conditions Flashcards
(316 cards)
1
Q
why is there no screening for prostate cancer
A
wilson- junger criteria not met
2
Q
what is a surgical stem (nature)
A
infection inflammation neoplasia hereditary degenerative iatrogenic/ trauma neurological
3
Q
what is the management of acidosis
A
bicarbonate
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
5
Q
are urinary tract obstructions painful
A
acute - yes
chronic - no
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
7
Q
how is multiple myelomas treated
A
hydration
bisphosphonates for hypercalcaemia
glucocorticoids
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
9
Q
what does pathology of focal and segmental glomerulonephritis show
A
focal and segmental sclerosis with distinctive patterns eg. tip lesions, collapsing
10
Q
what is the commonest cause of nephrotic syndrome in adults (25%)
A
membranous nephropathy
11
Q
what drug reduces proteinuria
A
ACEi/ ARB
12
Q
what is the treatment for UTI
A
identify organisms and give antibiotics - amoxicillin, cephalosporin, trimethoprim
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
14
Q
what area is bladder pain felt
A
suprapubic
15
Q
what are the measures to slow the rate of decline of CKD
A
BP control
control proteinuria
reverse contributing factors
control lifestyle
16
Q
what are problems with using creatinine to measure kidney function
A
muscle mass
age -
ethnicity - african americans higher
gender - women lower
17
Q
what percentage of ESRD is glomerulonephritis responsible for
A
30%
18
Q
what is the 2nd most common haematological malignancy
A
multiple myeloma
19
Q
how does infective endocarditis lead to glomerulonephritis
A
immune complex formation in glomeruli
20
Q
does non proliferative glomerulonephritis present with nephrotic or nephritic syndrome
A
nephrotic
21
Q
what is nocturnal polyuria
A
nocturnal urine output >1/3 of total day urine output
22
Q
what is the filtration barrier of the kidney formed from
A
podocytes, glomerular basement membrane and endothelial cells
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
24
Q
what are complications of urinary tract obstructions
A
decompression haematuria
post obstructive diuresis
25
where is the urinary tract sterile
everywhere but terminal urethra
26
what lymph nodes drain he testicles
para-aortic
27
why will a urinated specimen always be contaminated
terminal urethra houses skin (perineal) and gut (rectal) flora
28
how does minimal change nephrotic syndrome normally present
in children - sudden onset oedema (days)
29
what are AKI risk events
sepsis
toxins - avoid radio contrast, gentamicin, NSAIDs
hypotension
hypovolaemia - haemorrhage , Diarrhoea , vomiting
major surgery
30
what is myeloma kidney
cast nephropahty causes tubular nephropahty
31
what should you do if the bacterial count for a UTI is 10^3- 10^4
treat if symptomatic
32
what is stage 1 of AKI
creatinine - 1.5-1.9x baseline or >26.5umol/l increase
| urine - < 0.5 ml/kg/ h for <6-12 hours
33
what are the initial stage of the treatment for localised prostate cancer
watchful waiting
| active surveillance
34
which organisms are most likely to cause a UTI
bowel organsisms - E.coli, staph aureus, klebsiella, enterococcus
35
what are complications of chronic urinary retention
UTI
post - decompression haematuria
pathological diuresis
electrolyte abnormalities - metabolic acidosis, low Na, high K
36
what is the most common type of adult renal malignancy
renal adenocarcinoma in proximal tubules
37
what is the triad of nephrotic syndrome
oedema
proteinuria >3.5 g/ day
hypoalbuminaemia <25 g/L
(also hyperlipidaemia)
38
will a unilateral ureter obstruction present with renal failure
no - only bilateral or if on single functioning kidney
39
why does diagnosis of urothelial tumours need more that one mode of imaging
can easily be missed in IVU, USS, flexible cystoscope
40
what is the prognosis for localised prostate cancer
80-90% 5 year survival
41
what is chronic urinary retention defined as
painless, palpable and permissible bladder after voiding
42
what are the blood pressure aims in CKD
125/ 75 with proteinuria
| 130/80 if no proteinuria
43
