Flashcards in Clinical Deck (547):
what is kidney agenesis?
a congenital absence of one or both kidneys
what is kidney hypoplasia?
a congenital condition causing small kidneys with normal development and function
what is a horseshoe kidney?
kidneys congenitally fused at either pole- usually lower
do simple cysts usually cause a functional disturbance?
what are the 2 main types of polycystic kidney disease?
-autosomal recessive PKD (prev known as infantile)
-autosomal dominant PKD (prev known as adult)
what is the most common subtype of ARPKD?
what does the perinatal group of ARPKD cause?
terminal renal failure
what happens to the medullary collecting ducts in ARPKD?
what liver condition is ARPKD associated with?
congenital hepatic fibrosis
what is the most common inherited kidney disease?
autosomal dominant polycystic kidney disease
compare ADPKD 1 and ADPKD2 in terms of chromosomes affected? (give percentages)
ADPKD 1: defect on chromosome 16 (90%)
ADPKD 2: defect on chromosome 4 (10%)
what is the aetiology of ARPKD?
what is the aetiology of ADPKD?
when does ADPKD present?
usually in middle adult life
what does ADPKD present with?
chronic renal failure
where do cysts arise in ARPKD?
medullary collecting tubules
where do cysts arise in ADPKD?
any part of the nephron
which other organs can be affected with cysts in ADPKD?
what functionally happens to the liver, pancreas, lung when affected in ADPKD?
no funcional effect
what aneurysm is ADPKD associated and what can this lead to?
berry aneurysm in circle of Willis
can lead to subarachnoid haemorrhage
compare ARPKD and ADPKD in terms of the gross shape of the kidney?
ARPKD- enlargment but shape is still there
ADPKD- massive enlargement, shape is distorted
why can haematuria occur in ADPKD?
cysts can be filled with blood
compare the causes of intracerebral haemorrhage and subarachnoid haemorrhage in ADPKD?
intracerebral- due to hypertension caused by chronic renal faiulre
subarachnoid- due to berry aneurysm in circle of Willis
what is the most common benign renal tumour?
what part of the kidney does a fibroma originate from?
what is an adenoma? (of anywhere)
a benign tumour of the epithelium
where do renal adenomas originate from?
usually capillary walls in the cortex
what type of cells do renal angiomyolipomas contain?
fat, muscle, blood vessels
what type of cells does a juxtaglomerular cell tumour arise from?
what renal tumour is tuberous sclerosis associated?
why can juxtaglomerular cell tumours cause secondary hypertension?
they overproduce renin
even though renal angiomyolipomas are benign, why may they cause kidney dysfunction?
because they can be large and multiple
what is the most common intra-abdominal tumour in children?
nephroblastoma (Wilm's tumour)
what cells does a nephroblastoma (Wilms tumour) arise from?
primitive renal tissue
where do urothelial carcinomas tend to arise?
renal pelvis and calyces
where do renal cell carcinomas arise from?
renal tubular epithelium
what are renal cell carcinomas also known as?
clear cell carcinoma
what is the commonest primary renal tumour in adults?
renal cell carcinoma
what age group do renal cell carcinomas tend to present in?
55-60 years old
who is more likely to get a renal cell carcinoma- M or F?
what does a renal cell carcinoma present with?
systemic features of malignancy
what are the paraneoplastic manifestations of renal cell carcinoma?
erythropoietic stimulating substance: polycythaemia and increased haemaglobin
hormone similar to parathyroid: hypercalcaemia
what specific finding is a poor prognosis of a renal cell carcinoma?
renal vein extension
compare blood and lymph spread in renal cell carcinoma?
blood spread is first
lymph spread is later
which is the most common subtype of renal cell carcinoma?
clear cell type
what system is used to histologically grade renal cell carcinomas?
Fuhrman grading system
what is the most common type of bladder cancer?
transitional cell carcinoma
where can transitional cell carcinomas arise?
renal calyces right down to urethra
what industries have occupational risk of transitional cell carcinoma?
what is the biggest risk factor of transitional cell carcinoma?
what chronic parasitic infestation is a risk factor for transitional cell carcinoma?
what is the commonest symptom of transitional cell carcinoma?
where do 75% of transitional cell carcinomas occur?
what does a pTa grade transitional cell carcinoma mean?
superficial and non invasive carcinomal
what does a pT1 grade transitional cell carcinoma mean?
what does a pT2 grade transitional cell carcinoma mean?
detrusor muscle invasion
which lymph nodes do transitional cell carcinomas tend to spread to?
obturator nodes in pelvis
why can transitional cell carcinomas in the badder lead to hydroureter and hydronephrosis?
obstruction causing back pressure of urine
what are the 3 risk factors of an adenocarcinoma in the urinary tract?
-congenital bladder extroversion
-long standing cystitis cystica
what are urachal remnants?
when the urachus- which connects bladder to umbilical cord- doesnt become fully obliterated
what is cystitis cystica?
a benign proliferation of the bladder as a response to chronic irritation
what are the 2 risk factors of a squamous cell carcinoma in the urinary tract?
