clinical Flashcards
(229 cards)
1
Q
pyelonephritis?
A
inflammation of kidneys
2
Q
nephrotoxicity?
A
renal damage due to toxins
3
Q
pyuria?
standard level
A
increase wbc in urine - means infection
at least 10 WBC/m^2 of urine
4
Q
proteinuria standard levels?
A
protein excretion more than 150mg/day
5
Q
different types of haematuria?
A
visible -macro - visibly red
microscopic
dipstick - after dipstick
6
Q
definition of microscopic haematuria?
A
more/equal to 3 abc in urine per high power field
7
Q
standard level of oliguria?
A
urine output less than 0.5ml/kg/hour
8
Q
anuria?
A
no urine output
9
Q
polyuria?
A
urine output larger than 3L/24HRS
10
Q
NOCTURIA definition?
A
waking up at night more than/equal to 1 occasion to pee
11
Q
serum creatinine? measures?
A
waste product that comes from normal wear and tear - sign that kidneys don’t work well -
more kidney damage/more creatinine
12
Q
normal gfr level? and what level does the kidney not work well?
A
more than/equal to 90 = 90-120
less than 60 = kidney doesn’t work well
13
Q
microalbuminua?
can also do?
A
sensitive dipstick test that detects tiny amounts of albumin in urine
albumin:creatinine ratio to check for kidney damage
14
Q
functions of kidney? 5
A
- regulate bp
- electrolyte balance(sodium/potassium/chlorine)
- excretory functions(drugs/urea)
- body fluid balance
- acid/base balance
15
Q
chronic renal failure is?
A
gradual loss of kidney function
16
Q
dialysis?
A
artificially removes waste products and extra fluid from blood - can be placed catheter form
like an artificial kidney
17
Q
how can trauma occur to ureter?
A
cut or tied during hysterectomy or colon resection
trauma from surgery
18
Q
obstruction of ureter occurs in what 3 ways?
A
intra-luminal - in lumen = stone
intra-mural - scar tissue/tumour
extra-luminal - pelvic mass/LN
19
Q
tcc?
A
transitional cell carcinoma
20
Q
hydronephrosis?
A
1/both kidneys become stretched and swollen - due to increased urine in them
21
Q
renal colic?
A
pain in flanks - pain in lower back
22
Q
two tumours in bladder?
A
squamous cell carcinoma
TCC of bladder
23
Q
LUTS?
A
clinical symptoms involving bladder/urethra
voiding - poor stream, urinary retention, incontinence, incomplete voiding
storage - increase freq., increase urgency
24
Q
urinary incontinence means?
A
loss of bladder control
25
pneumaturia?
air in urine - due to cold-vesical fistula - from colon
26
what is risk of bladder/renal cancer in patient with visible haematuria?
bladder = 25-30%
renal = 0.5-1%
27
pelvic floor dysfunction? lead to?
damage to pelvic floor muscles - lead to stress and incontinence
28
3 levels of control of micturition?
cortical centre - cortex - bladder sensation of fullness and inhibition of micturition
pons - micturition centre
sacral segments - micturition reflex - automatic/somatic/parasympathetic
29
mucturition cycle occurs how?
storage/filling phase
| voiding phase
30
sympathetic & parasympathetic & somatic innervation on micturition?
sympathetic - relaxation of urethral sphincter -open
parasympathetic - contraction of detrusor muscle - squeeze out
somatic - relaxation of external urethral sphincter - open
31
acute urinary retention define?
main cause
painful
inability to void - with palpable and permissible bladder
-due to BPO
32
chronic urinary retention define?
MAIN CAUSE
painless
palpable and percussible bladder AFTER voiding
muscle detrusor inactivity
33
two types of chronic urinary retention?
high pressure or low pressure - bladder filling pressure
34
what can occur due to catheter?
diuresis - increase urine freq.
35
diagnosis of UTI requires what 2 things?
microbiological evidence & symptoms
36
2 types of UTI?
