Renal and Urology Flashcards
What would red blood cell casts indicate?
renal AKI
What type of antibiotic is nephrotoxic? If eGFR was declining you would stop these drugs!
Aminoglycosides
What are the 3 zones of the adrenal cortex?
GlomerulosafasiculatareticularisGFRsalt sugar sex –> the deeper you go, the sweeter it gets
What does painless haematuria suggest?
Bladder cancer
(but remember to look into kidney/ureter cancer too)
What is Potter syndrome?
The kidneys fail to develop properly as the baby (usually males) is growing in the womb. The kidneys normally produce the amniotic fluid (as urine) –> there would then be less fetal urine
if a question mentions ‘oligohydraminos’ then it is RENAL AGENESIS
typical facial appearance that occurs in a newborn when there is no amniotic fluid:
flattened face, low se ears, wide eyes
less amniotic fluid = lungs don’t properly form and fetus is squashed –> clubbed feet, wrinkly skin
usually results in a stillbirth or if survives respiratory failure
What is a TURBT?
A trans urethral resection of bladder tumour (TURBT) is usually the first treatment you have for non muscle invasive bladder cancer—> if it’s through the muscle then remove the bladder and prostate/hysteretomy
TURBT can also diagnose bladder cancer and find out whether the cancer has spread into the muscle layer of the bladder wall
What antibiotic is used to treat UTIs? Pregnancy and non?
non-pregnant:
-Trimethoprim (targets Gram negative) or nitrofurantoin for 3 days and 7 days for men
-urine culture sent before starting abx in men, if over 65 in all genders and if there is visible or non-viable haematuria
IF PREGNANT:
-nitrofurantoin 7 days but avoid near term and use amoxicillin then for 7 days
-urine culture sent before and after treatment
What are the indications for dialysis?
AEIOU
-Acidosis
-Electrolyte abnormalities (potassium etc)
-Intoxicants (lithium, chronic kidney disease GFR <15)
-Overload (oedema)
-Uraemic symptoms (nausea, pruritus, malaise)
What is Maple Syrup urine disease?
sweet-smelling urine to do an inherited condition that causes amino acids to build up
metabolic acidosis
How bad do kidney stones need to be for them to be surgically assessed and how do you manage them?
Non- contrast CT KUB
PREG TEST
BLOOD CULTURES
Stones 4mm or less = high probability of passing themselves with pain relief and FLUIDS
Stones 5mm or larger in diameter will most likely need treatment and/or surgical removal:
-shock wave lithotripsy
-ureteroscopy for pregnant people
-percutaneous nephrolithotomy for staghorn or complex stones
prevention—> calcium stones: fluids, thiazides
-NSAIDs
-alpha blocker
-antibiotics if sign of infection
Most common microbe that causes a UTI?
E.coli
How does an enlarged prostate affect peeing? What drugs can be given to help?
weak flow of pee, start/stop peeing, leaking, getting up in the night
tamulosin = alpha-blockers = relaxes muscle so easier to pee
diuretics = speed up urine production during the day so don’t get up at night
finasteride and dutasteride = 5-alpha reductase inhibitors = shrink prostate
What is testicular torsion?
testes to twist around the spermatic chord. When this happens, it cuts off the blood flow to the testicle
sudden, severe pain on one side (usually LEFT)
needs to be treated within 4-6 hours to save unless in newborns where there is a high chance it won’t be saved
if the cremaster reflex is present is it most likely not testicular torsion
if you did the Prehn’s test and it helped relieved the pain it is most likely epididymitis and vice versus for testicular torsion.
What can renal colic (mid-lumbar) pain suggest?
UTI/renal stones or unusually triple A
What is the goal for urine output?
0.5ml/kg/hour
How do you resolve blood in a catheter?
little blood = resolve by itself
lots of blood = due to trauma or a clot = flush clot out
What is Bartter’s syndrome?
inherited severe hypokalaemia due to defective chloride absorption in the ascending loop of Henle
usually presents in childhood
polyuria + polydipsia
hypokalaemia
normotension
weakness
What pain killer is preferred in patient’s with renal impairement?
oxycodone is used in mild renal impairment (GFR 10-50mL), as metabolised by liver (and will also target breathlessness) instead of kidney’s like morphine and codeine
severe renal impairment = fentanyl
What drugs are nephrotoxic and can cause hyperkalaemia?
trimethoprim, ACE inhib, digoxin, losartan, spirloactone, NSAIDs and beta-blockers
When do you treat hyperkalaemia and what is the treatment for it?
** plasma-potassium concentration 6.5 mmol/litre or greater, or in the presence of ECG changes **
IV calcium chloride 10% or calcium gluconate 10% 10ml over 10mins
IV insulin (5–10 units) with 50 mL glucose 50% given over 5-15 minutes
sodium bicarbonate infusion should be considered
Salbutamol by nebulisation or IV: used with caution in patients with cardiovascular disease
Drugs exacerbating hyperkalaemia should be stopped
haemodialysis
What is IgA nephropathy (Berger’s disease)?
visible haematuria a few DAYS after URTI e.g. tonsilitis
What is Alport’s syndrome?
defect in the gene which codes for type IV collagen resulting in an abnormal glomerular-basement membrane (GBM)
-presence of anti-GBM antibodies
-haematuria, proteinuria, hypertension, oedema and temporary oliguria, uraemia and progressive renal failure
Why would you perform a pregnancy test on a male?
their urine may have a high hCG which would indicate prostate cancer
What is the most common cause of acute urinary retention in males?
benign prostatic hyperplasia (prostate gland enlargement)
What is the diagnostic difference between a testicular hydrocele/cyst and a testicular cancer?
a testicular cancer will not transilluminate (shine a pen through and light can be seen) where as hydroceles and cysts will
What are maintenance fluids?
25-30 ml/kg/day of water
1 mmol/kg/day of potassium, sodium and chloride
50-100 g/day of glucose to limit starvation ketosis
What is Henoch-Schonlein purpuara (HSP) and what is it also known as?
IgA small vessel vasculitis
usually seen in children after an infection
-features of IgA nephropathy may occur e.g. haematuria, renal failure, glomerulonephritis
-palpable purpuric rash over bum and extensor surfaces of arms and legs but truncal sparing
-abdo pain and PR bleeding
-polyarthritis of large joints
supportive and analgesia
BP and urinanalysis should be monitored