-long term schistosomiasis
why can calculi lead to a squamous cell carcinoma?
cause irritation which leads to metaplasia then dysplasia
what is the most common malignant bladder tumour in children?
what is urinary incontinence?
complaint of any involuntary leakage of urine
what is stress urinary incontinence?
involuntary leakage of urine on effort or exertion (ie sneezing/coughing)
what is urgency urinary incontinence?
involuntary leakage of urine accompanied by urgency
what is urgency?
complaint of a sudden compelling desire to pass urine which is difficult to defer
what is overactive bladder syndrome/urge syndrome/urgency-frequency syndrome?
urgency +/- urge incontinence, usually with frequency, and nocturia
what is detrusor overactivity incontinence?
involuntary leakage of urine due to an involuntary detrusor contaction
what is mixed urinary incontinence?
involuntary leakage of urine associated with urgency and also exertion/effort
what is the name of this collection of symptoms- slow stream, splitting of urinary stream, spraying of urinary stream, hesitancy, straining?
what is a frequency volume chart?
a chart which records volumes voided and times of each micturation for at least 24 hours
what are the 4 types of urinary incontinence? (urethral route)
what are the 2 main causes of extraurethral route of urine?
in storage phase, compare intravesical and urethral pressure?
intravesicle pressure is less than urethral pressure
in voiding phase, compare intravesical and urethral pressure?
intravesicle pressure is more than urethral pressure
what is urodynamic testing?
determines pressures within the micturation system
in a normal situation, what happens to the intravesicle pressure on coughing?
in a normal situation what happens to the abdominal pressure on coughing?
in a normal situation what happens to the detrusor pressure on coughing?
what is the underlying cause of overflow incontinence?
bladder outflow obstruction causing chronic retention
in overflow incontinence, is there an urgency to urinate?
no, you don't realise you have done it
compare the frequency of urination in a normal patient to someone with urge syndrome?
frequency is increased
compare the volume of urine voided in a normal patient to someone with urge syndrome?
small voided volumes
in a patient with urge syndrome due to detrusor overactivity, what happens to the detrusor pressure on coughing?
what is the main cause of urge syndrome?
what are the causes of detrusor overactivity?
-something in the wall of the bladder causing irritation (stone, tumour)
-loss of central inhibition of micturation reflex (paraplegia)
compare loss of central inhibition of micturation reflex (paraplegia) to destruction of S2,3 centre in terms of cause of urge incontinence?
loss of central inhibition (paraplegia)- overacitivty of detrusor
destruction of S2-3 centre- loss of detrusor muscle function
what is idiopathic detrusor overacitivity?
urge syndrome caused by detrusor overacitivty with no undelying cause
how do you diagnose urge incontinence/syndrome?
what causes stress incontinence?
damage to pelvic floor or urethral function
what is the most common underlying cause of damage to pelvic floor/urethral function in stress incontinence?
how do you diagnose stress incontinence?
is there urgency in stress incontinence?
(unless mixed incontinence)
in a patient with stress incontinence, what happens to the detrusor pressure on coughing?
nothing (detrusor is working normally)
what happens to the volume of the urine leak in stress incontinence as the bladder becomes fuller?
why might people with stress incontinence go to the toilet frequently even though there is no sense of urgency?
a learned habit, a technique to prevent the bladder volume getting large therefore preventing leaking volumes being large
what is the most likely cause of a painless palpable mass arising from the pelvis which is dull to percus and unable to get below it in a female who has amenorrhoea?
what is the most likely cause of a painless palpable mass arising from the pelvis which is dull to percus and cannot get below it in a middle aged male?
how do you treat overflow urinary incontinence?
catheterise and teach patient to intermittently self catheterise (rehabilitates the bladder)
what is the dietary treatment of urge urinary incontinence?
what is the pharmacological treatment of urge urinary incontinence?
antimuscarinics (oxybutynin, tolterodine)
beta 3 adrenergic (mirabegron)
what invasive surgery can be done for the treatment of urge urinary incontinence?
enterocystoplasty (makes bladder larger)
what is the lifestyle treatment of stress incontinence?
what is the physio treatment of stress incontinence?
pelvic floor exercises
what is the surgical treatment of stress incontinence?
what is the cause of an ectopic ureter?
what is the main cause of a vesico-vaginal fistula in developing countries?
prolonged obstructed labour
describe the appearance of bowen's disease of the penis?
dry crusty appearance
describe the appearance of erythroplasia of queyrat?
red velvety appearance
what type of 'carcinoma-in-situ' are bowen's disease and erythroplasia of queyrat when sited on the penis?
which has a bigger risk of squmaous carcinoma of the penis- circumscised or uncircumcised?
where in the penis does squamous carcinoma tend to occur?
glans or prepuce
what are the risk factors of squamous carcinoma of the penis?
what occupational risk can predispose to SCC of scrotum?
what is benign nodular hyperplasia of the prostate?
irregular proliferation of both glandular and stromal prostatic tissue within the prostate
what is the aetiology of benign nodular hyperplasia?
alteration of androgen:oestrogen ratio
what is prostatism?
a group of symptoms caused by prostate disease
what are the main consequences of benign nodular hyperplasia of the prostate?
what is the management of benign nodular hyperplasia?
usually drugs: alpha blockers, 5 alpha reductase inhibitors
surgery: transurethral resection
what is the peak incidence of prostate carcinoma?
60 - 80 years old
where in the prostate are carcinomas most likely to occur?
peripheral ducts and glands
(usually posterior lobe)
why are symptoms of prostatism a sign of advanced prostate cancer?
peri-urethral zone involved at a later stage
why are prostatic cancer bone mets distinct?
osteosclerotic instead of osteolytic
what protein is usually increased in prostatic carcinomas?
prostate specific antigen (PSA)
how do you take a biopsy of the prostate?
multiple needle core biopsies under US (trans rectal)
what might you feel on a PR exam of a prostate carcinoma?
craggy, hard, irregular mass
what is the drug management of a prostate carcinoma?
what is the management of prostatic carcinoma bone mets?
what is the surgical management of a prostate carcinoma?
what type of prostate carcinoma is a radical prostatectomy reserved for?
what is a major risk factor for a testicular tumour?
what is the usual presenting complaint of a testicular tumour?
describe the pain felt with testicular enlargement in a testicular tumour?
why can gynaecomastia be a feature of testicular tumour?
what is the main type of testicular tumour?
germ cell tumours
what are the types of germ cell testicular tumours?
what are the types of stromal testicular tumour?
which specific stromal testicular cell tumour is known to cause gynaecomastia?
leydig cell tumour
what is the most common type of germ cell testicular tumour?
what is the peak age of incidence of a seminoma?