list some transplant causes of CKD
1- recurrence
| 2 - rejection, calcineurin toxicity
44
what is vasculitis
inflammatory reaction in the wall of any blood vessel
45
what is more expensive dialysis or transplant
transplant - 20,000 + ~6,500 on drugs
| dialysis - £35,000 per annum per patient
46
what is differential diagnosis of an upper tract TCC
stone, tumour, fungal ball
47
in scotland, what are the most common causes of CKD in order
```
diabetes
glomerulonephritis
unknown
pyelonephritis
polycystic kidney disease
hypertension
```
48
list some tubulointerstitial causes of CKD
1- UTI, stones, pyelonephritis
| 2 - drugs, toxins, sarcoid, prostatic disease, metazoic cancer,
49
which people are urinary tract infections common in
young, sexually active young women
50
what is the medical therapy for uncomplicated BPO
```
alpha blockers (main)
5 alpha reductase inhibitors
```
51
how may a spinal cord/ brain injury lead to a urinary infection
decreased sensation so don't know when to micturate or when fully micturated leads to stasis of urine
52
how are most upper tract TCC treated
nephro-uterectomy (total removal)
53
what are histological subtypes of renal cell carcinoma
clear cell (85%)
papillary (10%)
chromophobe (4%)
bellini type ductal carcinoma (1%)
54
what are tumour markers for testicular cancer
alpha fetoprotein
BHCH - human chorionic gonadotrophin
LDH - lactate dehydrogenase
55
what is the treatment of renal cancer
radical nephrectomy - laparoscopic
| chemo and radio resistant
56
what drug can be given to treat acute urinary retention
alpha blocker
57
what can be seen in paraneoplastic syndrome in renal cancer
anorexia, cachexia, pyrexia
hypertension, hypercalcaemia
anemia, raised ESR
58
how does acute pyelonephritis present
pyrexia, poor localisation, loin tenderness, signs of dehydration, turbid urine
59
how is anaemia treated in CKD
EPO and iron
| treat if <10 g/ dl or symptomatic
60
what are advantages of haemodialysis
rapid solute/ fluid removal
| rapid correction of electrolyte disturbances
61
what is anti- GBM disease
caused by circulating anti GBM - autoantibodies to type 4 collagen present in glomerular and alveolar membrane
62
what are disadvantages of haemofiltration
need continuous anticoagulation
may delay mobilisation
may not have adequate clearance
63
what is the 5 year survival by stage of renal cancer
```
T1 - 95%
T2 - 90
T3 - 60%
T4 - 20%
N - 20%
M - median 12-18 months
```
64
what studies are done on a renal biopsy to diagnose glomerulonephritis
light & electron microscopy
| immunofluorescent studies
65
what is the main risk factor for acute urinary retention
| and others
benign prostatic obstruction
| UTI, urethral stricture, alcohol excess, post surgery)
66
what is the definition of acute kidney injury
syndrome of decreased renal function, measured by serum creatinine or urine output occurring over hours/ days
67
what investigation is done to grade urothelial tumours
flexible cystoscopy
68
what is the 4th stage of staging for prostate cancer
hormone refractory stage - stop responding to suppression of testosterone
69
what is microscopic haematuria classed as
5 RBC per high power field
70
what things don't cross the glomerular basement membrane and shouldn't be in the urine
RBC, WBC
| HMW proteins - albumin, globulins
71
what is the immediate treatment of acute urinary retention
catheterisation - urethral or suprapubic
72
what is polyuria
urine output > 3L/ 24 hours
73
what is the lifetime risk of getting a kidney stone in males
1 in 8
74
how is MSSU collected (mid stream specimen urine)
void and stop midstream, discard urine, and then collect next volume of urine
75
list some voiding LUTS
hesitancy, poor flow, intermittency, terminal dribbling
| due to underachieve bladder
76
what are the 4 most common presentations of glomerulonephritis
haematuria
heavy proteinuria
slowly increasing proteinuria
acute renal failure
77
what does of a diagnosis of UTI require
microbiological evidence AND symptoms signs;
| fever, loin/flank/ suprapubic pain or tenderness, urinary frequency or urgency
78
what are 3 disposing factors to a urine infection
