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Finals > Renal/urology > Flashcards

Renal/urology Flashcards

1
Q

What is the definition of AKI?

A

Rise in creatinine of >25 micromol/l in 48 hours

Rise in creatinine of more than 50% in 7 days

Urine output of <0.5ml/kg/hour

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2
Q

Name some risk factors for AKI

A

Older age, sepsis, CKD, heart failure, diabetes, liver disease, medications

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3
Q

Name some common medications that can increase the risk of AKI

A

NSAIDs, gentamicin, diuretics, ACE inhibitors, contrast agents

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4
Q

Name some pre-renal causes of AKI

A

Dehydration, shock, heart failure, sepsis

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5
Q

Name some renal causes of AKI

A

Acute tubular necrosis, glomerulonephritis, acute interstitial nephritis, haemolytic uraemic syndrome, rhabdomyolysis

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6
Q

Name some post renal causes of AKI

A

Kidney stones, tumours, BPH, neurogenic bladder, strictures in urethra etc.

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7
Q

What is acute tubular necrosis?

A

Damage and death of the epithelial cells in the renal tubules due to ischaemia/hypoperfusion/nephrotoxins

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8
Q

What is seen in urinalysis of someone with acute tubular necrosis?

A

Muddy brown casts on urinalysis

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9
Q

How can you prevent AKI?

A

Avoid nephrotoxic drugs where appropriate, ensure adequate fluid intake, additional fluids before contrast

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10
Q

How do you manage AKI?

A

Reverse the underlying cause, IV fluids, withhold medication that may worsen condition, dialysis may be required in severe cases

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11
Q

What is CKD?

A

Progressive and permanent decrease in kidney function

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12
Q

What are the causes of CKD?

A

Diabetes, hypertension, age related decline, glomerulonephritis, polycystic kidneys, medications, renal artery stenosis

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13
Q

What are the symptoms associated with high urea/poor kidney function

A

Itching, loss of appetite, nausea, oedema, muscle cramps, peripheral neuropathy, pallor, hypertension

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14
Q

How do you confirm the diagnosis of CKD?

A

eGFR - two tests are required 3 months apart to confirm diagnosis

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15
Q

What are the stages and associated eGFRs?

A

Stage 1 = eGFR >90
Stage 2 = eGFR 60-89
Stage 3a = eGFR 45-59
Stage 3b = eGFR 30-44
Stage 4 = eGFR 15-29
Stage 5 = eGFR <15 (end stage)

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16
Q

How do you treat hypertension in those with CKD?

A

ACE inhibitors are 1st line

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17
Q

What is a significant result in urine albumin:creatinine?

A

> 3mg/mmol

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18
Q

What supportive management can be offered to those with CKD?

A

Optimise hypertensive/diabetic control, dietary advice regarding water and electrolyte intake, iron supplementation and EPO to treat anaemia

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19
Q

Why is CKD associated with anaemia?

A

Healthy kidneys produce EPO which stimulate production of RBC, in CKD this process does not occur as well –> anaemia

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20
Q

Why with CKD associated with bone disease?

A

High serum phosphate occurs due to reduced phosphate excretion

There is low vitamin D as the kidneys are essential in metabolising vitamin D

Active vitamin D is essential in calcium absorption from intestines and kidneys

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21
Q

How do you treat renal related bone disease?

A

Active vitamin D
Low phosphate diet
Bisphosphonates for osteoporosis

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22
Q

What is the preferred method for delivering long term dialysis?

A

Haemodialysis via AV fistula

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23
Q

What are the symptoms of nephritic syndrome?

A

Haematuria, oliguria, proteinuria (<3g), fluid retention

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24
Q

Why does nephrotic syndrome occur?

A

The basement membrane in the glomerulus becomes highly permeable resulting in significant proteinuria

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25
Q

What are the symptoms of nephrotic syndrome?

A

Proteinuria, low serum albumin, peripheral oedema, high cholesterol, frothy urine

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26
Q

What is the most common cause of nephrotic syndrome in children and adults?

A

Children = minimal change disease

Adults = membranous nephropathy

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27
Q

What is IgA nephropathy?

A

Nephritic syndrome that can occur 1-2 days after URTI

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28
Q

What is post-strep glomerulonephritis?

A

Nephritic syndrome that occurs 1-3 weeks following a strep infection

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29
Q

What is the pathology of anti-GBM?

A

Anti-GBM antibodies attack the glomerulus and pulmonary basement membranes causing pulmonary haemorrhage and glomerulonephritis

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30
Q

What systemic disease can cause glomerulonephritis?

A

HSP, vasculitis, lupus nephritis

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31
Q

What is renal tubular acidosis?

A

Metabolic acidosis due to imbalance of the hydrogen and bicarbonate ions

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32
Q

What is the pathology of type 4 renal tubular acidosis (most common)?

A

Caused by reduced aldosterone which leads to insufficient potassium and hydrogen ion excretion in the distal tubules (diabetes is most common cause)

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33
Q

What is the pathology of HUS?

