RENAL & UROLOGY Flashcards
most common cause of acute bacterial prostitis
E coli
(adhesions on fibrae can adhere to mucosal / urothelial cells)
think **gram negative **
m/c caused by urine reflux (UTI source)
other causes:
Proteus
Klebsiella
Pneudomonas
positive leukocyte esterase
positive nitrites
UTI
Leukocyte esterase = infection
Nitrites = gram (-) bacteria
bacteria convert urinary nitrates to nitrites
via the nitrate reductase
staph saprophyticus does not produce nitrites (gram (+) coccus)
painful urination
frequency
sexually active
positive leukocyte esterase
no CVA tenderness
gram stain no organisms
chlamydia trachomatis
no muramic acid in cell wall (decreased staining ability)
No CVA tenderness → less likely to be pyelonephritis
Neisseria gonorrhoeae would show gram-negative diplococci on stain.
indole positive rod
E coli
breaks down tryptophan
catheter associated UTI’s
E coli
klebsiella pneumoniae
proteus mirabilis
p. aeurginosa
Escherichia coli
Klebsiella pneumoniae
Proteus mirabilis
Pseudomonas aeruginosa
Enterococcus spp
Candida spp
ectopic pregnancy caused by PID is commonly caued by prior infection of -? (2)
n. gonorrhoea
chlamydia trachomatis
how best to treat calcium oxalate stones
increase calcium reabsorption
(thiazide diuretics)
hydrochlorothiazide
hypertension
increased renin
increased aldosterone
ms weakness, HA
juxtaglomerular cell tumour
(renin-secreting)
secondary hyperaldosteronism
NOTE: renal artery stenosis also fits (if in answer choice) - renovascular disease
renal cell carcinoma (clear cell type) strongly associated with
gene
hematuria, rusty urine, renal mass, smoker
deletion chromosome 3p
at VHL gene
overexpression angiogenic growth factors
clue cells are seen in
what is seen on gram stain of organism
gardnerella vaginalis
(anaerobic gram variable rod)
list 2 common paraneoplastic conditions assoc with RCC
erythrocytosis (increased EPO)
hypercalcaemia (increased PTHrP)
RCC can produce EPO
fever
loss of appetite
chest pain on deep breath
smoker
haematocrit increased (i.e. 56%)
multiple round lesions both lungs
biopsy:
metastatic disease originates from where
kidney
(RCC)
metastasis to lung (cannonball)
also bone - osteolytic
what is diagnostic of pyelonephritis
white cell casts
(only formed in renal tubules)
upper and lower UTIs (i.e. pyelonephritis, cystitis) can show: bacteruria, microscopic haematuria, pyuria
urinary outflow obstruction will cause increased
tubular hydrostatic pressure
(backwards flow of urine)
in Bowman space (HSP) = HSP > BS favours filtration
in glomerular capillaries = favours absorption (as proteins can’t cross, and oncotic pressure low in BS)
inulin is …
and represents …
freely filtered only
GFR
PAH is …
and represents …
freely filtered & secreted
(fully excreted)
RPF
creatinine is used to measure …
GFR
(in place of inulin)
there is some secretion with creatinine so it can overestimate GFR
clearance equation
Ux V
Px
accumulation cystine in tissues
crystal formation & deposition
PCT dysfunction - impaired reabsorption (renal Fanconi)
NAGMA, RTA2
hypophasphatemic rickets (bow leg)
cystinosis
rare lysosomal storage disorder
mutations in ___ (PKD1, PKD2) results in ADPKD
polycystin
flank pain
haematuria
HTN
aneurysmal vascular disease
ADPKD
berry aneurysms, mitral valve prolapse, hepatic cysts
congenital urinary tract abnormalities are complicated by (2)
ureteral obstruction
vesicoureteral reflux
chronic reflux –> hydronephrosis (dilation renal pelvis) –> compression atrophy renal parencyma –> renal insufficiency
seen in
hydronephrosis
renal pelvis dilation
recent URTI
HTN
haematuria
erythrocyte casts
proteinuria
IgA nephritis
GIT infection can occur (mucosal)
IgA depositis renal mesangium
Africa, Middle East
SCC bladder
schistosoma haematobium
(trematode)
smoking also a risk of bladder SCC
but if in endemic area - trematode m/c
painless haematuria
occasional dysuria
urinary frequency
fatigue, weightloss, anorexia
bladder cancer
cytoscopy for Dx
schistosoma haematobium - SCC m/c
smoking - transitional cell carcinoma m/c
m/c bladder cancer assoc with smoking
transitional cell carcinoma (m/c)
SCC can also occur (trematode m/c if in endemic area)
common causes of transitional cell carcinoma (4)
phenacetin
smoking
analine dyes
cyclophosphamide
Phenacetin: think P for Papillary necrosis and Pee (bladder cancer)
G6PD deficiency - haemolysis
central diabetes insipidus impairs H2O reabsorption from
collecting duct
(& DCT)
lack of ADH
male smoker
microscopic haematuria
flank pain, weight loss, fever
polycythemia
hypercalcemia
polygonal clear cells
renal cell carcinoma
(adenocarcinoma of tubular epithelial cells)
accumulation lipd & carbohydrate
paraneoplastic syndromes
PTHrp
EPO
requently metastasise to brain / lung
adenocarcinoma of tubular epithelial cells
renal cell carcinoma
clear polygonal cells
lipid and carbohydrate acucmulation
common sites of RCC metastasis
brain
lung
EMA: Positive in epithelial-origin tumors, such as renal cell carcinoma (RCC).
CEA: Negative in RCC (but often positive in colorectal and some lung cancers).
EMA+ and CEA+ can be seen in
RCC
EMA: Positive in epithelial-origin tumors, such as renal cell carcinoma (RCC).
CEA: Negative in RCC (but often positive in colorectal and some lung cancers).
haematuria
RBC casts
variable proteinuria
nephritic
occur 2-4 weeks after acute strep pyogenes infection
low serum C3
proliferative glomerulonephrtis
(PSGN)
strep pyogenes - pharyngitis
deposition C3, IgG
antistreptolysin O
anti DNAse titers
glomeruli enlarged & hyperceullar (prolif glom)
diarrhoea causes metabolic ___ by loss of ___
acidosis
HCO3-
HCO₃⁻ loss lowers blood pH → **non-anion **gap metabolic acidosis
to maintain electroneutrality chloride (Cl⁻) increases
(hyperchloremic acidosis)
vomiting causes metabolic ___ by loss of ___
alkalosis
HCl-
serum levels seen following diarrhoea:
K+
HCO3-
pH
PCO2
K+ = decreased
HCO3- = decreased
pH = decreased
PCO2 = decreased
k+ loss (renal K+ wasting from volume depletion)
Hco3 direct loss in stool
pH decreased - nonanion gap metabolic acidosis
PCO2 respiratory compensation - blow off acid
non-AG: ph <7.35 + decreaseed hco3, decreased co2
(HCO3 lost, CL compensates - NAGMA)