stasis of urine - obstruction, loss of feeling
pushing bacteria up urethra - sexual activity, catheterisation
generalised predisposition - diabetes
79
what are mesangial cells
tree like group of cells which support the capillaries
80
what is treatment of complicated BPO
cyctolitholapaxy and TURP
81
what is the prognosis for castrate resistant prostate cancer
median survival 18-22 months
82
what are the statistic for death in each stage of AKI
1 - 8%
2- 25%
3- 33%
83
how is reflux nephropathy investigated
micturating cystogram
84
what are common causes of obstruction in men, women and both
men - BPH
women - uterine prolapse
both - tumours, calculi
85
what are the general measures in the treatment of non -proliferative glomerulonephritis
treat oedema - NaCl/ fluid restriction, loop diuretic
treat hypertension - ACEi
reduce risk of infection - vaccine
treat dyslipidaemia - statins
reduce risk of thrombosis - heparin, warfarin
86
how is post streptococcal glomerulonephritis treated
antibiotics for infection
loop diuretics for oedema
vasodilator for hypertension
87
where do ureteric calculi normally get lodged
pelvi- ureteric junction
cross of iliac vessels
vesicle- ureteric junction
88
what should you consider when differentiating between a complicated and uncomplicated UTI
age, sexual activity, gender, predisposing factors, foreign body
89
in glomerulonephritis, what is the microscopic finding of RBS
dysmorphic RBS (mickey mouse)
90
how may an upper tract TCC present
frank haematuria
flank/ loin pain
unilateral steric obstruction
metastatic symptoms
91
what form of glomerulonephritis is most common in children
minimal change glomerulonephritis
92
what are the 4 stages of testicular cancer
I - disease confined to testes
II - infra diaphragmatic nodes involved
III - supra diaphragmatic nodes involved
IV - extra lymphatic disease
93
which type of urinary infections should be investigated
complicated - men, children
94
what are presentations of late stage CKD
pruritus
nausea / vomiting
pericarditis
neuropathy
95
how may you investigate a UTI in the lower tract
flow studies, residual bladder scan, cystoscopy
96
what is the most common cause of ESRF leading to need for dialysis
diabetic nephropathy
97
what pathology does proteinuria occur from
podocyte pathology
98
how is the diagnosis of amyloid made (extracellular proteins)
biopsy - congo red staining
| light microscopy - apple green biofrongens
99
what are methods of estimating GFR
```
creatinine
Inulin clearance
isotope GFR
24 hour urine collection + blood
GFR estimating equations
```
100
what is the treatment of hyperkalaemia
calcium gluconate (stabilise myocardium)
salbutamol, insulin - shift K back to cell
diuresis - remove K
101
what is the treatment of anti GBM disease
corticosteroids, plasma exchange, cytotoxic B cell therapy , complement inhibitors
102
how may a child present with a UTI
diarrhoea (systemic response to infection)
excessive crying - pain
fever, nausea/ vomiting, loss of appetite
failure to thrive
103
how are high grade bladder tumours treated
radical surgery - can be very complicated
104
what may be a problem when interpreting a MSSU
bacterial species not normally present in terminal urethra may be pathogenic at low colony numbers
105
what is the differential diagnosis of nephrotic syndrome
```
congestive heart failure (high JVP, normal albumin, minimal proteinuria)
hepatic disease (abnormal LFTs, no proteinuria)
```
106
what is the classic triad of renal cancer symptoms
flank pain, mass and haematuria
| 50% are asymptomatic
107
how does a flow rate study tell if BOO is present
if Qmax < 10 ml/s - 90% chance of BOO
108
what are the complications of CKD (related to a worsening GFR)
```
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
```
109
what are complications of a TURP
bleeding, infection, retrograde ejaculation (goes back into bladder)
stress urinary incontinence
110
what is the percentage of recurrence of uteric stones in 10 years
50%
111
what is the peak age for urolithiasis in men and women
men - 30
| women - 35 or 55
112
what is the most common cause of AKI
