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CP - JL > Renal & Urology > Flashcards

Renal & Urology Flashcards

1
Q

Acute renal failure presentation

A

rapid rise in creatinine and urea, generally feeling unwe;;

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2
Q

Nephrotic syndrome presentation

A

Oedema, hypoalbunaemia and proteinuria

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3
Q

Acute nephritis presentation

A

oedema, proteinuria, haematuria and acute renal failure

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4
Q

Why can damage to the glomerulus cause tubular damage

A

As blood flows from afferent arteriole –> glomerulus –> efferent arteriole –> tubules

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5
Q

Mechanisms of Damage to the kidney

A

1) Glomerular
2) Tubular
3) Vascular

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6
Q

Damage to glomerulus

A

Immunological vs non-immunological

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7
Q

Tubular damage

A

ischaemic vs toxins

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8
Q

Vascular damage

A

thrombotic microangiopathy vs vasculitis (most common cause of renal disease in adults)

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9
Q

What is thrombotic microangiopathy

A

thrombi in small capillaries/arterioles due to endothelial damage. Damage due to bacterial toxins, drugs or abnormalities of clotting cascade/complement system. Common presenting feature of HUS with E.coli

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10
Q

Nephrotic sydrome is due to damage to what

A

GLomerulus

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11
Q

Complications of nephrotic syndrome

A

thrombosis and infection

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12
Q

Causes of nephrotic syndrome in adults and children

A

1) membranous nephropathy 2) FSGS 3) Minimal change disease 4) Diabetes, lupus nephritis and amyloid

In children 1) minimal change diseases 2) FSGS

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13
Q

Causes of Nephritis in adults

A

Post infective glomerulonephritis –> few weeks post strep throat
IgA Nephropathy –> teenagers and young adults with haematuria
Vasculitis –> fever, generally unwell, rash, myalgia, arthralgia
Lupus –> young women

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14
Q

Causes of nephritis Children

A

1) post infective glomeruloneprhtis
2) IgA Nephropathy
3) Henoch-Schonelein Purpura –> IgA specific antibody –> typically young boys with arthralgia, abdominal pain, rash, haematuria
4) HUS –> E.COli cause get acte nephritis, homeless and trhombocytopenia

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15
Q

Acute renal failure presentation

A

anuria/oliguria and high creatinine and urea

Think causes of pre-renal, renal and post-renal

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16
Q

Main causes of acute renal failure in adults

A

Vasculitis and intersitial nephritis (often due to drug reactions)

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17
Q

Main causes of acute renal failure in children

A

Henoch-schonein purpura, HUS and actue intersitial nephritis

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18
Q

Acute renal failures complcations

A

cardiac failure, arrhythmia, Jaundice, GI Bleeds, infections especially lung and UTI

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19
Q

Chronic renal failure causes adults

A

Diabetes, glomerulonephritis, reflux nephropathy

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20
Q

Chronic renal failure children

A

developmental abnormalities, reflux nephropathy and then glomerulonephritis

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21
Q

Effects of chronic renal failure

A

Hypertension, anaemia, renal bone disesase

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22
Q

Acute bilateral renal obstruction features

A

pain, acute renal failure, anuria

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23
Q

Chronic unilateral obstruction

A

initially asymptomatic, decreased renal function if prolonged and cortical artrophy

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24
Q

bilateral partial obstruction

A

initially polyuric with progressive renal scarring and impairment

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25
Q

Renal calculi common when

A

Male predominant in 20-30yrs

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26
Q

Types of stones

A

Calcium, struite, urate and cystitne stones

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27
Q

Stag horn calculi common with which stome

A

struite

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28
Q

struite stones made from

A

magnesium ammonium phosphate

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29
Q

Why does citrate cause stones

A

low citrate causes stones as it normally binds calcium preventing stones forming

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30
Q

Commonest type of renal cell carcinoma

A

Clear cell carcinoma arising from the cortex peak in men 65-80

31
Q

What is Von Hippel Lindau Syndrome

A

VHL gene causes breakdown of hypoxia inducible factor-1 oncogene –> mutation in VHL gene means that there is increased cell growth and cell survival. Causes kidneys in tumours,, blood vessels and pancreas. Often seen in clear cell renal carcinomas

32
Q

Renal cell carcinoma symtpoms

A

haematuria, palpable abdominal mass, costovertebral pain

33
Q

Paraneoplastic syndromes of RCC

A

cushings, hypercalcaemia, polycythaemia

34
Q

Morphology of clear cell carcinoma

A

well defined yellow tumours –> hemorrhagic areas, may extend into perinephric fat or renal vein. Clear cells, delicate vasculature and small bland nuclei

35
Q

Morphology of papillary tumours

A

multiple, cuboid foamy cells. Fibrovascular cores surrounded by foamy macrophages or caclium

36
Q

Normal urine volume

A

750-2000ml oliguria is 400ml, anuria is 100ml, polyuria is over 3000ml

37
Q

Normal plasma urea

A

3-8mmol

38
Q

Causes of high urea

A

GI blled, renal hypo perfusion, trauma, renal disease, post renal obstruction

39
Q

Urea excretion

A

filtered at glomerulus, 40% reabsorbed in the tubules

40
Q

Differentiating between pre-renal and renal renal failure

A

pre-renal has low sodium (less than 20 in urine), renal has over 40. This is because in both renin-angiotensinoged system activated to retain sodium and water but in renal failure the tubules can’t reabsorb the Na hence Na concentration higher in the urine