UNCOMPLICATED
COMPLICATED
37
MESANGIAL CELLS?
group of cells which support capillaries in glomeruli
38
albumin - filtration?
cannot be filtered - albumin cannot be filtered too large
39
4 presentations of Glomerulonephritis ?
haematuria
heavy proteinuria
slowly increasing proteinuria
acute renal failure
40
nephrotic syndrome? due to?
increase protein in urine -
| due to damage to bv in kidney
41
main causes of haematuria?4
uti
urinary tract stone
urinary tract tumour
Glomerulonephritis
42
kimmelsteil-wilson lesion?
long standing diabetes - leading to kidney condition - affects the bv in the glomeruli -
43
signs of diabetic nephropathy?
first sign of diabetic kidney disease - albumin in urine - - microalbuminuria
44
sign of acute renal failure?
rapidly risisng creatinine
45
what properties make urine bacteriostatic? 3
low pH
high osmolarity
high ammonia - NH3
46
what contaminates the urine?
by terminal urethral flora
47
is contamination present in MSSU?
YES - but less contamination
48
results of MSSU culture means?
```
10^5 = infection present
10^3/4 = infection 50% if asymptomatic/ probable infection if symptoms
```
10^2 = no infection
49
hydroureter?
dilation/enlargement
50
HORMONES that the kidney produce? 3
erythropoietin
vit D
renin
51
how much of the cardiac output do kidneys take?
20-25%
52
what does creatine serum levels depend on? 4
```
age
ethnicity
gender
weight
muscle mass
```
53
classification of ckd?
1 to 5
54
what molecules do not cross filtration barrier?
abc/albumin/globulins
55
definition of ckd?
prescence of kidney damage - abnormal blood/urine etc
or
gfr less than 60 present for over/equal to 3 months
56
what two things used to see prognosis of ckd?
by albumin levels in urine and gfr level
57
RRT includes?
dialysis and transplant
58
PCR & ACR means?
| 24hr UC MEAN?
pcr - protein creatinine ratio
acr- albumin creatinine ratio
24HR urine collection
59
complications of prolonged low eGFR? 6
```
anaemia
bone disease
fluid overload
hypertension
acidosis
electrolyte imbalance
```
60
size of prostate? measured in?
cc-cubic centimetres
any! continuously growing as you grow up
61
prostatic zones - which Is most likely for prostate cancer?
peripheral zone
62
benign prostatic hyperplasia?
occurs In what prostatic zone?
fibromuscular and glandular hyperplasia
transition zone
63
assessment of Luts by? 2
IPSS score sheet -prostate symptoms
freq volume charts
64
two types of LUTS? examples of each
voiding - hesitancy.poor stream, dribbling, incomplete emptying
storage - freq, nocturia, urgency, urge
65
avg number of times to go to bathroom a day?
4-8
66
examination looking for?
penis?
DRE?
PHIMOSIS
external urethral meatus
prostate size
nodules/firmness
67
what bloods to test for prostate?
PSA
| goes up as prostate size goes up
68
size of prostate mean?
size doesn't mean anything - can have large and no symptoms etc
all about investigations and symptoms
69
flow rate study values for BPO?
Qmax less than 10ml/s - means most likely BOO
70
ALPHA BLOCKERS?
mechanism?
used in BOO
tamsulosin
relaxes smooth muscle of prostate and bladder neck
71
5A-reductase inhibitors?
mechanism?
used in BOO
finasteride
dutasteride
converts testosterone into something else
reduces prostate size
72
TURP?
SCOPE into urethra
and removes parts of prostate
followed by use of catheter
73
two ways of catheter?
suprapubic
| urtheral
74
uterocele?
doesn't allow urine to flow - blocks it
too narrow
bulge in ureter
75
nephrostomy?
tube through back to drain kidney directly
76
CT UROGRAM?
