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Yr 5 - Renal & Urology > Revision - Renal Stones & Renal > Flashcards

Revision - Renal Stones & Renal Flashcards

1
Q

What are 2 key complications of renal stones?

A

1) Infection –> pyelonephritis

2) AKI due to obstruction

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2
Q

Anatomically, what nerve does the ureter lie close to?

A

Genitofemoral nerve

This causes ‘loin to groin’ pain (i.e. referred testicular pain in men).

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3
Q

What are the 5 different types of kidney stoines?

A

1) Calcium oxalate (most common)

2) Calcium phosphate

3) Cystine

4) Struvite

5) Uric acid

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4
Q

What is the major risk factor for calcium oxalate stones?

A

Hypercalciuria

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5
Q

Causes of hypercalciuria?

A

Note - any cause of hypercalcemia is likely to result in secondary hypercalciuria.

1) Hyperthyroidism
2) Renal tubular acidosis
3) Sarcoidosis
4) Vitamin D intoxication
5) Glucocorticoid excess
6) Paget disease
7) Paraneoplastic syndromes e.g. lung squamous cell carcinoma

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6
Q

Why is hypocitraturia a risk factor for calcium oxalate stones?

A

Because citrate forms complexes with calcium, making it more soluble.

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7
Q

What is the key risk factor for cystine stones?

A

Cystinuria –> Inherited recessive disorder of transmembrane cystine transport leading to DECREASED ABSORPTION of cystine from intestine and renal tubule.

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8
Q

Risk factors for uric acid stones?

A

1) low urinary pH

2) high protein diet

3) loss of fluid due to chronic diarrhea or malabsorption

4) diabetes or metabolic syndrome

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9
Q

Which type of kidney stones are not visible on xray?

A

Uric acid stones (radiolucent)

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10
Q

What are struvite stones formed from?

A

Magnesium, phosphate & ammonium

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11
Q

What do struvite stones occur as a result of?

A

Urease producing bacteria

They are associated with chronic infections

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12
Q

What is typical urine pH?

A

Variation from 5-7

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13
Q

pH of urine after eating?

A

Post-prandial drop in pH due to purine metabolism producing uric acid

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14
Q

Describe typical urine acidity in uric acid stones

A

Acidic (around 5)

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15
Q

Describe typical urine acidity in struvate stones

A

Alkaline (>7)

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16
Q

Which diuretics can cause renal stones?

A

Loop diuretics –> cause urinary excretion of calcium

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17
Q

Do thiazide diuretics cause renal stones?

A

No - they do not cause urinary excretion of calcium

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18
Q

Which medications may increase the risk of renal stones?

A

1) aspirin

2) antacids

3) diuretics

4) antiretrovirals

5) Abx e.g. ciprofloxacin

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19
Q

What is the most important differential for renal colic?

A

Ruptured AAA

Always consider in older men w/ risk factors

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20
Q

Presentation of portal vein thrombosis?

A

Severe RUQ pain, often with jaundice

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21
Q

What is there often a preceding history of in diverticulitis?

A

Constipation

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22
Q

Gold standard imaging in renal stones?

A

Non-contrast CT KUB

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23
Q

When may an US be indicated over a CT KUB?

A

In younger or pregnant patients

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24
Q

What is the most effective analgesia for renal colic?

A

NSAIDs

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25
Q

Typical NSAID used in renal colic?

A

IM diclofenac

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26
Q

What size renal stone may indicate a ‘watching and waiting’ approach’?

A

<5mm

review again in 4 weeks

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27
Q

What may be used for the medical expulsion of renal stones?

A

alpha-adrenoceptor blocker (e.g. tamsulosin) for small distal ureteric stones.

28
Q

For patients with an infected urinary system due to renal stones, what is the 1st line of management?

A

Relieving the obstruction –> stent or nephrostomy

29
Q

For patients who do not have an infected system with renal stones, what is the 1st line management?

A

Primary stone treatment with either:

  • ureteroscopy and laser stone fragmentation
  • extracorporeal shock wave lithotripsy (ESWL).
30
Q

What can reduce the incidence of calcium based stones?

A

Lemon juice (can increase urinary citrate)

31
Q

Who is ESWL contraindicated in?

A

Pregnant women –> do ureteroscopy instead

32
Q

What surgical management is indicated for complex renal calculi and staghorn calculi?