poor perfusion - failure of circulation to provide sufficient plasma flow (loss of volume/ pressure)
113
does focal and segmental glomerulonephritis respond well to steroids
no - trial anyway
| cyclosporine, rituximab, cyclophosphamide alternatives
114
what is the scoring system for benign prostatic hyperplasia
```
IPSS - international prostate symptomatic score sheet
7 domains + QOL
mild = 0-7
moderate = 8-19
severe = >20
```
115
describe CKD classification by albuminuria in terms of albumin excretion in mg/hr an A:CR
A1 - <30, ratio <3
A2 - 30-300, ratio 3-30
A3 - >300, ratio >30
116
what is the diagnostic triad for prostate cancer
PSA
| digital rectal examination
117
what is a CIS bladder tumour
non muscle invasive but very aggressive
| precursor of muscle invasive
118
what surgical intervention is used for BPO
TURP - transurethral resection of prostate
119
what hormonal therapy can be given to treat prostate cancer
chemical castration - LHRH analogue, negative feedback on androgen receptors
anti - androgens
oestrogen (3rd line)
120
what is stage 3 of AKI
creatinine - 3x baseline or >354umol increase
| urine - anuria for >12 hours or <0.3 ml/ kg/ h for over 24 hours
121
what are the indications for dialysis in AKI
```
A - low bicarb
E - high K
I - aspirin, metformin, lithium, methanol, theophylline, ethylene glycol
o - pulmonary oedema
u - pericarditis
```
122
what are some intrinsic causes of a urinary tract obstruction
```
stone
uteric tumour (TCC)
blood clot
fungal ball
scar tissue
```
123
why doe CKD increase CV disease
```
increased BP
vascular stiffness
inflammation
oxidative stress
abnormal endothelial function
```
124
is PSA cancer or prostate specific
prostate specific but not cancer
| high flash positive from infection/ inflammation
125
is haematuria nephritic or nephrotic
nephritic
126
what % of prostate cancers occur in the peripheral zone
80
127
what things can elevate PSA levels (give false positive test result)
```
UTO
chronic prostatitis
catheterisation/ recent urological procedures
ejaculation
BPH
prostate cancer
```
128
how does myeloma lead to renal failure
cast nephropathy
| light chain nephropahthy
129
what does diagnosis of glomerulonephritis depend on
biopsy
130
what advice would you give to prevent UTIs
fluid intake
| void every 2-3 hours, before bed and before/ after intercourse
131
what is nocturia
waking up at night on 1 or more occasions to micturate
132
what signs will be present if there is obstruction at the level of the ureter
```
upper urethral and bladder dilation
bilateral hydroureter (water expansion of ureter)
```
133
what is active surveillance when treating prostate cancer
deferring treatment until absolutely necessary to avoid unnecessary side effects
do PSa, rectal examination, MRI regularly
134
why is PSA test repeated again in 3 weeks
half life is 2.2 days
135
what are advantages of haemofiltration
greater haemodynamic stability
| control over volume status
136
why does benign prostate hyperplasia present with LUTS
in transitional zone - compresses urethra
137
describe the ECG changes seen in hyperkalaemia
1) tall tented T eaves
2) PR interval increases
3) P wave widens and flattens till it eventually disappears
4) prolonged/ widened QRS
138
how is the diagnosis of post streptococcal glomerulonephritis made
evidence of infection - high ASOT, anti-DNase B, low C3
139
how may you investigate a painless lump in the testes
MSSU
ultrasound
tumour markers
140
what is the most common cause of glomerulonephritis worldwide
IgA nephropathy
141
what is the most common cancer amongst young men
testicular cancer - peak incidence 3rd decade
142
what are the 3 classes of neurological causes of LUTS
- supra-pontine - stroke, alzheimers, parkinsons
- infra- pontine supra sacral - spinal cord injury, disc prolapse, spina bifida
- infra- sacral - MS, diabetes, cauda equina
143
what is stage 2 of AKI
creatinine - 2-2.9x baseline
| urine - <0.5 ml/kg/h for >12 hours
144
what scoring system is used to grade prostate cancer
Gleason pathological grading system
145
what is the difference in solute removal in haemodialysis and heamofiltration
haemodialysis - by diffusion in intermittent therapy
