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urinary system > conditions > Flashcards

conditions Flashcards

1
Q

why is there no screening for prostate cancer

A

wilson- junger criteria not met

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2
Q

what is a surgical stem (nature)

A 
infection
inflammation 
neoplasia
hereditary 
degenerative 
iatrogenic/ trauma 
neurological
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3
Q

what is the management of acidosis

A

bicarbonate

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4
Q

what is a urothelial cancer

A

malignant tumour of the lining transitional cell epithelium (uroethmelium)
anywhere from renal calyces to tip of urethra

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5
Q

are urinary tract obstructions painful

A

acute - yes

chronic - no

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6
Q

what are risk factors for developing prostate cancer

A

age
race/ ethnicity - afro-caribbean men
geography - north europe/ america
family - 1st degree relative 2x risk

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7
Q

how is multiple myelomas treated

A

hydration
bisphosphonates for hypercalcaemia
glucocorticoids

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8
Q

what are metastatic disease symptoms of prostate cacner

A 
back pain 
paraplegia (off legs) 
lymph node enlargement
acute urinary retention
loin pain 
weight loss, fatigue, fever
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9
Q

what does pathology of focal and segmental glomerulonephritis show

A

focal and segmental sclerosis with distinctive patterns eg. tip lesions, collapsing

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10
Q

what is the commonest cause of nephrotic syndrome in adults (25%)

A

membranous nephropathy

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11
Q

what drug reduces proteinuria

A

ACEi/ ARB

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12
Q

what is the treatment for UTI

A

identify organisms and give antibiotics - amoxicillin, cephalosporin, trimethoprim

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13
Q

what percentage of Type 1 and 2 diabetics will have nephropathy

A

1 - 4% in 10 years, 25% in 25 years

2 - 10% by 5 years, 30% by 20 years

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14
Q

what area is bladder pain felt

A

suprapubic

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15
Q

what are the measures to slow the rate of decline of CKD

A

BP control
control proteinuria
reverse contributing factors
control lifestyle

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16
Q

what are problems with using creatinine to measure kidney function

A

muscle mass
age -
ethnicity - african americans higher
gender - women lower

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17
Q

what percentage of ESRD is glomerulonephritis responsible for

A

30%

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18
Q

what is the 2nd most common haematological malignancy

A

multiple myeloma

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19
Q

how does infective endocarditis lead to glomerulonephritis

A

immune complex formation in glomeruli

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20
Q

does non proliferative glomerulonephritis present with nephrotic or nephritic syndrome

A

nephrotic

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21
Q

what is nocturnal polyuria

A

nocturnal urine output >1/3 of total day urine output

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22
Q

what is the filtration barrier of the kidney formed from

A

podocytes, glomerular basement membrane and endothelial cells

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23
Q

what are the 4 steps in the clinical approach to treating CKD

A

1) dieted aetiology
2) slow rate of renal decline
3) assessment of complications related to reduced GFR
4) prepare for renal replacement therapy

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24
Q

what are complications of urinary tract obstructions

A

decompression haematuria

post obstructive diuresis

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25
Q

where is the urinary tract sterile

A

everywhere but terminal urethra

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26
Q

what lymph nodes drain he testicles

A

para-aortic

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27
Q

why will a urinated specimen always be contaminated

A

terminal urethra houses skin (perineal) and gut (rectal) flora

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28
Q

how does minimal change nephrotic syndrome normally present

A

in children - sudden onset oedema (days)

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29
Q

what are AKI risk events

A

sepsis
toxins - avoid radio contrast, gentamicin, NSAIDs
hypotension
hypovolaemia - haemorrhage , Diarrhoea , vomiting
major surgery

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30
Q

what is myeloma kidney

A

cast nephropahty causes tubular nephropahty

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31
Q

what should you do if the bacterial count for a UTI is 10^3- 10^4

A

treat if symptomatic

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32
Q

what is stage 1 of AKI

A

creatinine - 1.5-1.9x baseline or >26.5umol/l increase

urine - < 0.5 ml/kg/ h for <6-12 hours

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33
Q

what are the initial stage of the treatment for localised prostate cancer

A

watchful waiting

active surveillance

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34
Q

which organisms are most likely to cause a UTI

A

bowel organsisms - E.coli, staph aureus, klebsiella, enterococcus

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35
Q

what are complications of chronic urinary retention

A

UTI
post - decompression haematuria
pathological diuresis
electrolyte abnormalities - metabolic acidosis, low Na, high K

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36
Q

what is the most common type of adult renal malignancy

A

renal adenocarcinoma in proximal tubules

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37
Q

what is the triad of nephrotic syndrome

A

oedema
proteinuria >3.5 g/ day
hypoalbuminaemia <25 g/L
(also hyperlipidaemia)

