Urology - symptoms + signs Flashcards

Question

PKD polycystic kindey disease symptoms and signs

Answer 1

• Palpable kidneys/abdominal mass • Abdominal/flank pain o Need to exclude nephrolithiasis, infection, haemorrhage, UTIs, hepatic enlargement * Nocturia * Haematuria * UTIs (dysuria, urgency, suprapubic pain, fever) • Impaired urine concentrating capacity – excessive water + salt loss • Renal cysts o Kidneys progressively enlarge + become distorted with little recognisable parenchyma on imaging studies o Renal function drops • Renal stones o Twice as common as in the general population o Uric acid stones are more common than calcium oxalate stones • Hepatomegaly o Due to polycystic liver disease • Liver cysts – most common extra-renal manifestation of ADPKD • Intracranial (berry) aneurysms o May cause cranial nerve palsies or seizures • HTN o Will often present before renal function abnormalities o Presents at a relatively young age – detection of HTN before any other clinical manifestations is often how disease is first detected in pt 20-34 years of age o Associated with L ventricular hypertrophy • Cardiac murmur o Mitral valve prolapse, MR, AR • Aortic root dilation o Can cause aortic insufficiency • Aortic root aneurysms • Abdominal wall hernias Often there is • Bilateral renal enlargement and cysts Or • Presence of multiple bilateral renal cysts + hepatic cysts

Answer 2

Classic triad - Haematuria - Loin pain - Loin mass ``` Varicocele - Testicular swelling (blockage of the L gonadal vein which drains into the L renal vein) Weight loss Anorexia Sweating Fatigue Fever ``` Symptoms of metastatic disease(commonly metastasises to the lungs + bones) - Haemoptysis - Bone pain - Pathological fractures Paraneoplastic syndromes - Anaemia - Polycythaemia - Hypercalcaemia - Hepatic dysfunction - Amyloidosis - Renin - raised BP

Answer 3

• HTN o Renal hypoperfusion - hyperactivation of the renin-angiotensin-aldosterone axis o Abrupt onset o Resistant to standard medical therapy o HTN w hypokalaemia (due to hyperaldosteronism) * Hx of other peripheral vascular disease * Vascular risk factors – corneal arcus, xanthomata, xanthelasmata, raised BP * Abdominal ± carotid or femoral bruits, weak leg pulses * Hx of unexplained kidney dysfunction developing in a normotensive/hypertensive pt with vascular disease/risk factors * Biochemical evidence of renal impairment occurring during treatment with ACEi or ATII antagonist • Sudden or unexplained pulmonary oedema o CCF -May present with “flash pulmonary oedema” – recurrent episodes of acute pulmonary oedema with no obvious precipitant

Answer 4

- Osteopenia - Salt + pepper skull - Subperiosteal erosions - Brown tumours - pseudofractures - Rugger jersey spine

Answer 5

``` Children + young adults Associated with eczema + asthma Loss of podocyte foot processes/podocyte fusion Vacuolation Appearance of microvilli on histology ``` Normal light microscopy

Answer 6

young adults HIV heroin use * Podocyte fusion * Segmental scars on histology

Answer 7

Severe chronic uraemia – yellow skin (lemon yellow, uraemic frost) Uraemic encephalopathy – clouding of consciousness, acute confessional state, myoclonic jerks, seizure, coma, hiccoughing

Answer 8

Haemoptysis Haematuria anti-GBM ab patients tend to be fluid overloaded (nephritic syndorme) autoimmune - ab are formed against the GBM + alveolar membrane

Answer 9

``` Analgesic nephrotpathy chronic NSAID use haematuria Anaemia UTI ``` ``` Acute tubulointerstitial nephritis drug hypersensitivity reaction fever rash arthralgia oesinophilia ``` Acute tubular necrosis commonly due to renal ischaemia other causes - drugs, contrast agents, hypovolaemia (diuretics, heart failure) Early oliguria followed by recovery of renal function and increase in renal output GFR remains low due to tubular damage full renal capacity regained within 6 weeks Acute tubular necrosis – hypovolaemia, nephrotoxic drugs (hyponatraemia, hyperkalaemia) Patients recover within a few days/week Acute interstitial nephritis – adverse reaction to a drug Fever, rash, nausea, vomiting

Answer 10

Nephrotic range proteinuria Large kidneys on US Collapsing focal segmental glomerulosclerosis on renal biopsy

Answer 11

Symptoms of CKD tend to occur once GFR <30 ``` Anorexia N+V Pruritus Fatigue Muscle cramps Peripheral oedema Pulmonary oedema ```

Answer 12

Most common cause of intrinsic AKI Results from renal hypoperfusion (e.g. CCF) or nephrotoxic drugs Oliguria + features of renal failure ``` features of renal failure Anorexia N+V Pruritus Fatigue Muscle cramps Peripheral oedema Pulmonary oedema ```

Answer 13

Granulomatosis with polyangiitis (Wegener's) Eosinophilic Granulomatosis with polyangiitis (Churg Strauss) Microscopic polyangiitis