| haemofiltration - by convection in continuous therapy
146
how may a stone in the urinary tract present
```
renal pain
uteric colic
dysuria
haematuria
UTI
```
147
what is the management of oedema in CKD
salt ad fluid restriction , loop diuretics
148
what is the peak age incidence of prostate cancer
65-75 years
75% > 65
1 %< 50
(45% <70 - treat if no comorbidities)
149
what is SLE
systemic autoimmune disease with antibodies against nuclear components e.g double stranded (ds)DNA
deposition of antibody complexes causes inflammation and tissue damage
150
what is the management of CV disease in CKD
BP, aspirin, cholesterol, exercise
151
how may an iatrogenic complication of CKD occur
build up urea - uraemia pericarditis
| drug toxin
152
list some glomerular causes of CKD
1- glomerulonephritis
| 2- diabetes, amyloid, myeloma
153
what are techniques to remove kidney/ ureteric stones
open surgery
endoscopic surgery
ESWL - extracorpeal shockwave lithotripsy
PCNL - percutaneous nephrolithotomy
154
why may you do an USS for CKD
check size, symmetry, anatomy, exclude obstruction
155
is proteinuria nephritic or nephrotic
nephrotic
156
what is normal range of PSA
```
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
what imaging procedure can be done to investigate frank haematuria
cystourethroscopy
158
what may membranous nephropathy occur secondary to
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
what is the most common type of bladder cancer
transitional cell carcinoma
160
what blood tests would you do to investigate AKI
```
FBC, U&E, bicarb
LFT (hepatorenal disease)
clotting - in case biopsy
blood gas
ANCA (vasculitis), Ig (myeloma), C3/4 dsDNA (lupus)
```
161
what is the commonest cancer diagnosed in men
prostate
162
what investigation is used to asses the size of the prostate
digital rectal
163
what is the treatment for renal bone disease in CKD
diet and phosphate binders
give active vit D3
parathyroidectomy
164
in high pressure chronic urinary retention what 2 type of diuresis may occur
physiological - <200ml/ hour
| pathological - >200 ml/ hour +/- postural hypotension
165
what are complications of acute urinary retention
```
UTI
post - decompression haematuria
pathological diuresis
renal failure
electrolyte abnormalities
```
166
when does anti GBM disease normally present
two peaks - 3rd decade and 6th decade
167
what tests can diagnose proteinuria
24 hour urine collection
| urine protein creatinine ratio
168
what is the treatment for minimal change nephrotic syndrome
prednisolone
| relapses treated with immunosuppression
169
what should you always do before performing a renal biopsy
check clotting factors
170
what are indications for surgical treatment of ureteric stones
obstruction of urinary tract
recurrent haematuria, pain and infection
progressive loss of kidney function
patient occupation
171
how do 5a reductase inhibitors help BPO
reduce prostate size and reduce LUTs
172
what are some clinical features of multiple myeloma (excess immunoglobulins and light chains)
```
raised ESR
anaemia
weight loss
fractures
back pain
```
173
what closes off the ureter and stops reflux
increased pressure in the bladder as it fills
174
how does IgA nephropathy usually present
asymptomatic
| microscopic haematuria
175
what are presentations of early stage CKD
```
asymptomatic
fatigue
anaemia
hypertension
oedema
bone pain to renal disease
```
176
how are the majority of prostate cancers diagnosed
opportunistic PSA testing
177
what are risk factors for testicular cancer
caucasians
family history
previous cancer in contralateral tests
178
what should you do if a child presents with a urinary obstruction
send to paediatric surgeon
179
how do you treat uncomplicated BPO
watchful waiting
180
which form of glomerulonephritis does not leas to kidney failure
minimal change disease
181
what is anuria
absolute - no urine output
| relative - <100ml/ 24 hours
182
what are complications of nephrotic syndrome
thromboembolism -
infection - urinary loss of immune mediators
hypelipidaemia-
183
what must be kept constant in glomerular capillaries to keep filtration working
