Revision List GU Flashcards
1
Q
What is glomerulonephritis?
A
Inflammation of glomeruli and nephrons
2
Q
Effects of glomerulonephritis?
A
- Loss of filtration mechanism –> haematuria + proteinuria
- Restriction of blood flow in glomerulus –> compensatory hypertension
- AKI
3
Q
What diseases can results in glomerulonephritis?
A
- Acute nephritic syndrome
- Nephrotic syndrome
- Asymptomatic urinary abnormalities - haematuria, proteinuria
- CKD - progressive decline in kidney function
4
Q
What is acute nephritic syndrome?
A
Immune response to infection/other disease
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
6
Q
Causes of ANS?
A
- IgA nephropathy - commonest
- ANCA associated vasculitis
- SLE
- Good Pasture’s syndrome
- Systemic sclerosis
- Post streptococcal infection
7
Q
What is IgA nephropathy?
A
Abnormaloty in IgA glycosylation which leads to IgA deposition in the mesangium.
8
Q
How to diagnosis IgA nephropathy?
A
Biopsy - diffuse mesangial IgA deposits
Subendothelial, subepithelial deposits on EM
9
Q
Management of IgA nephropathy?
A
> 50% crescents = steroids and immunosuppression
<50% crescents = BP control ACEi/ARB –> 125/75
10
Q
Treating ANCA associated vasculitis?
A
Immunosuppression
Induce remission: cyclophosphamide, steroids, rituximab
Maintaining: azathioprine
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
12
Q
Treatment of SLE?
A
Immunosuppression
- steroids, mycophenolate mofetil
- rituximab - 2nd line
13
Q
What is Good Pasteur’s Syndrome?
A
Co-existence of acute glomerulonephritis and pulmonary alveolar haemorrhage
Anti glomerular basement membrane Ab
14
Q
Treating Good Pasteur’s Syndrome?
A
Plasma exchange to remove Ab
Steroids/Immunosuppression
15
Q
Diagnosis of ANS?
A
- Good Hx
- eGFR, proteinuria, U&E, albumin
- Culture - throat swab
- Urine dipstick
Renal biopsy if necessary
16
Q
What is nephrotic syndrome?
A
Kidney disorders - too much protein passed in urine
17
Q
Triad of nephrotic syndrome?
A
- Hypoalbuminaemia
- Proteinuria
- Oedema
+ severe hyperlipidaemia
18
Q
Primary causes of nephrotic syndrome?
A
- Minimal change disease
- Membranous - asymptomatic proteinuria +/- haematuria/hypertension/ renal impairment
- Focal segmental glomerulosclerosis
19
Q
Secondary causes of nephrotic syndrome?
A
- Diabetes Mellitus
- Amyloid
- Infections
- SLE
- Drugs - gold/ penicillame
- Malignancy
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
21
Q
Treating focal segmental glomerulonephritis?
A
- Corticosteroids and immunosuppression
e. g. cyclophosphamide and ciclosporin
22
Q
Treatment of nephrotic syndrome?
A
Supportive:
- Manage complications
- control fluid store - diuretics, ACEi/ARB/Spironolactone
- statins
- anticoagulation - Treat underlying cause
23
Q
How to treat minimal change disease?
A
- Fused podocytes on EM - steroids
24
Q
Membranous nephropathy histology?
A
Mesangial expansion
Thickened BM
Immune complex deposition
25
Membranous nephropathy treatment?
1. Steroids, cyclophosphamide, CNI, rituximab
26
What is pyelonephritis?
Infection of the renal parenchyma and soft tissue of renal pelvis/ upper ureter.
27
What are the risk factors for pyelonephritis?
1. Structural renal abnormalities
2. Calculi (stones)
3. Catheterisation
4. Pregnancy
5. Diabetes
6. Immunocompromised patients
28
Routes of infection for pyelonephritis?
1. Ascending urethra
2. Haematogenous - S.aureus, candida
3. Lymphatic spread - rare
29
Clinical presentation of pyelonephritis?
1. Loin pain
2. Fever
3. Pyuria
Others: headache, rigor, significant bacteruria, malaise, nausea, vomiting, oliguria
30
Investigations of pyelonephritis?
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
31
Treatment of pyelonephritis?
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
32
Complications of pyelonephritis?
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
33
Chronic kidney disease
Chronic usually progressive renal damage.
Haematuria, proteinuria, or anatomical
eGFR <60mL/min/1.73m2 for > 3 months
34
What is estabilished renal failure stage?
Stage 5 <15mL/min
35
What is Stage 4 CKD?
15-29
36
What is stage 3 CKD?
```
3a = 45-59 = moderate decrease
3b = 30-44 = moderate - severe
```
37
What is stage 2 CKD?
60-89 = slight GFR
38
Aetiology of CKD?
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
Risk factors of CKD?
1. DM
2. HTN
4. CVD - IHD, PVD, cerebrovd
5. Structural renal disease
6. Recurrent UTI
7. Smoking
8. Proteinuria
40
Pathophysiology of CKD?
