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Phase 2a Concise > Renal + UG > Flashcards

Renal + UG Flashcards

1
Q

Acute kidney injury

A

syndrome of abrupt decreased renal function

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2
Q

AKI patho/ dx

A

Criteria for dx

  • Rise in creatinine >26umol/L in 48hrs
  • Rise in creatinine 1.5x baseline
  • Urine output <0.5ml/kg/h for 6+ hrs

3 stages in AKI

May cause sudden life-threatening biochem disturbances

Associated with - diarrhoea, haematuria, haemoptysis, hypotension, urine retention

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3
Q

AKI causes

A

Pre-renal (decreased perfusion/drop in BP/flow obstruction)
haemorrhage, burns, D+V, sepsis (systemic vasodilation), NSAIDs, ACEi/ARB - renal hypoperfusion, atherosclerosis - flow obstruction

Renal (intrinsic renal disease)
glomerulonephritis, ATN, drug reaction, infiltration, vasculitis, DIC

Post renal
in renal tract - stone, malignancy, clot, prostatic hypertrophy

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4
Q

AKI Px

A

depends on underlying cause

signs
maybe palpable bladder, kidneys
arrhythmias (hyperkalaemia)
pericarditis - with uraemia
impaired platelet function - bruising
infection - immune suppression
postural hypotension
oedema

symptoms
oliguria
symptoms of uraemia - fatigue, weakness, anorexia, N+V, confusion, seizures, coma
SOB - anaemia and PO secondary to volume overload
Thirst

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5
Q

AKI DDx

A

AAA, alcohol toxicity, alcoholic and DKA, chronic renal failure, dehydration, GI bleed, HF, metabolic acidosis, CKD

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6
Q

AKI Ix

A

Bloods - FBC, U+E, creatinine, Ca, phosphate, anaemia and ESR high suggests myeloma/vasculitis

Urine dipstick - can suggest infection (leukocytes, nitrates), glomerular disease (blood, protein)

Urine (mid-stream) and blood cultures - ?infection

USS

CT-KUB

ECG, CXR, renal biopsy

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7
Q

AKI Mx

A

Treat cause

Stop nephrotoxic drugs - NSAIDs, ACEi, gentamicin, amphotericin

Optimise fluid balance - crystalloid

Tx hyperkalaemia - calcium gluconate, insulin and glucose

Tx acidosis - sodium bicarb

Tx PO - diuretics, furosemide

Renal replacement therapy (RRT) - haemofiltration, haemodialysis

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8
Q

Benign prostatic hyperplasia

A

increase in size of prostate

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9
Q

BPH patho

A

benign proliferation of muculofibrous and glandular layers

Inner (transitional) zone enlarges (prostate carcinoma sees peripheral layer expansion)

Narrows urethra

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10
Q

BPH Px

A

signs
abdo exam - enlarged bladder

symptoms
LUTS - frequency, urgency, hesitancy, incomplete bladder emptying, need to push/strain, nocturia, poor stream/flow, post-micturition dribbling, UTI, haematuria,

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11
Q

BPH DDx

A

bladder tumour, stones, trauma, prostate cancer, chronic prostatitis, UTI

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12
Q

BPH Ix

A

DRE - prostate enlarged, smooth

Serum electrolytes, renal USS - exclude renal damage

Transrectal USS - see prostate

PSA may be raised in large BPH

Biopsy, endoscopy

Low flow rate

Frequency vol chart - nocturia

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13
Q

BPH Mx

A

avoid caffeine, alcohol, void twice in a row

Alpha 1 antagonist - oral tamsulosin - relaxes SM in bladder neck. S/E drowsiness, dizziness, ejaculatory failure. CI postural hypotension

5-alpha-reductase inhibitor - oral finasteride - blocks testosterone -> dihydrotestosterone (active form, responsible for prostatic growth). S/E impotence, decreased libido

Surgery - TURP, TUIP, open prostatectomy

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14
Q

Chronic kidney disease

A

abnormal kidney structure/function, present for 3+ months

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15
Q

CKD patho

A

progressive impairment in renal function

classification based on decreased kidney function (GFR), or kidney damage (presence of albuminuria) and the cause of kidney disease (glomerular, tubulointerstitial, blood flow…)

tends to progress to end stage renal failure

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16
Q

CKD causes

A

UK - diabetes, glomerulonephritis, HTN, renovascular disease

PKD, infective, obstructive, reflux nephropathies, SLE, amyloidosis, myeloma, hypercalcaemia, vasculitis, drugs