pressure
184
what does pathology of focal and segmental glomerulonephritis show
focal and segmental sclerosis with distinctive patterns eg. tip lesions, collapsing
185
what is the most common presentation of bladder cancer
painless frank haematuria
186
what are symptoms and signs of a urinary tract obstruction
pain, frank haematuria, palpable mass, signs of complication
187
what are emergencies related to UTIs
```
acute kidney injury
acute urinary retention
sepsis
sever heamaturia causing haemorrhage stroke
testicular torsion
paraphimosis/ priapism
```
188
what is the prognosis for localised prostate cancer
>90% 15 year survival
189
how may an iatrogenic CKD be prevented
ask about drug medication
190
when should someone be counselled for RRT
when risk of failure is 10-20% in 1 year
191
why are females more susceptible to urine infections
```
shorter urethra
lack of prostatic bacteriostatic secretion
closeness of urethra to rectum
sexual activity
pregnancy (pressure on ureter/ kidney)
```
192
what is oliguria
urine output < 0.5ml/ kg/ hour
193
how can you investigate haematuria
flexible cystoscopy
194
why is anaemia a complication of CKD
reduced erythropoietin and red cell survival
195
what is the gold standard investigation for a UTI
MSSU with microbiology (bacteria > 10^5)
196
describe the glomerular filtration rate classification of GFR
```
G1 - >90
G2 - 60-89
G3a - 45-59
G3b - 30-44
G4 - 15 - 29
G5 - <15
```
197
how are low grade bladder tumours treated
endoscopic resection and chemo
198
what are the immediately dangerous consequences of AKI
```
A - acidosis
E - electrolyte (high K)
I - intoxication - toxins in blood
O - oedema (pulmonary)
U - uraemia complications
```
199
how does anti- GBM disease manifest in the kidneys and lungs
renal - oliguria/anuria, haematuria, AKI, renal failure
| lung- SOB, haemoptysis (pulmonary haemorrhage in 50-90%)
200
what urinalysis would you look at in a UTI
blood, leucocytes, protein, nitrates
201
what are 2 main causes of squamous cell carcinoma in the bladder
schistosomiasis
| chronic cystitis
202
what signs will be present if there is obstruction at the level of the renal pelvis
```
unilateral hydrometer
unilateral hydronephrosis (back pressure to kidney)
```
203
list some cystic/ congenital causes of CKD
1- renal dysplasia
| 2- polycystic kidney disease, fabric disease
204
what is acute urinary retention defined as
painful inability to void with a palpable and percussible bladder
205
what is the difference between global and segmental glomerulonephritis
global - all glomerulus affect
| segmental - part affected
206
what is the difference in the 5 year survival for low and high grade bladder TCC
low - 90%
| high - 50%
207
what is the prognosis for metastatic prostate cancer
3-5 years
208
what is the essential treatment of testicular cancer
radical orchidectomy
| +/ - radiotherapy and chemotherapy
209
what is the most common type of uteric stone
calcium oxalate
| 2nd - Ca oxalate and phosphate
210
what is henoch schonelein purpura (HSP)
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
what should you do if a MSSU is too difficult to collect
suprpubic aspirate
212
what is chronic kidney disease
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
what age group do seminomas and non seminomas mainly affect
seminomas - 30-40
| non seminomas - 20-30
214
what is the relationship between the levels of PSA and cancer probability
```
0-1 - 5%
1-2.5 - 15%
2.5 - 4 - 25%
4-10 - 40%
>10 - 70%
```
215
why do CKD patients get renal bone disease
high phosphate and lower Ca absorption lead to secondary hyperparathyroidism (PTH tries to correct imbalance)
low Ca as lack of activated vit D
216
what is the commonest cause of urological emergency admissions
colic
217
how does hyperglycaemia reduce GFR
increased growth factors
RAAS activation
oxidative stress
production of advanced glycolysation products
218
how is the diagnosis of minimal change nephrotic syndrome made
electron microscopy - effacement of podocyte processes
219
how does henoch schonelein purpura (HSP) present
purpuric rash on extensor surfaces (legs)
| polyarthristis, abdominal pain, nephritis
