Renal/Uro Flashcards
What is amyloidosis?
is a clinical disorder caused by extracellular deposition of insoluble abnormal proteins.
What is amyloidosis associated with?
- rheumatoid arthritis
- juvenile chronic arthritis
- ankylosing spondylitis
- psoriasis & psoriatic arthritis
- Still’s disease
- Behget syndrome
How does amyloidosis present?
- Largely determined by the organ or system affected & the picture is often confused by the underlying disease.
- Renal dysfunction is one of the most common presenting features of patients with systemic amyloidosis.
How do we dx amyloidosis?
Amyloidosis is diagnosed when Congo red-binding material (bright green fluorescence observed under polarized light
after Congo red staining) is demonstrated in a biopsy specimen
What is the most common genetic cause of renal failure in adults?
Autosomal dominant polycystic kidney disease (ADPKD)
How do we treat BPH?
a1-adrenergic receptor antagonists (e.g. terazosin, tamsulosin)
* relaxes smooth muscle in the prostate & bladder neck thereby decreasing the degree of blockage of urine flow.
* 5a-reductase inhibitors (e.g. finasteride)
* inhibits 5a-reductase, which reduces production of dihydrotestosterone, a hormone responsible for enlarging the prostate.
How do we manage urethral injury?
If you suspect urethral injury do not attempt urethral catheterisation but refer urgently to the Urologists.
- Some Urologists perform a retrograde urethrogram.
- Others prefer suprapubic catheterisation & subsequent imaging.
What is sterile pyuria?
Sterile pyuria is a condition where white blood cells are present in urine, but no bacteria are detected
What is the triad in RCC?
Haematuria, loin pain and loin mass
What is the most common cancer in men?
Prostate
Why do you get metabolic acidosis in renal failure?
In chronic renal failure with ingestion of normal protein, fixed acids (e.g. lactic acid, phosphoric acid etc) will be produced from protein catabolism. Because the failing kidney does not produce enough NH4+ to excrete all the of the fixed acid, metabolic acidosis (with respiratory compensation) results.
What is functional incontinence?
involuntary leakage of urine due to environmental or physical barriers to toileting. This type of incontinence is sometimes referred to as toileting difficulty. This may occur in a person with poor memory / eyesight / mobility or who has difficulty removing clothing, or there may be an unwillingness to go to the toilet because of depression,
anxiety, or anger, etc.
Which UC tx can cause oligospermia?
Sulfasalazine
What is necessary before undergoing a PSA test?
not have an active urinary infection.
- not have ejaculated in the past 48 hours.
- not have exercised vigorously in the past 48 hours.
- not have had a prostate biopsy in the past 6 weeks.
How do we classify CKD?
Chronic kidney disease (CKD) is classified using a combination of estimated glomerular filtration rate (eGFR) and urinary albumin:creatinine ratio (ACR). Increased ACR is associated with increased risk of adverse outcomes. Decreased GFR is associated with increased risk of adverse outcomes. Increased ACR and decreased GFR in combination multiply the risk of adverse outcomes.
Where do you see the eggplant deformity?
Penile fracture
What is the commonest type of renal stone?
Calcium oxalate
A 50-year-old man undergoes a CT abdominal scan with contrast. Following the procedure, his renal function has deteriorated. Dx?
Acute tubular necrosis
What is the most common causative organism of UTI in young adult women?
S saprophyticus
What is the most common cause of glomerulonephritis worldwide?
IgA nepropathy?
How does IgA nephropathy present?
typically presents as nephritic syndrome (visible haematuria) 24-48 hours after an upper respiratory tract infection. High-dose prednisolone can reduce proteinuria and delay renal impairment, and in patients with deteriorating renal function, immunosuppressive drugs are often used.
How do we differentiate between IgA nephropathy and post-streptococcal glomerulonephritis?
IgA nephropathy may be differentiated from a post-streptococcal glomerulonephritis where visible haematuria occurs 1 to 3 weeks after the onset of streptococcal infection.
How does Wegener’s granulomatosis present?
Granulomatosis (granulomatosis with polyangiitis [GPA]) is a systemic vasculitis that typically involves small and medium vessels. Although any organ may be targeted, the classic triad consists of upper and lower respiratory tract involvement and pauci-immune glomerulonephritis
How does Churg-Strauss syndrome present?
Churg-Strauss syndrome or eosinophilic granulomatosis with polyangiitis (EGPA) whose main features include asthma, gastrointestinal and cardiac involvement with significant (>10% of peripheral WBC count) peripheral eosinophilia or tissue eosinophilia.
How does Goodpasture’s syndrome present?
eosinophilia. Goodpasture’s syndrome (anti-glomerular basement membrane antibody disease) is another differential where the presentation of pulmonary haemorrhage and glomerulonephritis is clinically indistinguishable from Wegener’s granulomatosis. But, the presence of involvement in other sites (e.g. upper respiratory tract) argues against a diagnosis of Goodpasture’s syndrome.
How does exercise cause hyperkalaemia?
Shifts K+ from cells into blood
Which colour does nitrofurantoin cause in urination?
Brown urine
How do we prevent renal stones?
Advise to consume less oxalate by reducing tea, chocolate, nuts, strawberries, rhubarb, spinach, beans & beetroot & to drink plenty of fluids especially in the summer.
What is Alport syndrome?
Alport syndrome is a X-linked or autosomal recessive inherited rare defect in the genes encoding the chains of type IV collagen of the
basement membranes.
How does Alport syndrome present?
Presents as sensorineural deafness, pyelonephritis, haematuria, renal failure.
* Treatment is dialysis or renal transplant for end stage renal failure.
What is analgesic nephropathy?
- It begins after several months of NSAID, paracetamol or phenacetin exposure.
- A unique feature of allergic interstitial nephritis caused by NSAIDs is that patients may present with nephrotic syndrome.
- In such patients, massive proteinuria with hypoalbuminaemia and oedema are present in addition to the typical features of acute interstitial nephritis.
What is Balkan nephropathy?
Balkan nephropathy was first identified among several small, discrete communities along the Danube River.
How does Balkan nephropathy present?
The symptoms are not typical for the common chronic nephritis:
* Incidence only in adults (no children affected)
* lack of high blood pressure
* xanthochromia (presence of bilirubin) of palms and soles (Tanchev’s sign)
Tx for pyelonephritis in the community?
Cefalexin
What is pneumaturia?
Pneumaturia is the passage of gas mixed with urine, usually as a result of a vesico-colic fistula.
* Causes include diverticulitis (50-70%), malignancy (20%) & Crohn’s disease (10%).
* May occasionally be due to gas-producing bacterial infections of the urinary tract.
* The patient presents with dysuria and frequency, and may describe bubbles in the urine.
* There may also be faecaluria.
What is Fanconi syndrome, and how does it present?
Fanconi syndrome is a generalised inherited or acquired disturbance of renal tubular transport.
* Leads to aminoaciduria, glycosuria, phosphaturia, renal tubular acidosis type 2 (proximal), & hypophosphataemic rickets (children) or osteomalacia (adults).
Which vaccine can be used to treat non-muscle invasive bladder ca?
BCG
How is phenytoin metabolised?
In the liver
