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phase 2a > Renal & Urinary > Flashcards

Renal & Urinary Flashcards

1
Q

3 risk factors for developing kidney stone?

A 
metastable urine
- high calcium/oxalate/urate/cysteine
- high PTH -- high calcium 
- dehydration
- Dents disease -- high cysteine 
anatomical abnormality eg horseshoe kidney, trauma 
renal tubule acidosis
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2
Q

what 2 types of stones are the most common? in what kind of urine do they develop?

A

calcium stones – oxalate or phosphate – most common
ca oxalate in acidic urine
ca phosphate in alkaline urine

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3
Q

what are struvite stones associated with? how do they form?

A

infection
bacteria make ammonia
= alkaline urine
= precipitation of magnesium + phosphate

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4
Q

what is kidney stone pain like?

A 
severe
unilateral
loin to groin 
colicky 
sudden onset
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5
Q

apart from pain, 3 other features of kidney stone?

A 
urgency
frequency
writhing
frank or microscopic haematuria 
nausea/vom
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6
Q

what is the gold standard imaging for ?kidney stones? what would you see? 3

A

CT kidneys, ureter, bladder - without contrast
stone is bright white

fat stranding in perinephric tissues
inflammation
hydronephrosis
cortical thickening

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7
Q

best analgaesia for acute kidney stone?

A

paracetamol or diclofenac

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8
Q

3 surgical managements for kidney/ureter stones?

A

lithotripsy
percutaneous nephrolithotomy
ureteral stent

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9
Q

a treatment for uric acid stones?

A

alkalise the urine eg sodium bicarb

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10
Q

treatment for cysteine stones?

A

captopril (cysteine binder)

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11
Q

give 5 risk factors for AKI?

A 
Infection
dehydration
peripheral vascular disease
NSAIDS
diabetes 
heart failure
liver disease - causes decreased blood to kidney 
age over 65
contrast dyes 
hypovolaemia
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12
Q

3 pre-renal causes of AKI?

A 
Dehydration / diarrhoea
bleeding
shock
sepsis
heart failure
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13
Q

Renal causes of AKI?

A 
glomerular nephritis - nephritic/nephrotic syndromes 
acute tubular necrosis
acute interstitial nephritis - infection/ischaemia/connective tiss dis
infection 
NSAID
TTP 
vasculitis 
henoch-scholein purpura
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14
Q

3 post renal causes of AKI?

A 
kidney stone
mass in ureter
urethral stricture - post surgery
benign prostate hyperplasia
prostate cancer
problem with nerves so cannot urinate
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15
Q

what is the criteria for AKI?

A

increase in serum creatinine, more than 25mmol/l over 48 hrs or a 50% rise in last week
or less than 0.5ml/kg/hr urine output

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16
Q

3 complications of AKI?

A

hyperkalaemia, causes arrythmia
fluid overload, causes pulm hypertension
metabolic acidosis
uraemia, causes encephalopathy

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17
Q

what is a normal GFR?

A

60ml/min/1.73m2 +

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18
Q

what staging system is used for AKI?

A

KDIGO

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19
Q

renal cell carcinoma is what kind of cancer?

A

adenocarcinoma

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20
Q

risk factors for renal cell carcinoma?

A 
male
black
smoking 
haemodialysis
von hippel lindau
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21
Q

what is the most common type of RCC?

A

clear cell

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22
Q

4 places RCC commonly metastasises to?

A

lungs - cannonball
brain
bone
adrenals

local fat
renal vein

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23
Q

clinical presentation of RCC? - 5

A 
haematuria
loin pain
palpable mass 
fever
weight loss
varicocele 
enlarged lymph nodes
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24
Q

3 common paraneoplastic syndromes related to RCC?

A

renin = hypertension
EPO = polycythaemia
PTH-like molecule = hypercalcaemia

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25
Q

stauffers syndrome is a triad of:

A

deranged LFT
hypoglycaemia
fever
(stauffers syndrome is a paraneoplastic syndrome associated with renal cell carcinoma)

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26
Q

what is oncocytoma?

A

benign kidney mass

in the collecting duct

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27
Q

what is the most common bladder cancer?

A

transitional cell carcinoma

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28
Q

what is the epidemiology of transitional cell carcinoma?