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38
Q

will a unilateral ureter obstruction present with renal failure

A

no - only bilateral or if on single functioning kidney

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39
Q

why does diagnosis of urothelial tumours need more that one mode of imaging

A

can easily be missed in IVU, USS, flexible cystoscope

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40
Q

what is the prognosis for localised prostate cancer

A

80-90% 5 year survival

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41
Q

what is chronic urinary retention defined as

A

painless, palpable and permissible bladder after voiding

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42
Q

what are the blood pressure aims in CKD

A

125/ 75 with proteinuria

130/80 if no proteinuria

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43
Q

list some transplant causes of CKD

A

1- recurrence

2 - rejection, calcineurin toxicity

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44
Q

what is vasculitis

A

inflammatory reaction in the wall of any blood vessel

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45
Q

what is more expensive dialysis or transplant

A

transplant - 20,000 + ~6,500 on drugs

dialysis - £35,000 per annum per patient

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46
Q

what is differential diagnosis of an upper tract TCC

A

stone, tumour, fungal ball

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47
Q

in scotland, what are the most common causes of CKD in order

A 
diabetes
glomerulonephritis
unknown
pyelonephritis
polycystic kidney disease
hypertension
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48
Q

list some tubulointerstitial causes of CKD

A

1- UTI, stones, pyelonephritis

2 - drugs, toxins, sarcoid, prostatic disease, metazoic cancer,

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49
Q

which people are urinary tract infections common in

A

young, sexually active young women

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50
Q

what is the medical therapy for uncomplicated BPO

A 
alpha blockers (main)
5 alpha reductase inhibitors
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51
Q

how may a spinal cord/ brain injury lead to a urinary infection

A

decreased sensation so don’t know when to micturate or when fully micturated leads to stasis of urine

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52
Q

how are most upper tract TCC treated

A

nephro-uterectomy (total removal)

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53
Q

what are histological subtypes of renal cell carcinoma

A

clear cell (85%)
papillary (10%)
chromophobe (4%)
bellini type ductal carcinoma (1%)

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54
Q

what are tumour markers for testicular cancer

A

alpha fetoprotein
BHCH - human chorionic gonadotrophin
LDH - lactate dehydrogenase

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55
Q

what is the treatment of renal cancer

A

radical nephrectomy - laparoscopic

chemo and radio resistant

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56
Q

what drug can be given to treat acute urinary retention

A

alpha blocker

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57
Q

what can be seen in paraneoplastic syndrome in renal cancer

A

anorexia, cachexia, pyrexia
hypertension, hypercalcaemia
anemia, raised ESR

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58
Q

how does acute pyelonephritis present

A

pyrexia, poor localisation, loin tenderness, signs of dehydration, turbid urine

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59
Q

how is anaemia treated in CKD

A

EPO and iron

treat if <10 g/ dl or symptomatic

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60
Q

what are advantages of haemodialysis

A

rapid solute/ fluid removal

rapid correction of electrolyte disturbances

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61
Q

what is anti- GBM disease

A

caused by circulating anti GBM - autoantibodies to type 4 collagen present in glomerular and alveolar membrane

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62
Q

what are disadvantages of haemofiltration

A

need continuous anticoagulation
may delay mobilisation
may not have adequate clearance

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63
Q

what is the 5 year survival by stage of renal cancer

A 
T1 - 95%
T2 - 90
T3 - 60%
T4 - 20%
N - 20% 
M - median 12-18 months
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64
Q

what studies are done on a renal biopsy to diagnose glomerulonephritis

A

light & electron microscopy

immunofluorescent studies

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65
Q

what is the main risk factor for acute urinary retention

and others

A

benign prostatic obstruction

UTI, urethral stricture, alcohol excess, post surgery)

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66
Q

what is the definition of acute kidney injury

A

syndrome of decreased renal function, measured by serum creatinine or urine output occurring over hours/ days

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67
Q

what investigation is done to grade urothelial tumours

A

flexible cystoscopy

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68
Q

what is the 4th stage of staging for prostate cancer

A

hormone refractory stage - stop responding to suppression of testosterone

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69
Q

what is microscopic haematuria classed as

A

5 RBC per high power field

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70
Q

what things don’t cross the glomerular basement membrane and shouldn’t be in the urine

A

RBC, WBC

HMW proteins - albumin, globulins

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71
Q

what is the immediate treatment of acute urinary retention

A

catheterisation - urethral or suprapubic

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72
Q

what is polyuria

A

urine output > 3L/ 24 hours

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73
Q

what is the lifetime risk of getting a kidney stone in males

A

1 in 8

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74
Q

how is MSSU collected (mid stream specimen urine)

A

void and stop midstream, discard urine, and then collect next volume of urine

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75
Q

list some voiding LUTS

A

hesitancy, poor flow, intermittency, terminal dribbling

due to underachieve bladder

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76
Q

what are the 4 most common presentations of glomerulonephritis

A

haematuria
heavy proteinuria
slowly increasing proteinuria
acute renal failure

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77
Q

what does of a diagnosis of UTI require

A

microbiological evidence AND symptoms signs;

fever, loin/flank/ suprapubic pain or tenderness, urinary frequency or urgency

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78
Q

what are 3 disposing factors to a urine infection

A

stasis of urine - obstruction, loss of feeling
pushing bacteria up urethra - sexual activity, catheterisation
generalised predisposition - diabetes

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79
Q

what are mesangial cells

A

tree like group of cells which support the capillaries

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80
Q

what is treatment of complicated BPO

A

cyctolitholapaxy and TURP

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81
Q

what is the prognosis for castrate resistant prostate cancer

A

median survival 18-22 months

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82
Q

what are the statistic for death in each stage of AKI

A

1 - 8%
2- 25%
3- 33%

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83
Q

how is reflux nephropathy investigated

A

micturating cystogram

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84
Q

what are common causes of obstruction in men, women and both

A

men - BPH
women - uterine prolapse
both - tumours, calculi

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85
Q

what are the general measures in the treatment of non -proliferative glomerulonephritis