30-50 years old
which lymph nodes does a seminoma usually spread to?
para-aortic lymph nodes
why is there such a high cure rate for seminomas, even with mets?
what is the peak age of incidence of a teratoma?
what cells does a teratoma arise from?
all 3 cell lines: endoderm, mesoderm, ectoderm
what are the 4 types of teratoma?
differentiated teratoma (DT)
malignant teratoma intermediate (MTI)
malignant teratoma undifferentiated (MTU)
malignant tertoma trophoblastic (MTT)
which of the teratomas is benign?
differentiated teratoma (DT)
which of the teratomas is entirely malignant?
malignant teratoma undifferentiated (MTU)
which of the teratomas contains trophoblastic (placental) tissue?
malignant teratoma trophoblastic (MTT)
which of the teratoma contains a mixture of differentiated and undifferentiated tissue?
malignant teratoma intermediate (MTI)
what hormone can malignant teratoma trophoblastic tumours secrete?
human chorionic gonadatrophin (bHCG)
what is a mixed seminoma teratoma tumour?
a type of germ cell tumour of the testes with seminoma and any variant of teratoma
what hormone can seminomas secrete?
placental alkaline phospatase (PLAP)
what part of the embryo secretes alpha fetoprotein? (AFP)
what tumours can secrete alpha fetoprotein? (AFP)
germ line tumours (testicular or ovarian)
compare glomerulonephritis and pyelonephritis in terms of what causes it?
glomerulonephtiris- immunologcal basis
pylonephritis- infectious agent
why can glomerulonephritis occur several weeks after an infection despite it being non-infective?
(ie antibody production)
what are the 2 main types of glomerulonephritis?
which is more common- diffuse or focal glomerulonephritis?
what is the main type of infectious agent which causes pyelonephritis
what parts of the kidneys are involed in pyelonephritis?
renal pelvis, calyces
spread into the tubules and interstitium
what is the most common organism of pyelonephritis?
what are the 2 subtypes of pyelonephritis?
is pyelonephritis more common in F or M?
what are the 2 ways of infection spread causing pyelonephritis? -which is more common?
ascending infection (common)
what is cystitis?
infection/inflammation of the bladder
why is pyelonephritis more common in females?
they have a shorter, wider urethra
why can pregnancy be a risk factor for pyelopnephritis?
ureteric dilatation with urine stasis because of:
what hormonal effects in pregnancy causes ureteric dilation with urine stasis? (a risk factor for pyelonephritis)
relaxation of smooth muscle in ureters
what anatomical effects in pregnancy cause ureteric dilation with urine stasis? (a risk factor for pyelonephritis)
obstruction from pregnant uterus
what is a major risk factor for pyelonephritis due to urine stasis?
urinary tract obstruction
what type of reflux can be a risk factor for pyelonephritis?
how can vesico-ureteric reflux be congenital?
ureters enter bladder perpendicular instead of oblique
what condition is a risk factor for pyelonephritis due to sugar content of urine?
why do patients with chronic pyelonephritis urinate large volumes?
kidney damage so isn't able to concentrate urine as effectively
what infection of the kidney does 'sterile pyuria' indicate?
how does TB spread to the kidneys?
haemotengous spread (usually from lung primary)
what is dysuria?
painful passing of urine
what is the principle techniquie for diagnosing TB?
what is the type of inflammation/necrosis that occurs with TB?
caseating granulomatous inflammation
when can cystitis become necrotising?
if associated with outlet obstruction
what can form within the benign hyperplasia of ureteritis or cystitis cystica?
fluid filled cysts
is urethral obstruction more common in F or M?
why is urethral obstruction more common in males?
they have a longer, tortuous urethra
what is the main cause of bladder outlet obstruction in a newborn male?
posterior urethral valves (in utero development abnormality)
what are the 2 main causes of hydronephrosis?
urinary tract obstruction
prolonged vesico-ureteric reflux
would a neurogenic disturbance (ie in a paraplegic patient) cause unilateral or bilateral hydronephrosis?
would a urethral obsturcion cause unilateral or bilateral hydronephrosis?
would a calculi or neoplasm in a ureter cause unilateral or bilateral hydronephrosis?
what happens to urine production if there is a sudden and complete obstuction?
urine production quickly ceases
what happens to urine production if there is gradual and partial obstruction?
urine production remains the same
compare sudden and complete obstruction to gradual and partial obstruction in terms of hydronephrosis?
sudden: little dilation
what is the term for secondary infection of a hydronephrotic kidney?
how do you determine whether there is haematuria?
urine dipstick test
what does macroscopic haematuria mean?
wht does microscopic haematuria mean?
what is a common contaminate of urine in a women of child-bearing age, causing it to become red?
why might there be myglobin within the urine? (causing it to become red)
mcArdle disease (metabolic disorder)
what drugs cause red urine?
senna containing laxatives
what toxins can cause red urine?
what colour urine might increased urobilinogen in the urine cause?
brown coloured urine
what causes pneumaturia?
any connection between bowel and bladder
what causes faecaluria?
any connection between bowel and bladder
on CT urogram, what is indicated if there is a defect of bladder filling?
there is an obstruction within the bladder
what is a urethrocystoscopy?
an endoscopic picture of the bladder by placing an endoscope through the urethra
what is post-obstructive diuresis?
dramatic increase in urine output (200ml/hr) after release of urinary tract obstruction (must be bilateral- ie both kidneys affected)
what are the 2 factors necessary for post-obstructive diuresis?
accumulation of total body water, sodium and urea (eg oedema, CCF, hypertension, uraemia)
impairement of tubular re-absorption
compare physiological post-obstructive diuresis to pathological post-obstructed diuresis?
physiological- self limiting, stops after return to euvolaemic state
pathological- inappropriate diuresis beyond euvolaemic state
usually post-obstructive diuresis is self limiting, how long does this take?
in severe cases of post-obstructive diuresis beyond euvolaemic state, what management is needed?
what is the treatment for ureteric colic?