A

smoking

PAH - hairdressers, rubber factory

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29
Q

when does squamous cell carcinoma in the bladder develop, give some risk factors?

A

irritation of the bladder – transitional epithelium becomes squamous
schistosomiasis
catheter
kidney stones

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30
Q

investigations for bladder cancers?

A

flexible cystoscopy

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31
Q

clinical presentation of bladder cancer? 3

A

painless haematuria
dysuria
raised WCC
recurrent inf

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32
Q

surgery for bladder cancer?

A

TURBT - BCG + chemo

cystectomy

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33
Q

what is the actual function of the prostate?

A

produces seminal fluid

to sustain semen

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34
Q

what kind of cancer is prostate cancer normally?

A

adenocarcinoma

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35
Q

5 LUTS?

A 
frequency
urgency
nocturia
terminal dribbling 
haematuria
dysuria/pain
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36
Q

presentation of prostate cancer?

A 
urine retention 
lower abdo  pain 
LUTs eg frequency, dribbling 
asymetrical hard, lumpy prostate with loss of median sulcus
weight loss, etc
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37
Q

investigations for prostate cancer?

A

PSA - non specific
multiparametric MRI
biopsy
transrectal USS

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38
Q

how is prostate cancer graded & staged?

A

Gleasson score to grade (higher is worse)

TMN to stage

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39
Q

treatment options for prostate cancer?

A

prostatectomy
radiotherapy
brachytherapy - radioactive beads into prostate
flutamide - anti testosterone

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40
Q

3 times when PSA may be high?

A 
cancer
BPH
exercise
post ejaculation 
infection
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41
Q

5 risk factors for CKD?

A 
smoking
hypertension
SLE
infection eg HIV
ACEi
nephrotic/nephritic syndromes 
polycystic kidney 
vesicourethral reflux
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42
Q

4 pathophysiological effects of declining kidney function?

A

fluid balance/BP regulation disrupted – hypervolaemia/hypertension
vit D metabolism poor – bone resorbed
hyperkalaemia, uraemia
decreased EPO = normocytic anaemia
metabolic acidosis - as less H+ excretion and less bicarb production

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43
Q

5 clinical presentations of CKD?

A 
HTN 
oedema
uraemia = sallow/frost
anaemia -- lethargy, pallor 
frothy urine
muscle cramps (hyperK)
nausea
anorexia
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44
Q

what is ACR and what does it show/mean?

A

albumin/creatinine ratio

more than 3 means proteinuria

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45
Q

how is GFR calculated?

A

eGFR - creatinine

gold standard - inulin - but v invasive

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46
Q

end stage renal failure is what GFR?

A

15 or less

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47
Q

what does FBC show in CKD?

A

normocytic anaemia

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48
Q

2 types of dialysis?

A

haemodialysis - more effective

peritoneal dialysis - easier for pt

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49
Q

why is BPH more common with age?

A

5a reductase converts testosterone to dihydrotestosterone
5a reductase increases with age
dihydrotestosterone is more active

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50
Q

presentation of BPH?

A

LUTS eg frequency, straining, hesitancy, weak stream, urgency, incontinence, nocturia
enlarged but smooth prostate

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51
Q

tests for BPH?

A

PSA slightly raised
urinalysis to exclude infection
transurethral biopsy to exclude cancer
urodynamics/flow studies

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52
Q

what scoring system is used for BPH?

A

IPSS

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53
Q

2 drugs for BPH?

A

a1 antagonists eg tamsulosin - relax smooth muscle - 1st line
5a reductase inhibitors eg finasteride - shrink prostate - 2nd line/for severe

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54
Q

2 lifestyle changes/conservative management in BPH?

A

reduce fluid intake/caffeine
urethral milking
incontinence pads
bladder training

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55
Q

3 Complications of BPH?

A

UTI
urine retention
stones
nephropathy

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56
Q

5 risk factors for UTI?

A 
sexually active 
catheterised 
enlarged prostate 
renal tract tumour
renal stones 
urinary retention 
woman
incontinence
poor hygeine
dehydration
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57
Q

what does pyuria mean?

A

neutrophils in the urine

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58
Q

what is cystitis?

A

inflammation of the bladder

associated with UTI

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59
Q

uncomplicated vs complicated UTI?

A

uncomplicated - healthy non pregnant women

everyone else - complicated

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60
Q

4 bacteria that commonly cause UTI? Which is most common?