INJECT dye in and take x rays to see clear flow of urinary tract
77
common place for upper tract TCC? can lead to?
renal pelvis and collecting system
lead to bladder TCC
78
END STAGE RENAL disease? gfr is?
irreversible damage to persons kidneys
gfr is less than 15
79
advanced ckd is called?
uraemia - increased level of urea in blood - should be removed by kidneys
80
when is RRT indicated?
when eGFR IS less than 10
81
requirements in a dialysis? 4
semipermeable membrane
blood exposure to membrane
dialysis access
anticoagulation
82
what are the markers on how well dialysis works?
creatinine and urea
83
what restrictions are there in dialysis patients? 2
fluid and diet
84
what risk is there in haemodialysis?
blood clots risk and air embolus risk!
85
how peritoneal dialysis works?
2 types - EXPLAIN
via a cuffed catheter using peritoneal membrane
CAPD - DURING DAY
APD - OVERNIGHT
86
ARRYHTMIAS are related to what?
related to removal of K electrolyte
87
mortality of dialysis patients?
increased
88
what is conservative kidney management?
supportive care
end of life care
just priority to symptoms management
89
2 principles/mechanisms of dialysis? explain each
diffusion and ultra filtration
diffusion - equalising and balancing on both sides
ultrafiltration - shifting fluid and some molecules
90
pyuria?
standard level?
presence of pus cells in urine
more than 10 WBC
means presence of inflammation/uti
91
pyelonephritis?
infection in upper urinary tract ivolving kidneys
92
chronic pyelonephritis?
renal scarring and loss of function
infection/prescence of uti
93
catheter related infection explain?
due to long term catheters - lead to bacteriuria
94
vesicle-ureteric reflux?
abnormal flow of urine from bladder back up ureters
95
if urine is sterile does that mean okay?
no might still have pus cells
96
uraemia? why? sign of? mechanism explain?
increase urea in plasma
clinical sign of renal failure
where kidney lost ability to remove urea/waste from blood
97
donor transplant method?
living donor nephrectomy
preserve donor kidney - use of cold storage
transplantation
98
transplant surgical complications? 3
bleeding
ureteric leak
infection
99
2 types of donors?
what's better?
deceased and living
living over deceased works better and increases graft survival
100
paired and pooled donation means?
paired donation - cross over between pairs
pooled donation - dominos effect on pairs for donating
101
consider what in order to be a donor?
age,sex,race
| health - gfr, smoking, BMI etc
102
what complications can occur after donation? 5
rejection - t cell mediated/ acute antibody mediated
diabetes
infection - uti, viral (cmv CYTOMEGALOVIRUS /bk virus)
cvs -hypertension etc
malignancy
103
what can be used to help. rejection in transplants?
immunosuprresion
antiviral therapy
antibiotics therapy - prophylaxis
104
why does anaemia occur as complication of renal cancer?
due to kidneys making erthropoeitin
105
difference between benign and malignant tumours?
differentiation
rate of growth
invasion
mets
benign - well differ., slow growth, localised, no mets
malignant - poor differ., fast growth, invasion, mets
106
what happens when renal function is impaired?
active drug build up and build up of toxic metabolites
107
do we want high or narrow therapeutic index? and why?
we want high therapeutic index
as narrow leads to toxicity or death
108
who are susceptible for drug induced nephrotoxicity?4
elderly
poly pharmacy
children
underlying Renal dysfunction
109
renal impairment affect on drugs?
increases half life of drugs and protein binding is reduced to allow more free available
110
ways to prevent drug induced nephrotoxicity? 4
drugs used that have high index
reduce dose
increase dose interval
monitor blood levels
111
drug induced renal toxicity lead to what 4 syndromes?
acute renal failure
nephrotic syndrome
renal tubular dysfunction with potassium wasting
chronic renal failure
112
what two drugs most likely to cause nephrotoxicity?
THEN NAME OTHERS
NSAIDS
aminoglycosides antibiotics
ACE inhibitors
113
what two things are major things to check in kidney systemic disease? 2
proteinuria
| haematuria
114
sepsis leads to what in kidney?
