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RENAL & UROLOGY Flashcards

1
Q

most common cause of acute bacterial prostitis

A

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

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2
Q

positive leukocyte esterase
positive nitrites

A

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)

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3
Q

painful urination
frequency
sexually active
positive leukocyte esterase
no CVA tenderness
gram stain no organisms

A

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.

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4
Q

indole positive rod

A

E coli

breaks down tryptophan

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5
Q

catheter associated UTI’s

A

E coli
klebsiella pneumoniae
proteus mirabilis

p. aeurginosa

Escherichia coli
Klebsiella pneumoniae
Proteus mirabilis
Pseudomonas aeruginosa
Enterococcus spp
Candida spp

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6
Q

ectopic pregnancy caused by PID is commonly caued by prior infection of -? (2)

A

n. gonorrhoea
chlamydia trachomatis

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7
Q

how best to treat calcium oxalate stones

A

increase calcium reabsorption
(thiazide diuretics)

hydrochlorothiazide

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8
Q

hypertension
increased renin
increased aldosterone
ms weakness, HA

A

juxtaglomerular cell tumour
(renin-secreting)

secondary hyperaldosteronism

NOTE: renal artery stenosis also fits (if in answer choice) - renovascular disease

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9
Q

renal cell carcinoma (clear cell type) strongly associated with

gene

hematuria, rusty urine, renal mass, smoker

A

deletion chromosome 3p
at VHL gene

overexpression angiogenic growth factors

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10
Q

clue cells are seen in

what is seen on gram stain of organism

A

gardnerella vaginalis
(anaerobic gram variable rod)

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11
Q

list 2 common paraneoplastic conditions assoc with RCC

A

erythrocytosis (increased EPO)
hypercalcaemia (increased PTHrP)

RCC can produce EPO

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12
Q

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

A

kidney
(RCC)

metastasis to lung (cannonball)

also bone - osteolytic

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13
Q

what is diagnostic of pyelonephritis

A

white cell casts
(only formed in renal tubules)

upper and lower UTIs (i.e. pyelonephritis, cystitis) can show: bacteruria, microscopic haematuria, pyuria

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14
Q

urinary outflow obstruction will cause increased

A

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)

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15
Q

inulin is …
and represents …

A

freely filtered only
GFR

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16
Q

PAH is …
and represents …

A

freely filtered & secreted
(fully excreted)
RPF

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17
Q

creatinine is used to measure …

A

GFR
(in place of inulin)

there is some secretion with creatinine so it can overestimate GFR

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18
Q

clearance equation

A

Ux V
Px

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19
Q

accumulation cystine in tissues
crystal formation & deposition
PCT dysfunction - impaired reabsorption (renal Fanconi)
NAGMA, RTA2
hypophasphatemic rickets (bow leg)

A

cystinosis

rare lysosomal storage disorder

20
Q

mutations in ___ (PKD1, PKD2) results in ADPKD

A

polycystin

21
Q

flank pain
haematuria
HTN
aneurysmal vascular disease

A

ADPKD

berry aneurysms, mitral valve prolapse, hepatic cysts

22
Q

congenital urinary tract abnormalities are complicated by (2)

A

ureteral obstruction
vesicoureteral reflux

chronic reflux –> hydronephrosis (dilation renal pelvis) –> compression atrophy renal parencyma –> renal insufficiency

23
Q

seen in

A

hydronephrosis

renal pelvis dilation

24
Q

recent URTI
HTN
haematuria
erythrocyte casts
proteinuria

A

IgA nephritis

GIT infection can occur (mucosal)