NSAIDs +/- opiate,
+ alpha blocker (tamsulosin) for small stones expected to pass
wait for 1 month to see if surgical intervention is necessary
what is the likelihood of spontaneous passage of renal stones if they are less than 4mm?
what is the likelihood of spontaneous passage of renal stones if they are between 4-6mm?
what is the likelihood of spontaneous passage of renal stones if they are above 6mm?
what are the indications for urgent intervention of a renal stone?
persistent nausea and vomiting
what is the intervention for renal stones in the absence of infection?
what is the intervention for renal stones with infected hydronephrosis?
what age is torsion of the spermatic cord most common?
torsion of spermatic cord is usually spontaneous but may occur with what?
describe the pain with torsion of spermatic cord?
sudden onset severe pain
may have prev episodes of self limiting pain
referral of pain to lower abdomen
on examination of torsion of spermatic cord what signs do you see?
testis high in scrotum
absence of cremasteric reflex
what is the management of torsion of spermatic cord?
prompt surgical exploration
why must you fix the contralateral side in testicular torsion?
to prevent it occuring to the other testis
-due to bell clapper deformity
what is the most common cause of testicular torsion?
bell clapper deformity
how is torsion of appendage differentiated from torsion of spermatic cord?
testis should be mobile
cremasteric reflex present
blue dot sign
what is generally seen in the history of epididymitis?
is the cremasteric reflex present in epididymitis?
what is a general indicator of epididymitis over testicular torsion?
what will you see on doppler US of epididymitis?
swollen epididymis, increased bloodflow
what is the management of confirmed torsion of appendage?
will resolve spontaneously
what is the management of epididymitis?
analgesia + scrotal support
ofloxacin 400mg 14 days
instead of pain, what may be felt in idiopathic scrotal oedema?
what is paraphimosis?
painful swelling of foreskin distal to a phimotic ring
what often causes paraphimosis within hospital?
forgetting to replace foreskin in natural position after catheterisation or cystoscopy
what is priapism?
prolonged (often painful) erection >4hours
is priapism associated with sexual arousal?
what are the 5 causes of priapism?
-intracorporeal injection for erectile dysfunction
-haematological conditions (eg sickle cell)
what are the classifications of priapism?
ischaemic (low flow)
non-ischamic (high flow)
what is seen in the aspirate of blood from corpus cavernosum in low flow (ischaemic) priapism?
dark blood, low O2, high CO2
what is seen in the aspirate of blood from corpus cavernosum in high flow (non-ischaemic) priapism?
normal arterial blood flow
what is seen in duplex US in low flow (ischaemic) priapism?
minimal or absent flow
what is seen in duplex US in high flow (non-ischaemic) priapism?
normal to high flow
what is the management of ischaemic priapism?
aspiration +/- irrigation with saline
injections of alpha-agonist
(only if early presentation)
what is the management of a non-ischaemic priapism?
observe, may resolve spontaneously
if not: selective arterioal embolisation with non-permanent materials
what is fornier's gangrene?
necrotising fasciitis occuring around the male genitalia
what are the 4 main risk factors of fornier's gangrene?
how does fornier's gangrene start?
as a cellulitis: swollen, red, tender, pain, fever
what investigations can confirm gas in the tissues in fornier's gangrene?
US or X-ray
what is the management of fornier's gangrene?
what types of pathogens cause emphysematous pyelonephritis?
gas forming uropathogens
usually E coli
what risk factors predisposed to emphysematous pyelonephritis?
what investigations can confirm gas in the tissues in emphysematous pyelonephritis?
what does a perirenal abscess usually result from?
a rupture of an acute cortical abscess
or from haematogenous seeding from other sites of infection
how do you investigate a perirenal abscess?
what is the management of a perinephric abscess?
percutaneous or surgical drainage
describe renal trauma type 1?
non-expanding haematoma, subcapsular, no parenchymal laceration
describe renal trauma type 2?
laceration less than 1cm parencymal depth
no urinary extravasation
describe renal trauma type 3?
laceration greater than 1cm
no collecting system rupture or extravasation
describe renal trauma type 4?
laceration through cortex, medulla and collecting system
arterial/venous injury with contained haemorrhage
describe renal trauma type 5?
avulsion of hilum
what are the indications for imaging the kidneys after trauma in an adult?
non visible haematuria + shock/penetrating injury
what are the indications for imaging the kidneys after trauma in a child?
frank or non-visible haematuria
what is the investigation for imaging the kidneys after trauma?
what fracture is bladder injury most commonly associated with?
what are the 6 main signs of bladder injury?
inability to void
lower abdo bruising
diminished bowel sounds
what is the imaging investigation of choice for possible bladder trauma?
on examination of a urethral injury what 5 main signs are seen?
blood at external urethra meatus
inability to urinate
palpably full bladder
'high riding' prostate
butterfly perineal haematoma
what is the imaging investigation of choice for possible urethra trauma?
what fractures are urethral injuries often associated with?
fracture of pubic rami
when do penile fractures typically occur?