RFs - FHx, CVD, proteinuria, smoking, ethnicity (african, Afro-Caribbean, Asian)

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17
Q

CKD Px

A

signs
increased skin pigmentation, pallor, HTN, peripheral oedema, LVH, pleural effusions
CKD cx - anaemia, pericarditis
Underlying disease - eg SLE

symptoms
malaise
anorexia, wt loss
insomnia
nocturia, polyuria (impaired concentrating ability)
itching
N+V+D
amenorrhoea, erectile dysfunction
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18
Q

CKD DDx

A

AKI (CKD - normochromic anaemia, small kidneys on USS, renal osteodystrophy)

acute on chronic kidney disease

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19
Q

CKD Ix

A

ECG - hyperkalaemia

Urinalysis - haematuria, proteinuria, mid-stream to MC&S, albumin:creatinine ratio, protein:creatinine ratio

Urine microscopy

Serum biochem - U+E, bicarb, creatinine (high urea, creatinine), low eGFR, raised ALP, raised PTH if CKD stage 3+

Bloods - raised phosphate, low Ca, low Hb

Auto-AB screening for disease, eg SLE, scleroderma. Viral antigen tests

USS - small kidneys

CT

Biopsy, histology

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20
Q

CKD Mx

A

Treat BP
Treat bone disease, tx PTH if raised - vit D, calcitriol
Control diabetes
CVD - simvastatin, aspirin

Anaemia - iron/folate/folic acid
Acidosis - sodium bicarb
Oedema - furosemide

RRT - haemofiltration, haemodialysis, peritoneal dialysis

Kidney transplant

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21
Q

CKD Cx

A

Anaemia - due to reduced EPO production by kidney

Bone disease - renal osteodystrophy - renal phosphate retention, impaired 1,25-diOH vit D production -> fall in Ca, PTH increases to compensate, skeletal decalcification

Neurological - dysfunction, polyneuropathy

CVD - higher risk

Skin disease - pruritus, brown discolouration of nails

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22
Q

Glomerulonephritis

A

inflammation of glomeruli and nephrons

can cause

  • damage to filtration mechanism - haematuria, proteinuria
  • glomerular damage constricts blood flow - compensatory HTN
  • loss of filtration capacity - AKI
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23
Q

Nephritic syndrome

A

inflammation - may involve glomerulus, tubule, interstitial renal tissue

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24
Q

Nephritic syndrome causes

A

often immune response triggered by infection

IgA nephropathy
post-strep infection
IE, SLE, bacterial infection
Systemic sclerosis
ANCA vasculitis
Goodpasture's
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25
Q

Nephritic syndrome Px

A 
GFR decrease
haematuria
proteinuria
HTN
oedema from salt and water retention
oliguria
uraemia - anorexia, pruritus, lethargy, nausea
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26
Q

Nephritic syndrome Ix

A

measure eGFR, proteinuria, U+E, albumin

Culture - from throat/infected skin

Urine dipstick - proteinuria, haematuria

Renal biopsy if needed

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27
Q

Nephritic syndrome Mx

A

Tx cause

HTN - salt restriction, loop diuretics, CCB

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28
Q

Nephrotic syndrome

A

Due to podocyte damage

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29
Q

Nephrotic syndrome patho

A

triad of proteinuria, hypoalbuminaemia, oedema

Podocyte pathology - abnormal structure/function, immune damage, injury, death - proteins leak out

Hyperlipidaemia often present - liver goes into overdrive due to albumin and protein loss - increased clot risk, raised cholesterol

Causes - primary renal disease (eg minimal change disease, membranous nephropathy), secondary (eg DM, lupus, myeloma)

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30
Q

Nephrotic syndrome Px

A 
mild BP increase
Proteinuria >3.5g/24hr
mild decrease in GFR
hypoalbuminaemia
oedema - ankles, genital, abdo wall
frothy urine
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31
Q

Nephrotic syndrome DDx

A

CCF - oedema, but has raised JVP

Liver disease, eg cirrhosis - hypoalbuminaemia and oedema, but signs of chronic liver failure

