Renal/Uro Flashcards
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Diagnostic criteria for CKD
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)
Definition of kidney failure
GFR <15 or treatment by dialysis
Staging of CKD by eGFR
- > 90 (normal)
- 60-89
- 30-59
- 15-29
- <15 (kidney failure)
Staging CKD by albumin (excretion rate)
A1. <30 mg/day
A2. 30-300
A3. >300
Aetiologies of CKD
- Diabetic kidney disease +++ (36%)
- Glomerulonephritis
- Hypertensive vascular disease
- Polycystic kidney disease
Other - CT disorders, vasculitides
Approach to management of CKD (acronym)
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
Complications of CKD (acronym)
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
Diagnostic criteria for AKI
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
Pre-renal causes of AKI
ALL DUE TO RENAL HYPOPERFUSION
- Decreased tissue perfusion - hypovolaemia (GIT loss, renal loss, skin or resp loss, third spacing), hypotension (shock), oedematous states, drugs
- Selective renal ischaemia - renal artery stenosis
Renal causes of AKI
Vascular (vasculitis, thrombosis), glomerular (GN), Tubular (acute tubular necrosis ++MC, nephrotoxins), interstitial (allergic interstitial nephritis)
Post-renal causes of AKI
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)
LUTS/IPSS
acronym
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
Pathophys of prostate cancer
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
Prostate cancer spread
- Direct invasion (beyond capsule)
- Lymphatic spread (groin nodes)
- Haematological spread (predileciton for bony mets to pelvis and spine)
Investigations for possible Prostate Ca
- Lab PSA (N<4) - high sens, low spec
- Imaging - transrectal US, also MRI (not medicare), CT (standard for staging)
- Needle biopsy guided by transrectal US (gold standard dx - Gleason Grading score)
DDx scrotal swellings
Benign - inguinoscrotal hernia, hydrocoele, epididymal cyst, varicocoele, spermatocoele
Malignant - testicular tumour
Description, clinical features, on palpation, management of Inguinoscrotal hernia
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)
Description, clinical features, on palpation, management of hydrocoele
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
Description, clinical features, on palpation, management of varicocoele
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)
Description, clinical features, on palpation, management of Testicular cancer
D; malignancy of testicles
CF: painless testicular enlargement +/- hydrocoele
P: hard lump/nodule on testes, can feel cord, not transilluminable
M: surgical + adjuvant
Description, clinical features, on palpation, management of Epididymal cyst (spermatocoele)
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)
Clinical features of testicular torsion
- 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
Diagnosis of nephrotic syndrome
- proteinuria >3.5g/day
- hypoalbuminaemia
- oedema
- hyperlipidaemia
