renal tract Flashcards

Question

treatment of hydronephrosis

Answer 1

mild to mod = wait and see approach, preventative antibiotic therapy to lower risk of UTI severe - surgery if affects kidney function to fix blockage or correct reflux

Answer 2

pre renal renal post renal

Answer 3

hypovolaemia hypotension impaired cardiac pump efficiency vascular disease limiting renal blood flow

Answer 4

>65 history of AKI chronic kidney disease eGFR<60 symptoms of urological obstruction or conditons which may lead to this chronic conditions - liver, heart, diabetes neurological or cognitive impairment or disability sepsis hypovolaemia oliguria nephrotoxic drug use within last week exposure to iodinated contrast agents within last week

Answer 5

nausea, vomiting, drowsiness, breathlessness (pulomnary oedema or metaoblic acidosis) arrhythmias hyperkalaemia metabolic acidosis hyponatraemia hypoglycaemia (reduced vit D) and hyperphsophataemia (phosphate retention)

Answer 6

tests to differentiate between pre renal and intrinsic causes - urine specific gravity and urine osmalarity - urine sodium - fractional excretion of sdium

Answer 7

prompt fluid replacement (blood in case of haemorrhagic shock or crystalloid in vomiting, diarrhoea, polyuria) treat underlying cause e.g. if related to cardiac pump insifficiency or occlusion of renal vasculature

Answer 8

acute tubular necrosis as result of renal ischaemia or direct renal toxins disease affecting the interstitium, renal vasculature, acute glomerulonephritis

Answer 9

``` haemorrhage burns diarrhoea and vomiting fluid loss from fistula acute pancreatitis diuretics MI congestive cardiac failure endotoxic shock myoglobinaemia haemoglobinaemia hepatorenal syndrome radiological contrast agents drugs - aminoglycosides, NSAIDs, ACEi, platinum derivatives, abruptio placentae pre-eclampsia, eclampsia ```

Answer 10

risk facotrs, urological symptoms, multi system disease affecting kidneys alteration of urine volume biochemical abnormalities

Answer 11

blood count urine and blood cultures urine dipstick testing and microscopy histological investigations

Answer 12

fluid correction sodium and potassium restricted stop nephrotoxic drug and adjust doses of others

Answer 13

occurs when both urine outflow tracts are obstructed or when tract is obstructed in paitent with a single functioning kidney quickly reversed if obstruction releived

Answer 14

renal ultrasonohraphy for hydronephrosis and dilated ureters bladder outflow obstructed ruled out by flushing of existing catheter or insertion of urethral catheter - removed unless larged vol of urine obtained

Answer 15

temporary measures to relieve fluid build up - urethral/suprapubic catheterisation or percutaneous nephrostomy until definitive treatment of obstructing lesion can be undertaken

Answer 16

abnormal kidney structure or function present for >3 months with implications for health classification is based on GFR category, presence of albuminuria as a marker of kidney damage and the cause of kidney disease

Answer 17

older ppl | more in females

Answer 18

intrinsic kidney disease - associated conditons: hypertension, DM nephrotoxic drugs - lithium, ciclosporin, calcinuerin inhibitors, aminoglycosides, mesalazine obstructive kidney disease - assoicated conditions: neurogenic bladder, BPH, urinary division surgery, recurrent urinary stones Multisystem disease: SLE, vascultitis, myeloma, AD polycystic kidney disease, alports disease, familial glomerulonephritis, DM, polycystic kidney disease acute renal failure

Answer 19

``` AKI CVD hypertension or proteinuria diabetes smoking NSAIDs - chronic use nephrotoxic drugs untreated urinary outflow obstruction SLE ```

Answer 20

anaemia platelet abnormalities skin pigmentation pruritis GI - anorexia, nausea, vomiting, diarrhoea endocrine/gonads - ammennhoria, erectile dysfunction, infertility polyneuropathy CNS- coma, confusion CVS - uraemic pericarditis, hypertension, peripheral vascular disease, heart failure renal - nocturia, poluria, salt and water retention, oedema renal osteodystrophy - osteomalacia, muscle weakness, bone pain, hyperparathyroidism, osteosclerosis, dynamic bone disease

