Urology/ Nephrology Flashcards
most common type renal stone
calcium oxalate
32 F
HTN
headache
K+ 7.2
acute deterioration after ACEi started
renal artery stenosis
acute loss of renal excretory function
acute tubular necrosis
renal problem with increased antistreptolysin O titres
post streptococcal glomerulonephritis
IgA nephropathy is also called
Bergers disease
24hr-28hr after URTI or GI infection
nephritic Vs nephrotic disease
NEPHRITIC: (blood, low protein, oliguria, haematuira)
- poststreptococcal glomerulonephritis
- IgA nephropathy
- Alports
- glomerulonephritis
NEPHROTIC syndrome:
- deibatic nephropathy
- focal segmental glomerulosclerosis
inability to clean under foreskin is associated with..
cancer of penis in adulthood
haematuria
flank pain
HTN
polycystic kidney disease
specific gravity in urine: high vs low
LOW= dilute urine
e/g. excessive fluid intake
HIG= dehydrated
renal artery stenosis
proteinuria
SIADH
heart failure (less blood flow to kidneys
smooth flucutal swelling within scrotum
separate to testes
when aspirated –> milky fluid
spermatocele
(similar to epididymal cysts but milky rather than clear fluid)
initial imaging investigation for enlarged kidneys ?polycystic
US
interstitial cystitis (bladder pain syndorme)
diagnosis of exclusion
extended duration of symptoms
pelvic pain
urinary symptoms
lack of gynaecological symptoms
How is CKD classified
eGFR
AND
albumin to creating ration (ACR)
has to be > 3 months
BCG vainne cane be used of a treatment for which cancer
bladder
CKD blood gas
metabolic acidosis
what foods contain oxalate (and so should avoid in renal stones)
tea, chocolate, nuts, strawberries, rhubarb, spinach, beans, beetroot, fluids
Alkalosis, insulin, B agonists, hypo-osmolarity
all push K+ INTO cells (–> HYPOkalaemia)
HENCE Cushings is low K+ –> alkalosis
Addisons —> acidosis
does hydrocele transluminate
YES
BPH management drugs
a- adrenergic receptor ANTAGONISTS
5a-reductase inhibitors
other:
transurethral microwave therapy
transurethral needle ablation
TURP
diabetes insipidus
most common cause= LESS ADH
2nd= non responsive to ADH
opposite impact of ADH
excessive thirst, excretion of large amounts of diluted (low osmolality) urine
management:
- STOP DRUGS
- ensure adequate water intake
- consider: thiazide diuretics (excrete NaCl),, NSAIDs, sodium restiriton, desmopressin (ADH)
how to tell difference between diabetes insidious and polydipsia
Water deprivation test
vague pains
bilateral hydronephrosis
drawing together of the ureters in midline on CT/MRI
prei-aoritc mass
retroperitoneal fibrosis
associated with:
autoimmune disease
metastatsis
drugs: BB, methydopa
raised ESR and CRP, aneamia, uraemia
NICE recognise any of the following criteria to diagnose AKI in adults:
↑ creatinine > 26µmol/L in 48 hours
↑ creatinine > 50% in 7 days
↓ urine output < 0.5ml/kg/hr for more than 6 hours
what is normal anion gap (1)
how calculated (1)
8-14
(Na + K) - (Cl + Bicarb)
management minimal change disease
steroids
what causes minimal change disease
(NEPHROTIC syndrome)
The majority of cases are idiopathic, but in around 10-20% a cause is found:
drugs: NSAIDs, rifampicin
Hodgkin’s lymphoma, thymoma
infectious mononucleosis
Features
nephrotic syndrome
normotension - hypertension is rare
highly selective proteinuria
only intermediate-sized proteins such as albumin and transferrin leak through the glomerulus
renal biopsy
normal glomeruli on light microscopy
electron microscopy shows fusion of podocytes and effacement of foot processes
prognosis minimal change disease
1/3 have just one episode
1/3 have infrequent relapses
1/3 have frequent relapses which stop before adulthood
acid base balance in diarrheoa
Diarrhoea - normal anion gap metabolic acidosis
kidneys on US - size in chronic
SMALL shrunken kidnetsy
electrolye change seen in chronic renal failure
hypocalcaemia
when is biopsy indicated in minimal change disease
if steroid response poor
vomiting acid base balance
Diarrhoea can cause a normal anion gap acidosis whereas vomiting causes alkalosis
what infection causes haemolytic uraemia syndrome
E coli
triad of acute kidney injury, microangiopathic haemolytic anaemia and thrombocytopenia
Management
treatment is supportive e.g. Fluids, blood transfusion and dialysis if required
there is no role for antibiotics, despite the preceding diarrhoeal illness in many patients
the indications for plasma exchange in HUS are complicated
as a general rule plasma exchange is reserved for severe cases of HUS not associated with diarrhoea
eculizumab (a C5 inhibitor monoclonal antibody) has evidence of greater efficiency than plasma exchange alone in the treatment of adult atypical HUS
Post-streptococcal glomerulonephritis; what test confirms it
anti-streptolysin O titre
Too many bags of NaCl - what complication
hyperchloaremic metabolic acidosis
in water deprivation test what to conclude if mOsm/kg does not change with exogenous ADH
nephrogenic diabetes insipidus
(unresponsive to ADH–> nephrogenic diabetes insipidus)
what caner do you have varicocele in
Features of renal cell carcinoma:
classical triad: haematuria, loin pain, abdominal mass
pyrexia of unknown origin
left varicocele (due to occlusion of left testicular vein)
endocrine effects: may secrete erythropoietin (polycythaemia), parathyroid hormone (hypercalcaemia), renin, ACTH
25% have metastases at presentation
Kidney transplant failure:
A 24-year-old woman is recovering from a renal transplant. Less than 24 hours after the procedure she reports worsening pain at the transplant site. On examination she is febrile, tender over the transplant and has been anuric since the procedure. Her creatinine has risen markedly over the last 24h.
Pre-existing antiboides against ABO or HLA antigens
(HYPERACUTE rejection)
FYI cell mediated (cytotoxic T cell) rejection is cause of acute rejection in first 6 months to first 24hr
kidneys in diabetic nephropathy vs chronic kidney disease
ENGLARGED
Chronic diabetic nephropathy will have large/normal sized kidneys on ultrasound whereas most patients with chronic kidney disease have bilateral small kidneys
peritoneal dialysis - most common cause
Complications
peritonitis
coagulase-negative staphylococci such as Staphylococcus epidermidis is the most common cause. Staphylococcus aureus is another common cause
antibiotics should cover both Gram positive and Gram negative organisms
the BNF recommends vancomycin (or teicoplanin) + ceftazidime added to dialysis fluid OR vancomycin added to dialysis fluid + ciprofloxacin by mouth
aminoglycosides are sometimes used to cover the Gram negative organisms instead of ceftazidime
sclerosing peritonitis
CKD on haemodialysis - most likely cause of death
IHD
