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Paddy Phase 2 Qs > Renal & Urogenital > Flashcards

Renal & Urogenital Flashcards

1
Q

What are the commonest causes of Acute Kidney Injury?

A 
Sepsis
Major Surgery
Cardiogenic Shock
Other Hypovolaemia
Drugs
Hepatorenal Syndrome
Obstruction
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2
Q

Which drugs are contraindicated with PDE5 inhibitors?

A

Nitrates - Some, like tadalafil, also interact with alpha blockers

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3
Q

What is Addison’s Disease?

A

Addison’s disease, also known as primary adrenal insufficiency and hypocortisolism, is a long-term endocrine disorder in which the adrenal glands do not produce enough steroid hormones (cortisol and aldosterone).
Symptoms generally come on slowly and may include abdominal pain, weakness, and weight loss. Darkening of the skin in certain areas may also occur. Under certain circumstances, an adrenal crisis may occur with low blood pressure, vomiting, lower back pain, and loss of consciousness. An adrenal crisis can be triggered by stress, such as from an injury, surgery, or infection

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4
Q

What would indicate that something was CKD rather than AKI?

A

Normochromic Anaemia
Small Kidneys on Ultrasound
Presence of Renal Osteodystrophy
Duration of Symptoms

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5
Q

What is the commonest type of renal cancer?

A

Renal Cell Carcinoma

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6
Q

What are the three most common presenting symptoms of STIS?

A

Urethral Discharge
Genital Ulcers
Genital Ulcers

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7
Q

What is Peyronies Disease?

A

Also known as bent penis syndrome, causes curvature of the penis.

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8
Q

What is the treatment for renal cell carcinomas?

A

Radical nephrectomy. Cryotherapy and radio frequency ablation for patients unfit for surgery.
Chemo & Radiotherapy generally does not work on these tumours.

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9
Q

What is the most common cause of acute nephritic syndrome?

A

Often caused by an immune response triggered by an infection or other disease. Typically post streptococcal glomerulonephritis develops in a child 1-3 weeks after a streptococcal infection such as pharyngitis with a Lancefield Group A beta haemolytic streptococcus. The bacterial antigen becomes trapped in the glomerulus, leading to an acute diffuse proliferative glomerulonephritis.

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10
Q

What is autonomic dysreflexia?

A

Occurs in lesions above T6, overstimulation of sympathetic nervous system below level of lesion - causes headache, severe hypertension, flushing. Can become paraplegic causing urinary incontinence.

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11
Q

What drives the uptake of potassium into cells?

A

Insulin and catecholamines

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12
Q

When should you refer a case of AKI to a specialist?

A

If the patient is not responding to treatment
If there are complications
If they are stage 3 AKI
AKI with hypertension
AKI due to possible intrinsic renal disease
AKI with difficult fluid balance such as heart failure or pregnancy

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13
Q

Define Acute Kidney Injury.

A

A Syndrome of Decreased Renal Function, measured by serum creatinine or urine output, occurring over hours-days.
3 varying guidelines:
- Rise in Creatinine of more than 26 micromol/L within 48 hours
- Rise in creatinine more than 1.5 x baseline (before AKI) within 7 days
- Urine output less than 0.5ml/kg/h for more than 6 consecutive hours

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14
Q

How is systemic acidosis treated?

A

Oral Sodium Bicarbonate

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15
Q

How is creatinine clearance calculated?

A 
1.23 x (140 - Age) x (Weight in kg)
divided by 
Serum creatinine (micromol/l)
This is the calculation for men.
For women multiply by 1.04 instead of 1.23 - This is called the Cockroft-Gault equation
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16
Q

What must you do when on the wards to support AKI?

A

Treat Sepsis
Stop Nephrotoxic Medication such as NSAIDS, ACE-I’s, ARB, aminoglycosides
Stop drugs that may increase complications: diuretics (especially potassium sparing), metformin, antihypertensives
Check all drug dosages are appropriate for renal impairment
Consider gastroprotection (H2 antagonist, PPI) and nutritional support
Avoid radiological contrast

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17
Q

How are renal caniculi managed?

A

Stones less than 5mm usually pass in the urine - increase fluid intake

If larger than 5mm - medical expulsive therapy - start with nifedipine or alpha blockers.
Can try extracorporeal shockwave lithotripsy or ureteroscopy or percutaneous nephrolithotomy if more complex.
Anelgesia such as diclofenac to ease pain and antibiotics if infected.

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18
Q

Where are the three most common places for renal caliculi to lodge?

A

Pelviureteric Junction
Pelvic Brim
Vesicoureteric Junction

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19
Q

Which organism is most commonly associated with Urinary Tract Infections?

