Urology Flashcards
What are hyaline casts?
Tamm-Horsfall protein
When might you see Tamm-Horsfall protein in the urine?
After exercise, during fever or with loop diuretics
What medication can you give for autosomal dominant polycystic kidney disease?
Tolvaptan
Why do you get hypocalcaemia in chronic kidney disease?
Kidneys cant activate vitamin D or excrete phosphate, calcium is converted to calcium phosphate, which causes hyperparathyroidism
What is the first line management of symptomatic BPH?
Alpha-1 antagonists - like tamulosin (relaxed prostatic smooth muscle)
What may cause raised PSA?
prostate cancer, BPH, prostatitis, UTI, ejaculation in last 48hrs, vigorous exercise in last 48hrs, urinary retention
What is the most common cancer to develop after a renal transplant?
squamous cell carcinoma (due to T-cell suppression)
What are the drugs that commonly cause acute interstitial nephritis?
penicillin, rifampicin, NSAIDs, allopurinol, furosemide
What are the features of membranous glomerulonephropathy/nephritis?
- often associated with malignancy
- causes a nephrotic syndrome
- on microscopy: thickened basement membrane, with electron dense deposits
What is the management of membranous glomerulonephropathy?
- ACE-I or ARB
- many spontaneously resolve
- immunosuppression for severe cases: steroid + cyclophosphamide
What is henoch-schonlein purpura?
An IgA mediated small vessel vasculitis - affects the kidneys
What are the features of Henoch-Schonlein purpura?
Palpable purpuric rash, over buttocks and extensor surfaces, abdominal pain, polyarthritis, IgA nephropathy - haematuria and renal failure
What is the management of Henoch-Schonlein purpura?
- analgesia for arthralgia
- generally self limiting
- measure blood pressure and urinalysis
What are the common signs and symptoms of renal cell cancers?
Haematuria, loin pain, abdominal mass, pyrexia
How does CKD affect fracture risk?
CKD can mean no activation of vitamin D, so poor bone quality
Which transporter do thiazide diuretics block?
Na-Cl in DCT - can cause hypercalcaemia and hypocalciuria
What are the features of acute tubular necrosis?
^ urine sodium, low urine osmolality, normal urea:creatinine ratio
What is the management of renal stones > 20 mm?
Percutaneous nephrolithotomy
What is the management of minimal change disease?
Oral steroids
What are the features of focal segmental glomerulosclerosis?
- nephrotic syndrome and CKS
nephropathy in younger adults
Why does CKD cause a high phosphate?
- low vit D activation in kidneys
- kidneys usually excrete phosphate but are not working so phosphate is high
How does compartment syndrome cause AKI?
compartment syndrome leads to rhabdomyolysis, leads to deposition of myoglobin in the tubules causing AKI with blood
What is the surgical management of testicular torsion?
urgent fixation of both testicles
What are the typical features of IgA nephropathy?
visible haematuria following recent viral infection
How can you differentiate between pre-renal and renal/post AKI?
pre = high serum urea:creatinine ratio, usually responds to fluid challenge, BP changes
renal = ratio less than 100
What investigation is used to assess whether someone has CKD?
urinary albumin:creatinine ratio
What investigation is used to diagnose vesico-ureteric reflux?
micturating cystourethrogram
What investigation is used to diagnose bladder cancer?
Cystoscopy
What is the first line management of pain with renal colic?
IM diclofenac
If kidney impairment: IV paracetamol
How can you differentiate dehydration from AKI on bloods?
Dehydration - urea rise much higher than creatinine
How do you calculate the anion gap?
+ve ions minus -ve ions
What is a normal anion gap?
8-14 mmol/L
What is the maximum rate of potassium infusion?
10mmol/hour
What are the most common causes of nephrotic syndrome in adults and children?
Adults: membranous nephropathy
Children: minimal change disease
How do you investigate suspected diabetes insipidus?
Water deprivation test
high plasma osmolality, low urine osmolality
What is henoch-schonlein purpura?
IgA mediated small vessel vasculitis, usually seen in children following an infection. Causes purpuric rash with oedema over buttocks and extensor surfaces
What should be monitored in patients with henoch-schonlein prurpura?
Blood pressure and urinalysis
Which common drugs are nephrotoxic?
NSAIDs, aminoglycosides, ACE-I, ARBs, diuretics, contrast - should be stopped in AKI
Why do you get IgA nephropathy/HSP following a viral infection?
IgA is produced on mucosal surfaces during infection, builds up on kidneys
What type of picture does IgA nephropathy present with?
Nephritic - 1-2 days following URTI,
Why is nephrotic syndrome associated with a hyper-coagulable state?
Antithrombin 3 and plasminogen is lost via kidneys
What are the features of acute interstitial nephritis?
Allergic picture - fever, rash etc
Raised eosinophils, sterile pyuria and white cell casts
Usually drug induced
What factors can affect eGFR?
Pregnancy, muscle mass (amputees, body-builders), eating red meat before taking the sample
How do you distinguish between renal and pre-renal AKI?
pre-renal (kidneys hold onto sodium to preserve volume, good response to fluid challenge, raised urea)
renal: poor response to fluid challenge
What ABG results would you see with mesenteric ischaemia?
Metabolic acidosis with high lactate
How do you work out urea:creatinine ratio?
Urea/(creatinine/1000) - if > 100 pre-renal
What is the management of proteinuria in patients with CKD?
ACE-I or ARBs
or SGLT-2 Inhibitors
How do you classify CKD stages?
- > 90egfr with signs of kidney damage
- 60-90egfr with signs of kidney damage
3a. 45-59
3b. 30-44 - 15-29
- <15
What test is done to screen for diabetic nephropathy?
Albumin:creatinine ratio on spot sample then in early morning specimen
Why does nephrotic syndrome cause a hypercoagulable state?
loss of anticoagulant proteins from blood
What is the mechanism of action of calcium resonium?
Removes potassium from the body, by binding to it in the GI tract, promoting it’s excretion in faeces
At what ACR should patients be started on an ACE-I in CKD?
> 30
What investigation do you do in AKI of unknown origin?
Renal ultrasound
What do you use to screen for adult PKD?
Ultrasound
What is the difference in blood findings between interstitial nephritis and glomerulonephritis?
glomerulonephritis - haematuria and proteinuria. raised platelets
interstitial nephritis - mild proteinuria
What should you check before starting EPO injections?
iron levels - correct deficiencies before starting EPO
Why does adrenal insufficiency cause a metabolic acidosis with hyperkalaemia?
less aldosterone, more sodium loss, more potassium retention. more sodium loss also causes H+ retention causing acidosis
What are the features of acute interstitial nephritis?
Fever, rash, arthralgia, eosinophilia, hypertension, renal impairment. Urine microscopy: sterile pyuria and white cell casts
what features on a urine dip indicate an infection?
Raised nitrates and leukocytes - if inflammation can just be raised leukocytes
What is a normal anion gap?
10-18
What picture on an ABG does prolonged diarrhoea produce?
A metabolic acidosis with hypokalaemia
When might you offer haemodialysis in AKI?
When the patient has pulmonary oedema, hyperkalaemia or acidosis
