinine

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32
Q

What are the signs and symptoms of AKI?

A 
Weakness
Fatigue
Confusion
Skin pallor
Hypertension
Abdominal pain 
Tachycardia
Oliguria
Fever 
Rash
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33
Q

what blood test specifically would be very reduced in AKI?

A

eGFR

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34
Q

What scan should you do in the first 24 hours of a patient having suspected AKI and why?

A

Renal tract ultrasound to see if their is any obstruction and the size of the kidneys

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35
Q

what signs on an ECG might you see in hyperkalaemia caused by AKI?

A

tall tented T waves

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36
Q

what is the cause of pre-renal AKI?

A

Kidney usually gets 20% of normal cardiac output

So caused by hypovolemia or reduced cardiac output

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37
Q

give 4 causes of hypo perfusion in pre-renal AKI

A 
Haemorrhage= loss of blood 
hypovolaemia and hypotension
sepsis= vasodilation
Over diuresis with diuretics
Diarrhea and vomiting
Severe burns
CCF
liver cirrhosis
renal artery stenosis
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38
Q

What is the most common cause of intrinsic AKI?

A

acute tubular necrosis

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39
Q

How can pre renal AKI lead to acute tubular necrosis?

A

Prolonged reduced perfusion of the kidney can damage the tubular cells

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40
Q

give 3 vascular causes of acute tubular necrosis

A 
vasculitis
hypotension
Reduced cardiac output 
Sepsis 
haemolytic uraemia syndrome
cholesterol emboli
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41
Q

give an example of an exogenous nephrotoxin which could cause acute tubular necrosis in AKI

A

radio contrast drugs

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42
Q

give 2 examples of endogenous nephrotoxins which could cause acute tubular necrosis in AKI

A

pigments
crystals (urate)
immunoglobulins

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43
Q

Post renal AKI is caused by renal tract obstruction from the renal pelvis to the urethra. Give examples of causes of obstructions

A 
BPH
Bladder carcinoma
Cervical carcinoma
Retroperitoneal fibrosis
Renal stone disease
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44
Q

What is the initial treatment for AKI?

A

Iv fluids for fluid loss
Stop nephrotoxic drugs
Treat the underlining cause

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45
Q

when should acute dialysis be considered for AKI? (3 instances)

A

persistant hyperkalaemia
metabolic acidosis
uraemic encephalopathy
pericarditis

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46
Q

give 3 risk factors for the development of AKI into CKD

A

diabetes
hypertension
Small kidneys

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47
Q

Chronic kidney disease is 4 times more common in what race?

A

afro-carribean

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48
Q

what is the most common cause of CKD in the uk?

A

Diabetes= secondary cause of glomerular disease

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49
Q

give 4 other causes of CKD

A

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

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50
Q

give 3 skin symptoms of CKD

A

epistaxis
skin pigmentation
pruritis

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51
Q

give a blood symptom of CKD

A

anaemia

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52
Q

give 2 genital/sexual symptoms of CKD

A

amenorrhoea

erectile dysfunction

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53
Q

give 2 circulatory/cardiovascular symptoms of CKD

A

heart failure

pericarditis

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54
Q

give 2 renal symptoms of CKD

A

nocturia

oedema

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55
Q

give 3 infective risk factors for CKD

A

TB, malaria, schistosomiasis

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56
Q

give 4 systemic disease risk factors for CKD

A 
SLE
wegener's
amyloidosis
polycystic kidney disease
sickle cell disease
thrombotic thrombocytopenia purport
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57
Q

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

a) high
b) high
c) high
d) low
e) low
f) high
g) low= anaemia

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58
Q

in which two conditions that can lead to CKD would you suggest immunosuppression?

A

systemic vasculitis

goodpastures

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59
Q

give 3 risk factors for the development of hydronephrosis

A

pregnancy
cancer
Urinary tract obstruction

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60
Q

the incidence of hydronephrosis is 1 in 300 ____ per year and 1 in 600 ____ per year

A

unilateral

bilateral

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61
Q

what type of hydronephrosis is characterised by loin pain that radiates to the groin, with an enlarged kidney?

A

acute upper

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62
Q

what type of hydronephrosis is characterised by flank pain, renal failure and polyuria?

A

chronic upper

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63
Q

what kind of hydronephrosis is characterised by suprapubic pain, distension, dullness and retention?

A

acute lower

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64
Q

what type of hydronephrosis is characterised by freq, hesitancy, overflow incontinence and distension?