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32
Q

Nephrotic syndrome Ix

A 
renal biopsy
urine dipstick
CXR/USS
serum albumin low
serum creatinine, eGFR, lipids, glucose
tests for underlying cause
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33
Q

Nephrotic syndrome Mx

A

Tx cause
reduce oedema - diuretics, fluid and salt restriction
reduce proteinuria - ACEi/ARB
Reduce cx risk - warfarin, simvastatin

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34
Q

Nephrotic syndrome Cx

A

susceptible to infection

thromboembolism

hyperlipidaemia

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35
Q

Renal cell carcinoma

A

Kidney cancer, arises from PCT epithelium

may spread (renal vein, via lymph, bone, liver, lung)

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36
Q

RCC RFs

A

smoking, obesity, HTN, renal failure, PKD, FHx

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37
Q

RCC Px

A

often asym

signs
abdo mass
varicocele - invasion of left renal vein, compression of left testicular vein
polycythaemia - EPO production
HTN - from renin secretion by tumour
Iron deficient anaemia - from haematuria
fever

symptoms
haematuria
loin/left flank pain
wt loss

38
Q

RCC Ix

A

USS, CT chest abdo, MRI

Bloods - polycythaemia/anaemia, ESR raised, abnormal liver biochem

Renal biopsy

Bone scan if signs, or serum Ca raised

39
Q

RCC Mx

A

Localised - surgery - nephrectomy, ablative (cryoablation, radiotherapy)

Metastatic - immunotherapy, molecular therapy

40
Q

Bladder cancer

A

type of transitional cell carcinoma

can spread to pelvic structures, lymph nodes, liver, lungs

41
Q

Bladder cancer Px

A

painless haematuria
recurrent UTIs
void irritability

42
Q

Bladder cancer Ix

A

cystoscopy (bladder endoscopy), biopsy

Urine microscopy - sterile pyuria

CT/MRI/ image lymph nodes

43
Q

Bladder cancer Mx

A

surgical resection, chemo

cystectomy (bladder removal)

chemo and radio

44
Q

Prostate cancer

A

most are adenocarcinomas arising from peripheral zone

can spread to seminal vesicles, bladder, rectum, via lymph, bone, brain, liver, lung

A hormone-sensitive malignancy (testosterone)

45
Q

Prostate cancer Px

A 
LUTS
nocturia
hesitancy
poor stream
terminal dribbling
obstruction
wt loss, bone pain, anaemia
46
Q

Prostate cancer DDx

A

BPH, prostatitis, bladder tumours

47
Q

Prostate cancer Ix

A

DRE - hard, irregular prostate

Raised PSA

Trans-rectal ultrasound scan (TRUSS), biopsy

Urine biomarkers, MRI

48
Q

Prostate cancer Mx

A

no spread
prostatectomy, radiotherapy, hormone therapy

metastatic
orchidectomy
LHRH agonist - goserelin/leuprorelin
Androgen receptor blockers - bicalutamide

for symptoms - analgesia, tx metastases, radiotherapy

49
Q

Testicular tumours

A

tumour of testes

mostly from germ cells - seminomas, teratomas

50
Q

Testicular tumour RFs

A

undescended testes, infant hernia, infertility, FHx

51
Q

Testicular tumours Px

A

signs
hydrocele
abdo mass

symptoms
painless lump in testicle
testicular pain/abdo pain
cough, SOB - lung metastases
back pain - para-aortic lymph node metastases
52
Q

Testicular tumour DDx

A

testicular torsion, lymphoma, hydrocele, epididymal cyst

53
Q

Testicular tumour Ix

A

USS
biopsy, histology
Serum tumour markers - alpha-fetoprotein, b-hCG
CXR, CT - staging

54
Q

Testicular tumour Mx

A

Orchidectomy
Radiotherapy
Chemo
offer sperm storage

55
Q

UTIs

A

inflammatory response of urothelium to bacterial invasion - associated with bacteriuria, pyuria

5 pathogens in primary care - KEEPS
Klebsiella
E coli
Enterococci
Proteus spp
Staph (coagulase -ve)
(broader range in hospital/catheterised)

Upper tract - pyelonephritis
Lower tract - cystitis, prostatitis, epididymo-orchitis, urethritis

Uncomplicated - normal renal tract structure, function
Complicated - structural/functional abnormality, eg stones, obstruction

