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Fire Through Finals > Renal + urology > Flashcards

Renal + urology Flashcards

1
Q

What are the causes of CKD?

A

Diabetic nephropathy

Hypertension

Chronic glomerulonephritis

Chronic pyelonephritis

Adult PCKD

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2
Q

What constitutes stages 1-5 of CKD?

A

1: >90ml/min + evidence of renal damage*
2: 60-90ml/min + evidence of renal damage
3a: 45-59
3b: 30-44
4: 15-29
5: <15

*Renal damage: Deranged electrolytes, U+Es

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3
Q

Outline the diagnosis process of CKD

A

eGFR < 60ml/min, repeat in 2 weeks to exclude AKI

if eGFR <60ml/min OR ACR >=3mg, repeat in 3 months

if 3 month repeats as above, diagnose CKD

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4
Q

When should referral to nephrology be made for
Symptoms
eGFR
Proteinuria

A

Clinical:

  • Persistent haematuria + cancer symptoms
  • Uncontrolled HTN on 4 drugs
  • Features of PCKD, RAS

eGFR:
- >25%/15 point decrease in 12 months
>25% decrease in 3 months of starting RAAS
- Increased CKD category

ACR
- >70 alone OR >30 with persistent haematuria

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5
Q

How do you manage anaemia in CKD?

A

Check iron status
Correct iron levels first
Then Erythropoetin if benefit likely

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6
Q

What is an important side effect of erythropoetin therapy

A

Accelerated Hypertension
Can lead to encephalopathy and seizures

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7
Q

How do you manage proteinuria in CKD if you are…

Non-Diabetic

Diabetic

A

Offer ARB/ACEI if ACR

Non-diabetic:

>70mg/mmol

30-70 with hypertension

Diabetic:

3mg/mmol

+ SGLT2i if ACR 3-30mg/mmol

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8
Q

How to protect bones in CKD

A

Reduce phosphate intake (phsophate pulls Ca2+ from bones)

If CKD 4-5 Give phosphate binders: calcium acetate, sevelamer

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9
Q

When is sevelamer favoured over calcium acetate?

A

Hypercalcaemia and vascular calcification

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10
Q

When should a CKD patient be dialysed?

A

eGFR < 15 (stage 5)

Renal transplant

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11
Q

What are the two main forms of dialysis?

A

Peritoneal

Haemodialysis

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12
Q

Patient reports pain distal to AV fistula, what could be occuring

A

STEAL syndrome

Fistula removes arterial blood, causing ischaemia of distal limb

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13
Q

What are the two commonest causes of peritonitis in dialysis?

How does NICE recommend you treat it?

A

Coag -ve staph eg Staph epidermidis

Staph aureus another cause

Vanc + ceftazidime added to fluid

OR

Vanc orally + Ceftazidime in fluid

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14
Q

How do you manage hyperkalaemia on bloods?

A

ECG

Stop drugs eg ACEIs

IV calcium gluconate for cardiac protection

Insulin/dextrose or neb salbutamol to shift K+ into cells

Calcium resonium to remove K+ from body

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15
Q

What are the causes for non visible haematuria that is

Spurious

Persistent

A

Spurious:

UTI, Menstruation, vigorous exercise, sexual intercourse

Persistent

Urogen cancer, stones, BPH, inflammation, nephritic syndromes

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16
Q

What infection can cause haematuria?

A

TB

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17
Q

Who gets referred for haematuria

Urgently

Non-urgently

A

Urgent

>=45 years + visible haematuria that is unexplained/persistent after UTI

>=60 years + unexplained NON-visible haematuria + dysuria/raised WCC

Non-urgent

>=60yrs + recurrent/persistent unexplained urinary tract infection

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18
Q

What features would make you suspect prostate cancer

A

LUTS, bloody/painful urination in an older man, especially if black

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19
Q

Who gets referred for prostate cancer?

A

2 week referral for

Malignant features on PR exam

Raised PSA

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20
Q

What is the first line and GS investigation for prostate cancer?

A

1st: Multiparametric MRI

GS: TRUS biopsy if Likert scale >3/5

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21
Q

What scoring system aids diagnosis of prostate cancer?

A

Gleason scoring

>=6 indicates cancer

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22
Q

What are the treatment options for bladder cancer?

A

Localised (T1/2): Radical prostatectomy + radiotherapy

Localised advanced (T3/4): Above + hormonal therapy

Metastatic

Anti-androgen therapy: Gosrelin to downregulate/bicalutamide to block

Bilateral orchidectomy

Docetaxel chemotherapy

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23
Q

What features raise suspicion of bladder cancer?