A

treat oedema - NaCl/ fluid restriction, loop diuretic
treat hypertension - ACEi
reduce risk of infection - vaccine
treat dyslipidaemia - statins
reduce risk of thrombosis - heparin, warfarin

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86
Q

how is post streptococcal glomerulonephritis treated

A

antibiotics for infection
loop diuretics for oedema
vasodilator for hypertension

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87
Q

where do ureteric calculi normally get lodged

A

pelvi- ureteric junction
cross of iliac vessels
vesicle- ureteric junction

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88
Q

what should you consider when differentiating between a complicated and uncomplicated UTI

A

age, sexual activity, gender, predisposing factors, foreign body

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89
Q

in glomerulonephritis, what is the microscopic finding of RBS

A

dysmorphic RBS (mickey mouse)

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90
Q

how may an upper tract TCC present

A

frank haematuria
flank/ loin pain
unilateral steric obstruction
metastatic symptoms

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91
Q

what form of glomerulonephritis is most common in children

A

minimal change glomerulonephritis

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92
Q

what are the 4 stages of testicular cancer

A

I - disease confined to testes
II - infra diaphragmatic nodes involved
III - supra diaphragmatic nodes involved
IV - extra lymphatic disease

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93
Q

which type of urinary infections should be investigated

A

complicated - men, children

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94
Q

what are presentations of late stage CKD

A

pruritus
nausea / vomiting
pericarditis
neuropathy

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95
Q

how may you investigate a UTI in the lower tract

A

flow studies, residual bladder scan, cystoscopy

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96
Q

what is the most common cause of ESRF leading to need for dialysis

A

diabetic nephropathy

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97
Q

what pathology does proteinuria occur from

A

podocyte pathology

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98
Q

how is the diagnosis of amyloid made (extracellular proteins)

A

biopsy - congo red staining

light microscopy - apple green biofrongens

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99
Q

what are methods of estimating GFR

A 
creatinine
Inulin clearance
isotope GFR
24 hour urine collection + blood
GFR estimating equations
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100
Q

what is the treatment of hyperkalaemia

A

calcium gluconate (stabilise myocardium)
salbutamol, insulin - shift K back to cell
diuresis - remove K

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101
Q

what is the treatment of anti GBM disease

A

corticosteroids, plasma exchange, cytotoxic B cell therapy , complement inhibitors

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102
Q

how may a child present with a UTI

A

diarrhoea (systemic response to infection)
excessive crying - pain
fever, nausea/ vomiting, loss of appetite
failure to thrive

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103
Q

how are high grade bladder tumours treated

A

radical surgery - can be very complicated

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104
Q

what may be a problem when interpreting a MSSU

A

bacterial species not normally present in terminal urethra may be pathogenic at low colony numbers

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105
Q

what is the differential diagnosis of nephrotic syndrome

A 
congestive heart failure (high JVP, normal albumin, minimal proteinuria)
hepatic disease (abnormal LFTs, no proteinuria)
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106
Q

what is the classic triad of renal cancer symptoms

A

flank pain, mass and haematuria

50% are asymptomatic

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107
Q

how does a flow rate study tell if BOO is present

A

if Qmax < 10 ml/s - 90% chance of BOO

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108
Q

what are the complications of CKD (related to a worsening GFR)

A 
A - acidosis/ anaemia 
B - bone disease
C - cardiovascular 
D - death and dialysis 
E - electrolyte imbalance
F - fluid overload/ oedeama
G - gout
H - hypertesion
I- iatrogenic
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109
Q

what are complications of a TURP

A

bleeding, infection, retrograde ejaculation (goes back into bladder)
stress urinary incontinence

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110
Q

what is the percentage of recurrence of uteric stones in 10 years

A

50%

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111
Q

what is the peak age for urolithiasis in men and women

A

men - 30

women - 35 or 55

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112
Q

what is the most common cause of AKI

A

poor perfusion - failure of circulation to provide sufficient plasma flow (loss of volume/ pressure)

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113
Q

does focal and segmental glomerulonephritis respond well to steroids

A

no - trial anyway

cyclosporine, rituximab, cyclophosphamide alternatives

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114
Q

what is the scoring system for benign prostatic hyperplasia

A 
IPSS - international prostate symptomatic score sheet 
7 domains + QOL
mild = 0-7
moderate = 8-19
severe = >20
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115
Q

describe CKD classification by albuminuria in terms of albumin excretion in mg/hr an A:CR

A

A1 - <30, ratio <3
A2 - 30-300, ratio 3-30
A3 - >300, ratio >30

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116
Q

what is the diagnostic triad for prostate cancer

A

PSA

digital rectal examination

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117
Q

what is a CIS bladder tumour

A

non muscle invasive but very aggressive

precursor of muscle invasive

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118
Q

what surgical intervention is used for BPO

A

TURP - transurethral resection of prostate

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119
Q

what hormonal therapy can be given to treat prostate cancer

A

chemical castration - LHRH analogue, negative feedback on androgen receptors
anti - androgens
oestrogen (3rd line)