AKD
115
diabetic nephropathy means?
diabetes 40% leads to nephropathy
116
mechanism of diabetic nephropathy?
what changes to glomeruli occurs? 4
changes to glomeruli =
glomerular hyperfiltration
altered glomerular composition
renal hypertrophy
glomerular hypertension
117
what are the results of diabetic nephropathy?
albuminuria -leaky
thickening of membrane
decrease gfr
leads to
increase creatinine levels
scarring fibrosis of glomeruli
and then END STAGE renal failure
118
what are lesions of present in diabetes nephropathy?
kimmelsteil Wilson nodules in glomeruli
119
lupus leads to what in kidneys?
lupus nephritis - immune mediated glomerulonephritis and glomerular damage
120
multiple myeloma means? and can do what to kidneys?
abnormal plasma cells - proliferation of plasma cells
lead to cast nephropathy- abnormal plasma cells enter kidney and enter tubules and block and damage
121
main symptom of renal stones?
colic pain
122
stone type most common?
calcium oxalate
123
explain ESWL AND PCNL?
PCNL = key hole surgery - through incision in back - and use of X-rays and contrast for guidance
ESWL = use of sound waves to break up SMALL stones - creates vibrations - and allow residue mess to be passed in urine
124
MOST COMMON cancer in men?
prostate
125
PSA test explain?
normal level
what values we use?
psa a substance naturally produced by prostate - higher level found - enlarged prostate /cancer
0-0.4
WE USE AGE-RELATED RANGE - as with age - prostate size increases naturally
126
two tests for screening prostate? AND WHEN?
DRE
PSA TEST
for over 50 yrs men
127
any screening for prostate cancer?
no as not meet wilson-junger criteria
128
why is PSA alone not good for diagnosing prostate cancer?
as prostate specific NOT cancer specific
129
staging vs grading- what each mean?
| and how each measured?
staging - spread - bY EXAMINATION/TESTS
grading - aggressiveness BY BIOPSY
130
BRACHYTHERAPY?
radiotherapy
| placing radioactive substances in prostate - to treat the cancer
131
2 HORMONE THERAPY DRUGS USED for prostate cancer explain mechanisms?
LHRH antagonists - stop body producing testosterone
anti-androgens - block testosterone reaching cells
can be used in combo
132
2 types o testicular cancers?
seminoma - older
| nonseminoma - younger
133
tumour markers for testicular cancer?
AFP
BHCG
LDH
134
metastases of testicular cancer?
chest-lungs
bone
para-aortic lymph nodes
135
high levels of potassium in blood leads to what?
normal range? and when is it elevated?
leads to arrythmias - changes in ECG
normal is less than/equal to 5.1
abnormal is 6.5
136
average size of prostate?
increase age and prostate size increases naturally - 20cc
137
upper and lower tract of Urinary System?
upper - above bladder
| lower - lower bladder
138
BPH affects what prostatic zone?
transition zone
139
BOO leads to?
LUTS
140
phimosis?
tight forsekin on penis
141
signs of UTI in urine?
pus cells
blood - severe
cloudy
142
when is TURP carried out?
when prostate size less than 100cc
143
2 types of catheters?
suprapubic
| urethral
144
short term urethral catheter should not be left longer than?
4 weeks
145
long term urethral Catheter should not be left longer then?
12 weeks
146
pelvic mass compression explain?
compression in women leading to BOO
147
FRANK haematuria means?
visible blood urine
148
renal failure occurs only if?
BOTH URETERS are affected and obstructed
149
hydroureter and hydronephrosis?
hydronephrosis - swollen kidneys
| hydrometer - swollen ureters
150
IVU imaging?
contrast x ray imaging of kidneys and bladder
151
investigation for renal colic?
CT-KUB
152
PERCUTANEOUS nephrostomy insertion?
used for urinary tract obstruction - needle to drain
153
use of CT-KUB vs CT-urogram?
CTKUB - for stones/renal colic/ no contrast
CTUROGRAM - for obstructing masses - pelvic mass/tumour - contrast
154
what's the most important first step in septic patient?
resuscitation- IV FLUIDS/ABC/MONITOR
155
pyelonephritis includes what structures?
cd + PELVIS
156
confused elderly means?
infection present - uti?
