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General Medicine > Renal & Urology > Flashcards

Renal & Urology Flashcards

1
Q

Renal | Investigations

A

USS kidney; dilatation, PKD, masses, stones
CT KUB; *GS stones, bladder/prostate Ca
Renal biopsy; glomerulopathies

Urine dipstick
24hr urinary protein
A:Cr or P:Cr

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2
Q

Nephrotic syndrome | Features

Primary
Secondary

A 
Oedema
Proteinuria
Hypoalbuminaemia
Hyperlipidaemia
Hypercoagulable state
Sepsis; loss of Ig

May be primary or secondary (to malignancy, infection, autoimmune disease, drugs)

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3
Q

Nephrotic syndrome

Minimal change disease | Epidemiology, Clinical features

A

Most common in children, boys

Facial oedema
NO haematuria
Does not cause renal failure!

Inv; urinalysis, 24hr urinary protein, A:Cr, serum albumin

[Management]
Oral prednisolone 60mg for 6/52
Fluid restriction, low-salt diet
(Furosemide, albumin)
CYClophosphamide for relapses
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4
Q

Nephrotic syndrome

FSGS & Membranous nephropathy

A

Asymptomatic proteinuria
(Microscopic haematuria)
HTN, renal impairment

May progress to CKD/ESRF

[Management]
ACEi/ARB
Oral prednisolone for 6/12
Ciclosporin for maintenance

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5
Q

SLE | Lupus nephritis

A

ANA sensitive
Anti-dsDNA specific
Low C3 C4

Rash, photosensitivity, arthritis, CNS effects

Nephritis or general nephrosis

[Management]
High dose corticosteroids
CYC or MMF

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6
Q

Acute GN | Features

A

Haematuria; red cell casts (under microscope)
Proteinuria, inflammation causes leaky capillaries
HTN, kidneys cannot remove waste/extra fluid from blood so retention causes HTN
Oedema, salt and water retention in tissues
(Oliguria/uraemia)

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7
Q

Nephritic GN

Post-streptococcal GN | Epidemiology & Management

A

Child preceding strep infection 1-3/52 prior
Strep throat, otitis media, cellulitis/impetigo

[Management]
AntiHTN, diuretics
Salt and fluid restrict
Dialysis

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8
Q

Nephritic GN

IgA nephropathy | Epidemiology & Management

A

Children, young males
Preceding URTI or viral gastroenteritis
Haematuria

[Management]
ACEi/ARB
Steroids

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9
Q

Nephritic GN

Anti-GBM

Rapidly progressive GN; any aggressive GN progressing to renal failure over days-weeks

A

Goodpasture’s; GN with lung haemorrhage
AKI, haematuria, oliguria, renal failure, haemoptysis, SOB

Alport’s; GN with sensorineural deafness

[Management]
Plasma exchange; to remove antibodies
Corticosteroids
CYClophosphamide

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10
Q

Henoch-Schonlein purpura (HSP)

Haemolytic uraemic syndrome (HUS)

A

[HSP]
Small vessel vasculitis
Variant of IgA nephropathy

Purpuric rash on extensor surfaces, legs
Flitting polyarthritis
Abdominal pain, GI bleeding
Nephritis

Tx as IgA; ACEi/ARB, steroids
(IgA kidney only)

[HUS]
Preceding gastroenteritis (E.coli O157) diarrhoea + fever

Haemolysis
Thrombocytopenia
AKI

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11
Q 
UTI | Types
Complicated
Pregnancy
Catheter-associated
Urinary sepsis
A

Complicated; stones, DM, abnormal anatomy, VUR, PKD, obstruction, sickle cell

Pregnancy Tx; PO nitrofurantoin, amoxicillin (asx)
Catheter-associated sx Tx; IV gentamicin, do not Tx if asymptomatic bacteriuria
Urinary sepsis Tx; IV gentamicin

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12
Q

Pyelonephritis | Investigations & Management

A

USS kidney; calculi, obstruction, hydronephrosis
CT KUB; tissue damage

[Management]
IV co-amoxiclav OR
IV gentamicin

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13
Q

Nephrolithiasis | Aetiology, Types & Management

A

Dehydration, hypercalcaemia, infection
Renal tubular acidosis

Calcium oxalate; opaque
Uric acid
Cystine; semi-opaque
Struvite; staghorn calculus

USS kidney; dilatation of renal pelvis, hydronephrosis
CT KUB; stones

[Management]
Conservative; diclofenac
Medical; tamsulosin
Surgical; ESWL, stent, keyhole removal (PCNL)

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14
Q

Prostatitis | Clinical features & Management

A

Perineal pain, scrotal pain
Frequency, dysuria, lower back pain, suprapubic pain
Fever, nausea, malaise
Swollen/tender prostate on PR

Inv; STI screening

Tx; ciprofloxacin

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15
Q

AKI | Clinical features & Aetiology

Stage 1-3
Serum Cr vs. urine output

A

Prerenal; hypotension, hypovolaemia, hypoperfusion (ischaemia)
Intrarenal; GN, ATN, AIN, inflammation, infection, autoimmune disease, drugs, trauma, vascular
Postrenal; obstruction of urine outflow, BPH, calculi, bladder/prostate tumour