IgA depositis renal mesangium

25
Africa, Middle East SCC bladder
**schistosoma haematobium** (trematode) | smoking also a risk of bladder SCC ## Footnote but if in endemic area - **trematode** m/c
26
painless haematuria occasional dysuria urinary frequency fatigue, weightloss, anorexia
bladder cancer | cytoscopy for Dx ## Footnote **schistosoma haematobium - SCC m/c smoking - transitional cell carcinoma m/c**
27
m/c bladder cancer assoc with smoking
transitional cell carcinoma (m/c) | SCC can also occur (trematode m/c if in endemic area)
28
common causes of **transitional** cell carcinoma (4)
phenacetin smoking analine dyes **cyclophosphamide** ## Footnote *Phenacetin*: think P for **Papillary** necrosis and **Pee** (bladder cancer) G6**P**D deficiency - haemolysis
29
central diabetes insipidus impairs H2O reabsorption from
collecting duct (& DCT) | lack of ADH
30
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 ## Footnote PTHrp EPO requently metastasise to brain / lung
31
adenocarcinoma of tubular epithelial cells
renal cell carcinoma | clear polygonal cells lipid and carbohydrate acucmulation
32
common sites of RCC metastasis
brain lung ## Footnote **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).
33
EMA+ and CEA+ can be seen in
RCC ## Footnote 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).
34
haematuria RBC casts variable proteinuria nephritic occur 2-4 weeks after acute strep pyogenes infection low serum C3
proliferative glomerulonephrtis (PSGN) | strep pyogenes - pharyngitis ## Footnote deposition C3, IgG antistreptolysin O anti DNAse titers glomeruli enlarged & hyperceullar (prolif glom)
35
diarrhoea causes metabolic _\_\_ by loss of _\_\_
acidosis HCO3- ## Footnote HCO₃⁻ loss lowers blood pH → **non-anion **gap metabolic acidosis to maintain electroneutrality chloride (Cl⁻) increases (hyperchloremic acidosis)
36
vomiting causes metabolic _\_\_ by loss of _\_\_
alkalosis HCl-
37
serum levels seen following diarrhoea: K+ HCO3- pH PCO2
K+ = decreased HCO3- = decreased pH = decreased PCO2 = decreased ## Footnote 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)
38
new medication fever erythematous rash peripheral eosinophilia AKI (high BUN Cr) mild pyuria haematuria biopsy: periglomerular & peritubular lymphocytic/histiocytic infiltrate | diagnosis
**immune reaction** (hypersensitivity reaction) | **drugs** or **autoimmune** (sjogrens, SLE) can cause immune Rx ## Footnote biopsy: show interstitial infiltrate - T cells, monocytes, eosinophis, plasma cells inflamamtory cells cause tubulitis --> AKI electrolyte & volume derrangements **AIN common with:** NSAIDS, diuretics, sulfonamides, autoimmune classic triad: fever, eosinophils, erythematous rash (10% AIN)
39
another name for uromodulin associated with nephronophthisis, medullary cystic kidney disease, familial juvenille hyperuricemic nephropathy, multiple myeloma, chronci kidney disease, acute tubular necrosis
Tamm-Horsfall protein | not associ AIN
40
nasal congestion, cough, SOB asthma, allergic rhinitis erythematous nasal mucosa bilateral crackles lung bases, peripheral infiltrates, pleural effusion peripheral eosinophilia biopsy: necrotising vasculitis, granulomas, eosinophilic noecrosis | diagnosis
**Churg-Strauss** **eosinophilic** granulomatosis with polyangitis ## Footnote **s/s:** mall vessel vasculitis eosinophilic necrosis + granulomas + necrotising vasculitis asthma ear/nasal/sinus inflammation peripheral neuropathy ANCA+ **can involve:** arthraliga, skin lesion (nodules, maculopapular rash), cardiomyopathy, lung, kidney, GIT +/- nephritic syndrome (complication) Tx: **cyclophosphamide** - steroids, immunomodulators ***don't confuse with Wegners*** *granulomatosis with polyangitis* *small vessel necrotising vasculitis sinopulmonary kidney epistaxis, haemoptysis haematuria nephritic (complication)*
41
nasal crusting dry cough palpable purpura ANCA+ haeamturia, proteinuria segmental necrotising glomerulonephritis cresent formation
**Wegners** granulomatosis (granulomatosis with polyangitis) | no eosinophilia ## Footnote small vessel necrotising vasculitis sinopulmonary i.e. dry cough kidney ie.e. nephritis epistaxis, haemoptysis haematuria nephritic (complication) biopsy: granulomatosis with polyangitis
42
is the cause of this urothelial carcinoma
cigrette smoking | men, smoke - higher risk ## Footnote haemturia urinary tract obstruction hydronephrosis pelvic dilation compressive atrophy renal cortical parenchyma can be asymptomatic years
43
what is urothelial epithelium
lines urinary tract
44
acute allograft rejection will be mediated by _\_\_ which are recognised by _\_\_ on surface of _\_\_ cells
CD8+ T lymphocytes MHCI donor | see **inflammatory infiltrate of small arterioles** rise in creatinine ## Footnote <6mo CD8+ usually fast than CD4+ - i.e. chronic allograft dysfunction
45
acute allograft rejection will be mediated by ___ which are recognised by ___ on surface of ___ cells
CD4+ T lymphocytes MHCII donor | see vascular arteriosclerosis, sm ms proliferation, parnechymal fibrosis ## Footnote & atrophy see **cytokine production, humoral and cellular hypersensitivty Rx (II, IV)** mo-yrs

BSIC (27 decks)

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