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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
Renal calculi common when
Male predominant in 20-30yrs
26
Types of stones
Calcium, struite, urate and cystitne stones
27
Stag horn calculi common with which stome
struite
28
struite stones made from
magnesium ammonium phosphate
29
Why does citrate cause stones
low citrate causes stones as it normally binds calcium preventing stones forming
30
Commonest type of renal cell carcinoma
Clear cell carcinoma arising from the cortex peak in men 65-80
31
What is Von Hippel Lindau Syndrome
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
Renal cell carcinoma symtpoms
haematuria, palpable abdominal mass, costovertebral pain
33
Paraneoplastic syndromes of RCC
cushings, hypercalcaemia, polycythaemia
34
Morphology of clear cell carcinoma
well defined yellow tumours --> hemorrhagic areas, may extend into perinephric fat or renal vein. Clear cells, delicate vasculature and small bland nuclei
35
Morphology of papillary tumours
multiple, cuboid foamy cells. Fibrovascular cores surrounded by foamy macrophages or caclium
36
Normal urine volume
750-2000ml oliguria is 400ml, anuria is 100ml, polyuria is over 3000ml
37
Normal plasma urea
3-8mmol
38
Causes of high urea
GI blled, renal hypo perfusion, trauma, renal disease, post renal obstruction
39
Urea excretion
filtered at glomerulus, 40% reabsorbed in the tubules
40
Differentiating between pre-renal and renal renal failure
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
How to treat pre-renal/renal renal failure
pre-renal give IV saline. DO NOT GIVE FLUUIDS TO RENAL RENAL FAILURE --> will overload the heart causing cardiac failure
42
Changes in nodular hyperplasia
Nodule formation, diffuse enlargement of the transition/periurethral zone and enlargement of the nodules
43
Where are most prostate carcinomas
the peripheral zone --> palpable on digital rectal examination
44
what is hormone is needed for BPH
androgen (DTH)
45
Who is prostate enlargement more common in
African men. | Increased risk if BRCA2 gene and 1st degree relative with prostate carcinoma
46
What is the scoring system for prostate adenocarcinomas
Gleasons scoring system
47
What cells produce sperm
Sertoli
48
what cells produce androgens
Leydig
49
Testicular tumours more common in...
Northern european men, least common in africans/asians
50
Seminoma stats
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
Teratoms
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
Hamartoma
tumour of structures expected to be found in that area
53
Epididymoorchitis
inflammation of the seminiferous tubules surrounded by a purulent exude of neutrophils and inflammatory cells
54
Idiopathic granulomatous orchitis
typically older adults symptoms of UTI, trauma or flu Swollen, painful tender, later may have mass indistinguishable from neoplasm
55
Sarcoidosis of testis
Mimics malignancy. Check to rule out TB and fungal infection
56
Malakoplakia
May affect testis or epididymis. Soft yellow.brown/tan nodules. Tubules contains eosoniphilic rich histiocytes (VON HASERMANS HISTRIOCYTES)
57
Von hasermann histiocytes in what
Malakoplakia of the testis (inflammation)
58
Myofibroblastic pseudotumous or testis
benign, reactive, proliferative process causing atypical inflammation and myofibroblastic reaction
59
Sperm Granuloma
foreign body giant cell reaction to extravasated sperm. common following vasectomy. Often asymptomatic except swelling of upper pole of epidymis and spermatic cord
60
Tuberculous Orchitis
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
Causes of secondary hypogonadism
pituitary failure, drugs (opiods, corticosteroids, ketoconazole, chemo) obesity (as fat coverts testosterone to oestrogen)
62
Cystitis as UTI
Lower UTI infection
63
Pyelonephritis
Upper UTI infection --> symptoms of a lower UTI, fever, evidence of systemic infection (e.g. rigours, nausea, VnD, raised CRP, WBC etc)
64
Urethral sydrome
mostly affects 30-50yr old women. Lower UTI symptoms without demonstrable infection
65
Sterile pyuria
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
Sources of UTI infection
Perinuem, fistulae, haematogenous (spreading from the blood but rare).
67
Main organisms causing a UTI
E.Coli, staph. saprophylitus, proteus
68
Describe proteus and kidney stones
proteus causes kidney stones and kidney stones harbour proteus
69
Antibiotics or UTIs
Nitrofurantoin, piumecillinam, trimethoprim, fosfomycin
70
Treatment of cystitis
3 days of antibiotics in females, 7 days in males
71
Pyelonephritis treatment
Cefuroxime and ciprofloxacin. Piperacillin tazobactum if over 65. Then target therapy based on sensitivity. Give for 7-14 days
72
When to treat asymptomatic bacteriruia
1) pregnant 2) infants to protect pyelonephritis and renal damage 3) prior to urological procedures e.g. changing catheter to prevent UTI/bacterumia
73
Asymptomatic bacteriruria
Significant bacteria but no symptoms. Could be long term catheters etc.
74
Causes of crytochidism
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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