renal

Question 1

indications for urostomy

Answer 1

cystectomy for bladder cancer, pelvic clearance for extensive cancer
→ ileal conduit / indiana pouch (with ileocaecal valve)

Question 2

complications of renal transplant

Answer 2

immediate: surgical complications (pain, infection, bleeding)
early: rejection
late: failure
immunosupression: opportunistic infections (CMV), malignancy (lymphoma)

Question 3

nephrotic vs nephritic syndrome

Answer 3

nephrotic: oedema, hypoalbuminaemia, proteinuria (+ hyperlipidaemia)
nephritic: haematuria, proteinuria, oedema (+ HTN)

Question 4

causes of nephrotic syndrome

Answer 4

primary:
membranous glomerulonephritis (older pts)
minimal change (children)
focal segmental glomerulosclerosis (young adults)

secondary:
diabetes, amyloidosis, SLE, HBV/HCV

Question 5

causes of nephritic syndrome

Answer 5

primary:
IgA nephropathy: days after URTI / GI infection
mesangiocapillary glomerulonephritis

secondary: 
post-strep: 2-12wks after throat / skin infection 
goodpasture's: anti-GBM  vasculitis
SLE
cryoglobulinaemia

Question 6

differentials for palpable kidneys

Answer 6

bilateral: PKD, RCC (5%), hydronephrosis, amyloidosis
unilateral: PKD + nephrectomy, RCC, simple cyst, hydronephrosis, renal agenesis → hypertrophy of other kidney

Question 7

presentation of PKD

Answer 7

loin pain
haematuria
recurrent UTIs 
renal stones 
abdo mass / palpable kidneys 
HTN 
hepatomegaly (if liver cysts)

Question 8

investigations PKD

Answer 8

bloods: raised Hb (excess erythrompoeitin) 
U&Es deranged 
creatinine 
genetic testing 
urine dip → haematuria 
renal USS (diagnostic for +ve FH)
CT abdo + pelvis

Question 9

management PKD

Answer 9

cons: monitor renal function & for complications
genetic counselling
med: treat HTN
analgesia for renal pain / treat cause (e.g. renal stones)
dialysis for renal failure
surg: CT-guided cyst aspiration
nephrectomy for recurrent bleeds / infection
renal transplant

Question 10

management PKD

Answer 10

cons: monitor renal function & for complications
genetic counselling
med: treat HTN
analgesia for renal pain / treat cause (e.g. renal stones)
dialysis for renal failure
surg: CT-guided cyst aspiration
nephrectomy for recurrent bleeds / infection
renal transplant

Question 11

indications for renal replacement therapy

Answer 11

complications refractory to Tx
acidosis
electrolyte abnormalities: hyperkalaemia
intoxicants: salicylates, methanol, lithium
overload (fluid)
uraemia → encephalopathy

Question 12

causes of chronic kidney disease

Answer 12

diabetes
HTN
glomerulonephritis
PKD 
systemic conditions: SLE, vasculitis
nephrotoxic drugs: lithium, mesalazine 
obstruction: recurrent urinary stones

Question 13

management of chronic kidney disease

Answer 13

cons: diet, exercise, stop nephrotoxic drugs, smoking cessation
med: treat HTN
diuretics → oedema
EPO + vit D replacement
surg: RRT, transplant

Question 14

RFs for renal cell carcinoma

Answer 14

smoking
HTN
von-hippel lindau
dialysis

Question 15

presentation of renal cell carcinoma

Answer 15

loin pain / mass
haematuria
varicocele
FLAWS

Question 16

types of renal cell carcinoma

Answer 16

1. clear cell (75%)
2. papillary
3. chromophobe
4. collecting duct

Question 17

complications of haemodialysis

Answer 17

site infection, sepsis
site stenosis
air embolism
dialysis disequilibrium syndrome (cerebral oedema)

Question 18

complications of peritoneal dialysis

Answer 18

peritonitis
sepsis
hernias

Question 19

management renal stones

Answer 19

cons: observation (<5mm → 95% pass spontaneously)
high fluid intake
med: analgesia
tamsulosin (alpha-blocker, promotes expulsion)
treat UTI
surg: extracorporeal shockwave lithotripsy (ESWL)
cystoscopy + JJ stent insertion (to bypass blockage)
percutaneous nephrolithotomy
uretero-renoscopy + laser

Question 20

types of kidney stones

Answer 20

calcium oxalate (most common) 
magnesium ammonia phosphate (struvite): assoc w infection (proteus)
uric acid (gout) 
calcium phosphate 
cysteine

Question 21

causes of kidney stones

Answer 21

hypercalcaemia
dehydration
gout
urinary tract abnormalities e.g. horse-shoe kidney

Question 22

management of renal obstruction

Answer 22

requires urgent Tx:
percutaneous nephrostomy
cystoscopy + JJ stent insertion
+ IV ABx + fluids

Question 23

types of testicular cancer (+ tumour markers)

Answer 23

germ cell (95%):
seminomas (50%)
non-seminoma: teratoma, choriocarcinoma, yolk sac, mixed
non-germ cell: leydig cell, gonadoblastoma

teratoma + seminoma most common
teratoma (all 3 germ cell layers) → younger pts, more aggresive, AFP + bHCG
seminoma (epithelium of seminoferous tubules) → older pts, less aggressive, bHCG only

Question 24

causes of AKI

Answer 24

pre-renal: reduced perfusion
hypovolaemia: diarrhoea, vomiting, haemorrhage, dehydration, burns
reduced cardiac output: heart failure

renal:
acute tubular necrosis: ischaemia / nephrotoxic agents (e.g. ACEi, gentamicin, contrast media, rhabdomylysis)
glomerulonephritis
vascular: HUS, TTP, DIC, vasculitides

post-renal: obstruction
renal calculi
tumours
prostate enlargement

Question 25

ABx therapy for acute pyelonephritis

Answer 25

broad-spectrum cephalosporin 
OR fluoroquinolone (if non-pregnant)