Decreased GFR, oliguria, raised U/Cr

Serum Cr OR urine output
Stage 1; 1.5-1.9x baseline
Stage 2; 2.0-2.9x baseline
Stage 3; >3.0x baseline

Urine output <0.5mL/kg/hr
Stage 1; for 6-12hrs
Stage 2; for >12hrs
Stage 3; for >24hrs

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16
Q

AKI | Complications & Management

A

[Complications]
Fluid overload; pulmonary oedema
Hyperkalaemia; ATN
Acidosis

[Management]
Sepsis 6
Stop nephrotoxic drugs; ACEi, ARB, gentamicin, NSAIDs, diuretics, metformin, antiHTN
Renal replacement therapy; haemodialysis, haemofiltration

Prerenal; Tx sepsis, fluid resuscitation, increase perfusion by circulatory support
Renal; renal biopsy
Postrenal; catheter, nephrostomy, urological surgery

17
Q

CKD | Aetiology, Classification

A

Abnormal kidney structure/function for >3/12

GFR classifcation
Stage 1; >90 + protein/haematuria, biopsy/imaging pathology
Stage 2; 60-89
Stage 3a; 45-59 (Mild)
Stage 3b; 30-44 (Moderate)
Stage 4; 15-29 (Severe)
Stage 5; <15 (Failure)

May be classified A1-3 by albuminuria, A:Cr

[Aetiology]
DM, HTN
SLE, RA, infection

18
Q

CKD | Complications & Management

Monitoring

A 
[Complications]
Hyperkalaemia
Hypocalcaemia; less vit D, hyperPTH
Osteoporosis
HTN; negative feedback from reduced GFR, increased renin
Oedema
Anaemia; reduced EPO
[Management]
Target BP/proteinuria
ACEi/ARB
Manage CV risk; atorvastatin, antiplatelet, DM, smoking
Renal drug modifications
Specialist referral if GFR < 30

[Monitoring]
FBC, U&Es
Vit D, Ca, phosphate, PTH

19
Q

PKD | Clinical features, Investigations & Management

A

Autosomal dominant commonly, PKD1 mutation

Loin pain, haematuria, HTN, progressive renal failure

[Extrarenal]
Liver cysts, ovarian cysts
Berry aneurysms causing SAH

Inv; USS kidney, genetic testing

[Management]
AntiHTNs
RRT and transplantation

Prognosis; ESRF by 50s

20
Q

Bladder cancer | Clinical features

RFs

A

Age >55yrs
Painless haematuria

[RFs]
Smoking
Schistosomiasis
Occupational exposure; painters, decorators, dye, rubber, roofers
Pelvic radiation

Inv; cystoscopy, biopsy, CT urogram

[Management]
TURBT, radical cystectomy

21
Q

Prostate cancer | Epidemiology & Management

BPH | Clinical features

Management

A

Age >50yrs
Nocturia, frequency, hesitancy, dysuria

Inv; abnormal PR, raised PSA
Gleason score, histological dx

Tx; tamsulosin, TURP, robotic prostatectomy

[BPH]
Age >50yrs
Storage sx; frequency, urgency, nocturia
Voiding sx; weak stream, hesitancy, dribbling, straining, incomplete emptying

Tx; tamsulosin/finasteride + behavioural

22
Q

RCC | Epidemiology

A

Age >55yrs
Triad; haematuria, loin pain, palpable mass

RFs; smoking, HTN

23
Q

Incontinence | Types

Stress
Urge
Mixed

A

Leaking, nocturnal enuresis, frequency, hesitancy, straining, intermittent stream, dribbling, incomplete emptying

[Stress]
Raised IAP; coughing, laughing
RFs; age, obesity, postnatal NVD, prolapse

Tx; pelvic floor exercises, duloxetine

[Urge] OAB
Running water, caffeine, obesity
RFs; stroke, dementia, Parkinson’s

Inv; USS bladder scan, urodynamics studies
Tx; bladder retraining, pelvic floor exercises, oxybutinin (anti-ACh)

[Management]
Conservative; smoking cessation, reduce caffeine, limit fluid intake before bedtime, avoid constipation, weight loss if high BMI

Surgical; bulking agents, slings, colposuspension

24
Q

Scrotal masses | Types

Testicular torsion
Epididymal cyst
Hydrocele
Epididymo-orchitis
Variocele
Testicular tumour
Indirect inguinal hernia
A

Testicular torsion; severe sudden onset testicular pain, adolescents, not eased on elevation, loss of cremasteric reflex
Epididymal cyst; 40yrs, painless, above and behind
Hydrocele; soft fluctuant, get above it, transilluminate
Epididymo-orchitis; dysuria, urethral discharge, pain eased on elevating testis, Chlamydia
Variocele; left sided smaller swelling, ‘bag of worms’
Testicular tumours; young males, painless lump

Orchitis is associated with mumps

Indirect inguinal hernia; not possible to get above

General Medicine (7 decks)

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