A

Thrombosis in small vessels throughout the body triggered by shiga toxins for shigella or E.coli 0157

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34
Q

What is the triad of findings in HUS?

And what symptoms does that cause?

A

Haemolytic anaemia, AKI, thrombocytopenia

–>

Fever, abdo pain, lethargy, pallor, reduced urine output, haematuria, hypertension, bruising, jaundice, confusion

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35
Q

What is the management for HUS?

A

Supportive care - IV fluids, treat hypertension, blood transfusions, haemodialysis

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36
Q

What is released in rhabdomyolysis?

A

Myoglobin, potassium, phosphate and CK

CK >10000

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37
Q

What are the causes of rhabdomyolysis?

A

Prolonged immobility, extremely vigorous exercise, crush injuries, seizures, statins

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38
Q

What are the symptoms associated with rhabdomyolysis?

A

Muscle pain, muscle weakness, reduced urine output, red brown urine, fatigue, confusion

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39
Q

What is the management of rhabdomyolysis?

A

IV fluids, treat any hyperkalaemia

40
Q

What extra-renal manifestations are associated with PKD?

A

Cerebral aneurysms, cysts on liver/spleen/pancreas/ovaries, mitral regurg, colonic diverticula

41
Q

Which type of PKD is worse?

A

Autosomal recessive is more severe and often leads to renal failure before adulthood

42
Q

What treatment is done for people with PKD?

A

Antihypertensives, analgesia, antibiotics, drainage of cysts, dialysis, renal transplant, screen for complications

43
Q

What symptoms are associated with BPH?

A

Hesitancy, weak flow, urgency, frequency, intermittency, straining, terminal dribbling, incomplete emptying, nocturia

44
Q

What is done to assess someone with/for BPH?

A

International prostate scoring system, DRE (large but smooth with intact central sulcus), urinary frequency volume chart, urine dip, bloods including PSA

45
Q

What lifestyle advice can be given to someone with BPH?

A

Reduce caffeine/alcohol, avoid large fluid intakes in evening, avoid constipation, bladder retraining

46
Q

What medications can be given to men with BPH?

A

Alpha blockers - tamsulosin (fast acting)
5-alpha reductase inhibitors - finasteride (can take up to 6 months)

47
Q

What surgical options are available for men with BPH?

A

TURP is main one and most common

48
Q

Which zone of the prostate are the majority of prostate cancers found?

A

Peripheral zone

49
Q

What would a prostate feel like in someone with prostate cancer?

A

May feel firm, hard, asymmetrical, craggy, loss of central sulcus

50
Q

What are the 1st line and definitive investigations for prostate cancer?

A

1st line = mutliparametric MRI
Definitive = prostate biopsy

51
Q

Where does prostate cancer spread to?

A

Lymph nodes, bones, lungs, liver

52
Q

What options are there for managing prostate cancer?

A

Active surveillance, watchful waiting, radiotherapy, brachytherapy, hormone therapy (used in non-local disease), surgery

53
Q

What are the two types of testicular cancer?

A

Seminomas
Non-seminomas (usually teratomas)

54
Q

What are the risk factors for testicular cancer?

A

Undescended testes
Male infertility
Family history
Low birth weight
Infantile hernia
Kleinfelter’s syndrome

55
Q

What are the features of testicular cancer lumps?

A

Painless, arising from testicle, hard, irregular, no transillumination

56
Q

What tumour markers are used for testicular cancer?

A

Alpha fetoprotein
Beta-hCG
LDH - non-specific

57
Q

What is the management for testicular cancer?

A

Surgery to remove testicle, chemotherapy (if advanced or adjuvant to prevent recurrence), radiotherapy

58
Q

What is the most common type of bladder cancer in the UK?

A

Transitional cell carcinomas (95%)
SCC (5%)

59
Q

What are the main risk factors for bladder cancer?

A

Smoking and increased age, aromatic amines found in dye and cigarette smoke

60
Q

What symptoms are associated with bladder cancer?

A

Painless haematuria
>45 with visible haematuria =2ww
>60 with microscopic haematuria plus dysuria or raised WCC =2ww

61
Q

What investigations are used in bladder cancer?

A

Flexible cystoscopy + biopsy and CT urogram

62
Q

What is the management for bladder cancer?

A

TURB, intravesical chemotherapy/BCG, radical cystectomy

Chemo + radiotherapy may be used

63
Q

What is the triad of symptoms associated with RCC?

A

Haematuria, flank/loin pain, palpable mass

64
Q

What risk factors are there for RCC?

A

Smoking, obesity, hypertension, end-stage renal failure, male

65
Q

What is the classical metastasis for RCC?

A

Cannonball mets in the lung (spreads via inferior vena cava)

66
Q

What paraneoplastic features are associated with RCC?