A

chronic lower

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65
Q

give 10 causes of hydronephrosis

A 
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
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66
Q

why are neonates given a routine kidney ultrasound?

A

can get hydronephrosis

normally self limiting

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67
Q

what is hydronephrosis?

A

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

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68
Q

what treatment would you recommend for a stricture in hydronephrosis?

A

stent or pyeloplasty

69
Q

give 2 complications of hydronephrosis?

A

kidney scarring

kidney failure

70
Q

what is the second most common cancer death cause of males in the UK?

A

prostate cancer

71
Q

what percentage of over 80s have dormant malignant changes in their prostate?

a) 10%
b) 20%
c) 50%
d) 80%

A

d) 80%

72
Q

On PR what would a cancerous prostate feel like?

A

hard, irregular

73
Q

symptoms of what other physiological condition present with prostatic cancer?

A

lower urinary tract obstruction symptoms: Increase frequency and urgency, haematuria, cannot fully empty etc

74
Q

What factors in a diet are risk factors for developing prostate cancer?

A

Reduce vitamin D intake

High calcium intake

75
Q

What are the risk factors for prostate cancer?

A

Infections:chlamydia, gonorrhoea, syphillis
Age >50
Fhx (especially if they have Prostate cancer under 60)
Ethnicity= ^ African/African-carribean
Low amount of exercise
Obesity

76
Q

What are the signs of prostate cancer has metastasised?

A

Weight loss
Anaemia
Back pain

77
Q

what kind of cancer is prostate cancer?

A

adenocarcinoma

78
Q

what medical imaging might you suggest in suspected prostate cancer?

A

transrectal ultrasound

79
Q

what staging is used for prostate cancer?

A

Gleason score = the most common grade + the highest other grade in the samples
Grade is 1-5

80
Q

when would you perform an orchidectomy (removal of testicles) in prostate cancer?

A

if metastatic

81
Q

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?

A

(LHRH + anti adrogen treament ) with radiotherapy

82
Q

what surgery would you recommend in prostate cancer?

A

radical prostatectomy

83
Q

give 2 complications of prostate cancer

A

metastasis
urinary incontinence
sexual dysfunction

84
Q

Who is most at risk of pyelonephritis?

A

Women and children

85
Q

What is the pathology of pyelonephritis?

A

Same organism that cause LUTI= E.coli, Klebsiella, Pseudomonas, enterococcus travel up the ureter and cause infection of the kidneys

86
Q

what 2 signs may you expect in the kidneys in pyelonephritis?

A

renal cortical abscesses

pus in medulla

87
Q

What are the symptoms of pyelonephritis?

A 
1-2 days onset 
Loin/flank pain unilaterally or bilaterally 
fever
Nausea and vomiting
Tenderness 
Haematuria
\+/- LUTI symptoms
88
Q

How do you diagnose pyelonephritis?

A

A patient with proven UTI infection + loin pain and or fever

89
Q

What are the risk factors for pyelonephritis?

A 
Catheter
Immunosuppression (DM2)
Female and sexually activity
Urinary obstruction
Age >65
Pregnant 
Prostatitis 
Prostate enlargement 
Renal structural abnormalities
90
Q

What test are done to identify pyelonephritis?

A

Urine dip stick test to confirm UTI= leucocytes, protein, nitrates and blood
Mid urine stream= culture
CT

91
Q

What is the treatment for pyelonephritis?

A

Oral ciprofloxacin/ co-amoxiclav or trimethoprim if sensitive for 7-14 days
Fluids
Painkillers

92
Q

what is the name for chronic pyelonephritis?

A

reflux nephropathy

93
Q

reflux nephropathy is caused by what?

A

vesicoureteric reflux (back flow from valve between ureter and bladder)

94
Q

give an example of a situation where asymptomatic bacteraemia in urine should be treated

A

pregnancy

95
Q

why should tetracycline, trimethoprim, sulphonamides and quinolone be avoided in treating pyelonephritis in pregnancy?

A

teratogenic

96
Q

Suggest a antibiotics that could be used to treat pyelonephritis in pregnancy

A

Cefalexine (cephalosporins)

97
Q

give 3 features of bladder carcinoma

A

Painless haematuria = most common
Burning sensation wheen peeing
frequency
urgency

98
Q

give 2 symptoms of advanced bladder cancer

A 
referred boneand pelvic pain
oedema
flank pain
palpable mass
Weight loss
99
Q

what type of cancer accounts for 90% of bladder cancer

A

transitional cell carcinoma/ urepithelial cells

100
Q

name 3 other types of cancer which make up the remaining 10% of bladder cancers

A

squamous cell
adenocarcinoma
sarcoma

101
Q

name 2 common causes of bladder cancer

A

smoking
occupational carcinogen exposure
genetic mutation

102
Q

what medical imaging might you use to diagnose bladder cancer?