A 
e.coli most common 
staph saphrophyticus 
klebsiella pneumoniae 
pseuddomonas aeruginosa 
proteus - stones as they increase the pH of urine
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61
Q

what is pyelonephritis?

A

infection in the kidney

inflammation of upper urinary tract, renal pelvis, parenchyma, upper ureter

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62
Q

5 clinical presentations of UTI?

A 
frequency
dysuria
urgency
incontinence
confusion
suprapubic pain
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63
Q

3 features that suggest pyelonephritis over UTI?

A

loin pain
fever
haematuria

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64
Q

what do nitrates suggest?

A

gram neg bacteria eg e coli

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65
Q

what do urine casts suggest?

A

damage to epithelium/tubular necrosis/glomerulus

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66
Q

what does epithelium in MSU suggest?

A

poorly taken sample, may be contaminated

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67
Q

what number of bacteria in an MSU is significant?

A

10^5

10^4 may be contamination

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68
Q

what samples do you need, to test for TB in urine?

A

3 early morning samples

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69
Q

how to treat uncomplicated UTIs in young women?

A

3 days abx

eg nitrofurantoin or trimethoprim

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70
Q

how to manage ‘complicated’ UTI?

A

MSU for culture

7 days abx

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71
Q

what about abx for UTI in pregnancy?

A

nitrofurantoin = 1st line
2nd line = cefalexin or amoxicillin
(not trimethoprim)

72
Q

3 things about UTI in pregnancy?

A

urinalysis is an unreliable test, always send for culture
asymptomatic bacteriuria is common
always treat, they are at much higher risk of pyelonephritis

73
Q

when would/wouldn’t you treat or test a ?UTI?

A

3 UTI symptoms – empirical abx
2 UTI symptoms + nitrates – empirical abx

2 UTI symptoms + leucocytes – send MSU

symptoms but no leuco/nitr in dipstick or it looks clear - unlikely to be a UTI

74
Q

2 bacteria that are yellow on a CLED?

A

yellow on CLED = lactose fermenting
e.coli
staph saprophyticus

75
Q

2 organisms that are blue on a CLED?

A

blue on cled = non lactose fermenting
salmonella
shigella
pseudomonas

76
Q

pink colonies on a MacConkey plate are_____

A

lactose fermenting
e coli
staph saprophyticus

77
Q

pyelonephritis is most common in ___

A

females under 35

esp pregnant

78
Q

3 ways infection can spread to the upper urinary tract and cause pyelonephritis?

A

ascending from urethra, common in intercourse
haematogenous, in sepsis
lymphatic

79
Q

presentation of pyelonephritis?

A 
fever 
rigors 
unilateral loin (-- groin) pain 
pyuria
nausea
haematuria
dysuria/frequency
80
Q

investigations for pyelonephritis?

A 
urine dip -- leuco and nitrates 
MSU shows white cell casts
CRP
USS
DMSA scan if recurrent
81
Q

treatment for pyelonephritis?

A 
broad spec abx - coamoxiclav, gentamycin 
analgaesia
antipyretics 
fluid 
drain kidney
82
Q

5 bacteria that can cause prostatitis, which is most common?

A 
e coli - most common
pseudomonas
klebsiella
proteus mirabilis
chlamydia
gonorrhoea
staph aureus (disseminated from somewhere else)
83
Q

5 clinical signs/symptoms of prostatitis?

A 
pain - perineal/rectal/pelvic/back 
hesitance, straining, dribbling 
dysuria, frequency, urgency
tachycardia, pyrexia
malaise, myalgia 
palpable bladder 
prostate feels hot/swolen/tender
84
Q

investigations for prostatitis?

A 
urinalysis/MSU
Blood/semen culture 
trans urethral ultrasound - TRUSS
MRI of prostate 
DRE
CRP
85
Q

management for prostatitis?

A

ciprofloxacin 14 days

if abscess - TRUSS guided drainage

86
Q

treatment for chronic prostatitis?

A

analgaesia
tamsulosin
stool softener - docusate

87
Q

most common cause of urethritis?

A

STI

eg chlamydia

88
Q

presentation of urethritis? - 5

A 
dysuria
haematuria/pus in urine 
discharge 
urethral pain / itching 
inflammation 
skin lesion
reactive arthritis 
conjunctivitis
epididymitis
89
Q

management of chlamydia?