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120
Q

what is stage 3 of AKI

A

creatinine - 3x baseline or >354umol increase

urine - anuria for >12 hours or <0.3 ml/ kg/ h for over 24 hours

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121
Q

what are the indications for dialysis in AKI

A 
A - low bicarb
E - high K
I - aspirin, metformin, lithium, methanol, theophylline, ethylene glycol 
o - pulmonary oedema
u - pericarditis
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122
Q

what are some intrinsic causes of a urinary tract obstruction

A 
stone
uteric tumour (TCC) 
blood clot
fungal ball
scar tissue
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123
Q

why doe CKD increase CV disease

A 
increased BP
vascular stiffness
inflammation 
oxidative stress
abnormal endothelial function
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124
Q

is PSA cancer or prostate specific

A

prostate specific but not cancer

high flash positive from infection/ inflammation

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125
Q

is haematuria nephritic or nephrotic

A

nephritic

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126
Q

what % of prostate cancers occur in the peripheral zone

A

80

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127
Q

what things can elevate PSA levels (give false positive test result)

A 
UTO
chronic prostatitis
catheterisation/ recent urological procedures
ejaculation 
BPH
prostate cancer
128
Q

how does myeloma lead to renal failure

A

cast nephropathy

light chain nephropahthy

129
Q

what does diagnosis of glomerulonephritis depend on

A

biopsy

130
Q

what advice would you give to prevent UTIs

A

fluid intake

void every 2-3 hours, before bed and before/ after intercourse

131
Q

what is nocturia

A

waking up at night on 1 or more occasions to micturate

132
Q

what signs will be present if there is obstruction at the level of the ureter

A 
upper urethral and bladder dilation 
bilateral hydroureter (water expansion of ureter)
133
Q

what is active surveillance when treating prostate cancer

A

deferring treatment until absolutely necessary to avoid unnecessary side effects
do PSa, rectal examination, MRI regularly

134
Q

why is PSA test repeated again in 3 weeks

A

half life is 2.2 days

135
Q

what are advantages of haemofiltration

A

greater haemodynamic stability

control over volume status

136
Q

why does benign prostate hyperplasia present with LUTS

A

in transitional zone - compresses urethra

137
Q

describe the ECG changes seen in hyperkalaemia

A

1) tall tented T eaves
2) PR interval increases
3) P wave widens and flattens till it eventually disappears
4) prolonged/ widened QRS

138
Q

how is the diagnosis of post streptococcal glomerulonephritis made

A

evidence of infection - high ASOT, anti-DNase B, low C3

139
Q

how may you investigate a painless lump in the testes

A

MSSU
ultrasound
tumour markers

140
Q

what is the most common cause of glomerulonephritis worldwide

A

IgA nephropathy

141
Q

what is the most common cancer amongst young men

A

testicular cancer - peak incidence 3rd decade

142
Q

what are the 3 classes of neurological causes of LUTS

A
  • supra-pontine - stroke, alzheimers, parkinsons
  • infra- pontine supra sacral - spinal cord injury, disc prolapse, spina bifida
  • infra- sacral - MS, diabetes, cauda equina
143
Q

what is stage 2 of AKI

A

creatinine - 2-2.9x baseline

urine - <0.5 ml/kg/h for >12 hours

144
Q

what scoring system is used to grade prostate cancer

A

Gleason pathological grading system

145
Q

what is the difference in solute removal in haemodialysis and heamofiltration

A

haemodialysis - by diffusion in intermittent therapy

haemofiltration - by convection in continuous therapy

146
Q

how may a stone in the urinary tract present

A 
renal pain 
uteric colic
dysuria
haematuria
UTI
147
Q

what is the management of oedema in CKD

A

salt ad fluid restriction , loop diuretics

148
Q

what is the peak age incidence of prostate cancer

A

65-75 years
75% > 65
1 %< 50
(45% <70 - treat if no comorbidities)

149
Q

what is SLE

A

systemic autoimmune disease with antibodies against nuclear components e.g double stranded (ds)DNA
deposition of antibody complexes causes inflammation and tissue damage

150
Q

what is the management of CV disease in CKD

A

BP, aspirin, cholesterol, exercise

151
Q

how may an iatrogenic complication of CKD occur

A

build up urea - uraemia pericarditis

drug toxin

152
Q

list some glomerular causes of CKD

A

1- glomerulonephritis

2- diabetes, amyloid, myeloma

153
Q

what are techniques to remove kidney/ ureteric stones

A

open surgery
endoscopic surgery
ESWL - extracorpeal shockwave lithotripsy
PCNL - percutaneous nephrolithotomy

154
Q

why may you do an USS for CKD

A

check size, symmetry, anatomy, exclude obstruction

155
Q

is proteinuria nephritic or nephrotic

A

nephrotic

156
Q

what is normal range of PSA

A 
0-4 ug/mL
<50 - 2.5 is upper limit
50-60 - 3.5 is upper limit
60-70 - 4.5 is upper limit
>70 - 6.5 is upper limit
157
Q

what imaging procedure can be done to investigate frank haematuria

A

cystourethroscopy

158
Q

what may membranous nephropathy occur secondary to

A

majority are primary (in isolation)
malignancy - lung, breast, prostate, GI
infection - hep B/C, streptococcus, malaria
immune - SLE, rheumatoid arthritis, sarcoidosis
drugs - gold, NSAIDs, penicillamine