-buckling injury when penis slips out of vagina and strikes pubis
what sound is heard on penile fracture?
cracking or popping
what are the symptoms of penile fracture?
what is the management of a penile fracture?
prompt exploration and repair
'degloving of penis' to expose all 3 compartments
what is the investiation of choice for testicular trauma?
what is the management of a urethral injury?
delayed reconstruction after at least 3 months
what is the management of bladder injury with no indications for immediate repair?
repeat cystogram in 14 days
what is the verumontanum of the prostate?
where the ejaculatory ducts drain to each side of the prostatic urethra
what is the transitional zone of the prostate?
the area which surrounds the urethra, proximal to the verumontanum
what is the central zone of the prostate?
cone shaped region which surrounds the ejaculatory ducts
what is the peripheral zone of the prostate?
which zone of the prostate gives rise to benign prostate hyperplasia?
which zone of the prostate gives rise to the majority of carcinomas?
what is the anterior part of the prostate made up?
what is the most common malignancy affecting men in the UK?
what type of cancers are the majority of prostate cancers?
what scoring system grades prostate cancers?
what hormones is the growth of prostate cancer cells under the influence of?
what happens if prostate cells are deprived of androgenic stimulation?
what can initially happen on treatment of prostate carcinoma with LHRH agonists?
initial androgen surge
what can be given to prevent initial androgen surge with LHRH?
what is the function of LHRH in prostate carcinoma?
cause suppression of pituitary LH and FSH secretion and therfore testosterone production
compare steroidal and non-steroidal anti-androgens in terms of libido and sexual interest?
steroidal (eg cyprosterone): loss of libido and sexual interest
non-steroiral: no loss of libido or sexual interest
what are the 2 types of transitional cell carcinoma? and give percentages
non papillary 20%
compare papillary and nonpapillary transitional cell carcinomas in terms of percentage that are considered to be malignant?
non-papillary: all considered to be malignant
what are the 2 subtypes of papillary transitional carcinoma?
invasive papillary carcinoma
what are the 2 subtypes of nonpapillary transitional carcinoma?
flat non invasive carcinoma
flat invasive carcinoma
what are the most common benign asymptomatic renal lesions?
benign renal cysts
what imaging is best for looking at a renal cyst?
what is the main consequence of angiomyolipomas?
(may have wunderlich's syndrome- massive retroperitoneal bleeding)
what imaging is best for looking at a suspected angiomyolipoma?
what benign renal tumour can appear to be a carcinoma?
what feature of oncocytoma is very characteristic?
what type of carcinoma is a renal cell carcinoma?
what part of the kidney is affected by renal cell carcinoma?
proximal convoluted tubule
if renal cell carcinoma is multifocal or bilateral then what syndrome should you suspect?
von hippel-lindau syndrome
what is the best imaging for diagnosing a renal cell carcinoma?
triple phase contrast CT
what is the main form of renal cell carcinoma treatment?
radical or partial nephrectomy
what are the 4 main premalignant conditions of penile cancer?
Erythroplasia of Queyrat
Balanitis Xerotica Obliterans
what do you see in balanitis xerotica obliterans of the penis?
white patches, fissuring, bleeding, scarring of prepuce and glans
what is the treatment of balantis xerotica obliterans?
may need glans resurfacing
what is the main difference in location of bowen's disease and erythroplasia of queyrat of the penis? (both are squamous cell carcinoma in situ)
erythroplasia of queyrat is on glans, prepuce or shaft
bowen's is on the other parts of genitalia
what is the treatment of bowen's disease or srythroplasia of queyrat of the penis?
what is the surgical treatment of a penis carcinoma?
what is the best imaging technique for suspected testicular tumour?
what hormone is 100% elevated in a malignant teratoma trophobastic?
what is the main underling cause for glomerulonephritis?
why can renal artery stenosis worsen pre-existing hypertension?
RAS kicks in
what type of necrosis is found in the kidneys due to malignant hypertension?
compare seminomas and teratomas in terms of radio/chemotherapy?
why can a patient become anaemia due to kidney failure?
loss of production of erythropoietin
what must you do to a patient who has a pericardial rub in the presence of uraemia?
why might vomiting cause acute kidney injury?
due to dehydration
what does ACEI/ARBs have a protective function against?
-help preserve kidney function
what does ACEI/ARB have a negative effect on?
(ie in vomiting)
who is at risk of contrast nephropathy?
patients who are dehydrated
patients who already have renal impairment
in what condition are you most likely to feel palpable kidneys?
why must you always correct hypotension in kidney disease?
kidneys need a certain perfusion to work
below what blood pressure should you aim to get a patient who has kidney disease?
what is the diastolic pressure above in accelerated hypertension?
what can be seen on fundoscopy of accelerated hypertension?
what is leukonychia found in?
what immunoglobulin is involved in Henoch-Schonlein Purpura?
what is the classic distribution of Henoch-Schonlein Purpura?
extensor surfaces of legs and buttocks
what is rhabdomyolysis and why can it cause kidney injury?
myoglobin is a product and cannot be processed properly by the kidney
what is the CK like in rhabdomyolysis?
how many grams of protein in the urine classes as asymptomatic low grade proteinuria?
up to 1g
how many grams of protein in the urine classes as heavy proteinuria?
1-3g per day
how many grams of protein in the urine classes as within nephrotic range?
>3g per day
what are the 2 main ways to quantify urine protein?