A

doxycycline

azithromycin - if preg

90
Q

management for gonorrhoea?

A

ceftriaxone + azithromycin

91
Q

does chlamydia infect the vagina?

A

no, chlamydia and gonorrhoea cannot infect squamous epithelium

92
Q

what is the incubation period for chlamydia and gonorrhoea?

A

chlamydia = 1-3 weeks

gon: 10 days for women, 1-5 days in men

93
Q

presentation of gonorrhoea & chlamydia in women?

A

asymptomatic
change in vaginal discharge
menstrual irregularity
dysuria

94
Q

3 complications of GC/ chlamydia in women?

A

PID
neonatal transmission
fitz-hugh-curtis: diagnose at nephrostomy, similar to gallbladder dis

95
Q

what does gonorrhoea look like on a gram stain?

A

gram neg
diplococci
in the cytoplasm of polymorphs

96
Q

what organism causes syphilis?

A

treponema pallidum

97
Q

what are the features of primary syphilis?

A

chancre

macule - papule - non tender solitary ulcer

98
Q

5 features of secondary syphilis?

A 
may or may not follow chancre
rash
mucous membrane lesions
generalised lymphadenopathy
alopecia
bone pain
hepatitis 
nephrotic syndrome 
deafness 
iritis
meningitis
CN palsy
99
Q

treatment for syphilis?

A

penicillin

100
Q

how is CKD defined?

A

GFR less than 60
GFR less than 90 with renal damage
albuminuria - more than 30mg/24hr or ACR more than 3

101
Q

what is the most common cause of CKD?

A

diabetes

-damage to efferent arteriole

102
Q

what is nephritis? what are the two types?

A

nephritis = general inflammation of the kidney
glomerulonephritis
interstitial nephritis

103
Q

3 conditions that cause glomerulonephritis and lead to a nephritic syndrome?

A

goodpastures
rapidly progressive glomerulonephritis (can come from goodpastures)
IgA nephropathy
Henloch-schonlein purpura - essentially this is like a sstemic version of IgA nephropathy
post streptococcal glomerulonephritis
membranoproliferative glomerulonephritis
SLE

104
Q

post streptococcal glomerulonephritis develops in who following what kind of conditions?

A

tonsilitis
impetigo
under 30s
immune complexes are deposited in glomerulus, causing inflammatory damage to podocytes

105
Q

goodpastures syndrome is caused by

A

antibodies to glomerular basement membrane

106
Q

3 conditions that cause glomerulonephritis leading to nephrotic syndrome?

A 
minimal change
focal  segmental glomerular sclerosis
diabetes 
membranous glomerulonephritis
amyloidosis
107
Q

membranous glomerulonephritis is caused by

A

igG deposition in the glomerular membrane

108
Q

minimal change disease is commonest in

A

children

109
Q

nephritic & nephrotic syndrome?

A

nephritic: haematuria (cola), mild proteinuria,, HTN, peripheral oedema
nephrotic: severe/frothy proteinuria, central oedema, hypoalbuminuria, lipid/clot

110
Q

epidemiology, aetiology and investigations for IgA nephropathy?

A

in the 20s
following GI or URT infection
dipstick
mesangial proliferation ang IgA at biopsy

111
Q

aetiology, epidemiology of membranoproliferative glomerulonephritis?

A

20s and 60s
igG and c3 deposition in basement membrane
idiopathic
secondary - NSAIDs, malignancy, rheumatoid
is the most common primary cause of nephrotic syndrome in adults (diabetes is most common secondary cause)

112
Q

management of nephritic syndrome?

A

steroids

BP control

113
Q

gold standard investigation for nephritic/nephrotic syndromes?

A

nephritic = biopsy - crescent shaped glomeruli

nephrotic - needle biopsy and microscopy - light, electron, fluroescence

114
Q

pathophysiology in nephrotic syndrome?

A

damage to glomerulus = protein esp albumin leak into urine instead of being filtered and retained
loss of albumin = oedema

115
Q

what happens in minimal change disease?

A

T cells release cytokines which damage podocytes

‘minimal change’ seen at microscopy, may see loss of podocytes

116
Q

management for nephrotic syndrome?