A

Polycythaemia = due to secretion of unregulated EPO

Hypercalcaemia - due to secretion of a hormone that mimics action of PTH

Hypertension - due to increased renin

Stauffer’s syndrome - abnormal LFTs without liver mets

67
Q

What investigations are done in RCC?

A

USS - can differentiate cyst from tumour
CT scan - senstitive for small tumours
Excretion uropathy

68
Q

What is the management of someone with RCC?

A

Surgery - partial or total nephrectomy

Arterial embolisation, ablation, percutaneous cryotherapy

69
Q

Where do renal stones most commonly get stuck?

A

Vesico-ureteric junction

70
Q

What is the most common type of renal stone and what are the other types?

A

Calcium stones (80%)
Uric acid
Struvite (associated with staghorn calculus)
Cystine (associated wtih geentic condition that leads to high cystine levels in urine –> recurrent renal stones)

71
Q

What are the symptoms of renal stones?

A

Renal colic - unilateral loin to groin pain, fluctuates in severity as the stone moves and settles

May also have haematuria, N+V, sepsis

72
Q

What is the first line investigation in someone with renal colic?

A

Non-contrast CT KUB (within 24 hours)

73
Q

What type of analgesia is given in renal colic?

A

IM/PR diclofenac (if renal function allows)

IV paracetamol if not suitable for NSAIDs

74
Q

When are surgical interventions required for renal stones?

A

10mm or larger or do not pass spontaneously or where there is complete obstruction or infection

75
Q

What findings would you see on a urine dipstick that indicate UTI?

A

Nitrites (best indicator), leukocytes, microscopic haematuria

76
Q

What bacteria cause UTIs?

A

E.coli, klebsiella, enterococcus, pseudomonas aeruginosa, staph aureus, candida albicans

77
Q

What antibiotics are used for UTIs?

And what length course is used for different types of people

A

1st line = trimethoprim/nitrofurantoin
2nd line = fosfomycin
Pregnancy = amoxicillin, cefalexin

3 days in simple lower UTIs
5-10 days for immunosuppressed, abnormal anatomy or impaired renal function
7 days for men, pregnant women or catheter related UTI

78
Q

What are the risk factors for pyelonephritis?

A

Female, structural urological abnormalities, vesico-ureteric reflux, diabetes

79
Q

What symptoms are associated with pyelonephritis?

A

Fever, loin/back pain, N+V, haematuria, dysuria, renal angle tenderness

80
Q

What antibiotics are used in pyelonephritis?

A

Cefalexin, co-amox, trimethoprim, ciprofloxacin

81
Q

What are the typical findings on testicular examination in someone with hydrocele?

A

Testicle is palpable within hydrocele
Soft, fluctuant, transilluminated
Irreducible and has no bowel sounds

82
Q

When do hydroceles require surgery/aspiration?

A

If large or symptomatic

In babies need surgery if not corrected by 1-2years of age

83
Q

What are the symptoms and examination findings of someone with varicocele?

A

Symptoms = throbbing/dull pain or discomfort worse on standing, dragging sensation, infertility

Examination = bag of worms, disappears when lying down, asymmetry in testicle size

84
Q

What examination findings are present in those with epididymal cyst?

A

Soft round lump typically at top of testicle, separate from testicle, may transilluminate if large

85
Q

Do epididymal cysts need removing?

A

Usually harmless so no but can be removed if causing pain

86
Q

What are the causes of epididymo-orchitis?

A

E.coli, chlamydia trachomatis, neisseria gonorrhoea, mumps

87
Q

What are the symptoms of epidiymo-orchitis?

A

Gradual onset (hours) of unilateral testicular pain, heavy dragging sensation, swelling of testicle and epididymis, tenderness on palpation

88
Q

What antibiotics are typically used for epidydmo-orchitis?

A

If enteric cause - ofloxacin, levofloxacin, co-amoxiclav
If STI - IM ceftriaxone, doxycyline

89
Q

What are the causes of ED?

A

Spinal cord disease, diabetes, vascular disease, trauma, hypertension, drugs, psychological causes

90
Q

What medications can be used to treat ED?

A

Phosphodiesterase-5-inhibitors = sildenafil

Intracavernosal injections of alprostadil

91
Q

What are the causes of acute urinary retention?

A

BPH, urethral obstruction, medications, UTI, postoperatively

92
Q

What symptoms are common in acute urinary retention?

A

Inability to pass urine, lower abdominal pain, considerable pain or distress, acute confusional state

93
Q

What investigations and management are done in acute urinary retention?

A

Bladder USS
Bloods - U+Es, creatinine, FBC, CRP
Catheterisation

94
Q

What is a complication of treating acute urinary retention?

A

Post-obstructive diuresis - requires IV fluids

95
Q

When is the PSA blood test very useful?

A

In monitoring response to treatment in those with prostate cancer

96
Q

What investigation is required in a child/adult with nephrotic syndrome?

A

Child - none as likely minimal change disease

Adult - renal biopsy to determine cause

97
Q

What is required before contrast in someone with CKD?

A

IV fluids

Finals (21 decks)

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