41
Q

How to treat pre-renal/renal renal failure

A

pre-renal give IV saline. DO NOT GIVE FLUUIDS TO RENAL RENAL FAILURE –> will overload the heart causing cardiac failure

42
Q

Changes in nodular hyperplasia

A

Nodule formation, diffuse enlargement of the transition/periurethral zone and enlargement of the nodules

43
Q

Where are most prostate carcinomas

A

the peripheral zone –> palpable on digital rectal examination

44
Q

what is hormone is needed for BPH

A

androgen (DTH)

45
Q

Who is prostate enlargement more common in

A

African men.

Increased risk if BRCA2 gene and 1st degree relative with prostate carcinoma

46
Q

What is the scoring system for prostate adenocarcinomas

A

Gleasons scoring system

47
Q

What cells produce sperm

A

Sertoli

48
Q

what cells produce androgens

A

Leydig

49
Q

Testicular tumours more common in…

A

Northern european men, least common in africans/asians

50
Q

Seminoma stats

A

onset 35-45, testicular enlargement with or without pain,. Can get gynocomasteia (due to raised hCG), exopthalmous and infertility. Raised PLAP levels, well demarcated cream coloured region. Monotonous polygonal cells, clear cytoplasm, central nuclei divided into lobules

51
Q

Teratoms

A

usually from 0-20. benign pre-puberty, malignant post. Pure teratomas don’t secrete tumour markers. Well demarcated, mixture of endoderm, ectoderm and mesoderm

52
Q

Hamartoma

A

tumour of structures expected to be found in that area

53
Q

Epididymoorchitis

A

inflammation of the seminiferous tubules surrounded by a purulent exude of neutrophils and inflammatory cells

54
Q

Idiopathic granulomatous orchitis

A

typically older adults
symptoms of UTI, trauma or flu
Swollen, painful tender, later may have mass indistinguishable from neoplasm

55
Q

Sarcoidosis of testis

A

Mimics malignancy. Check to rule out TB and fungal infection

56
Q

Malakoplakia

A

May affect testis or epididymis. Soft yellow.brown/tan nodules.
Tubules contains eosoniphilic rich histiocytes (VON HASERMANS HISTRIOCYTES)

57
Q

Von hasermann histiocytes in what

A

Malakoplakia of the testis (inflammation)

58
Q

Myofibroblastic pseudotumous or testis

A

benign, reactive, proliferative process causing atypical inflammation and myofibroblastic reaction

59
Q

Sperm Granuloma

A

foreign body giant cell reaction to extravasated sperm. common following vasectomy. Often asymptomatic except swelling of upper pole of epidymis and spermatic cord

60
Q

Tuberculous Orchitis

A

Epididymis is a TB reservoir. Painless scrotal swelling. Uni or bilateral mass, scrotal fistula, inferitility
Casesating granulomatous inflammation with fibrous thickening and enlargement of epididymis and adjacent structures

61
Q

Causes of secondary hypogonadism

A

pituitary failure, drugs (opiods, corticosteroids, ketoconazole, chemo) obesity (as fat coverts testosterone to oestrogen)

62
Q

Cystitis as UTI

A

Lower UTI infection

63
Q

Pyelonephritis

A

Upper UTI infection –> symptoms of a lower UTI, fever, evidence of systemic infection (e.g. rigours, nausea, VnD, raised CRP, WBC etc)

64
Q

Urethral sydrome

A

mostly affects 30-50yr old women. Lower UTI symptoms without demonstrable infection

65
Q

Sterile pyuria

A

Pus cells in urine but no organism grown. Pus cells mean inflammation but no infection i.e. stones, trauma, vasculitis. Could be acid-fast bacilli difficult to grow

66
Q

Sources of UTI infection

A

Perinuem, fistulae, haematogenous (spreading from the blood but rare).

67
Q

Main organisms causing a UTI

A

E.Coli, staph. saprophylitus, proteus

68
Q

Describe proteus and kidney stones

A

proteus causes kidney stones and kidney stones harbour proteus

69
Q

Antibiotics or UTIs

A

Nitrofurantoin, piumecillinam, trimethoprim, fosfomycin

70
Q

Treatment of cystitis

A

3 days of antibiotics in females, 7 days in males

71
Q

Pyelonephritis treatment

A

Cefuroxime and ciprofloxacin. Piperacillin tazobactum if over 65. Then target therapy based on sensitivity. Give for 7-14 days

72
Q

When to treat asymptomatic bacteriruia

A

1) pregnant
2) infants to protect pyelonephritis and renal damage
3) prior to urological procedures e.g. changing catheter to prevent UTI/bacterumia

73
Q

Asymptomatic bacteriruria

A

Significant bacteria but no symptoms. Could be long term catheters etc.

74
Q

Causes of crytochidism

A

Anomalies in development, variation in gubernaculum attachment, poor development of spermatic vessels, failure of reabsorption of vaginal process and failure of spermatic cord to develop properly

CP - JL (14 decks)

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