220
how are bladder tumours classified
by grade 1-3 and stage TNM combination
221
what imaging test is mandatory in renal cancer
CT scan of abdomen and chest
222
what are symptoms of uraemia
```
nausea/ vomiting
anorexia
cramp
fatigue
pruritis
drowsiness
```
223
what is a radio contrast nephropathy
AKI following administration of iodinated contrast agent
| normally resolve after 72 hours
224
what are some extrinsic causes of a urinary tract obstruction
```
obstruction from crossing vessel
Lymph nodes
abdominal mass (tumour)
iatrogenic
prostate/ cervical cancer
```
225
where do renal cancers commonly metastasise to
lungs, bone, brain, liver
226
how may wegners granulomatosis present
```
URT- epistaxis, saddle nose, sinusitis
LRT - cough, dyspnoea, haemoptysis
glomerulonephritis
pulmonary haemorrhage
joints - arthritis, myalgia
pericarditis
vasculitic sin rash
```
227
what is membranoproliferative glomerulonephritis divided into
immune complex associated - increased/ abnormal immunoglobulin deposition in the kidney
C3 glomerulonephropathy - defect in complement pathway
228
how would you treat a post renal cause of AKI
catheter + nephrostomy
229
what does chronic urinary retention present as
LUTS or complications
230
what is dysuria
pain of micturition
231
when do complications of CKD usually manifest
when GFR <20mls/ min
232
when does post streptococcal glomerulonephritis typically present
10-21 days after infection typically of throat (2 weeks) or skin (3-6 weeks)
233
what is the usual route of infection
ascending
234
what is the difference between a complicated and uncomplicated UTI
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
what is the treatment for locally advanced prostate cancer
hormonal therapy and radiation
236
what is the treatment for wegners granulomatis
high dose glucocorticoids ply immunsuppresant
| plasma exchange if renal failure/ pulmonary hameorrage
237
how is myeloma diagnosed
bone marrow aspirate
serum paraprotein
urinary bence-jones protein (BJP)
238
what are clinical features of myelomas
anaemia, back pain, fractures, infections, high ESR, high Ca
239
what are complications of BPO
```
progression of LUTS
acute urinary retention
chronic urinary retention (new bed wetting)
urinary incontinence
UTI
renal failure from high back pressure
```
240
what is the emergency treatment of urinary obstruction
percutaneous nephrostomy insertion or retrograde stent insertion
definitive treatment - treat cause
241
what are risk factors for developing renal cancer
family history
obesity, smoking
anti- hypertensive medication
end stage renal failure (cystic changes in kidney)
242
how is multiple myeloma diagnosed
bone marrow aspirate
urinary bence jones protein
serum free light chains in blood
243
how may a lower tract obstruction present
LUTS
incontinence
frank heamaturiea
urinary retention
244
what genes may increase the chance of developing prostate cancer
HPC 1
| BRAC 1 &2 - breast cancer gene in females passed on to offspring
245
what is the treatment of membranous nephropathy
general measures
| immunosuppression if symptomatic
246
how does Gleason score relate to risk of death from CAP
6 - 18-30% (ISUP 1)
7 - 42-70% (ISUP 2-3)
8-10 - 60-87%
247
what abnormalities in the renal tract may lead to a UTI
stones, renal outflow obstruction, BOO, horseshoe kidney, bladder tumour, fistula bladder / bowel
248
what is PSA
kallikrein serine protease (liquifies semen) produced by glands of the prostate
249
what causes post streptococcal glomerulonephritis
streptococci antigen deposits in glomerulus leading to immune complex formation and inflammation
250
what is the first line treatment for renal and ureteric calculi (<2cm)
ESWL
251
what are serological markers of membranous nephropathy
PLA2R antibody positive
THSD7A
diffusely thickened GBM due to sub epithelial deposits go IgG
252
list some proliferative glomerulonephritis
```
post infective nephrtitis (diffuse proliferative)
IgA nephropathy (focal proliferative)
Cresentric nephritis (focal necrotising)
```
253
what are patients with CKD most likely to die of
cardiovascular disease
254
