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Phase 2 Mine > Revision List GU > Flashcards

Revision List GU Flashcards

1
Q

What is glomerulonephritis?

A

Inflammation of glomeruli and nephrons

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2
Q

Effects of glomerulonephritis?

A
  1. Loss of filtration mechanism –> haematuria + proteinuria
  2. Restriction of blood flow in glomerulus –> compensatory hypertension
  3. AKI
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3
Q

What diseases can results in glomerulonephritis?

A
  1. Acute nephritic syndrome
  2. Nephrotic syndrome
  3. Asymptomatic urinary abnormalities - haematuria, proteinuria
  4. CKD - progressive decline in kidney function
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4
Q

What is acute nephritic syndrome?

A

Immune response to infection/other disease

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5
Q

What is ANS characterised by?

A 
1. Haematuria
2 Proteinuria
3. Hypertension
4. Oedema/fluid overload
5. Oliguria
6. Uraemia and symptoms of it:
- anorexia, pruritus, lethargy and nausea
7. Decrease kidney function
8. Moderate severe decrease in GFR
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6
Q

Causes of ANS?

A
  1. IgA nephropathy - commonest
  2. ANCA associated vasculitis
  3. SLE
  4. Good Pasture’s syndrome
  5. Systemic sclerosis
  6. Post streptococcal infection
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7
Q

What is IgA nephropathy?

A

Abnormaloty in IgA glycosylation which leads to IgA deposition in the mesangium.

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8
Q

How to diagnosis IgA nephropathy?

A

Biopsy - diffuse mesangial IgA deposits

Subendothelial, subepithelial deposits on EM

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9
Q

Management of IgA nephropathy?

A

> 50% crescents = steroids and immunosuppression

<50% crescents = BP control ACEi/ARB –> 125/75

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10
Q

Treating ANCA associated vasculitis?

A

Immunosuppression
Induce remission: cyclophosphamide, steroids, rituximab
Maintaining: azathioprine

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11
Q

Clinical presentation of SLE?

A 
Arthritis
Renal failure
ANA
Serositis - pleuritis/pericarditis
Haemotological - pancytopoenia
Photosensitivity
Oral Ulcers
Immunological - dsDNA Ab, Anti-sm, Anti-rho, Anti-RNP, Anti-phospholipid Ab
Neuro - Seizures, Psychosis
ts
Malar rash
Discoid rash
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12
Q

Treatment of SLE?

A

Immunosuppression

  • steroids, mycophenolate mofetil
  • rituximab - 2nd line
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13
Q

What is Good Pasteur’s Syndrome?

A

Co-existence of acute glomerulonephritis and pulmonary alveolar haemorrhage
Anti glomerular basement membrane Ab

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14
Q

Treating Good Pasteur’s Syndrome?

A

Plasma exchange to remove Ab

Steroids/Immunosuppression

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15
Q

Diagnosis of ANS?

A
  1. Good Hx
  2. eGFR, proteinuria, U&E, albumin
  3. Culture - throat swab
  4. Urine dipstick
    Renal biopsy if necessary
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16
Q

What is nephrotic syndrome?

A

Kidney disorders - too much protein passed in urine

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17
Q

Triad of nephrotic syndrome?

A
  1. Hypoalbuminaemia
  2. Proteinuria
  3. Oedema
    + severe hyperlipidaemia
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18
Q

Primary causes of nephrotic syndrome?

A
  1. Minimal change disease
  2. Membranous - asymptomatic proteinuria +/- haematuria/hypertension/ renal impairment
  3. Focal segmental glomerulosclerosis
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19
Q

Secondary causes of nephrotic syndrome?

A
  1. Diabetes Mellitus
  2. Amyloid
  3. Infections
  4. SLE
  5. Drugs - gold/ penicillame
  6. Malignancy
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20
Q

What is focal segmental glomerulonephritis?

A

Scarring of segments of nephrons
CD80 in podocytes - increase permeability in glomerulus –> proteinuria, haematuria –> secondary hypertension and renal impairment

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21
Q

Treating focal segmental glomerulonephritis?