A

E. Coli

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20
Q

Where do thiazide diuretics act? Give an example

A

Distal Convoluted Tubule - Bendroflumethiazide

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21
Q

What complications can be associated with Nephrotic Syndrome?

A

Venous Thrombosis - due to clotting factors being lost in urine
Sepsis - Loss of immunoglobulin in the urine increases susceptibility to infection
AKI is rarely the result of progression of underlying renal disease and more often a consequence of hypovolaemia.

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22
Q

Which conditions can predispose somebody to developing kidney stones?

A

Recurrent UTIs
Metabolic Abnormalities: Hypercalciuria/hypercalcaemia, hyperparathyroidism, neoplasia, sarcoidosis, Cushings Syndrome, Addisons Disease, Hyperthyroidism, Vitamin D Excess

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23
Q

Chronic Cystitis

Schistosomiasis

A

Pelvic Irradiation

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24
Q

How can bone disease be associated with chronic kidney disease?

A

Renal phosphate retention and impaired production of 1.25 dihydroxyvitamin D (the active hormonal form of vitamin D) lead to a fall in serum calcium concentration and hence to a compensatory increase in parathyroid hormone (PTH) secretion. A sustained excess of PTH results in skeletal decalcification and osteosclerosis (hardening of bone) may be a result of hyperparathyroidism.

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25
Q

What are the causes of Nephrotic Syndrome?

A

Most common causes in adults:

  • Membranous Nephropathy (this is usually idiopathic but may occur in association with drugs such as NSAIDS, autoimmune diseases such as SLE, neoplasia, infections and other causes such as sickle cell)
  • Focal Segmental Glomerulosclerosis (particularly in black adults)
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26
Q

Which part of the nephron do potassium sparing diuretics act? Give an example.

A

Collecting Duct - Spironolactone

27
Q

Why is there increase cardiovascular disease in patients with CKD?

A

An increased frequency of hypertension, dyslipidaemia and vascular calcification.

28
Q

What are the commonest type of bladder cancer?

A

Transitional Cell Carcinomas.

29
Q

Where in the brain is the micturtion centre? What do the signals from this centre do?

A

Pons - If timely to urinate, stimulates signals to spinal interneurons that excite the detrusor and relax the internal urethral sphincter - urine is voided.

If untimely to urinate, signals excite the spinal interneurons to keep external urethral sphincter contracted - so urine is retained.

When timely to urinate, these signals cease and the urethral sphincter relaxes.

30
Q

By what mechanism does water become concentrated in the urine?

A

Through aquaporins in the collecting duct.

31
Q

What causes vaginal discharge in STIs?

A

Candida Albicans, Trichomonad vaginalis, nesseria gonorrhoeae, chlamydia trachomas and herpes simplex.

32
Q

What are the risk factors for bladder tumours?

A 
Smoking
Aromatic Amines (working in rubber industry)
33
Q

Which spinal level are the kidneys located at?

A

T12-L3

34
Q

Why are UTI’s more common in women than in men?

A

They have a shorter urethra, so an ascending infection is more likely.

35
Q

How can the appearance of blood in the urine be differentially diagnosed depending on when it occurs?

A

If only apparent at start of urination, usually due to urethral disease.
If at the end of micturition, suggests bleeding from prostate or bladder base
If throughout, suggests bleeding is from a source in the bladder or above.

36
Q

Where is Aldosterone secreted from and what does it stimulate?

A

The Adrenal Cortex - it is a steroid and stimulates Na+ reabsorption by the distal convoluted tubule and cortical collecting ducts.

37
Q

When a patient has had renal replacement therapy, what pharmacological treatment should be given?

A

Monoclonal Antibodies - eg basiliximab, daclizumab
Calcineurin Inhibitors - eg tacrolimus, ciclosporin
Antimetabolites - eg mycophenolic acid
Glucorticosteroids

38
Q

How can you diagnose a renal stone?

A

Urine tests - mid stream urine

Non-contrast CT is the investigation of choice.

39
Q

What is a Wilms tumour?

A

A Childhood tumour of primitive renal tubules and mesenchymal cells. The chief abdominal malignancy in children.

40
Q

How is hyperkalaemia treated?

A

Often responds well to dietary restriction of potassium intake - drugs which cause potassium retention should be stopped.

41
Q

How are the terms glomerulonephritis and glomerulopathy differentiated?

A

If there is predominant inflammation on histology - glomerulonephritis
If inflammation is absent, glomerulopathy is more accurate.

42
Q

Where in the kidney is renin secreted from?

A

Afferent arterioles of the kidney by the juxtaglomerular cells.

43
Q

What causes renin secretion?

A

Decrease in arterial blood pressure - detected by baroreceptors
Decrease in sodium load delivered to the distal tubule. Measured by macula densa.
Sympathetic nervous activity

44
Q

What Can Cause Cushing’s syndrome?

