Renal/Uro Flashcards
CKD definition
reduction in kidney function (eGFR <60) and/or structural kidney damage that persists for 3+ months
CKD stages
based on serun eGFR
G1 90+ normal and high
G2 60-89 mild reduction related to normal range for a young adult
G3a 45-59 mild to moderate reduction
G3b 30-44 moderate to severe reduction
G4 15-29 severe reduction
G5 <15 end-stage kidney failure
CKD pathophysiology
chronic damage to the glomeruli which causes various types of remodelling
causes:
DM
HTN
meds eg NSAID
primary glomerular diseases
obstructive uropathies
systemic disease eg SLE
CKD presentation
generally unwell (fatigue, SOB, cramps)
polyuria, oliguria, nocturia
pallor, cachexia, malnourished
hypertensive, oedema, flank masses if PKD,
frothy urine
CKD Ix
first test- urine dipstick to look for blood and exclude UTI
ACR urinalysis
serum Cr
eGFR (repeat in 6mo then 3mo)
- no meat 12 hours before test
BMI, lipids, HbA1c, lipid profile
renal USS
AD polycystic kidney disease pathophysiology
ADPKD presentation
middle age
large bilateral flank masses
haematuria
hypertension
associations (aneurysm > SAH), CKD
ADPKD diagnosis
USS shows multiple cysts in kidney, sometimes also liver
types of renal artery stenosis
atherosclerotic
fibromuscular dysplasia
renal artery stenosis epidemiology
men with ASCVD risk factors
young women
renal artery stenosis presentation
resistant hypertension
flash pulmonary oedema
renal artery stenosis diagnosis
1st: duplex USS
most useful: CTA
gold standard: DSA
renal cell carcinoma pathophysiology
malignancy of kidney
most common type is clear cell adenocarcinoma
originates from PCT cells
gene deletion of chr3 (acquired or inherited as part of vHL syndrome)
renal cell carcinoma presentation
50-70 yrs
triad: flank pain, haematuria, palpable mass
maybe FLAWS
Internist tumours (paraneoplastic syndrome)
renal cell carcinoma diagnosis
CT scan
amyloidosis pathophysiology
multisystem disease due to deposition of abnormal amyloid proteins
type 1 is AL
type 2 is AA
familial is ATTR
amyloidosis presentation
multisystem
key ones are cardiomyopathy and amyloid kidney disease
amyloidosis diagnosis
gold standard is biopsy, fat pad most easily accessible
- congo red
- apple green birefringence under polarised light
common causes of UTI
most common overall - E.coli
young women - S.saprophyticus
ppl with chronic UTI and staghorn kidney stone - P.mirabilis
Klebsiella
UTI presentation
dysuria, polyuria, urgency
suprapubic discomfort
delirium, confusion in elderly
change in urine appearance
red flags for upper UTI
fever
costovertebral angle tenderness
vital sign derangements
UTI investigations
1st: urine dip
- unreliable in women >65 and if catheterised
- if positive for nitrite or leukocyte of RBC likely UTI
- if neg for nitrite and positive for WBC send for culture to confirm
- if neg for all nitrite, WBC and RBC consider other diagnosis
send urine sample for culture if pregnant, plastic, paediatric, persistent or peeing blood
UTI mx
assess for sepsis risk or risk of upper UTI
simple analgesia
nitrofurantoin or trimethoprim 1st line for uncomplicated UTI
no improvement after 48 hrs - pivmecillinam
UTI complications
upper UTI (pyelonephritis) > septic shock
renal abscess
renal papillary necrosis