A 
steroids - mainstay 
ciclosporin
diuretics
ACEi
albumin
anticoagulant - apixaban, lmw heparin, warfarin (warfarin has a delayed effect)
117
Q

the two forms of polycystic kidney disease?

A

autosomal dominant - develops in adulthood
PKD1 on chr 16 / PKD on chr 4

autosomal recessive - rarer but worse
develops in childhood
chr 6 PKDH1

118
Q

what protein is mutated in polycystic disease, what is its normal function and what happens when its mutated?

A

polycystin protein
allows calcium influx to inhibit cell proliferation
mutation = cell overproliferation and overexpression of water channels
= fluid formed cysts

119
Q

what are 3 pathophysiological effects of the cysts in polycystic kidney disease?

A

compress blood flow – hypoperfusion – RAAS activation – hypertension
block the collecting ducts – stasis of urine – kidney stones
renal failure

120
Q

5 renal signs/symptoms of polycystic kidney disease?

A 
pain
palpable enlarged kidneys
haematuria
nocturia
polyuria, polydipsia,
hypertension
121
Q

5 extra-renal complications of polycystic disease? caused by cysts forming elsewhere

A 
hepatomegaly
splenomegaly
pancreatic dysfunction 
infertility
mitral/aortic regurg 
berry anneurysm
aortic root dilatation 
diverticulae
122
Q

3 presentations of autosomal recessive polycystic kidney disease?

A 
at birth:
- olighydramosis (lack of amniotic fluid)
underdeveloped lungs -- resp failure 
low ears, flat nasal bridge 
congenital liver fibrosis
123
Q

investigations to diagnose PKD?

A

U & E
USS
genetic testing

124
Q

management of polycystic kidney disease?

A

tolvaptan / v2 antagonist
cyst drainage
dialysis

avoid contact sports, nsaids, anticoagulants

125
Q

where is an epidydimal cyst/ what does it feel like?

A

smooth
in the epidydimus, above the testicle
feels clearly separate from testicle

126
Q

investigations for epidydimal cyst?

A

uss

transluminates on exam, as is fluid filled

127
Q

a lump that’s separate from the testicle could be:

A

epidydimitis / varicocele if solid

epidydimal cyst if fluid filled

128
Q

what is a hydrocele?

A

a collection of fluid within the tunica vaginalis - between the parietal and visceral layers

129
Q

aetiology of hydrocele?

A

idiopathic most common esp in younger men

secondary - tumour, trauma, tb, torsion

130
Q

what is a communicating hydrocele caused by?

A

failure of the tunica vaginalis to close at birth

131
Q

what is a simple hydrocele caused by?

A

overproduction of serous fluid by the mesothelium

132
Q

what does a hydrocele look/feel like?

A

painless soft swelling
in the scrotum, above and below testicle
not reducible
transluminates

133
Q

3 management options for a large problematic hydrocele?

A

aspiration
remove it
sclerotherapy

134
Q

what is a varicocele?

A

swelling of the veins in the pampiniform plexus

135
Q

which side is it more common to have a varicocele, why?

A

left
as the left testicular vein flows into renal vein before vena cava
the right testicular vein flows straight into vena cava

136
Q

left sided varicocele can be caused by

A

renal cell carcinoma

137
Q

classically a varicocele feels like

A

a bag of worms

138
Q

how does a varicocele change when lying down?

A

it should disappear

if it doesnt there could be a retroperitoneal tumour

139
Q

if the left scrotum is smaller where is the varicocele?

A

left

140
Q

what are the 5 gleasson stages?

A

1 - well formed uniformly distributed
2 - mostly well formed with minor poorly formed
3 - mostly poorly formed with minor well formed
4 - poorly formed glands
5 - necrosis, cords, nests, sheets

141
Q

risk factors for testicular torsion?

A 
young
trauma
bell clapper deformity 
bicycle riding 
cryptorchidism 
large testicles
142
Q

presentation of anti-glomerular basement membrane disease / goodpastures ?

A 
oliguria
nephritic 
haemoptysis 
SOB 
cough
143
Q

what is Alports syndrome?

A

genetic problem with type 4 collagen
= renal failure, hearing loss, problems with eyesight - lenticonus
x linked recessive or autosomal recessive

144
Q

what are the stages of CKD?

A 
1 - kidney damage but GFR over 90
2. kidney damage GFR 60-90
3A - 45-60
3b - 30-45 
4 - 15-30
5 - less than 15
145
Q

what is first line for urgency incontinence?

