Renal/ Urology Flashcards
What organism is the most common cause of peritonitis secondary to peritoneal dialysis?
Staphylococcus epidermidis
What is the most common cause of death in dialysis patients?
Ischaemic heart disease
What size will the kidneys be (enlarged or small) in diabetic nephropathy versus CKD?
Diabetic nephropathy - normal or enlarged kidneys
CKD - small kidneys
What test is used to confirm the causative organism is post streptococcal glomerulonephritis?
Anti-Streptolysin O titre
How is anion gap calculated?
(sodium + potassium) - (bicarbonate + chloride)
Normal is 8-14mmol
What causes a normal anion gap metabolic acidosis?
gastrointestinal bicarbonate loss: diarrhoea, fistula, renal tubular acidosis
drugs: e.g. acetazolamide
ammonium chloride injection
Addison’s disease
What causes a raised anion gap metabolic acidosis?
lactate
ketones
urate: renal failure
acid poisoning: salicylates, methanol
5-oxoproline: chronic paracetamol use
What is the daily glucose requirement?
50-100g/day
What is the most common cause of nephrotic syndrome in children/ young adults? How is it treated?
Minimal change disease - treated with steroids
Doesn’t develop into esrf
What is the inheritance pattern in polycystic kidney disease?
Autosomal dominant
When dosed IgA nephropathy vs post steptococcal glomerulonephritis present?
IgA nephropathy - days
Post streptococcal glomerulonephritis - 1-2 weeks
Other than raised CK what other biochemical abnormality do you see in rhabdomyolysis?
Hypocalcaemia
Patients with rhabdomyolysis should have a bone profile taken to measure calcium and phosphate. Calcium typically binds to myoglobin released from damaged muscle tissue causing serum hypocalcaemia.
MUDPILES = the causes of raised anion gap metabolic acidosis. What is included in it?
M- Methanol
U - Uraemia (renal failure)
D - DKA
P - Propylene glycol
I - Infection
L - Lactic acidosis
E - Ethylene glycol
S - Salicytlates
How does acute interstitial nephritis present?
Fever, rash, arthralgia
Raised eosinophils
Raised urinary white cells
Which conditions can cause rapidly progressive glomerulonephritis?
Goodpasture’s, vasculitis, SLE
What type of glomerulonephritis is HIV associated with?
Focal segmental glomerulonephritis
How does polycystic kidney disease present?
Progressive renal impairment
Cyst haemorrhage/ infection
Hypertension, LVH
Increased malignancy risk
Berry aneurysms > subarachnoid haemorrhage
How is polycystic kidney disease treated?
Hypertension control
Tolvaptan to reduce cyst volume and progression
What are some of the potential causes of pre renal AKI?
Hypotension
Hypoperfusion > NSAIDs, ACE.I
Acute tubular necrosis
What are some of the causes of renal AKI?
Vasculitis
Glomerulonephritis
Drugs eg gent
What are some of the causes of post renal AKI?
Obstruction - stones, cancer, strictures
What ECGs changes are seen in hyperkalaemia?
Tall T waves
Small P waves
Wide QRS > VF
What ECG changes are seen in hypokalaemia?
Small / inverted T waves
Long PR
ST depression
How would you investigate proteinuria?
Exclude UTI and repeat
Check for haematuria and albumin: creatinine ratio
Check BP
Check U&Es
How does haenolytic uraemic syndrome present?
Childen
AKI
Follows gastroenteritis
E.Coli
Bloody diarrhoea
Proteinuria/ haematuria
Anaemia, thrombocytopenia, purpura
Admit for specialist reveiw
What causes renal artery stenosis and how does it present?
Causes - atheroma or firbomucular hyperplasia in the younger patient
High BP
Bruit
Reduced kindney function, proteinuria
Which type of renal stones are associated with proteus UTI?
Staghorn calculi
How would you investigate haematuria?
Renal function, ACR
PSA/ DRE - men
Pelvic US - if older female, other gynae sx
Renal US if visible haematuria or persistent
What are the most common causes of bladder ca?
Transitional cell carcinoma in the UK
Squamous cell carcinoma worldwide
What general advice can you give to try and prevent recurrent cystitis?
What other preventative measures are there?
Frequent urination (note in urge invontinence advice is the opposite - try to resistance urge for longer periods)
Increase fluids
Double void (go again after 5-10 mins)
Void after intercourse
Prophylactic abx
Men with BPH > finasteride, doxazosin
Women - topical oestrogen
How does interstitial cystitis present?
Frequency, urgency, pelvic/ suprapubic pain
MSU: no organism
Antispasmodics, amitriptyline and bladder surgery can help
What drugs can exacerbate/ cause incontinence?
Diuretics
A- blockers
Anticholinergics
What are the medication options for urge incontinence?
Oxybutynin
Solifenacin
Tolterodine
Duloxetine
What is retroperitoneal fibrosis/ how does it present?
Ureters become embedded in fibrous plaques in the retroperitoneal space
Associated with some longterm conditions
Fever, leg oedema, hypertension ,palpable mass, renal failure
Mx options: steroids, nephrostomy
Which medciations are used for BPH/ what drug classes are they?
Tamsulosin - alpha blockers
Finasteride - 5a reductase inhibitors
Tx for prostatitis?
Ciprofloxacin 4 weeks
What medications are used to treat prostate cancer?
Goserelin sc every 4-12 weeks (LHRH analogue)
Cyproterone acetate, flutamide, bicaluatmide (anti-androgens) - used to prevent side effects with LHRH analogues
What is hypospadias?
The urethral meatus opens on the ventral side of the penis
What is peyronie’s disease/ how does it present/ how is it managed?
Hard lumps in the shaft of the penis
Can cause pain when erect
No tx routinely but can refer to urology for consideration of surgical management
How is balanitis (inflammation of the glans/ foreskin) managed?
Oral abx (eg fluclox), topical antifungals eg clotrimazole
What is erythroplasia of queyrat?
premalignant condition of the glans > needs referral to urology for surgical management
How does testicular torsion present?
Severe scrotal pain, RIF pain, Hard high riding testicle
How does epididymo-orchitis present an how is it managed?
Acute testicular pain, swelling and tenderness, fevers, can be urinary symptoms
abx/ but if in doubt admit to urology
What is a hydrocele and how is it managed?
Collection of fluid in the tunica vaginalis
Presents with swelling in the scrotum - testis is within the swelling and not palpable separately. Should be able to get above the swelling.
Refer adults for US if can’t palpate the testicle
Some need referral to urology
Haematoceoeles are blood filled - need urgent referral (due to direct trauma)
What is a varicocele and how is it managed?
Collection of varicose veins in the pampniform plexus
Dull ache in the testis
Some managed with reassurance, some need referral for surgery
How do epididymal cysts present and how are they managed?
Middle aged men
Painless lump, often bilateral
US if unsure
Reassure/ referral to urology if painful
Note spermatocoeles are cysts that contain sperm and present in the same way with the same mx
How are testicular lumps investigated/ managed?
Testicular lumps should be treated as cancer until proven otherwise
US > but don’t delay referral
What is Fournier’s gangrene?
Necrotising fasciitis of the scrotal skin / penis
Mx - surgical debridement and IV abx
