Renal/Uro

Question 1

Diagnostic criteria for CKD

Answer 1

GFR <60 or evidence of kidney damage present for at least 3 months. Evidence - albuminuria, haematuria of no other cause, structural abnormalities (US), pathological abnormalities (biopsy)

Question 2

Definition of kidney failure

Answer 2

GFR <15 or treatment by dialysis

Question 3

Staging of CKD by eGFR

Answer 3

1. > 90 (normal)
2. 60-89
3. 30-59
4. 15-29
5. <15 (kidney failure)

Question 4

Staging CKD by albumin (excretion rate)

Answer 4

A1. <30 mg/day
A2. 30-300
A3. >300

Question 5

Aetiologies of CKD

Answer 5

1. Diabetic kidney disease +++ (36%)
2. Glomerulonephritis
3. Hypertensive vascular disease
4. Polycystic kidney disease
   Other - CT disorders, vasculitides

Question 6

Approach to management of CKD (acronym)

Answer 6

Really Sad Cus Dad Rates Steak
R - treat reversible causes
S - slow down progression
C - treat complications
D - adjust doses of renally excreted drugs
R - prepare for RRT
S - sick day plan

Question 7

Complications of CKD (acronym)

Answer 7

SOAK WET
S - Sleep (anaemia) – normocytic normochromic – exclude non-renal causes
O - overload (volume) – dietary sodium restriction, loop diuretic
A - acidosis metabolic – consider bicarbonate supplementation
K – hyperkalaemia – low potassium diet, avoid NSAIDs
W - way too high BP (HTN) – ACEI/ARB + diuretic
E - eating bone (osteoporosis) – phosphate dietary restriction, oral phosphate binders, vit D supplementation
T - triglycerides ++ - consider statin

Question 8

Diagnostic criteria for AKI

Answer 8

Creatinine increased > 1.5x baseline OR oliguria (<0.5mL/kg/hr for 6 hours or <400mL in 24 hours)
** eGFR not accurate in AKI so MUST use creatinine

Question 9

Pre-renal causes of AKI

Answer 9

ALL DUE TO RENAL HYPOPERFUSION

1. Decreased tissue perfusion - hypovolaemia (GIT loss, renal loss, skin or resp loss, third spacing), hypotension (shock), oedematous states, drugs
2. Selective renal ischaemia - renal artery stenosis

Question 10

Renal causes of AKI

Answer 10

Vascular (vasculitis, thrombosis), glomerular (GN), Tubular (acute tubular necrosis ++MC, nephrotoxins), interstitial (allergic interstitial nephritis)

Question 11

Post-renal causes of AKI

Answer 11

BLOCK
B- bladder outlet obstruction - BPH, blood clot, blocked catheter
L - loss of nerves (neurologic disease of the bladder eg SCI)
O - outside compression (pelvic tumour, AAA)
C: congenital abnormality
K: kidney stones (BL or ureteric)

Question 12

LUTS/IPSS

acronym

Answer 12

PISSED FUCK
Voiding
P – poor stream
I – intermittency
S – superimposed infection (not part of IPSS)
S – straining
E – erghh! Hesitancy
D – dribble
Storage
F – frequency
U – urgency
C – can’t hold it – incontinence
K – kept awake - nocturia

Question 13

Pathophys of prostate cancer

Answer 13

Genetic mutation in luminal cell (sometimes basal cell) –> uncontroleld proliferation –> luminal cells are andogen-dependent and thus so is prostate cancer –> eventually cells mutate so that they are androgen-independent and resistant to anti-androgens

Question 14

Prostate cancer spread

Answer 14

• Direct invasion (beyond capsule)
• Lymphatic spread (groin nodes)
• Haematological spread (predileciton for bony mets to pelvis and spine)

Question 15

Investigations for possible Prostate Ca

Answer 15

1. Lab PSA (N<4) - high sens, low spec
2. Imaging - transrectal US, also MRI (not medicare), CT (standard for staging)
3. Needle biopsy guided by transrectal US (gold standard dx - Gleason Grading score)

Question 16

DDx scrotal swellings

Answer 16

Benign - inguinoscrotal hernia, hydrocoele, epididymal cyst, varicocoele, spermatocoele
Malignant - testicular tumour

Question 17

Description, clinical features, on palpation, management of Inguinoscrotal hernia

Answer 17

D: protrusion of abdominal contents through the inguinal canal into the scrotum
CF: small bulge in groin, increased size with valsalva, disappear when lieing down, sometime sharp pain with straining, ++ pain if strangulated
P: testes separable from hernia, cord NOT palpable, cough impulse, may be reducible
M: surgical repair (open or laparoscopic)

Question 18

Description, clinical features, on palpation, management of hydrocoele

Answer 18

D: collection of serous fluid that results from a defect or irritation in the tunica vaginalis. Can be congenital, idiopathic or secondary (trauma, tumour, torsion)
CF: fluctuant, painless swelling of affected scrotum, may be reducible, transilluminable
P: testes NOT separable, cord palpable
M: conservative (self-limiting), needle drainage, surgical

Question 19

Description, clinical features, on palpation, management of varicocoele

Answer 19

D: Dilatation and tortuosity of venous plexus - due to incompetent valves in the testicular veins
CF: +/- pain with lump, not transilluminable, increased size with valsalva
P: testes separable, feel ‘bag of worms’ with cord
M: conservative, surgery (impaired fertility, pain ++, cosmetic, adolescence)

Question 20

Description, clinical features, on palpation, management of Testicular cancer

Answer 20

D; malignancy of testicles
CF: painless testicular enlargement +/- hydrocoele
P: hard lump/nodule on testes, can feel cord, not transilluminable
M: surgical + adjuvant

Question 21

Description, clinical features, on palpation, management of Epididymal cyst (spermatocoele)

Answer 21

D: a benign, sperm-filled epididymal retention cyst
CF: non-tender, cystic mass, transilluminates
P: testes separable, cord palpable
M: conservative, surgical excision if symptomatic (don’t needle aspirate)

Question 22

Clinical features of testicular torsion

Answer 22

• acute pain, tenderness, swelling
• N/V
• asymmetrically high-riding testes
• Long axis orientated transversely instead of longitudinally
• Reactive hydrocoele
  overlying erythema
• negative cremasteric reflex
• negative prehn’s sign

Question 23

Diagnosis of nephrotic syndrome

Answer 23

• proteinuria >3.5g/day
• hypoalbuminaemia
• oedema
• hyperlipidaemia