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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
3 factors that may affect eGFR to cause inaccurate result
pregnancy muscle mass - amputee/body builder red meat 12h before
26
hyperkalaemia on ECG
tall tented T waves flattened P waves wide QRS prolonged PR
27
what is a varicocoele?
an enlargement of the veins within the loose bag of skin that holds your testicles (scrotum) these veins = pampiniform plexus
28
nephritic syndrome - 2 key features
HTN + haematuria
29
whats the commonest cause of GN in adults?
IgA
30
ATN - 2 most common causes?
nephrotoxic drugs | infection
31
ATN - presentation
AKI
32
CKD - how does it affect calcium levels + why?
hypocalcaemia - low vit D → reduced renal absorption of calcium
33
CKD - effect on parathyroid?
secondary hyperparathyroidism (high PTH)
34
what is the role of a fistula in RRT?
arterialisation of the vein - easier to cannulate + lower risk of emboli
35
what causes the palpable thrill in fistula?
arterial blood from radial artery
36
which vein is the artery connected to in fistula in RRT?
cephalic vein at wrist
37
what are the complications of an AV fistula?
infection stenosis thrombosis bleeding
38
why is a fistula needed in RRT?
access to high pressure, high flow arterial blood
39
continuous ambulatory peritoneal dialysis - benefits
low tech, easy + convenient (holidays)
40
continuous ambulatory PED - disadvantages
peritonitis risk malaise + anorexia social issues, inconvenience
41
causes of fatigue in CKD
anaemia - normochromic, normocytic of chronic disease solute retention - cerebral depressants psychosocial - depression
42
causes of breathlessness in CKD
anaemia fluid overload HF - CHD, HTN
43
how does peripheral neuropathy occur in CKD
retention of beta-2-microglobulin -> amyloidosis of peripheral nerves underlying DM
44
how does CKD cause HTN?
renin-A2 activation
45
how does CKD cause osteomalacia?
reduced active vit D
46
how does CKD cause anaemia?
reduced EPO
47
what are 3 features of renal bone disease?
osteoporosis hyperparathyroidism osteomalacia
48
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)
49
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
50
what can cause raised urea?
late stage CKD dehydration HF diuretics
51
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
52
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
53
ABG in sepsis
metabolic acidosis with raised anion gap
54
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
55
what sort of scar would a renal transplant leave?
rutherford monson scar - J scar

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