159
Q

what is the most common type of bladder cancer

A

transitional cell carcinoma

160
Q

what blood tests would you do to investigate AKI

A 
FBC, U&amp;E, bicarb
LFT (hepatorenal disease)
clotting - in case biopsy 
blood gas
ANCA (vasculitis), Ig (myeloma), C3/4 dsDNA (lupus)
161
Q

what is the commonest cancer diagnosed in men

A

prostate

162
Q

what investigation is used to asses the size of the prostate

A

digital rectal

163
Q

what is the treatment for renal bone disease in CKD

A

diet and phosphate binders
give active vit D3
parathyroidectomy

164
Q

in high pressure chronic urinary retention what 2 type of diuresis may occur

A

physiological - <200ml/ hour

pathological - >200 ml/ hour +/- postural hypotension

165
Q

what are complications of acute urinary retention

A 
UTI 
post - decompression haematuria
pathological diuresis 
renal failure
electrolyte abnormalities
166
Q

when does anti GBM disease normally present

A

two peaks - 3rd decade and 6th decade

167
Q

what tests can diagnose proteinuria

A

24 hour urine collection

urine protein creatinine ratio

168
Q

what is the treatment for minimal change nephrotic syndrome

A

prednisolone

relapses treated with immunosuppression

169
Q

what should you always do before performing a renal biopsy

A

check clotting factors

170
Q

what are indications for surgical treatment of ureteric stones

A

obstruction of urinary tract
recurrent haematuria, pain and infection
progressive loss of kidney function
patient occupation

171
Q

how do 5a reductase inhibitors help BPO

A

reduce prostate size and reduce LUTs

172
Q

what are some clinical features of multiple myeloma (excess immunoglobulins and light chains)

A 
raised ESR
anaemia
weight loss
fractures
back pain
173
Q

what closes off the ureter and stops reflux

A

increased pressure in the bladder as it fills

174
Q

how does IgA nephropathy usually present

A

asymptomatic

microscopic haematuria

175
Q

what are presentations of early stage CKD

A 
asymptomatic
fatigue
anaemia
hypertension 
oedema
bone pain to renal disease
176
Q

how are the majority of prostate cancers diagnosed

A

opportunistic PSA testing

177
Q

what are risk factors for testicular cancer

A

caucasians
family history
previous cancer in contralateral tests

178
Q

what should you do if a child presents with a urinary obstruction

A

send to paediatric surgeon

179
Q

how do you treat uncomplicated BPO

A

watchful waiting

180
Q

which form of glomerulonephritis does not leas to kidney failure

A

minimal change disease

181
Q

what is anuria

A

absolute - no urine output

relative - <100ml/ 24 hours

182
Q

what are complications of nephrotic syndrome

A

thromboembolism -
infection - urinary loss of immune mediators
hypelipidaemia-

183
Q

what must be kept constant in glomerular capillaries to keep filtration working

A

pressure

184
Q

what does pathology of focal and segmental glomerulonephritis show

A

focal and segmental sclerosis with distinctive patterns eg. tip lesions, collapsing

185
Q

what is the most common presentation of bladder cancer

A

painless frank haematuria

186
Q

what are symptoms and signs of a urinary tract obstruction

A

pain, frank haematuria, palpable mass, signs of complication

187
Q

what are emergencies related to UTIs

A 
acute kidney injury
acute urinary retention
sepsis
sever heamaturia causing haemorrhage stroke 
testicular torsion 
paraphimosis/ priapism
188
Q

what is the prognosis for localised prostate cancer

A

> 90% 15 year survival

189
Q

how may an iatrogenic CKD be prevented

A

ask about drug medication

190
Q

when should someone be counselled for RRT

A

when risk of failure is 10-20% in 1 year

191
Q

why are females more susceptible to urine infections

A 
shorter urethra
lack of prostatic bacteriostatic secretion 
closeness of urethra to rectum 
sexual activity
pregnancy (pressure on ureter/ kidney)
192
Q

what is oliguria

A

urine output < 0.5ml/ kg/ hour

193
Q

how can you investigate haematuria

A

flexible cystoscopy

194
Q

why is anaemia a complication of CKD

A

reduced erythropoietin and red cell survival

195
Q

what is the gold standard investigation for a UTI

A

MSSU with microbiology (bacteria > 10^5)

196
Q

describe the glomerular filtration rate classification of GFR

A 
G1 - >90
G2 - 60-89
G3a - 45-59
G3b - 30-44
G4 - 15 - 29
G5 - <15
197
Q

how are low grade bladder tumours treated

A

endoscopic resection and chemo

198
Q

what are the immediately dangerous consequences of AKI

A 
A - acidosis
E - electrolyte (high K)
I - intoxication - toxins in blood
O - oedema (pulmonary)
U - uraemia complications
199
Q

how does anti- GBM disease manifest in the kidneys and lungs

A

renal - oliguria/anuria, haematuria, AKI, renal failure

lung- SOB, haemoptysis (pulmonary haemorrhage in 50-90%)

200
Q

what urinalysis would you look at in a UTI

A

blood, leucocytes, protein, nitrates

201
Q

what are 2 main causes of squamous cell carcinoma in the bladder

A

schistosomiasis

chronic cystitis

202
Q

what signs will be present if there is obstruction at the level of the renal pelvis