A
  1. Corticosteroids and immunosuppression

e. g. cyclophosphamide and ciclosporin

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22
Q

Treatment of nephrotic syndrome?

A

Supportive:

  1. Manage complications
    - control fluid store - diuretics, ACEi/ARB/Spironolactone
    - statins
    - anticoagulation
  2. Treat underlying cause
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23
Q

How to treat minimal change disease?

A
  1. Fused podocytes on EM - steroids
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24
Q

Membranous nephropathy histology?

A

Mesangial expansion
Thickened BM
Immune complex deposition

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25
Q

Membranous nephropathy treatment?

A
  1. Steroids, cyclophosphamide, CNI, rituximab
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26
Q

What is pyelonephritis?

A

Infection of the renal parenchyma and soft tissue of renal pelvis/ upper ureter.

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27
Q

What are the risk factors for pyelonephritis?

A
  1. Structural renal abnormalities
  2. Calculi (stones)
  3. Catheterisation
  4. Pregnancy
  5. Diabetes
  6. Immunocompromised patients
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28
Q

Routes of infection for pyelonephritis?

A
  1. Ascending urethra
  2. Haematogenous - S.aureus, candida
  3. Lymphatic spread - rare
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29
Q

Clinical presentation of pyelonephritis?

A
  1. Loin pain
  2. Fever
  3. Pyuria
    Others: headache, rigor, significant bacteruria, malaise, nausea, vomiting, oliguria
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30
Q

Investigations of pyelonephritis?

A
  1. Abdominal examination: tender loin, renal angle tenderness, vaginal examination
  2. Bloods inc. cultures: raised WCC, CRP and ESR may be in increase in acute infection
  3. Urine dipstick e.g. nitrite, leukocytes, proteins, foul smelling
  4. MSU - MCS
  5. Ultrasound: detection of calculi, obstruction, abnormal urinary anatomy and incomplete bladder emptying
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31
Q

Treatment of pyelonephritis?

A
  1. Fluid replacement
  2. IV Abx - broad spectrum
    - co-amoxiclav, cefalexin, ciprofloxacin, trimethoprim
  3. Drain obstructed kidney
  4. Catheter
  5. Analgesia
    Complete 7-14 days - depends on choice
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32
Q

Complications of pyelonephritis?

A
  1. Renal abscess - imaging, little response to Ab, more common in diabetes
  2. Emphysematous pyelonephritis - rare/gas accumulation in tissues, life threatening, may need nephrectomy
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33
Q

Chronic kidney disease

A

Chronic usually progressive renal damage.
Haematuria, proteinuria, or anatomical
eGFR <60mL/min/1.73m2 for > 3 months

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34
Q

What is estabilished renal failure stage?

A

Stage 5 <15mL/min

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35
Q

What is Stage 4 CKD?

A

15-29

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36
Q

What is stage 3 CKD?

A 
3a = 45-59 = moderate decrease
3b = 30-44 = moderate - severe
37
Q

What is stage 2 CKD?

A

60-89 = slight GFR

38
Q

Aetiology of CKD?

A
  1. Atherosclerotic renal vascular disease
  2. Hypertension
  3. Glomerulonephritis
  4. Diabetes Mellitus Type II
  5. Family History of CKD stage 5
  6. AKI
  7. Hypercalcaemia
39
Q

Risk factors of CKD?

A
  1. DM
  2. HTN
  3. CVD - IHD, PVD, cerebrovd
  4. Structural renal disease
  5. Recurrent UTI
  6. Smoking
  7. Proteinuria
40
Q

Pathophysiology of CKD?

A
  1. Destruction of nephrons - scarring
  2. Residual nephrons experience hyperinfiltration and glomerular hypertrophy
  3. Increase glomerular capillary pressure –> glomerulosclerosis
41
Q

How does ATII affect CKD?