RFs
female - shorter urethra
sex
pregnancy, menopause
catheter
tract obstruction - urine stasis
56
Q

Pyelonephritis

A

infection of renal parenchyma and soft tissues of renal pelvis and upper ureter

E coli commonly

57
Q

Pyelonephritis Px

A

loin pain
fever
pyuria

oliguria if causes AKI
bacteriuria
rigors

headache, malaise, N+V

58
Q

Pyelonephritis Ix

A

Urine dipstick - foul smelling, cloudy - nitrites, leucocytes, protein

Mid-stream urine sample - MC&S

Bloods - WCC elevated, CRP, ESR

USS - ?calculi, obstruction

59
Q

Pyelonephritis Mx

A

Rest, fluids, analgesia

ABs - oral ciprofloxacin/co-amoxiclav
severe - IV gentamicin/IV co-amoxiclav

Surgery - drain abscesses, relieve calculi

60
Q

Cystitis

A

urinary infection of bladder

E coli commonly

61
Q

Cystitis Px

A

signs
offensive smelling/cloudy urine
abdo/loin tenderness

symptoms
dysuria
frequency
urgency
suprapubic pain
haematuria
62
Q

Cystitis Ix

A

Mid-stream urine sample

Dipstick urinalysis - positive leucocytes, blood nitrites

Cystoscopy to exclude cancer

63
Q

Cystitis Mx

A

ABs
trimethroprim/cefalexin
ciprofloxacin/co-amoxiclav

64
Q

Prostatitis

A

infection or inflammation of the prostate gland

Acute - strep faecalis, E coli, chlamydia

Chronic - bacterial/non-bacterial

65
Q

Prostatitis Px

A 
acute
systemic unwellness
fever, rigors, malaise
pain on ejaculation
voiding LUTS - poor stream, hesitancy, incomplete emptying, terminal dribbling, straining, dysuria
pelvic pain

chronic
acute for >3 months
recurrent UTIs
pelvic pain

66
Q

Prostatitis Ix

A

DRE - tender, hot to touch, hard from calcification

Urine dipstick - leucocytes, nitrites

Mid-stream MC&S

STI screen

TRUSS - transurethral USS

67
Q

Prostatitis Mx

A 
acute
IV gentamicin, IV co-amoxiclav
2-4wks ciprofloxacin
2nd line - trimethroprim
TRUSS guided abscess drainage if needed

chronic
4-6 wks ciprofloxacin
tamsulosin
NSAIDs, ibuprofen

68
Q

Urethritis

A

urethral inflammation due to infectious/non-infectious cause

Primarily a sexually acquired disease

69
Q

Urethritis causes

A

N.gonorrhoea
Chlamydia (most common)
Trichomonas vaginalis

Trauma, stricture, irritation, urinary calculi

70
Q

Urethritis Px

A

may be asym

signs
skin lesions

symptoms
dysuria +/- discharge, blood/pus
urethral pain
penile discomfort
systemic symptoms
71
Q

Urethritis Ix

A

NAAT (nucleic acid amplification test)
female - vaginal swab, endocervical swab, first void urine
Male - first void urine

Microscopy of genital secretions

Blood cultures

Urine dipstick, urethral smear

72
Q

Urethritis Mx

A

chlamydia
oral azithromycin, or 1wk oral doxycycline
pregnant - oral erythromycin / oral azithromycin

gonorrhoea
IM ceftriaxone, oral azithromycin

patient education, contact tracing

73
Q

Epididymal cyst

A

Smooth, extratesticular, spherical cyst in head of epididymis

Lies above, behind testis, contains clear and milky fluid

Px
lump, often multiple, maybe bilateral
painful once large
well defined, will transluminate (since fluid filled)
testes palpable separate to cyst

DDx
spermatocele - fluid and sperm filled cyst in epididymis
hydrocele - fluid collection surrounds whole testis
varicocele

Ix
scrotal USS

Mx
surgical excision if painful

74
Q

Hydrocele

A

abnormal collection of fluid in tunica vaginalis

Primary /secondary

Px
scrotal enlargement - non-tender, smooth, cystic swelling
not usually painful unless infected
testis palpable within cyst
lies anterior, below testis, will transluminate

