urorenal Flashcards
wilms’ nephroblastoma - features + who does it affect?
<5y
anorexia + fever
abdo mass + flank pain
painless haematuria
renal stones - symptoms? urine dip findings?
unilateral severe abdo pain radiating to groin
blood, protein + leucocytes
name 6 causes of persistent non-visible haematuria
cancer - prostate, bladder, renal stones BPH + prostatitis urethritis eg chlamydia renal eg IgA nephropathy
what requires an urgent cancer referral for haematuria?
aged 45+ - visible haematuria that’s not a UTI
age 60+ - unexplained nonvisible haematuria plus either dysuria or raised WCC
what to do with a healthy patient age 35 with nonvisible haematuria?
don’t refer - pts under 40 with normal renal function, no proteinuria + normotension don’t need referral
renal colic analgesia
diclofenac
renal colic - investigations
USS
non-contrast CT to confirm
what size of renal stone will pass?
<5mm (unless obstructive)
ureteric obstruction due to stones + infection - mgmt?
surgical emergency
nephrostomy tube, ureteric catheter or ureteric stent
management of renal stones >5mm
shock wave lithotripsy
percutaneous nephrolithotomy
other options exist - depends on case
prevention of calcium renal stones
high fluid intake
low animal protein
low salt
thiazide diuretics
low ca diet doesn’t help!
make up of renal stones
calcium
oxalate
uric acid
minimal change - symptoms, signs + histology finding
nephrotic syndrome - urine protein + froth, facial/ankle swelling
normotension
fusion of podocytes on biopsy
nephrotic syndrome in children and young adults - diagnosis commonly?
minimal change GN
management of minimal change
8wk prednisolone - remission
penicillin as increased infec risk (Ig loss)
ADPKD screening investigation? what’s abnormal?
abdo USS
one or two cysts are normal - develop with age
HSP - features
palpable purpuric rash + oedema on buttocks + extensor surfaces
polyarthritis
abdo pain
heamaturia + renal failure
HSP - management + prognosis?
supportive - NSAIDs + bed rest
OR steroids if bad
monitor renal function
1/3 relapse
IgA nephropathy - presentation
young male
recurrent visible haematuria 1-2d post URTI
renal failure
differentiating IgA nephropathy + post-strep GN
post-strep - 1-2wk post URTI + proteinuria+++
IgA - 1-2d post URTI (A - it comes first) + not so much proteinuria
2 overlapping features of IgA nephropathy + post-strep GN
recent URTI
haematuria
haematuria + HTN - what is this broadly, speaking?
nephritic syndrome
proteinuria + oedema - what is this, broadly speaking?
nephrotic syndrome
renal cell carcinoma - features
fever triad - haematuria, loin pain, abdo mass endocrine effects left varicocoele (occlusion of left testicular vein)
3 factors that may affect eGFR to cause inaccurate result
pregnancy
muscle mass - amputee/body builder
red meat 12h before
hyperkalaemia on ECG
tall tented T waves
flattened P waves
wide QRS
prolonged PR
what is a varicocoele?
an enlargement of the veins within the loose bag of skin that holds your testicles (scrotum)
these veins = pampiniform plexus
nephritic syndrome - 2 key features
HTN + haematuria
whats the commonest cause of GN in adults?
IgA
ATN - 2 most common causes?
nephrotoxic drugs
infection
ATN - presentation
AKI
CKD - how does it affect calcium levels + why?
hypocalcaemia - low vit D → reduced renal absorption of calcium
CKD - effect on parathyroid?
secondary hyperparathyroidism (high PTH)
what is the role of a fistula in RRT?
arterialisation of the vein - easier to cannulate + lower risk of emboli
what causes the palpable thrill in fistula?
arterial blood from radial artery
which vein is the artery connected to in fistula in RRT?
cephalic vein at wrist
what are the complications of an AV fistula?
infection
stenosis
thrombosis
bleeding
why is a fistula needed in RRT?
access to high pressure, high flow arterial blood
continuous ambulatory peritoneal dialysis - benefits
low tech, easy + convenient (holidays)
continuous ambulatory PED - disadvantages
peritonitis risk
malaise + anorexia
social issues, inconvenience
causes of fatigue in CKD
anaemia - normochromic, normocytic of chronic disease
solute retention - cerebral depressants
psychosocial - depression
causes of breathlessness in CKD
anaemia
fluid overload
HF - CHD, HTN
how does peripheral neuropathy occur in CKD
retention of beta-2-microglobulin -> amyloidosis of peripheral nerves
underlying DM
how does CKD cause HTN?
renin-A2 activation
how does CKD cause osteomalacia?
reduced active vit D
how does CKD cause anaemia?
reduced EPO
what are 3 features of renal bone disease?
osteoporosis
hyperparathyroidism
osteomalacia
mechanism of renal bone disease
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)
mechanism of symptoms nephrotic syndrome
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
what can cause raised urea?
late stage CKD
dehydration
HF
diuretics
what is urea? what causes it to be raised and low?
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
what is creatinine? what causes it to be raised or low?
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
ABG in sepsis
metabolic acidosis with raised anion gap
varicocele - venous drainage. how is this linked to presentation?
left spermatic vein drains into left renal vein
right spermatic vein drains into IVC
normally on left - left sided valves often incompetent
what sort of scar would a renal transplant leave?
rutherford monson scar - J scar