A
  1. ATII modulates intraglomerular capillar pressure and GFR –> vasoconstriction of efferent arterioles –> increase glomerular hydraulic pressure + filtration fraction
  2. Affects mesangial cells and podocytes –> increased pore size and impaired selective function of membrane –> proteinuria
  3. Modulates cell growth directly and indirectly leading to excess matrix formation
  4. Plasminogen activator inhibitor inhibits proteolyse by plasmin –> accumulation of excess matrix and scarring
42
Q

What can determine the prognosis of CKD?

A
  1. Hypertension
  2. Proteinuria
  3. Degree of scarring on interstitium
43
Q

Symptoms of CKD?

A 
Anorexia
Nausea
Vomiting
Lethargy
Dyspnoea
Peripheral oedema
44
Q

Signs of CKD?

A
  1. Specific underlying cause
  2. Increase skin pigmentation or excoriation
  3. Pallor
  4. Hypertension
  5. Postural hypotension
45
Q

Diagnosing CKD?

A
  1. Assess renal function - urea, creatinine
  2. Biochemistry and haematology increased phosphate, potassium, calcium may be normal , normochromic normocytic anaemia
  3. Serology - autoantibodies for related systemic diseases for SLE, scleroderma
  4. Urinalysis - proteinuria, haematuria, microscopy, cell count
  5. ECG/ echocardiography: LVH and ischaemia and to assess cardiac function
  6. US: size, eclude hydronephrosis
  7. CT: renal massess, cysts and renal stones are more clear
  8. Renal biopsy: cause?
46
Q

Steps to treating CKD?

A
  1. Identify and treat reversible causes
  2. Limiting complications
  3. Symptom control
  4. Renal replacement therapy
47
Q

What does indentifying and treating reversible causes involve?

A
  1. Relieve obstruction
  2. Stop nephrotoxic drugs e.g. IV radiocontrast, NSAIDs
  3. Stop smoking, eat well, exercise
  4. Tight glucose control
  5. Pneumococcal and influenza vaccine
48
Q

What does limiting complications of CKD involve?

A
  1. BP - maintain at <130/80 with ACEi, Diuretics, Calcium Channel Blockers
  2. Mineral and bone disorders: check PTH and treat if high, vit D supplements, phosphate binders and avoid phosphate foods.
  3. CVD risk management: statin to lower cholesterol, anti-platelets, anticoagulant
49
Q

What does symptom control in CKD involve?

A
  1. Anaemia - iron/ folate/ b12
  2. Systemic acidosis - sodium bicarbonate to treat raised serum potassium, dyspnoea and lethargy
  3. Oedema - furosemide
50
Q

What does renal replacement therapy?

A
  1. Haemofiltration
  2. Haemodialysis
  3. Peritoneal dialysis
51
Q

What is haemodialysis?

A
  1. Blood passed over semi-permeable membrane against dialysis fluid flowing in opposite direction
    Can be through catheter or AV fistula.
52
Q

Complications of haemodialysis?

A
  1. Hypotension/cramps
  2. Nausea/headache
  3. Chest pain
  4. Fever/rigors
  5. Infected dialysis catheter
53
Q

What is peritoneal dialysis?

A

Mainly used in CKD - rare in AKI - peritoneal membrane = filter - done overnight 8 hours

54
Q

Complications of peritoneal dialysis?

A
  1. Infection e.g. peritonitis
  2. Abdominal wall herniation
  3. Intestinal perforation
  4. Loss of membrane function over time
55
Q

When in RRT indicated in AKI?

A
  1. Refractory pulmonary oedema
  2. Persistent hyperkalaemia
  3. Severe metabolic acidosis
  4. Uraemic encephalopathy/ pericarditis
  5. Pulmonary oedema
56
Q

How does CKD lead to anaemia?

A
  1. Decease renal function leading to decrease EPO production and decrease RBC production
  2. Decrease renal function –> decrease renal clearance of hepicidin - inhibits iron absorption
57
Q

Treatment of CKD linked anaemia?

A

IV iron and EPO

58
Q

Epidemiology of chalmydia?

A

F>M

15-25 year olds

59
Q

Epidemiology of gonnorrhea?