A 
unilateral hydrometer
unilateral hydronephrosis (back pressure to kidney)
203
Q

list some cystic/ congenital causes of CKD

A

1- renal dysplasia

2- polycystic kidney disease, fabric disease

204
Q

what is acute urinary retention defined as

A

painful inability to void with a palpable and percussible bladder

205
Q

what is the difference between global and segmental glomerulonephritis

A

global - all glomerulus affect

segmental - part affected

206
Q

what is the difference in the 5 year survival for low and high grade bladder TCC

A

low - 90%

high - 50%

207
Q

what is the prognosis for metastatic prostate cancer

A

3-5 years

208
Q

what is the essential treatment of testicular cancer

A

radical orchidectomy

+/ - radiotherapy and chemotherapy

209
Q

what is the most common type of uteric stone

A

calcium oxalate

2nd - Ca oxalate and phosphate

210
Q

what is henoch schonelein purpura (HSP)

A

a small vessel vasculitis and a systemic variant of IgA nephropathy with IgA deposition in skin, joints or gut in addition to the kidney

211
Q

what should you do if a MSSU is too difficult to collect

A

suprpubic aspirate

212
Q

what is chronic kidney disease

A

either the presence of kidney damage (abnormal blood, urine or X-ray findings) or GFR <60 ml/min/ 1.73m^2 that is present for > 3 months

213
Q

what age group do seminomas and non seminomas mainly affect

A

seminomas - 30-40

non seminomas - 20-30

214
Q

what is the relationship between the levels of PSA and cancer probability

A 
0-1 - 5%
1-2.5 - 15%
2.5 - 4 - 25%
4-10 - 40%
>10 - 70%
215
Q

why do CKD patients get renal bone disease

A

high phosphate and lower Ca absorption lead to secondary hyperparathyroidism (PTH tries to correct imbalance)
low Ca as lack of activated vit D

216
Q

what is the commonest cause of urological emergency admissions

A

colic

217
Q

how does hyperglycaemia reduce GFR

A

increased growth factors
RAAS activation
oxidative stress
production of advanced glycolysation products

218
Q

how is the diagnosis of minimal change nephrotic syndrome made

A

electron microscopy - effacement of podocyte processes

219
Q

how does henoch schonelein purpura (HSP) present

A

purpuric rash on extensor surfaces (legs)

polyarthristis, abdominal pain, nephritis

220
Q

how are bladder tumours classified

A

by grade 1-3 and stage TNM combination

221
Q

what imaging test is mandatory in renal cancer

A

CT scan of abdomen and chest

222
Q

what are symptoms of uraemia

A 
nausea/ vomiting 
anorexia
cramp 
fatigue
pruritis 
drowsiness
223
Q

what is a radio contrast nephropathy

A

AKI following administration of iodinated contrast agent

normally resolve after 72 hours

224
Q

what are some extrinsic causes of a urinary tract obstruction

A 
obstruction from crossing vessel 
Lymph nodes
abdominal mass (tumour) 
iatrogenic 
prostate/ cervical cancer
225
Q

where do renal cancers commonly metastasise to

A

lungs, bone, brain, liver

226
Q

how may wegners granulomatosis present

A 
URT- epistaxis, saddle nose, sinusitis 
LRT - cough, dyspnoea, haemoptysis 
glomerulonephritis
pulmonary haemorrhage 
joints - arthritis, myalgia
pericarditis 
vasculitic sin rash
227
Q

what is membranoproliferative glomerulonephritis divided into

A

immune complex associated - increased/ abnormal immunoglobulin deposition in the kidney
C3 glomerulonephropathy - defect in complement pathway

228
Q

how would you treat a post renal cause of AKI

A

catheter + nephrostomy

229
Q

what does chronic urinary retention present as

A

LUTS or complications

230
Q

what is dysuria

A

pain of micturition

231
Q

when do complications of CKD usually manifest

A

when GFR <20mls/ min

232
Q

when does post streptococcal glomerulonephritis typically present

A

10-21 days after infection typically of throat (2 weeks) or skin (3-6 weeks)

233
Q

what is the usual route of infection

A

ascending

234
Q

what is the difference between a complicated and uncomplicated UTI

A

uncomplicated - young sexually active females with clear reaction to sexual activity
complicated - due to structural/ functional abnormality, obstruction, stones, catheter, neurogenic bladder, renal transplant

235
Q

what is the treatment for locally advanced prostate cancer

A

hormonal therapy and radiation

236
Q

what is the treatment for wegners granulomatis

A

high dose glucocorticoids ply immunsuppresant

plasma exchange if renal failure/ pulmonary hameorrage

237
Q

how is myeloma diagnosed

A

bone marrow aspirate
serum paraprotein
urinary bence-jones protein (BJP)

238
Q

what are clinical features of myelomas

A

anaemia, back pain, fractures, infections, high ESR, high Ca

239
Q

what are complications of BPO

A 
progression of LUTS
acute urinary retention 
chronic urinary retention (new bed wetting)
urinary incontinence 
UTI 
renal failure from high back pressure
240
Q

what is the emergency treatment of urinary obstruction

A

percutaneous nephrostomy insertion or retrograde stent insertion
definitive treatment - treat cause