A

cytoscopy and take biopsy

103
Q

What is the treatment for non muscle invasive bladder cancer?

A

TURBT (transurethral resection of bladder tumour) via cystoscopy and then chemotherapy
Depends on staging and grading

104
Q

When is cystectomy done for bowel cancer?

A

In muscle invasive bladder caner

105
Q

what are 5 year survival rates for bladder cancer?

a) 5%
b) 25%
c) 50%
d) 75%

A

d) 75%

106
Q

what is the most common (80%) type of renal carcinoma?

A

renal cell carcinoma = mainly clear cell type

107
Q

what type of cancer makes up 20% of renal carcinoma cases?

A

transitional cell carcinoma

108
Q

what type of renal carcinoma is rare and occurs mainly in infants?

A

Wilm’s

109
Q

give 4 risk factors for development for renal cancer

A 
Age affects 60-70s olders rare to affect 50s 
Smoking
NSAIDs
obesity
CKD (dialysis)
Hypertension 
hepatitis C
FHx
110
Q

what are 5 year survival rates for renal cancer?

a) 5%
b) 25%
c) 50%
d) 70%

A

d) 70%

111
Q

What are the symptoms of urinary tract stones?

A 
Usually asymptomatic
Lower abdo/back pain
Pain and difficulty urinating
Fever
haematuria
stagnant urine
112
Q

what are whewellite and weddellite urinary calculi made of?

A

calcium oxalate

113
Q

Gout can cause what type of renal stone to develop?

A

Urate (uric acid)

114
Q

how can concentrated urine cause calculi

A

dehydration of urine causing minerals to crystallise into stones

115
Q

Give risk factors for the development of renal calculi?

A 
Fhx
Recurrent UTI
Gout
Hypertension
Drugs= aspirin, NSAIDS, Diuretics 
Bed bound
High protein low fibre diet 
Hyperparathyroidism 
Hypercalciuria
Renal structural abnormalities
Dehydration
116
Q

what surgical treatment might you recommend for urinary calculi?

A

cytolithotomy

fragmentation using cystoscope

117
Q

In a urine dipstick test what would be positive for UTI?

A

Nitrates and leukocytes

118
Q

What is sterile pyuria?

A

Elevated WCC count even though standard culture techniques indicate the urine is sterile

119
Q

What is stage 1 AKI?

A

1.5-1.9 fold from baseline serum creatinine level

Urine output = <0.5ml/kg/hr for >6 hours

120
Q

What is stage 2 AKI?

A

2-2.9 fold from baseline serum creatinine level

Urine output= <0.5ml/kg/hr for >12 hours

121
Q

What is stage 3 AKI?

A

> 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

122
Q

What happens in intrinsic AKI?

A

Damage structurally to the kidney tissue causing leakage of blood and protein through the kidney.
Can be detected by urine dipstick test

123
Q

What is more common Pre renal AKI or renal AKI?

A

Pre renal AKI

124
Q

What muscle condition can lead to intrinsic AKI?

A

Rhabdomylsis

125
Q

What are other causes of intrinsic AKI other than Acute tuberculosis necrosis?

A

Acute glomerulonephritis
Acute interstitial nephritis (AIN)= caused by NSAIDS
Nephrotoxic medication such as contrast

126
Q

What are the risk factors for AKI?

A 
Age >75 years as GFR reduces with age
DM
Cardiac failure
Liver disease
CKD
Nephrotoxic drugs
Hypovolemia
Sepsis
127
Q

What are systemic presentation of AKI caused by vasculitis?

A

Rash
Fever
Joint pain

128
Q

What are the early signs of AKI?

A

Usually asymptomatic with only reduction in urine output

129
Q

What are the complications of AKI?

A

Hyperkalaemia–> lead to arrhythmia
Pulmonary oedema–> see on Cxray
Metabolic acidosis
Uraemia = pericarditis, neuropathy and encephalopathy

130
Q

What are the stages of CKD?

A

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

131
Q

What are 3 neurological symptoms of CKD?

