Others (inc Renal biopsies, PKD, Phimosis, Peyronie's)

Question 1

Renal biopsies indication

Answer 1

Unexplained AKI/CKD

Acute nephritic syndrome

Suspected transplant rejection

Unexplained proteinuria/haematuria

Question 2

Pre-renal biopsy actions

Answer 2

Stop anticoagulants (aspirin 1wk, warfarin 3dys, LMWH 24hrs)

FBC, clotting, Group + save

US kidneys

Question 3

CI to renal biopsy

Answer 3

HTN 160/90

One kidney (except transplant)

Horseshoe kidney

Abnormal clotting

CKD with small kidenys (<9cm)

Neoplasm

Question 4

Post-biopsy actions

Answer 4

Minimum 6h of bed rest

Monitor BP, urine (blood)

Restart Aspirin/Warfarin after 24hr

Question 5

Genetics of autosomal dominant polycystic kidney disease (ADPKD)

Answer 5

PKD1 mutation (ch16) 85%

PKD2 mutation (ch4) 15%

Question 6

PKD1 mutation course

Answer 6

get end stage kidney failure by 50s

Question 7

PKD2 mutation course

Answer 7

gets end stage kidneys by 70s

Question 8

Renal signs of ADPKD

Answer 8

Renal enlargement with cysts

Abdo pain

Haematuria

Raised BP

Question 9

extra-renal sx of ADPKD

Answer 9

liver cysts

cranial aneurysm/subarach haemorrhage

mitral valve prolapse

ovarian cyst

diverticular disease

Question 10

Rx ADPKD

Answer 10

BP < 130/80

Pain relief by cystectomy/nephrectomy

Diet: More water, less salt and caffeine

Question 11

Autosomal recessive polycystic kidney disease (ARPKD) genetics

Answer 11

chromosome 6

Question 12

Rx for ARPKD

Answer 12

no rx, genetic counselling

Question 13

Retroperitoneal fibrosis pathophysiology

Answer 13

Fibrosis secondary to autoimmune

Scar tissue wrapps around the ureters causing obstruction

Question 14

Retroperitoniteal fibrosis cause

Answer 14

idiopathic retroperitoneal fibrosis (RPF),

inflammatory AAA

perianeurysmal RPF

Question 15

Typical presentation of retroperitoneal fibrosis

Answer 15

middle aged man with vague loin/back/abdo pain

Raised BP

Question 16

Ix for retroperitoneal fibrosis

Answer 16

US: hydronephrosis

CT/MRI: periaortic mass

Question 17

Rx for retroperitoneal fibrosis

Answer 17

retrograde ureteric stents

+/- dissection of ureters from retroperitoneal tissue

immunosuppression with low dose steroids

Question 18

Pyonephrosis

Answer 18

infected hydronephrosis

Question 19

Phimosis

Answer 19

Foreskin occludes the meatus

Question 20

Phimosis rx

Answer 20

In kids, time/gentle trials of retracting foreskin may help

Adults, circumcision

Question 21

Paraphimosis

Answer 21

tight foreskin becomes irretractable

venous blood unable to return

oedema and ischaemia of glans

Question 22

Paraphimosis rx

Answer 22

Ask pt to squeeze glans

Apply 50% glucose-soaked swab (to reduce oedema)

Icepack/lidocaine gel

Aspiration/Dorsal slit/circumcision

Question 23

Peyronie’s disease aka

Answer 23

penile angulation

Question 24

Peyronie’s disease pathophysiology

Answer 24

Multiple microvascular trauma during intercourse

Leads to penile curvature and painful erections

Question 25

Conditions ass with Peyronie’s disease

Answer 25

Dupuytrens

Atheroma

Radical prostectomy

Question 26

Age of Peyronie’s disease

Answer 26

>40 yo

Question 27

Rx of Peyronie’s disease

Answer 27

Potassium para-aminobenzoate PO

Intralesional verapamil, clostridial collagenase or interferon alpha 2B

Topical verapamil + dexamethasone

Question 28

Surgery for Pyronie’s disease

Answer 28

If > 3months

Tunical plication + penile prostheses