A

Percutaneous nephrolithotomy

33
Q

What 2 medications may be used to reduce the risk of renal stone recurrence?

A

1) thiazide diuretics

2) potassium citrate

34
Q

Management of large, proximal renal stones?

A

Percutaneous nephrolithotomy.

35
Q

What is the normal anion gap?

A

8-14 mmol/L

36
Q

How is the anion gap calculated?

A

(Na+ + K+) - (Cl- + HCO3-)

37
Q

What type of acid base disturbance does renal tubular acidosis cause?

A

Hyperchloraemic metabolic acidosis with a normal anion gap

38
Q

What can periureteric fat stranding on a CT indicate if a ureteric calculus is not present?

A

Recent stone passage

39
Q

What analgesia can be given in renal colic if NSAIDs are contraindicated?

A

IV paracetamol

40
Q

What are the most common causes of AIN?

A

1) Drugs:
- penicillin
- NSAIDs
- furosemide
- allopurinol

2) Systemic disease:
- SLE
- Sjogrens
- sarcoidosis

3) Infection:
- Hanta virus
- staphylococci

41
Q

Clinical features of AIN?

A

1) fever, rash & arthralgia

2) mild eosinophilia (allergic picture)

3) mild renal impairment

4) HTN

42
Q

What may urinalysis show in AIN? (2)

A

1) white cell casts

2) sterile pyuria

43
Q

Which NSAID is generally safe to continue in AKI?

44
Q

What medication should all patients with CKD be started on?

45
Q

What triad of features is seen in TURP syndrome?

A

1) hyponatraemia

2) fluid overload

3) glycine toxicity

46
Q

Management of TURP syndrome?

A

1) fluid restriction

2) treatment of the complications associated with the hyponatraemia

47
Q

What is a non-calcium based phosphate binder that treats hyperphosphataemia in patients with CKD mineral bone disease?

48
Q

1st line for reducing phosphate levels in CKD (to prevent further complications of CKD-mineral bone disease)?

A

Low phosphate diet

49
Q

What is generally the anticoagulant of choice in patients with marked CKD?

50
Q

In patients with diabetes and CKD, what is the target BP?

51
Q

What is calcium acetate?

A

Calcium based binder used to treat hyperphosphataemia in renal disease

52
Q

What infection is a risk factor for squamous cell carcinoma of the bladder?

A

Schistosomiasis

53
Q

What is the most common organism causing peritonitis secondary to peritoneal dialysis?

A

Coagulase-negative Staphylococcus e.g. Staph. epidermis

54
Q

What is the commonest type of glomerulonephritis in adults?

A

Membranous glomerulonephritis

55
Q

How does membranous glomerulonephritis typically present?

A

1) nephrotic syndrome

2) proteinuria

56
Q

What medication has been shown to reduce the rate of CKD progression in ADPKD?

57
Q

What is the most common extra-renal manifestation of ADPKD?

A

Liver cysts

58
Q

How are thyroid levels affected in nephrotic syndrome?

A

Loss of thyroxine-binding globulin lowers the total, but not free, thyroxine levels.

59
Q

What 2 parameters should be monitored in HSP to detect progressive renal involvement?

A

1) BP
2) Urinalysis

60
Q

What triad is seen in HUS?

A

1) anaemia
2) microangiopathic haemolytic anaemia
3) thrombocytopenia

61
Q

What can cause hyaline casts on urinalysis?

A

1) normal
2) after exercise
3) during fever
4) loop diuretics

62
Q

If large volumes of 0.9% saline are used, what is there a risk of?

A

Hyperchloraemic metabolic acidosis

63
Q

What is Alport syndrome?

A

It is due to a defect in the gene which codes for type IV collagen resulting in an abnormal GBM.

64
Q

Features of Alport’s syndrome

A
  • microscopic haematuria
  • progressive renal failure
  • bilateral sensorineural deafness
  • lenticonus: protrusion of the lens surface into the anterior chamber
  • retinitis pigmentosa
  • renal biopsy: splitting of lamina densa seen on electron microscopy
65
Q

What cardiac defect is ADPKD associated with?

A

Mitral valve prolapse

66
Q

What is the screening test for ADPKD?

Yr 5 - Renal & Urology (9 decks)

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