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Progress > urorenal > Flashcards

urorenal Flashcards

1
Q

wilms’ nephroblastoma - features + who does it affect?

A

<5y
anorexia + fever
abdo mass + flank pain
painless haematuria

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2
Q

renal stones - symptoms? urine dip findings?

A

unilateral severe abdo pain radiating to groin

blood, protein + leucocytes

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3
Q

name 6 causes of persistent non-visible haematuria

A 
cancer - prostate, bladder, renal
stones
BPH + prostatitis
urethritis eg chlamydia
renal eg IgA nephropathy
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4
Q

what requires an urgent cancer referral for haematuria?

A

aged 45+ - visible haematuria that’s not a UTI

age 60+ - unexplained nonvisible haematuria plus either dysuria or raised WCC

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5
Q

what to do with a healthy patient age 35 with nonvisible haematuria?

A

don’t refer - pts under 40 with normal renal function, no proteinuria + normotension don’t need referral

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6
Q

renal colic analgesia

A

diclofenac

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7
Q

renal colic - investigations

A

USS

non-contrast CT to confirm

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8
Q

what size of renal stone will pass?

A

<5mm (unless obstructive)

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9
Q

ureteric obstruction due to stones + infection - mgmt?

A

surgical emergency

nephrostomy tube, ureteric catheter or ureteric stent

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10
Q

management of renal stones >5mm

A

shock wave lithotripsy
percutaneous nephrolithotomy

other options exist - depends on case

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11
Q

prevention of calcium renal stones

A

high fluid intake
low animal protein
low salt
thiazide diuretics

low ca diet doesn’t help!

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12
Q

make up of renal stones

A

calcium
oxalate
uric acid

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13
Q

minimal change - symptoms, signs + histology finding

A

nephrotic syndrome - urine protein + froth, facial/ankle swelling
normotension
fusion of podocytes on biopsy

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14
Q

nephrotic syndrome in children and young adults - diagnosis commonly?

A

minimal change GN

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15
Q

management of minimal change

A

8wk prednisolone - remission

penicillin as increased infec risk (Ig loss)

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16
Q

ADPKD screening investigation? what’s abnormal?

A

abdo USS

one or two cysts are normal - develop with age

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17
Q

HSP - features

A

palpable purpuric rash + oedema on buttocks + extensor surfaces
polyarthritis
abdo pain
heamaturia + renal failure

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18
Q

HSP - management + prognosis?

A

supportive - NSAIDs + bed rest
OR steroids if bad
monitor renal function

1/3 relapse

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19
Q

IgA nephropathy - presentation

A

young male
recurrent visible haematuria 1-2d post URTI
renal failure

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20
Q

differentiating IgA nephropathy + post-strep GN

A

post-strep - 1-2wk post URTI + proteinuria+++

IgA - 1-2d post URTI (A - it comes first) + not so much proteinuria

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21
Q

2 overlapping features of IgA nephropathy + post-strep GN

A

recent URTI

haematuria

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22
Q

haematuria + HTN - what is this broadly, speaking?

A

nephritic syndrome

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23
Q

proteinuria + oedema - what is this, broadly speaking?

A

nephrotic syndrome

24
Q

renal cell carcinoma - features

A 
fever
triad - haematuria, loin pain, abdo mass
endocrine effects
left varicocoele (occlusion of left testicular vein)
25
Q

3 factors that may affect eGFR to cause inaccurate result

A

pregnancy
muscle mass - amputee/body builder
red meat 12h before

26
Q

hyperkalaemia on ECG

A

tall tented T waves
flattened P waves
wide QRS
prolonged PR

27
Q

what is a varicocoele?

A

an enlargement of the veins within the loose bag of skin that holds your testicles (scrotum)
these veins = pampiniform plexus

28
Q

nephritic syndrome - 2 key features

A

HTN + haematuria

29
Q

whats the commonest cause of GN in adults?

A

IgA

30
Q

ATN - 2 most common causes?

A

nephrotoxic drugs

infection

31
Q

ATN - presentation

A

AKI

32
Q

CKD - how does it affect calcium levels + why?

A

hypocalcaemia - low vit D → reduced renal absorption of calcium

33
Q

CKD - effect on parathyroid?

A

secondary hyperparathyroidism (high PTH)

34
Q

what is the role of a fistula in RRT?

A

arterialisation of the vein - easier to cannulate + lower risk of emboli

35
Q

what causes the palpable thrill in fistula?

A

arterial blood from radial artery

36
Q

which vein is the artery connected to in fistula in RRT?

A

cephalic vein at wrist

37
Q

what are the complications of an AV fistula?

A

infection
stenosis
thrombosis
bleeding

38
Q

why is a fistula needed in RRT?

A

access to high pressure, high flow arterial blood

39
Q

continuous ambulatory peritoneal dialysis - benefits

A

low tech, easy + convenient (holidays)

40
Q

continuous ambulatory PED - disadvantages

A

peritonitis risk
malaise + anorexia
social issues, inconvenience

41
Q

causes of fatigue in CKD

A

anaemia - normochromic, normocytic of chronic disease
solute retention - cerebral depressants
psychosocial - depression

42
Q

causes of breathlessness in CKD

A

anaemia
fluid overload
HF - CHD, HTN

43
Q

how does peripheral neuropathy occur in CKD

A

retention of beta-2-microglobulin -> amyloidosis of peripheral nerves
underlying DM

44
Q

how does CKD cause HTN?

A

renin-A2 activation

45
Q

how does CKD cause osteomalacia?

A

reduced active vit D

46
Q

how does CKD cause anaemia?

A

reduced EPO

47
Q

what are 3 features of renal bone disease?

A

osteoporosis
hyperparathyroidism
osteomalacia

48
Q

mechanism of renal bone disease

A

renal damage → phosphate retention
renal damage → loss of 1-alpha enzyme → reduced vit D activation, reduced gut Ca absorption, hypocalcaemia

both → increased PTH → activation of osteoclasts (→ tips + shafts of digits + pepper pot skull) + of osteoblasts (→sclerotic vertebrae)

49
Q

mechanism of symptoms nephrotic syndrome

A

increase in size + number of BM pores → protein leak

→ frothy urine

→ increased lipid synthesis, loss of anti-thrombin, high platelets → thrombotic tendency

→ loss of oncotic pressure → oedema

→ protein catabolism → wasting

50
Q

what can cause raised urea?

A

late stage CKD
dehydration
HF
diuretics

51
Q

what is urea? what causes it to be raised and low?

A

breakdown product of protein

may rise in people who are fit, on a high protein diet, GI bleed, catabolic state (trauma, infection, fever)
may be low in liver disease, over-hydration, malnutrition

52
Q

what is creatinine? what causes it to be raised or low?

A

breakdown product of creatine in skeletal muscle
plasma levels vary hugely according to muscle mass
also varies with age + gender
low - frail + elderly w CKD, amputee
high - muscular/athletic, late CKD

53
Q

ABG in sepsis

A

metabolic acidosis with raised anion gap

54
Q

varicocele - venous drainage. how is this linked to presentation?

A

left spermatic vein drains into left renal vein
right spermatic vein drains into IVC

normally on left - left sided valves often incompetent

55
Q

what sort of scar would a renal transplant leave?

A

rutherford monson scar - J scar

Progress (20 decks)

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