A

Older men who smoke and worked in textiles

Reporting recurrent urinary symptoms or painless haematuria

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24
Q

What is the first-line and definitive investigation for bladder cancer?

A

1st: CT-KUB

GS: TURBT

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25
Q

Who gets referred for bladder cancer?

A

>45yrs + unexplained or persistent haematuria where UTI has been accounted for

>=60yrs + non-visible haematuria + dysuria/raised WCC

.’. urgent haematuria criteria

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26
Q

How do you treat bladder cancer that is

Non-muscle invasive

Muscle invasive

Locally advanced/metastatic

A

non-muscle: radical cystectomy + adjuvant chemo

muscle invasive: As above + urinary diversion

Locally advanced/metastatic: Chemotherapy

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27
Q

What is the prognosis of bladder cancer?

A

Good if superficial but recurrs

Declines to 15% if metastatic

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28
Q

A non-tender, hard, irregular and non-transilluminable lump in a young white guy with HIV suggests?

A

Testicular cancer

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29
Q

Who gets referred for testicular cancer?

A

Man with non-painful change in shape of testis

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30
Q

What is the first line and GS investigation for testicular cancer?

A

1st: Scrotal USS

+ CT staging and tumour markers

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31
Q

What are the tumour markers for testicular cancer?

A

B-HCG for both

AFP if non-seminomatous

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32
Q

What is the management of testicular cancer?

A

Orchidectomy

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33
Q

Elderly man with increased urgency and reduced flow on urination suggests what condition?

A

Benign prostatic hypertrophy

34
Q

What are the investigations for BPH

A

PR exam

Dipstick urine

freq-volume chart 3 days

PSA if IPSS >=8

35
Q

In BPH, what are the management options if

moderate symptoms

prostatatic enlargement

mixed storage + obstructive symptoms

A

Tamsulosin

Finasteride

Anti-muscarinics (tolteridone/darifenacin)

36
Q

Elderly female with high BMI and parity has increased urinary frequency raises suspicion of?

A

Urinary incontience

37
Q

How can you differ between the following types of incontinence?

Urge

Stress

Overflow

A

Stress worse on sneezing or coughing

Overflow: Dribbling due to obstruction

Urge: Increased need to urinate due to overactive bladder

38
Q

What investigations should you perform for suspected incontinence?

A

Vaginal exam for prolapse and tone

Urine dipstick and culture

Bladder diary for 3 days

39
Q

What is the treatment route for someone with incontience with increased urgency?

A

Bladder retraining for 6 weeks

Medical

1st: Anti-muscarinics (no oxybutinin for frail women)
2: Mirabegnon

40
Q

How do you treat incontience that is worse on stressing?

A

Pelvic floor muscle retraining 3 months

Mid-urethral tape for surgery

Duloxetine if surgery declined

41
Q

Old man with Parkinson’s and BPH becomes confused following UTI and has reduced urinary output, what is the suspected diagnosis?

A

Acute urinary retention

42
Q

What is the investigation and management of acute urinary retention?

A

Urinalysis and culture for infection

U+Es for AKI

Admit if first presentation

Catheterise + alpha blockers 2-3 days

43
Q

Severe loin to groin pain associated with haematuria, nausea and vomiting in a middle aged man suggests what diagnosis?

A

Renal colic/stones

44
Q

What investigations should be performed for renal stones

A

Check routine bloods including eGFR

Non-Contrast CT-KUB

45
Q

What is the management for renal stones where

<5mm

5-9mm

10-19mm

>=20mm

A

Watch and wait

Shock wave lithotripsy (US waves)

Urethroscopy (scope up the tract)

Percutaneous nephrolithotomy (direct removal from kidney)

46
Q

What renal stone is most associated with the follwing

Most common

Gout

Proteus UTI

Recurrent stones and UTIs

A

Calcium

Uric acid

Struvite

Cysteine

47
Q

How can you prevent recurrence of the following stones?

Calcium

Oxalate

Uric acid

A

High fluid, low animal protein diet

Cholestyramine

Allopurinol

48
Q

What is the most common type of bladder cancer?

A

Transitional cell

49
Q

What renal imaging is most useful for…

The renal cortex

glomerular filtration

imaging kidneys in renal impairment

Bladder reflux

Evaluate lesions when staging malignancy

A

DMSA scintigraphy

DTPA

MAG3 urography

MCUG scan

PET/CT

50
Q

When prescribing treatment GnRH agonists for prostate cancer, what do you need to co-prescribe and why?

A

Anti-androgens (cyoproterone acetate)

Prevents flaring of symptoms when starting treatment

51
Q

What is the most common cause of peritonitis in peritoneal dialysis?

A

S. epidermidis

52
Q

How do you treat rhabdomyolysis?