24 hour urinary collection
urine protein/creatinine ratio
under microscopy of urine, compare what isomorphic and dysmorphic red blood cells indicate?
isomorphic- coming from lower down renal tract
dysmorphic- coming frohigher up the renal tract
what biochemistry abnormality does tented T waves on ECG suggest?
what does hyperkalaemia eventually lead to in terms of patients heart rate/pulse?
what stage of kidney disease does GFR >90 with symptoms indicate?
kidney damage with normal GFR
what stage of kidney disease does GFR from 60-89 with symptoms indicate?
kidney damage with mildly reduced GFR
what stage of kidney disease does GFR from 30-59 indicate?
moderately reduced GFR
what stage of kidney disease does GFR from 15- 29 indicate?
severely reduced GFR
what stage of kidney disease does GFR of less than 15 indicate?
what are the main features of nephrotic syndrome?
proteinuria >3g per day
why might it be hard to determine if someone has nephrotic syndrome?
often have normal renal function
oedema of what site is a classical sign of nephrotic syndrome?
compare nephrotic syndrome and nephritic syndrome in terms of pulmonary oedema?
no pulmonary oedema in nephrotic syndrome
pulmonary oedema in nephritic syndrome
why do you not tend to get pulmonary oedema in nephrotic syndrome even though oncotic pressure is low?
becasue the capillary pressure within the lungs is still very low
which are you more likely to get with acute kidney injury- nephrotic or nephritic syndrome?
what are the 5 main symptoms/signs of nephritic syndrome?
what is chronic kidney disease?
reduced GFR over a length of time
what is eGFR calculated using?
when muscle mass is low, is eGFR under or over estimated?
when muscle mass is high is eGFR under or over estimated?
stage 1 and stage 2 of CKD are dependent on evidence of kidney damage, what does this mean?
proteinuria, haematuria (in absence of lower urinary tract cause), or abnormal imaging
what does CKD do to cardiovascular disease?
what does proteinuria do to the likelyhood of CKD to progress stages?
increases risk of progression
why can reflux nephropathy cause CKD?
due to recurrent UTI causing scarring
what is the most common cause of CKD?
what might happen initially to gfr when putting a patient with CKD on an ACEI/ARB?
what do ACEI/ARB do to proteinuria?
what does smoking do to the rate of progression of CKD?
increases rate progression
at what stage of CKD are statins recommended?
how do you correct iron deficiency anaemia in CKD?
if patient on CKD is anaemic but iron has been replaced, what hmight be indicated?
why can bone disease occur in CKD?
vitamin D cant be hydroxylated properly
leading to reduced calcium absorption
leading to secondary hyperparathyroidism which takes calcium out of bones to maintain serum calcium
what happens to the levels of serum phosphate in CKD and what does this do to the levels of PTH?
serum phosphate increases
what eventually happens to CKD patients in secondary hyperparathyroidism?
what happens to the blood vessels and heart valves in a patient with CKD who has tertiary hyperparathyroidism?
vascular and valvular calficiation
how do you treat bone disease in CKD?
alfacalcidol (hydroxylated vit D)
at what gfr should dialysis education be started?
20ml/min (earlier if progressing fast)
what is the best form of access for haemodialysis?
how long does it take for an arteriovenous fistula to mature for haemodialysis?
at what gfr should you refer a patient to vascular surgeons for the creating of an arteriovenous fistula?
how long after creation of a catheter for peritoneal dialysis can it be used?
when do patients get put on the cadaveric transplantation list for a kidney?
within roughly 6 months of dialysis
what is acute kidney injury?
an abrupt reduction in kidney function defined as an absolute increase in serum creatinine by 26.4micromoles per litre (or 50% increase over baseline)
how should you split the causes of AKI?
what does pre-renal causes of AKI mean?
anything that reduces kidney perfusion
what does post-renal causes of AKI mean?
obstruction of renal outflow
what does renal causes of AKI mean?
what are the 3 subgroups of pre-renal AKI?
why might haemorrhages, diarrhoea, vomitting or burns cause AKI?
causes hypovolaemia which is a pre-renal cause of AKI
why might cardiogenic, septic or anaphylactic shock cause AKI?
causes hypotension which is pre-renal cause of AKI
why might NSAIDs or ACEI/ARBs cause AKI?
reduces renal perfusion which is a pre-renal cause of AKI
what is hepatorenal syndrome?
kidney failure as a result of liver failure
why does hepatorenal syndrome cause AKI?
reduces renal perfusion which is a pre-renal cause of AKI
how do you calculate urine output depending on weight?
what defines oliguria?
less than 0.5mls/kg/hr of urine output
what does untreated pre-renal AKI lead to?
acute tubular necrosis
what is the commonest form of AKI?
acute tubular necrosis due to decreased renal perfusion (from a combination of factors)
what is the main aim of pre-renal AKI treatment?
reverse factors that have caused it (ie eupportive treatment)
to reverse hypotension causing AKI, what do you do?
fluid challenge with saline, if over 1000mls has been given with no improvement seek help
what are the 4 subgroups of renal AKI?
glomerular disease (glomerulonephritis)
what is the main cause of vascular disease causing renal AKI?
vasculitis (eg ANCA associated)
what are the 3 main causes of interstitial nephritis causing renal AKI?
infection eg TB
systemic causes eg sarcoidosis
what types of drugs cause interstitial nephritis?
what type of renal AKI does rhabdomyolysis cause?
what kind of renal AKI does contrast cause?
what does renal vascular bruits indicate?
renal artery stenosis
why can compartment syndrome lead to AKI?
causes rhabdomyolysis (a renal cause of AKI)
what initial tests alow you to look for myeloma?
protein electrophoresis and bence-jones protein
what 3 things must you ensure before performing a renal biopsy?
what imaging technique do you usually use to assist with renal biopsy?
what are the 4 indications for immediate dialysis?