Answer 21

``` serum creatinine urine electrolytes blood count urine and blood cultures urine dipstick and microscopy histological investigations ```

Answer 22

elderly men >60

Answer 23

hyperplasia of both glandular and connective tissue elements | aetiology unknown

Answer 24

age, | metabolic syndrome,

Answer 25

increased frequency of micturition nocturia delay in initiation of micturition and post void dribbling acute urinary retention or retention with overflow incontinence also occurs

Answer 26

enlarged smooth prostate

Answer 27

serum electrolytes and renal ultrasonography to exclude renal damage resulting from obstruction prostate cancer present with similar symptoms serum PSA elevated in benign disease but elevated value is usually an indication for specialist referral and prostate biopsy

Answer 28

if mild symptoms - watchful waiting selective a1-adrenoreceptor antagonists such as tamsulosin = relax smooth muscle in bladder neck and prostate producing increase in urinary flow rate and improvement in obstructive symptoms 5a reductase inhbiitor finasteride = prevents further enlargement acute retention or retention with overflow = urethral catheterisation or if not possible suprapubic catheter drainage prostatectomy or permanent catheter as later treatment options

Answer 29

most common cancer in men | malignant change within prostate increasingly common with age

Answer 30

ethical familial and genetic risk factors - genetic mutations of androgen receptors of prostatic cells = hormone treatment effective

Answer 31

increasing age ethnicity - black African or black Carribean family history BRACA gene mutation

Answer 32

hard irregular gland

Answer 33

transrectal US of prostate elevated serum PSA transrectal prostate biopsy if mets are present, PSA usually markedly elevated endorectal coil MRI used to locally stage tumour

Answer 34

microscopic tumour usually by watchful waiting treatment of disease confined to gland is radical prostatectomy, radiotherapy = 80-90% 5 yr survival treatment of metastatic disease depends on removing androgenic drive to the tumour - bilateral orchiectomy (testes) , synthetic luteinising hormone releasing hormone analogues

Answer 35

M:F 3:1 5th commonest cause of cancer deaths

Answer 36

exposure to aromatic hydrocarbons - industrial workers, chimney sweep smoking

Answer 37

painless haematuria painless micturition renal colic due tot blood clot, disturbance of urinary stream, retention of urine

Answer 38

urine cytology - malignant cells | cystoscopy also possible

Answer 39

transurethral resection TCT an be completed by endoscopic resection intravesical chemo reduces high risk of occurrence may need radical cystectomy

Answer 40

often small and can be multiple local spread often includes spread via intravascular invasion to the renal vein and IVC

Answer 41

FHx | clinical evidence of neurological or ocular disease should raise possiblity of von hippel lindau disease

Answer 42

may be asymptomatic tumour detected during imaging of abdomen for unrelated conditon painless haematuria, groin pain, awareness of mass arising from the flank, chest symptoms and bone pain present to these sites

Answer 43

blood tests and ferritin to check for anaemia electrolytes and creatinine to check overall renal function raised corrected calcium and alkaline phosphatase suggest bony mets diagnostic staging and diagnosis by CT with contrast isotope bone scan if clinical or biochemical evidence of bony mets

Answer 44

surgery - only curative treatment except in very elderly, extensive local invasion and mets - partial or radical nephrectomy depending on size medical therapy - used for metastatic disease. biological therapy with immune modulators (interferons and interleukins). chemo not used as renal cancers arent usually sensitive radiotherapy for palliative painful bone mets

Answer 45

males >females | 20-50 yos

Answer 46

metabolic - hyperparathyroidism, idiopathic hyperclaciuria, disseminated malignancy, sarcoidosis, hypervitaminosis D familial metabolic causes - cysturia, errors of purine metabolism infection impaired urinary drainage - medullary sponge kidney, pelvi-uteric junction obstruction, ureteric stricture, extrinsic obstruction

Answer 47

summer months | most are calcium stones

Answer 48

ureteric/renal colic severe intermittent stabbing pain radiating from loin to groin microscopic or rarely, frank haematuria systemic symptoms such as nausea, vomiting, tachycardia, pyrexia loin or renal angle tenderness due to infection or inflammation iliac fossa tenderness if passed to distal ureter

Answer 49

raised WCC and CRP suggest infection and inflammation raised Cr = renal impairment stones often visible on plain abdo Xray. gold standard is non contrast CT serum calcium, phosphate and uric acid

Answer 50

acute presentation - analgesia, if <0.5cm then conservative treatment percutaneous nephrostomy or uteric stent insertion if painful or obstruction persistent elective presentation - extra-corpeal nephrolithotomy, endoscopic treatment or open nephrolithotomy