Ix
USS
serum alpha-fetoprotein and hCG to exclude cancer

Mx
resolve spontaneously
therapeutic aspiration, surgical removal

75
Q

Varicocele

A

abnormal dilation of testicular veins in pampiniform venous plexus, caused by venous reflux (lack of effective valves, increased reflux from compression of renal vein)

left side more commonly affected - angle at which left testicular vein enters left renal vein

Px
distended scrotal blood vessels
dull ache, scrotal heaviness
scrotum hangs lower on that side

DDx
secondary to other pathological processes blocking testicular vein, eg kidney tumours, retroperitoneal tumours

Ix
venography, colour doppler USS

Mx
surgery if pain, infertility, testicular atrophy

76
Q

Polycystic kidney disease

A

multiple cysts develop in kidney -> renal enlargement, kidney tissue destruction

loss of function - mechanical compression, apoptosis of healthy tissue, reactive fibrosis

autosomal dominant/recessive

77
Q

PKD Px

A 
signs
bilateral kidney enlargement
HTN
renal stones (uric acid)
progressive renal failure
symptoms
loin pain
haematuria
renal colic due to clots
excessive water and salt loss
nocturia

extrarenal
SAH, polycystic liver disease, pancreatitis, ovarian cysts

78
Q

PKD DDx

A

acquired, simple kidney cysts, dominant/recessive, medullary sponge kidney

79
Q

PKD Ix

A

USS

Genetic testing

80
Q

PKD Mx

A

BP control

Treat stones, give analgesia

Laparoscopic removal of cysts / nephrectomy (whole kidney)

RRT for ESRF

screen family, counselling

81
Q

Renal calculi

A

renal stones - crystal aggregates, form in CDs

82
Q

Renal calculi patho

A

classically get stuck:

  • pelviureteric junction
  • pelvic brim
  • vesicoureteric junction

stones form when solute conc exceeds saturation

obstruction -> hydronephrosis - obstruction and dilation of renal pelvis

stone types

  • calcium oxalate (75%)
  • magnesium ammonium phosphate
  • also urate, hydroxyapatite, cystine, others
83
Q

Renal calculi causes

A

hypercalciuria
high PTH, excessive diet Ca intake, renal disease (eg PKD)

hyperoxaluria
high diet intake, low dietary Ca, increased intestinal absorption due to GI disease, eg Crohn’s

uric acid stones
hyperuricaemia, dehydration, ileostomies

infection induced stones
usually UTI - Ca/Mg mixed

cystine stones
from cystinuria - genetic condition

84
Q

Renal calculi RFs

A 
anatomical abnormalities, eg duplex, obstruction
dehydration
infection
hypercalcaemia, hyperoxaluria, hypercalciuria, hyperuricaemia
renal disease
drugs
diet
gout
FHx
85
Q

Renal calculi Px

A

signs
pain - loin to groin, in waves (ureter peristalsis), rapid onset, spasmodic
dysuria/anuria, strangury (burning when peeing), frequency
haematuria
infection
proteinuria
sterile pyuria

symptoms
N+V

86
Q

Renal calculi DDx

A

vascular damage, bowel pathology, ectopic pregnancy, ovarian cyst torsion

87
Q

Renal calculi Ix

A

Urine dipstick - haematuria

Mid-stream specimen to MC&S

KUBXR - kidney, ureter, bladder x ray

NCCT-KUB - non-contrast CT

USS

88
Q

Renal calculi Mx

A 
Analgesic for renal colic - diclofenac
IV fluids
ABs - IV cefuroxime, gentamicin
Antiemetics
Oral nifedipine (CCB) or oral tamsulosin

Surgical
extracorporeal shockwave lithotripsy (ESWL)
Endoscopy with YAG laser
Percutaneous nephrolithotomy (PCNL) - keyhole surgery

89
Q

Renal calculi Cx

A

hydronephrosis, blockage of urinary flow, renal damage, infection

90
Q

Testicular torsion

A

twisting of spermatic cord

perhaps after sport

Px
inflammation of one testis - tender, hot, swollen
sudden onset pain in one testis
abdo pain
N+V

DDx
epididymo-orchitis, tumour, trauma, hydrocele

Ix
doppler USS, urinalysis to rule out infection

Mx
surgery - bilateral fixation of testes

Cx
infertility, infection, infarction of testes

Phase 2a Concise (9 decks)

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