157
asymptomatic bacteruria meaning?
over 10^5 bacteria in urine but no signs or symptoms of UTI
158
nephritic syndrome vs nephrotic syndrome?
nephritic - haematuria/red cell casts in urine - damaged end layer by inflammation cells
nephrotic - proteinuria/leaky albumin - leaky membrane no attacking
159
values to define nephrotic syndrome?
proteinuria more than/equal to 3.5
350 creatinine
serum albumin less than/equal to 30g/L
160
classification of glomerulonephritis? explain each?
proliferative - excessive numbers of cells in glomeruli - infiltrated by inflammation cells
non-proliferative - glomeruli looks normal but real of scarring
161
causes of glomerulonephritis? 8
```
IgA nephropathy
post-infection -post-streptcoccal
crescentic
minimal change
ANCA
SLE
diabetic
focal and segmental
```
162
what is the exclusion criteria for organ donation?
| list a few
situations that are unsuitable for transplant
active invasive cancer in last 3yrs
untreated systemic infection
hiv disease
163
3 ways authorisation can occur in organ donation?
express - self authorising
deemed authorisation -
nearest relative authorisation - if patient can't do it themselves
164
deemed authorisation of donating meaning?
where authorisation is deemed to be given - within safeguards are ensured
- no evidence of unwillingness to donate
- person is not in excepted category
- healthcare professional is able to carry out the duty of inquire
165
pre death procedure means?
medical procedure carried out for purpose of transplant etc and not to support patients health
166
2 types of donations?
death by neurological criteria - loss of brain function - on life support
donation after cardiac death - hearts stopped - ceases to be alive
167
timing of DCD?
is critical - have to rapid with removing organs and transplanting
168
ureterocele?
dilation of ureter - like a pouch - balloon dilation at opening of bladder
169
renal colic from what?
pain from stones
170
OLIGURIA standard levels?
reduced urine output
| less than 400mls/24hrs
171
anuria?
complete absence of urine output
172
triad for renal carcinoma? 3
flank pain
palpable mass
haematuria
173
why anaemia arises in kidney damage?
due to kidneys making erythropoietin
174
epithelium of proximal tubule?
simple cuboidal epithelium
175
parietal layer of glomeruli lined with what type of epithelium?
simple squamous epithelium
176
each kidney has what? 3
2 surfaces
2 borders
2 poles
177
what two 2 nerves run posterior kidney surface?
iliohypogastric nerve
ilioguinal nerve
178
contrast nephropathy?
kidney damage due to exposure to imaging contrast. material
179
e.coli is what type of bacteria?
gram -ve bacillus
180
serum calcium and serum phosphate relationship?
phosphate up
| calcium down
181
MOST COMMON RENAL TRACT STONE?
CALCIUM OXALATE
182
most common cause of nephrotic syndrome in children?
minimal change
183
serum and urine urea in dehydration?
serum - increased
| urine - decreased
184
alcohol affect on ADH??
suppresses ADH secretion
185
ramipril is what?
ACE inhibitor - stop production of angiotensin II
186
what is used to measure renal plasma flow?
PAH clearance
187
posterior urethral valves? common in who?
obstructive membranes that develop near bladder - common in infant in males
188
2 common renal tumours ?
renal cell - mostly of renal tissue
transitional cell - renal calyces/pelvis down
189
normal Ca level?
2.2-2.6mmol/l
190
CT KUB used when?
for renal colic
191
how does nephritic syndrome present?
haematuria
| hypertension
192
post-streptococcal glomerulonephritis presents how?
weeks after infection
haematuria
proteinuria
193
IgA nephropathy shows how?
days after infection
| hameturia
194
carbimazole - how side effects presents?
bone marrow suppression
mouth ulcers
sorry throat
195
how is minimal change seen under microscope?
seen with electron microscope - podocyte effacement
196
what mediates growth in childhood and infancy?
infancy - insluin and nutrition
| childhood - gh and th
197
causes of hyperkalaemia?