241
Q

what are risk factors for developing renal cancer

A

family history
obesity, smoking
anti- hypertensive medication
end stage renal failure (cystic changes in kidney)

242
Q

how is multiple myeloma diagnosed

A

bone marrow aspirate
urinary bence jones protein
serum free light chains in blood

243
Q

how may a lower tract obstruction present

A

LUTS
incontinence
frank heamaturiea
urinary retention

244
Q

what genes may increase the chance of developing prostate cancer

A

HPC 1

BRAC 1 &2 - breast cancer gene in females passed on to offspring

245
Q

what is the treatment of membranous nephropathy

A

general measures

immunosuppression if symptomatic

246
Q

how does Gleason score relate to risk of death from CAP

A

6 - 18-30% (ISUP 1)
7 - 42-70% (ISUP 2-3)
8-10 - 60-87%

247
Q

what abnormalities in the renal tract may lead to a UTI

A

stones, renal outflow obstruction, BOO, horseshoe kidney, bladder tumour, fistula bladder / bowel

248
Q

what is PSA

A

kallikrein serine protease (liquifies semen) produced by glands of the prostate

249
Q

what causes post streptococcal glomerulonephritis

A

streptococci antigen deposits in glomerulus leading to immune complex formation and inflammation

250
Q

what is the first line treatment for renal and ureteric calculi (<2cm)

A

ESWL

251
Q

what are serological markers of membranous nephropathy

A

PLA2R antibody positive
THSD7A
diffusely thickened GBM due to sub epithelial deposits go IgG

252
Q

list some proliferative glomerulonephritis

A 
post infective nephrtitis (diffuse proliferative)
IgA nephropathy  (focal proliferative) 
Cresentric nephritis (focal necrotising)
253
Q

what are patients with CKD most likely to die of

A

cardiovascular disease

254
Q

what characterises IgA nephropathy

A

IgA deposition in the mesangium and mesangial proliferation

255
Q

why is the kidney a target for systemic disease

A
  • high blood flow
  • glomeruli can trap proteins or immune complexes
  • metabolises drugs which may be toxic
256
Q

what percentage of men at 60 years and and 85 years will have benign prostatic hyperplasia

A

65 - 50%

85 - 90%

257
Q

what is benign prostatic hyperplasia characterised by

A

fibromuscular and glandular hyperplasia in transitional zone

258
Q

how may you investigate a UTI in the upper tract

A

USS kidneys, CT KUB/ IVU, MAG-3 venogram, DMSA scan

259
Q

what uteric stones are infective

A

triple phosphate - Ca, Mg, NH3

260
Q

what are the main presentations of UTI

A

dysuria, pain, increased frequency

cloudy offensive smelling urine

261
Q

what are risk factors for AKI

A

pre- existing CKD
age
male
co-morbidities - DM, CV disease, malignancy, chronic liver disease

262
Q

what are complications of a UTI

A 
sepsis
renal failure 
bladder malignancy (squamous cell carcinoma)
acute urinary retention 
frank haematuria 
bacteriuria of pregnancy 
clubbing of calyces
263
Q

what is the most common pathological class of testicular cancer

A

germ cell tumour (95%)

seminomatous / non seminomatous

264
Q

how is IgA nephropathy managed

A 
control BP  (ACEi)
prepare for RRT
265
Q

what test can be done to assess split renal function

A

DMSA or MAG-3 renogram

266
Q

what is the definitive treatment of localised prostate cancer

A

radical prostatectomy

267
Q

what are pre renal causes of AKI

A 
reduced circulation volume - dehydration, haemorrhage, D&amp;V
hypotension / shock
congestive heart/ liver failure 
arterial occlusion 
NSAIDs
268
Q

what is a urinary tract infection

A

infection affecting urinary tract - kidneys, ureter, bladder, urethra, prostate, epididymis, testis

269
Q

how does hyperkalaemia occur in CKD

A

K is normally exchanged with Na in the distal tubule - reduced Na delivery as GFR falls
>7 = fatal cardiac arrythmia

270
Q

what is the risk of developing bladder TCC if you have upper tract TCC

A

40% in 10 years - regular surveillance

271
Q

what is a common cause of UTIs in children

A

reflux nephropathy - bladder contacts and expels urine back to kidney leading to infection

272
Q

what are renal causes of AKI

A 
acute tubular necrosis
toxin related - drugs, radio contrast, snake
acute interstitial nephritis
acute glomerulonephritis
myeloma
273
Q

what are the 4 grades of bladder tumour

A

G1- well differentiated, non invasive
G2 - mod differentiated, non invasive
G3 - poorly differentiated, invasive

274
Q

does proliferative glomerulonephritis present with nephrotic or nephritic syndrome

A

nephritic - blood on dipstick

extra cells in glomerulus

275
Q

what urine investigations can be done to investigate glomerulonephritis

A

MC&S
A:CR/ P:CR
RBC casts

276
Q

what are the T stages of renal cancer

A

T1 - <7cm confined within capsule
T2 - >7 cm confined in capsule
T3 - local extension outside capsule
T4 - beyond Gerotas fascia

277
Q

what drugs are nephrotoxic

A

digoxin, diuretics
aminoglycosdies, ACEi/ ARB
metformin , morpheine (opiates)
NSAIDS