A

M>F

20-40

60
Q

Where can STIs infect in adults?

A
  1. Urethra
  2. Endocervical canal
  3. Rectum
  4. Pharyngitis
  5. Conjunctiva
61
Q

Where can STIs affect in children

A
  1. Conjuctiva

2. Atypical pneumonia - chlamydophilla

62
Q

Chlamydia and Gonnorrhea symptoms in men?

A
  1. Dysuria

2. Urethral discharge

63
Q

Chalmydia and Gonnorhea symptoms in women?

A

Non specific - discharge, menstrual irregularity, dysuria

64
Q

Incubation period of GC in men?

A

2-5 days

65
Q

Incubation period of GC in women?

A

upto 10 days

66
Q

Incubation period of CT in men?

A

7-21 days

67
Q

Incubation period of CT in women?

A

Ill defined

68
Q

Percent asymptomatic GC in men?

A

10%

69
Q

Percent asymptomatic GC in women?

A

50%

70
Q

Percent asymptomatic CT in men?

A

> 50%

71
Q

Percent asymptomatic CT in women?

A

> 70%

72
Q

Transmission rate female to male GC?

A

20-60-80% depending on one consistent partner or a number of partners

73
Q

Transmission rate female to male CT?

A

70%

74
Q

Transmission rate male to female GC?

A

50-90%

75
Q

Transmission rate male to female CT?

A

70%

76
Q

Complications of CT in men?

A

Epidydmo-orchitis

Reactive arthritis

77
Q

Complications of GC and CT in females?

A
  1. Pelvic inflammatory disease - infection spreads up fallopian tube –> inflammation and scarring
  2. Neonatal transmission
  3. Fitz-High Curtis syndrome - peri hepatitis but not decline in liver function
78
Q

Presentation of pelvic inflammatory disease?

A
  1. Tubular factor infertility
  2. Ectopic pregnancy
  3. Chronic pelvic pain
79
Q

How to diagnose chlamydia?

A
  1. NAAT
  2. Female - self collected vaginal swab
  3. Male - first void urine
80
Q

Aim of community screening CT?

A

People can be asymptomatic carriers for years without realising - decrease prevalence of complications .
Does not indicate recent partner change.

81
Q

Treatment of Chlamydia?

A
  1. Partner management
  2. Test for other STI
  3. Doxycycline 100mg bd for 7 days
    (Azithromycin 1g + 500mg daily 2 days) if doxcycline not tolerated - treatment for Mycobacterium Genitalium co-infection
    NO significant Abx resistance
82
Q

Diagnosis gonnorrhea?

A
  1. Microscopy of gram stained smears of genital secretions looking for bacteria
    - male urethra, female endocervix, rectum
  2. Culture on selective medium to confirm diagnosis
  3. Sensitivity testing
  4. NAAT
83
Q

Treatment of gonnorhea?

A
  1. Partner notification
  2. Test other STI
  3. Abx sensititivity
  4. ONE dose preferred because RESISTANCE - IM Ceftriaxone is current treatment
84
Q

Bacteria causing syphilis?

A

Treponema pallidum

85
Q

Primary syphillis clinical presentation?

A
  1. Primary chancre - 95% genital skin, nipples, mouth

2. Dusky macule, papule indurated clean based non tender ulcer

86
Q

Secondary chancre clinical presentation?

A
  1. 6-8 weeks after infections - primary chancre may be concurrent but also there may be no history of primary chancre
  2. 70% present with skin rash
  3. Other manifestation - mucous membrane lesions, generalised lymphadenopathy, alopecia, hoarseness, bone pain, hepatitis, nephrotic syndrome, deaf etc
87
Q

Diagnosis of syphilis?

A
  1. Identify motile spirochaetes

2. Serology - mainstay - EIA

88
Q

Treatment of syphilis?

A

Pencillin IM

Efficient follow up and partner notification

89
Q

Describe the STI/HIV transmission model

A 
R = BCD
R = reproductive rate
B = Infectivity rate
C = number of partners
D = duration of infection

Phase 2 Mine (12 decks)

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