A

Cushing’s syndrome is caused by either excessive cortisol-like medication such as prednisone or a tumour that either produces or results in the production of excessive cortisol by the adrenal glands.
Cases due to a pituitary adenoma are known as Cushing’s disease. It is the second most common cause of Cushing’s syndrome after medication. A number of other tumors may also cause Cushing’s. Some of these are associated with inherited disorders such as multiple endocrine neoplasia type 1 and Carney complex.

45
Q

What should the normal concentration of albumin be in the urine?

A

less than 20 mg/l

46
Q

Give an example of a loop diuretic? When would you choose to use a loop diuretic rather than a thiazide diuretic?

A

Furosemide - More effective in patients with renal impairment.

47
Q

What is the level of proteinuria that is considered nephrotic syndrome?

A

More than 3.5g in 24 hours

48
Q

Why does Oedema occur in nephrotic syndrome?

A

Due to Sodium Retention in the renal collecting tubules, together with an increase in capillary permeability.

49
Q

What is the commonest cause of Nephritic Glomerulonephritides?

A

IgA Nephropathy - Presents as asymptomatic non-visible haematuria or episodic visible haematuria which may be ‘synpharyngitic’ within 12-72 hours of infection.

50
Q

What are the symptoms of Nephrotic Syndrome?

A 
Massive Proteinuria (more than 3.5g per day)
Hypoalbuminaemia
Oedema
Lipiduria
Hyperlipidaemia
51
Q

What happens to the glomerular basement membrane in Nephrotic Syndrome caused by membranous nephropathy?

A

Deposition of IgG and complement C3 along the outer aspect of the basement membrane . The basement membrane expands with time and eventually resorb the deposits

52
Q

What is the commonest type of testicular tumour in men between 30 and 65 years old?

A

Seminoma - 55%

53
Q

How much urine can be stored in the bladder before the first sensation is felt?

A

100-200ml

54
Q

What is Nephrotic Syndrome?

A

There is massively increased filtration of macromolecules across the glomerular capillary wall due to structural and functional abnormalities of the glomerular podocytes.

55
Q

What Is Cushing’s Syndrome?

A

Cushing’s syndrome is a collection of signs and symptoms due to prolonged exposure to cortisol. Signs and symptoms may include high blood pressure, abdominal obesity but with thin arms and legs, reddish stretch marks, a round red face, a fat lump between the shoulders, weak muscles, weak bones, acne, and fragile skin that heals poorly. Women may have more hair and irregular menstruation. Occasionally there may be changes in mood, headaches, and a chronic feeling of tiredness

56
Q

How is Nephrotic Syndrome treated?

A

General Oedema treated with salt restriction and a thiazide diuretic. Avoid prolonged bed rest
Treatment of underlying disease - high rate of spontaneous improvement
If needed, treat with cyclophosphamide or chlorambucil with prednisolone.

57
Q

What class of drug is viagra? Give 3 examples

A

PDE5 Inhibitor - sildenafil, tadalafil, vardenafil

58
Q

Why is creatinine clearance calculated?

A

A reasonably accurate calculation of GFR

59
Q

What is the most common type of kidney stone?

A

Calcium Oxalate

60
Q

What are the six common ways in which urolithiasis can present?

A
  1. Pain - Typically Loin to Groin Pain
  2. Infection
  3. Haematuria
  4. Proteinuria
  5. Sterile Pyuria (Urine containing WBC’s)
  6. Anuria
61
Q

What Is Fanconi Syndrome?

A

Fanconi syndrome is a syndrome of inadequate reabsorption in the proximal renal tubules of the kidney.
The syndrome can be caused by various underlying congenital or acquired diseases, by toxicity (for example, from toxic heavy metals), or by adverse drug reactions.
It results in various small molecules of metabolism being passed into the urine instead of being reabsorbed from the tubular fluid (for example, glucose, amino acids, uric acid, phosphate, and bicarbonate).
Fanconi syndrome affects the proximal tubules, namely, the proximal convoluted tubule (PCT), which is the first part of the tubule to process fluid after it is filtered through the glomerulus, and the proximal straight tubule (pars recta), which leads to the descending limb of loop of Henle.

62
Q

What is acute glomerulonephritis (acute nephritic syndrome)?

A 
Abrupt onset of Haematuria with casts or dysmorphic red cells, 
Non-nephrotic range proteinuria
Oedema
Hypertension
Transient Renal Impairment
63
Q

Which foods can increase risk of renal stones?

A 
Chocolate
Tea
Rhubarb
Strawberries
Nuts
Spinach

Paddy Phase 2 Qs (15 decks)

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