A

Insomnia
Restless leg
Paraesthesia of legs

132
Q

How common is it for the presentation of symptoms in CKD?

A

Symptoms don’t present until late stage CKD

Usually asymptomatic

133
Q

What general systemic symptoms do you get in CKD?

A

Lethargy and nausea

134
Q

What MSK symptoms you get with CKD due to being a metabolic bone disease?

A

Osteomalacia and general joint and bone pain

135
Q

Why do you do urinalysis for CKD?

A

Haematuria or proteinuria indicate glomerular disease

136
Q

What scan do you do for CKD?

A

renal tract US for obstruction

137
Q

What screening do you do for CKD?

A

Myeloma screen

138
Q

What is the duration of deterioration in

a) AKI
b) CKD

A

a) days to weeks

b) months to years

139
Q

What is the main treatment for CKD?

A

BP under control and lowered
Treat the underlining cause
Prevent complications

140
Q

What are the common complications of CKD and how do you treat them?

A

Hyperkelaemia = reduce dietary intake
Anaemia = subcutaneous erythropoietin therapy
Metabolic bone disease = Vitamin D and phosphate binders
Acidosis= sodium bicarbonate
Heart disease

141
Q

What is treatment for end stage CKD?

A

Dialysis and transplant

142
Q

What are the two types of bladder cancer?

A

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

143
Q

How do you diagnose renal cancer?

A

Various scan

Cystoscopy and biopsy

144
Q

What is the treatment for renal carcinoma?

A

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

145
Q

What is the treatment for Wilms tumour?

A

Radiotherapy and chemotherapy

146
Q

What are general symptoms of hydronephrosis?

A

UTI symptoms of fever and pain
Haematuria
Loin pain
Increase frequency to urinate

147
Q

What is the initial treatment of hydronephrosis?

A

Treat underlining cause
Surgical drainage
Catheter to drain the urine

148
Q

What is the initial response to prostate canecer?

A

Unless very symptomatic to watch and wait

Active surveillance

149
Q

How is prostate cancer diagnosed?

A

PSA= very unreliable
Digitial rectam exam
Biopsy
MRI and CT

150
Q

What are the NICE staging of prostate cancer?

A

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

151
Q

In who is risk of renal abscess complication from pyelonephritis increased?

A

Patient with DM2

152
Q

What is the rarest type of renal stones

A

Cysteine

153
Q

What is the formation of struvite stones?

A

Mg/AL/CA phosphate stones

They occur after UTI and common in females

154
Q

What is the most common type of renal stones?

A

Calcium oxolate

155
Q

Why does hyperparathyroidism increae risk of calcium stone development?

A

Parathyroid involved in regulation of calcium

156
Q

What is

a) Nephrotic syndrome
b) Nephritic syndrome?

A

a) Loss of a lot of protein in the urine

b) Loss of a lot of blood in the urine

157
Q

What is the criteria for nephrotic syndrome?

A

1) Loss of 3.5 grams of protein/24 hrs
2) oedema= around legs and eyes
3) Hypoalbuminemia –> loss via urine

158
Q

How does the liver compensate for Hypoalbuminemia in nephrotic syndrome?

A

Increase the production of lipids and cause hyperlipidaemia

159
Q

What affect does nephrotic syndrome have on the urine output and the state of urine?

A

Urine is foamy and urine output is reduced due to the lack of oncotic pressure

160
Q

What is the main cause of nephrotic syndrome in

a) children
b) adults

A

A) Minimal change disease

b) Diabetes

161
Q

What are the two differentials for oedema?

A

Heart failure

Nephrotic syndrome

162
Q

What test should you immediately do regarding kidney function if a patient has oedema?

A

Urine dip stick test

163
Q

What is the criteria for nephritic syndrome?

A

1) Haematuria
2) Slight loss of protein
3) Mild hypertension
4) Urine output <300ml/day

164
Q

What is the cause of nephritic syndrome?

A

Post-streptococcal glomerulonephritis–> appears weeks after a URTI

165
Q

What surgery is done to treat urinary problems ascoiated with BPH?

A

Transuretheral resection prostate= trim away the excess prostate blocking the ureter

166
Q

Why is pyelonephritis more common in females?

A

Due to the shorter ureter and because the anus and bladder are closer so easier for bacteria to travel between the two

167
Q

Having AKI with jaundice can be indication of what cause?

A

Hepatorenal failure

168
Q

Build up of what chemicals in the body lead to renal stones?

A

Ammonia
Cysteine
Calcium
uric acid

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