-hyperkalaemia over 7 (or 6.5 unresponsive to medical therapy)
-severe acidosis (pH below 7.15)
-uraemia (urea over 40) with pericardial effusion
what are the 2 ways of treating post renal AKI to relieve obstruction?
what is the normal range for serum potassium?
what range of potassium indicates hyperkalaemia?
what range of potassium indicates life threatening hyperkalaemia?
what happens to the T wave, P wave and QRS complex in hyperkalaemia? (on ECG)
T wave becomes peaked
loss p of wave
widening of QRS complexes
what 4 drugs are indicated in acute life threatening hyperkalaemia?
what is the function of calcium gluconate in hyperkalaemia?
what is the function of insulin, dextrose and salbutamol in hyperkalaemia?
moves K back into cells
what is the function of calcium resonium?
prevents K absorption from the GI tract
what drug do you give a patient who is acidotic?
what are the 3 main nephrotoxic drugs?
antibiotics (eg gentamicin)
what are the 4 main risk factors for AKI development?
age, diabetes, CKD, co-morbidities
what is the most common cause of end stage renal disease?
what is the second most common cause of end stage renal disease?
what is glomerulonephritis?
immune-mediated disease of the kidneys afecting the glomeruli
does damage to endothelial or mesangial cells lead to a proliferative or non-proliferative glomerulonephritis?
does damage to podocytes lead to a proliferative or non-proliferative glomerulonephritis?
what abnormality is found in urine in proliferative glomerulonephritis?
red blood cells
what abnormality is found in urine in non-proliferative glomerulonephritis?
what does microalbuminuria mean?
30-300mg of albuminuria per day
is nephritic syndrome indicative of a proliferative or non-proliferative glomerulonephritis?
is nephrotic syndrome indicative of a proliferative or non-proliferative glomerulonephritis?
compare nephritic and nephrotic syndrome in terms of renal function?
nephritic- renal failure
nephrotic- normal renal function usually
why might nephrotic syndrome cause you to become mildly immunosuppressed?
lots of antibodies leave in the urine
why is there a prothrombotic state in nephrotic syndrome?
liver increases production of prothrombotic factors (exacerbated by volume depletion)
which vein should you be particularly concerned about thrombosis in within nephrotic syndrome?
renal vein thrombosis
compare focal and diffuse glomerulonephritis?
focal- less than 50% of glomeruli affected
diffuse- more than 50% of glomeruli affected
compare global and segmental glomerulonephritis?
global- all of glomerulus affected
segmental- parts of glomerulus affected
what drugs should be used for hypertension in the treatment of GN and why?
also control proteinuria
what indicates complete nephrotic syndrome remission?
proteinuria less than 300mg per day
what indicates partial nephrotic syndrome remission?
proteinuria less than 3g per day
what is the most common cause of nephrotic syndrome in children?
minimal change glomerulonephritis
what do you see on light microscopy, electron microscopy and immunofluorescence (renal biopsy) of minimal change glomerulonephritis?
EM- foot process fusion
can minimal change nephropathy progress to renal failure?
what is the main treatment for minimal change glomerulonephritis?
is minimal change glomerulonephritis proliferative ir non-proliferative?
what is the most common cause of nephrotic syndrome in adults?
focal segmental glomerulosclerosis
can focal segmental glomerulosclerosis progress to renal failure?
is focal segmental glomerulosclerosis proliferative or non-proliferative?
what is the 2nd most common cause of nephrotic syndrome in adults?
what is seen on renal biopsy of membranous nephropathy?
immune complex deposition in the basement membrane
can membranous glomerulonephritis progress to renal failure?
is membranous glomerulonephritis proliferative or non-proliferative?
what is the most common type of glomerulonephritis?
can IgA nephropathy progress to renal failure?
is IgA nephropathy proliferative or non-proliferative?
what vasculitis is IgA nephropathy associated with?
what glomerulonephritis is associated with glomerular crescents?
rapidly progressive glomerulonephritis
what are the 2 subgroups of rapid progressive glomerulonephritis?
what type of glomerulonephritis is SLE associated with?
rapidly progressive glomerulonephritis
is rapidly progressive glomerulonephritis proliferative or non proliferative?
what type of glomerulonephritis is goodpastures disease associated with?
rapidly progressive glomerulonephritis
compare post-strep glomerulonephritis and IgA nephropathy in terms of how long after URTI it occurs?
post strep- 2-3 weeks
IgA nephropathy- 2-3 days
is post strep glomerulonephritis proliferative or non-proliferative?
what does CKD do to the risk of cardiovascular disease?
what kind of diet must a patient who is on dialysis have?
fluid restricted (1l per day)
low phosphate (take phosphate binders with meals)
what is the gold standard dialysis access?
compare a fistula to other dialysis access in terms of infection risk?
fistula access has a reduced infection risk
what can happen if haemodialysis isn't done by a gradual build up?
-cerebral oedema and seizures
what type of diabetic patients can get a kidney pancreas dual transplant?
type 1 diabetic patients
which MHC class are HLA A, HLA B and HLA DR?
class 1: HLA A, HLA B
class II, HLA DR
what antibiotics are given for pneumocystits jirovecii?
what type of skin cancer is much increases post transplant?
what cancercan does post-transplant EBV infection cause?
what are the 3 phases of rejection?
what is hyperacute rejection caused by?
how is hyperacute rejection treated?
what is acute rejection caused by?