1. Destruction of nephrons - scarring
2. Residual nephrons experience hyperinfiltration and glomerular hypertrophy
3. Increase glomerular capillary pressure --> glomerulosclerosis
41
How does ATII affect CKD?
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
What can determine the prognosis of CKD?
1. Hypertension
2. Proteinuria
3. Degree of scarring on interstitium
43
Symptoms of CKD?
```
Anorexia
Nausea
Vomiting
Lethargy
Dyspnoea
Peripheral oedema
```
44
Signs of CKD?
1. Specific underlying cause
2. Increase skin pigmentation or excoriation
3. Pallor
4. Hypertension
5. Postural hypotension
45
Diagnosing CKD?
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
Steps to treating CKD?
1. Identify and treat reversible causes
2. Limiting complications
3. Symptom control
4. Renal replacement therapy
47
What does indentifying and treating reversible causes involve?
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
What does limiting complications of CKD involve?
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
What does symptom control in CKD involve?
1. Anaemia - iron/ folate/ b12
2. Systemic acidosis - sodium bicarbonate to treat raised serum potassium, dyspnoea and lethargy
3. Oedema - furosemide
50
What does renal replacement therapy?
1. Haemofiltration
2. Haemodialysis
3. Peritoneal dialysis
51
What is haemodialysis?
1. Blood passed over semi-permeable membrane against dialysis fluid flowing in opposite direction
Can be through catheter or AV fistula.
52
Complications of haemodialysis?
1. Hypotension/cramps
2. Nausea/headache
3. Chest pain
4. Fever/rigors
5. Infected dialysis catheter
53
What is peritoneal dialysis?
Mainly used in CKD - rare in AKI - peritoneal membrane = filter - done overnight 8 hours
54
Complications of peritoneal dialysis?
1. Infection e.g. peritonitis
2. Abdominal wall herniation
3. Intestinal perforation
4. Loss of membrane function over time
55
When in RRT indicated in AKI?
1. Refractory pulmonary oedema
2. Persistent hyperkalaemia
3. Severe metabolic acidosis
4. Uraemic encephalopathy/ pericarditis
5. Pulmonary oedema
56
How does CKD lead to anaemia?
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
Treatment of CKD linked anaemia?
IV iron and EPO
58
Epidemiology of chalmydia?
F>M
| 15-25 year olds
59
Epidemiology of gonnorrhea?
M>F
| 20-40
60
Where can STIs infect in adults?
1. Urethra
2. Endocervical canal
3. Rectum
4. Pharyngitis
5. Conjunctiva
61
Where can STIs affect in children
1. Conjuctiva
| 2. Atypical pneumonia - chlamydophilla
62
Chlamydia and Gonnorrhea symptoms in men?
1. Dysuria
| 2. Urethral discharge
63
Chalmydia and Gonnorhea symptoms in women?
Non specific - discharge, menstrual irregularity, dysuria
64
Incubation period of GC in men?
2-5 days
65
Incubation period of GC in women?
upto 10 days
66
Incubation period of CT in men?
7-21 days
67
Incubation period of CT in women?
Ill defined
68
Percent asymptomatic GC in men?
10%
69
Percent asymptomatic GC in women?
50%
70
Percent asymptomatic CT in men?
>50%
71
Percent asymptomatic CT in women?
>70%
72
Transmission rate female to male GC?
20-60-80% depending on one consistent partner or a number of partners
73
Transmission rate female to male CT?
70%
74
Transmission rate male to female GC?
50-90%
75
Transmission rate male to female CT?
70%
76
Complications of CT in men?
Epidydmo-orchitis
| Reactive arthritis
77
Complications of GC and CT in females?
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
Presentation of pelvic inflammatory disease?
1. Tubular factor infertility
2. Ectopic pregnancy
3. Chronic pelvic pain
79
How to diagnose chlamydia?
1. NAAT
2. Female - self collected vaginal swab
3. Male - first void urine
80
Aim of community screening CT?
People can be asymptomatic carriers for years without realising - decrease prevalence of complications .
Does not indicate recent partner change.
81
Treatment of Chlamydia?
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
Diagnosis gonnorrhea?
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
Treatment of gonnorhea?
1. Partner notification
2. Test other STI
3. Abx sensititivity
4. ONE dose preferred because RESISTANCE - IM Ceftriaxone is current treatment
84
Bacteria causing syphilis?
Treponema pallidum
85
Primary syphillis clinical presentation?
1. Primary chancre - 95% genital skin, nipples, mouth
| 2. Dusky macule, papule indurated clean based non tender ulcer
86
Secondary chancre clinical presentation?
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
Diagnosis of syphilis?
1. Identify motile spirochaetes
| 2. Serology - mainstay - EIA
88
Treatment of syphilis?
Pencillin IM
| Efficient follow up and partner notification
89
Describe the STI/HIV transmission model
```
R = BCD
R = reproductive rate
B = Infectivity rate
C = number of partners
D = duration of infection
```