MACHINE
```
MEDS - ACEi and NSAIDS
Acidosis
cellular destruction - burns/injury etc
hypoaldosterone/haemolysis
intake up
nephrotic failure
excretion impaired
```
198
which lobe in prostate most likely enlarged in carcinoma OR BPH?
Carcinoma - posterior lobe
| BPH - median lobe
199
signs of hyperkalaemia? 5
```
tall t waves
small p waves
widened qrs
sinusoidal pattern
asystole
```
200
what are the drugs to avoid in kidney failure?
```
ACEI
NSAIDS
GENTAMICIN
DIURETICS
METFORMIN
```
201
STEROID AFFECT ON MENTAL HEALTH? 2
DEPRESSION
insomnia
etc
202
when low and high dex tests used?
low - initial OR overnight test done
| high - to localise bushings
203
testicular torsion is what & lead to?
twisting of testicle due to trauma
this can cut blood flow to testicle - necrosis of testicle
EMERGENCY
204
aki classification explain? 3 stages
aki 1 = creatine rise 1.5x & urine output LESS THAN 0.5 for 6hrs
aki 2 = creatine rise 2x & urine output less than 0.5 for 12hrs
aki 3 = creatine rise 3x &urine output less than 0.3 for 24hrs
205
Gleason score explain?
3 to 5 score GRADING
majority to second most growth majority
3+3 - 6 LOW GRADE
5+5 - 10 HIGH GRADE
206
red cell casts mean -
hyaline casts mean -
brown casts mean -
nephritic syndrome
normal after exercise/fever/diuretics
tubular necrosis
207
affect of exercise on glucose? 3 stages
early drop - glucose uptake GLUT2
occasional rise - adrenaline affect
late drop - use of liver and muscle glycogen
208
para and sympathetic innervation of urination from where?
```
s = inferior and superior hypogastric plexuses
p = pelvic splanchnic nerves
```
209
DKA MOSTLY CAUSED BY WHAT MECHANISM
UNCONTROLLED LIPOLYSIS - excess free FA convert to ketones
210
PSA level with age?
50 - 3
60 - 4
70 - 5
211
things that increase PSA level? 5
```
BPH
PROSTATITIS/CANCER
VIGOROUS EXERCISE
URINARY RETENTION
EJACTULCATION
```
212
polycystic kidney disease I highly associated with what?
berry aneurysms in brain
213
2 commonest cause of nephrotic syndrome in adults?
focal segmental glomeruloscleroris THEN
| membranous glomerular disease
214
what is specific gravity?
how conc urine is with solutes
215
2 main causes of squamous cell carcinoma in bladder ?
schistomiaosis
| long term catheter
216
pheocytochroma treatment?
alpha blockers
then
beta blockers
217
action of carbimazole?
inhibit thyroid peroxidase enzyme - to stop producing thyroid hormones
218
renal cell carcinoma how is chemotherapy/radiotherapy done?
insensitive to it - so surgery main option
219
most common renal cell carcinoma in kids?
nephroblastoma - whilms
220
primary polidipsia ?
| presents how after fluid deprivation & desmopressin?
where you drink lots even though being well hydrated - pyschiatric disorder
like DI
but high osmolarity after both fluid deprivation & desmopressin
221
worsening Urinary symptoms - means?
urtheral obstruction and stricture
222
definition of AKI?
rise in creatinine and urea & results in oliguria
223
management of AKI?
fluids - if hypovaleamic
stop drugs - nephrotoxic etc
catheterisation
224
what diuretics increase/decrease serum potassium?
decrease K - thiazide, loop
increase K - ACE inhibitors, Spironolactone
225
when is erythropoietin excreted?
in response to hypoxia
226
which imaging is best for prostate?
MRI
227
RA - autoantibodies?2
| SLE - autoantibodies ? 2
RF, ANTI-CCP
ANTI-dsDNA, ANA
228
first line management of UTI?
First line management is with oral nitrofurantoin or trimethoprim.
229
special type of glomerulonephritis?
persistent activation of compliment pathway
C3
haematuria and proteinuria