T or B cell mediated response
what are the 3 phases of transplant immunosuppression?
what drug must azathioprine never be given with?
what are the types of donor kidney?
-deceased brain dead
-deceased cardiac death
what is diabetic nephropathy defined by?
albuminuria (greater than 300mg in 24 hours) on 2 occasions 3-6 months apart
what are the haemodynamic changes that diabetes does to the afferent arteriolar? and how?
vasodilation of afferent arteriole by vasoactive mediaprs
why does diabetes initially cause a raised GFR?
vasodilated afferent arteriole increases the blood flow and so increases the filtration pressure
how does diabetes cause renal hypertrophy?
plasma glucose stimulates several growth factos within the kidneys
what are kimmelstein wilson lesions?
nodular lesions of diabetic glomerulosclerosis
why does proteinuria occur in diabetes?
glomerular basement membrane thickens and the podocytes become impaired (bigger spaces between them)
why may haematuria require renal biopsy in the context of diabetic nephropathy?
haematuria is not a feature of diabetic nephropathy so need to look for another cause
how do you prevent/treat diabetic nephropathy?
-good glycaemic control
-good blood pressure control
what drugs are used as anti-hypertensive therapy to prevent/treat diabetic nephropathy?
what drugs are used to maintain good lipid control to prevent/treat diabetic nephropathy?
how do ACE I/ARBs help to reduce progression of proteinuria in diabetics?
dilates the efferent arteriole so reduces the filtration pressure
(this pressure was initially increased because of filation of the afferent arteriole due to diabetes)
what drug should you offer a diabetic patient with persistent microalbuminuria who is normotensive?
what drugs should you offer a diabetic patient with persistent microalbuminruria and hypertension?
plus diuretic or another antihypertensive
what is renovascular hypertension?
hypertension secondary to renal artery stenosis (renovascular disease)
why does renal artery stenosis cause hypertension?
reduces renal perfusion activates RAS system
what are the 2 main types of renovascular disease?
atherosclerotis renovascular disease
what is ischaemic nephropathy?
reduced renal blood flow (ie renal artery stenosis) beyond the level of autoregulatory compensation so gfr is reduced
what does ischaemic nephropathy lead to?
renal atrophy and progressive CKD
what is the treatment for renal artery stenosis?
blood pressure control
reduce cardiovascular risk factors
what is multiple myeloma?
a cancer of plasma cells which accumulates in the bone marrow
why can you get normocytic anaemia in multiple myeloma?
plasma cell accumulation in bone marrow and so intereferes with production of red blood cells
what paraprotein does myeloma tend to produce?
Bence Jones protein
why are the proteins secreted in myeloma not detected on urine dipstick?
urine dipstick only tests for albumi so doesnt detect abnormal paraproteins
what type of lesions are found on skeletal survey of multiple myeloma?
what are the 4 renal manifestations of myeloma?
hypercalcaemia (leading to AKI)
monoclonal immunoglobulin deposition disease
what are the 2 types of amyloidosis?
what type of conditions does secondary amyloidosis occur in?
chronic inflammatory conditions
what is seen histologically in amyloidosis?
positive congo red staining showing apple-green birifringence under polarised light
why can GPA, eGPA, MPA have pulmonary haemorrhage?
as a consequence of alveolar capillary involvement
what is seen on renal biopsy of GPA, MPA and eGPA?
segmental necrotising glomerulonephritis
what are the 6 classes of lupus nephritis?
1: minimal mesangial
2: mesangial proliferative
3: focal proliferative
4: diffuse proliferative
6: advanced sclerosing
how do you calculate the therapeutic index?
Lethal Dose 50/Effective Dose 50
what are the 2 phases of drug metabolism?
phase 1: oxidation, reduction and hydrolysis
phase 2: conjugation (makes drug water soluble)
do adverse drug reactions tend to happen in phase 1 or phase 2 of metabolism?
what are type A drug reactions?
dose dependent and predictable
what are type B drug reactions?
-dose independent and unpredictable
what are type C drug reactions?
What are type D drug reactions?
What are type E drug reactions?
end of treatment efects
what are type F drug reactions?
failure of therapy
what are the most common type of drug reactions?
compare ADPKD type 1 to ADPKD type 2 in terms of progression to end stage kidney failure?
ADPKD 1 develops ESKF at an earlier stage
what is the most common extral renal feature of ADPKD?
what is the management of ADPKD before renal failure?
control cyst haemorrhage/infection
what drug treatment can be used to reduce cyst volume and progression in ADPKD?
what is the management of ADPKD after renal failure?
what type of inheritance is Alport's syndrome?
what type of collagen is affected in Alports syndrome?
type IV collagen
what does alports syndrome cause?
what is the characteristic feature of alport's syndrome?
what confers bad prognosis in alport's syndrome?
what are the 3 main extra renal manifestations of alports syndrome?
ocular lens defect (anterior displacement)
what is the treatment of alports syndrome?
what is seen on renal biopsy of alports disease?
variable thickness glomerular BM
what is the inheritance of anderson fabrys disease?
what causes anderson fabrys disease?
inborn error of metabolism
(deficiency of a-galactosidase A)
what is seen on the skin of patients with anderson fabrys disease?
what is the treatment of anderson fabrys disease?
fabryzyme (enzyme replacement)
management of complications
what is the inheritance of medullary cystic kidney?
where are cysts fund in medullary cystic kidney?
corticomedullary junction or medulla
what is the gross appearance of medullary cystic kidney?
normal or small kidneys
what is the treatment of medullary cystic kidney disease?
what hapens to the collecting ducts in medullary sponge kidney?
how do you diagnose medullary sponge kidney?
what is seen in the cysts within medullary sponge disease?