A

oxybutynin - antimuscarinic

prevent parasympathetic contraction of detrusor

146
Q

what is the treatment for stress incontinence?

A

1 - bladder training

2 - duloxetine (SNRI)

147
Q

what are struvite stones made from?

A

magnesium ammonium phosphate

148
Q

what is prehns sign for? what is a positive prehns sign?

A

to identify testicular torsion
pos when lifting the testicle = relief of pain
pos sign = epidydimitis NOT testicular torsion

149
Q

what are kimmelstiel-wilson lesions?

A

when the mesangeal matrix invades glomerular capillaries

eg in diabetic hypertensive nephropathy

150
Q

what diet is best for kidney disease?

A

low potassium, phosphate, sodium, protein

151
Q

2 markers for testicular cancer?

A

alpha fetoprotein

beta hCG

152
Q

tumour marker for bladder cancer?

A

fibrin

153
Q

what are the stages of AKI?

A

1 - 150-200% increase in creatinine. less than 0.5ml/kg/hr for 6 hrs
2 - 200-300% increase in creatinine, less than 0.5mg/kg/hr for 12 hours
3 - less than 0.3ml/kg/hr

154
Q

what are first medications for vasculitis?

A

steroids

rituximab

155
Q

what investigation would you use to stage renal cancer?

A

CT or MRI

156
Q

what is the surgery for testicular torsion?

A

manual detorsion (it is an emergency)

157
Q

3 investigations for post streptococcal glomerulonephritis?

A

U&E
urinalysis
biopsy - dead bacterial cells and antibodies causing inflammation

158
Q

3 common places for renal stones to get lodged?

A

ureteropelvic junction
pelvic brim
vesicoureteral junction
ureteral crossing of iliac vessels

159
Q

presentation of CKD?

A 
fatigue
uraemic frost 
bone pain 
anorexia 
pruritis
arrythmia
160
Q

presentation of AKI?

A 
encephalopathy due to uraemia
arrythmia/muscle weakness 
oliguria
creatinine 
if post renal cause - luts 
signs of cause eg infection, vasculitis, etc 
metabolic acidosis
itchiness
161
Q

in nephrotic syndrome, what happens to cholesterol and coagulability?

A

albumin is lost
so liver increases production of albumin
along with this the liver increases production of cholesterol (xanthelasma) and coagulation factors (coagulopathy)

162
Q

what is focal segmental glomerulosclerosis? & what is it caused by?

A

focal segments of plaques

hiv, sickle cell, interferon drugs

163
Q

what is von hippel lindau syndrome?

A

mutation in VHL which regulates HIF – mutation = cancer
cysts form all over - kidney, pancreas, adrenals, phaeochromocytoma, liver
dominant or de novo

164
Q

what drugs should be stopped in AKI?

A

NSAIDS

ACEi

165
Q

what stones can/can’t be seen on x ray?

A

uric acid and cysteine stones are radiolUCent (can’t see)

calcium and struvite stones can be seen

166
Q

how is phosphate affected in CKD?

A

hyperphosphataemia

the kidnneys normally excrete phosphate, they can’t do that as well in CKD

167
Q

what things might suggest acute tubulointerstitial nephritis?

A 
rash
recently started a drug 
pyuria
eosinophils 
fever
168
Q

yolk sac tumour?

A

most common testicular cancer in boys
schiller duval bodies
high ALP

169
Q

what is the most common cause of epidydimitis?

A

gonorrhoea in young

e coli over 35

170
Q

NSAIDs cause what kind of AKI?

A

intrarenal

171
Q

what happens to calcium in CKD?

A

hypocalcaemia

172
Q

what antibiotics commonly cause AKI?

A

macrolides eg gentamycin – causes tubular necrosis

173
Q

IgA nephropathy and post strep glomerulonephritis are both nephritic conditions that develop after tonsilitis etc but what is the difference?

A

IgA - within a few days

post strep - within a few weeks

174
Q

which part of the prostate is cancer usually in?

A

peripheral

transitional in BPH

175
Q

what nerves innervate the bladder?

A

sympathetic - relax detrusor - inferior hypogastric
parasymp - contracts detrusor - pelvic
somatic - sphincter - pudendal

phase 2a (10 decks)

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