A

IV fluids

+ urinary alkalinisation

53
Q

What is a common complication of prostate cancer?

A

Erectile dysfunction

54
Q

What can throw off an eGFR?

A

Motherhood

Muscles

Meat (red, consumed 12hrs before)

55
Q

What quotas are needed for maintenance fluid for…

Water

glucose

Na+, K+, Cl-

A

25-30ml/kg/day

50-100g/day (WEIGHT IRRELEVANT)

1mmol/kg/day

56
Q

Who should Hartmann’s solution be avoided in?

A

Hyperkalaemics

57
Q

What blood results do you see in HUS/

A

Reduced Hb, thrombocytes

Fragmented blood film

58
Q

If a patient has gynaecomastia on spironolactone, what do you switch them to?

A

Eplernone

59
Q

What investigations and treatment is done in priapism?

A

Cavernosal blood gas analysis or doppler US

1st line: Aspirate + saline flush

60
Q

What is the US diagnostic criteria for polycystic kidney disease?

A

If + ve family history…

2 cysts, either side, <30yrs

2 cysts, bilateral 30-59

four cysts, bilateral, >60yrs

61
Q

How can you differentiate between AKI and dehydration on U+Es

A

Dehydration: urea increase > creat increase proportionally

62
Q

How is LUTS…

Investigated

Treated

A

Urinary freq-vol chart

International prostate symptom score >=8

If voiding prevalent: a-blocker

Prostatic enlargement: 5-a reductase (finasteride)

Mixed: Combo therapy

63
Q

How is hydronephrosis…

Identified

Managed

A

1st line: US

if colic suspected: CT scan

Rx

relieve blockage…

Acute upper tract: Nephrostomy

Chronic upper: stent

64
Q

High PLASMA osmolality and low URINE osmolality indicates what?

How do you…

Differentiate this from primary polydipsia

Differentiate the subtypes?

A

Diabetes insipidus

Urine osmolarity high after deprivation, DI low

Cranial: Desmopressin (ACTH) causes increased osmolarity

Nephrogenic: Desmopression does not change

65
Q

For hypokalaemia, what are the…

Investigations

Treatment

A

If found, ECG for T wave flattening, U waves and ST segment changes

Mild-mod (>2.5): Oral potassium

Severe (<=2.5): IV replacement <10mmol/hr

66
Q

How can you differentiate full torsion vs appendage only?

A

cremasteric reflex absent in true torsion

67
Q

How does the size of the kidney change if the patient has

CKD

Diabetic

A

CKD: Smaller

Diabetic: Larger

68
Q

How can dehydration be spotted as a cause of AKI?

A

Proportional raise in urea greater than that of creatinine

69
Q

How do you treat hydronephrosis if the blockage is due to…

Urinary retention

Neprho-ureteric blockage

A

Urethral catheter

Nephrostomy

70
Q

When do you dialyse an AKI patient?

A

If they are not responding to treatment…

Hyperkalaemia

Pulmonary oedema

Acidosis

Uraemia

71
Q

How does the following direct the cause of hypertension and headache…

low renin, high aldosterone

high renin, high aldosterone

A

Helps differentiate where excess aldosterone is coming from

Renin low: Primary (as renin not stimulating release) eg adenomas

Renin high: Secondary (as renin stimulating increased release) eg renal artery blockages cause hypoperfusion causing more renin to bring BP back up

72
Q

How can you prevent renal stones in a hypercalcaemic patient?

A
73
Q

What is the most common cause of death in dialysis patients?

A

IHD

74
Q

For prostatitis…

What is the most common organism

What antibiotic do you give

A

E.Coli

14 days quinilone

75
Q

How do you determine if a renal transplant patient is experiencing

Hyperacute rejection

Acute graft failure

Chronic graft failure

A

Hyperacute: Within hours

Acute: <6 months, rising creat + pyuria + proteinuria

Chronic: >6 months, recurrence of original disease

76
Q

Which renal condition causes ‘allergic’ picture, impaired renal function following drug therapy (particularly antibiotics)

A

Acute interstitial nephritis

77
Q

How can you roughly estimate paeds maintenance fluids if small losses are not important?

A

1st 10kg: 100ml/kg

2nd 10kg: 50ml/kg

Subsequent: 20ml/kg

78
Q

How long does it take for an AV fistula to work?

A

6-8 weeks

79
Q

Painless haematuria, flank pain and mass in a child suggests what?

A

Wilms tumour

80
Q

What cause of AKI has incresed urine sodium?

A

Acute tubular necrosis

Necrosis of tubules causes leakage

81
Q
A

Fire Through Finals (32 decks)

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