278
Q

what quantities of serum creatinine and urine volume are given for an AKI

A

increase in S creatinine >26.5 mol/l within 48 hours or >1.5 x baseline (from past 7 days)
or urine <0.5 ml/ kg/ h for 6 consecutive hours

279
Q

what is the main symptom nephrotic syndrome

A

generalised pitting oedema

280
Q

what is glomerulonephritis

A

group of inflammatory disorders of the kidney

281
Q

how is an upper tract TCC investigated

A

CT IVU

uteroscopy and biopsy

282
Q

what are risk factors for transition cell carcinoma

A

smoking (40%)
aromatic amines
genetic abnormalities
pelvic radiotherapy

283
Q

what specific blood tests may you do to investigate CKD

A 
C3/4 
autoantibody 
ANCA - vasculitis
anti GBM
serum electrophoresis - myeloma
284
Q

what is seen on urinalysis of the nephritic state

A

haematuria, dysmorphic RBCs, cellular casts

285
Q

which lymph nodes drain the prostate gland

A

pelvic lymph nodes

286
Q

what blood tests may you do to investigate CKD

A 
U&amp;E, FBC, HCO3
total protein albumin 
LFT
creatinine kinase
immunoglobulins
coagulation screen
287
Q

what blood tests would you request to investigate glomerulonephritis

A

FBC, U&E, LFT, CRP
immunoglobulins, complement C3/ 4
autoantibodies - ANCA, anti-dsDNA, anti-GBM
culture

288
Q

what are secondary causes of nephrotic syndrome

A

DM,
amyloid
myeloma
lupus nephrtitis

289
Q

what are the terms for the inflammation of; bladder, prostate, urethera, kidney, testis

A

cystitis, prostatitis, urethritis, pyelonephritis, orchitis

290
Q

what are signs of circulatory volume depletion and overload

A

depletion - orthostatic BP, skin turgor/ temperature

overload - raised JVP, crepitations, ascites, oedema

291
Q

how are patients prepared for RRT

A 
education 
select modality 
planning access
decide when to start 
multidisciplinary team
292
Q

what imaging test would you do to investigate AKI

A

renal USS

293
Q

what are the symptoms of locally invasive prostate cancer

A

haematuria
incontinence
perineal / suprapubic pain
haemospermia

294
Q

how does the Gleason pathological grading system classify grades of cancer

A

score 3-5 in terms of how well differentiated
summated - number of most common cells + number of 2nd most common cells
(cancer is heterogenous)
min 6 max 10

295
Q

what are disadvantage of haemodialysis

A

slower filtration

only fluid removal when treatment

296
Q

how do alpha blockers help BPO

A

smooth muscle relaxation - prostate innervated by sympathetic alpha adrenergic nerves
(can be selective/ non selective/ highly selective)

297
Q

what are post renal causes of AKI (seen on ultrasound)

A

obstruction - intraluminal, intramural, extramural

298
Q

what are complications of ureteric calculi

A

haematuria, fever, perforation , reflux, stricture formation

299
Q

why should you always sterilise a catheter before inserting

A

can move lower urethral flora up the tract

300
Q

list some storage LUTS

A

frequency, nocturia, urgency, urge incontinence

301
Q

what may focal and segmental glomerulonephritis be secondary to

A

HIV, heroin, lithium, lymphoma

302
Q

at what % of GFR will creatinine levels begin to drop

A

60%

303
Q

how would you investigate a stone in the urinary tract

A 
CT KUB 
USS
Urinalysis and culture
bloods
24 hour urine collection (high Ca)
304
Q

what is the differential diagnosis for a painless lump in testes

A

infection (epididymo-orchitis)
epidymal cyst
hydrocele
hernia - can’t get above lump

305
Q

what is the prognosis of each stage of testicular cancer

A

good, 5 year survival:
1 - 99%
2/3 - 96%
4 - 73%

306
Q

how may an obstruction in the urinary tract lead to an infection

A

slow urine flow can’t flush out the bacteria

or sediments form stone with cause more obstruction

307
Q

what is the prognosis of membranous nephropathy

A

resolves spontaneously in 1/3
25% on dialysis on 10 years
good prognosis if proetinura resolves

308
Q

what is the difference between primary and secondary glomerulonephritis

A

primary - only in glomerulus

secondary - other body systems affected (SLE, wagerers etc.)

309
Q

what is the difference between diffuse and focal glomerulonephritis

A

diffuse - >50% glomeruli affected

focal - <50% glomeruli affected

310
Q

list some blood flow/vessel causes of CKD

A

1 - renal vasculitis, renal artery stenosis

2 - heart failure, hypertension

311
Q

what is the name of the zones used the describe locations in the prostate

A

McNeals

312
Q

what is produced in excess in myeloma

A

light chains and immunoglobulins - by plasma cells

313
Q

describe the 2 forms of T staging a bladder tumour

A

Tis-T1 - non invasive of detrusor muscle

T2-4 - invade the detrusor muscle

314
Q

what is the microbiological evidence of a UTI

A

bacterial count of 10^5 cfg/ ml from MSSU specimen

315
Q

is there is frank haematuria, what is the res of malignancy in >50s

A

25-35%

316
Q

how does testicular cancer usually present

A

a painless lump (can be tender or inflammed)

urinary system (2 decks)

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