what characterises IgA nephropathy
IgA deposition in the mesangium and mesangial proliferation
255
why is the kidney a target for systemic disease
- high blood flow
- glomeruli can trap proteins or immune complexes
- metabolises drugs which may be toxic
256
what percentage of men at 60 years and and 85 years will have benign prostatic hyperplasia
65 - 50%
| 85 - 90%
257
what is benign prostatic hyperplasia characterised by
fibromuscular and glandular hyperplasia in transitional zone
258
how may you investigate a UTI in the upper tract
USS kidneys, CT KUB/ IVU, MAG-3 venogram, DMSA scan
259
what uteric stones are infective
triple phosphate - Ca, Mg, NH3
260
what are the main presentations of UTI
dysuria, pain, increased frequency
| cloudy offensive smelling urine
261
what are risk factors for AKI
pre- existing CKD
age
male
co-morbidities - DM, CV disease, malignancy, chronic liver disease
262
what are complications of a UTI
```
sepsis
renal failure
bladder malignancy (squamous cell carcinoma)
acute urinary retention
frank haematuria
bacteriuria of pregnancy
clubbing of calyces
```
263
what is the most common pathological class of testicular cancer
germ cell tumour (95%)
| seminomatous / non seminomatous
264
how is IgA nephropathy managed
```
control BP (ACEi)
prepare for RRT
```
265
what test can be done to assess split renal function
DMSA or MAG-3 renogram
266
what is the definitive treatment of localised prostate cancer
radical prostatectomy
267
what are pre renal causes of AKI
```
reduced circulation volume - dehydration, haemorrhage, D&V
hypotension / shock
congestive heart/ liver failure
arterial occlusion
NSAIDs
```
268
what is a urinary tract infection
infection affecting urinary tract - kidneys, ureter, bladder, urethra, prostate, epididymis, testis
269
how does hyperkalaemia occur in CKD
K is normally exchanged with Na in the distal tubule - reduced Na delivery as GFR falls
>7 = fatal cardiac arrythmia
270
what is the risk of developing bladder TCC if you have upper tract TCC
40% in 10 years - regular surveillance
271
what is a common cause of UTIs in children
reflux nephropathy - bladder contacts and expels urine back to kidney leading to infection
272
what are renal causes of AKI
```
acute tubular necrosis
toxin related - drugs, radio contrast, snake
acute interstitial nephritis
acute glomerulonephritis
myeloma
```
273
what are the 4 grades of bladder tumour
G1- well differentiated, non invasive
G2 - mod differentiated, non invasive
G3 - poorly differentiated, invasive
274
does proliferative glomerulonephritis present with nephrotic or nephritic syndrome
nephritic - blood on dipstick
| extra cells in glomerulus
275
what urine investigations can be done to investigate glomerulonephritis
MC&S
A:CR/ P:CR
RBC casts
276
what are the T stages of renal cancer
T1 - <7cm confined within capsule
T2 - >7 cm confined in capsule
T3 - local extension outside capsule
T4 - beyond Gerotas fascia
277
what drugs are nephrotoxic
digoxin, diuretics
aminoglycosdies, ACEi/ ARB
metformin , morpheine (opiates)
NSAIDS
278
what quantities of serum creatinine and urine volume are given for an AKI
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
what is the main symptom nephrotic syndrome
generalised pitting oedema
280
what is glomerulonephritis
group of inflammatory disorders of the kidney
281
how is an upper tract TCC investigated
CT IVU
| uteroscopy and biopsy
282
what are risk factors for transition cell carcinoma
smoking (40%)
aromatic amines
genetic abnormalities
pelvic radiotherapy
283
what specific blood tests may you do to investigate CKD
```
C3/4
autoantibody
ANCA - vasculitis
anti GBM
serum electrophoresis - myeloma
```
284
what is seen on urinalysis of the nephritic state
haematuria, dysmorphic RBCs, cellular casts
285
which lymph nodes drain the prostate gland
pelvic lymph nodes
286
what blood tests may you do to investigate CKD
```
U&E, FBC, HCO3
total protein albumin
LFT
creatinine kinase
immunoglobulins
coagulation screen
```
287
what blood tests would you request to investigate glomerulonephritis
FBC, U&E, LFT, CRP
immunoglobulins, complement C3/ 4
autoantibodies - ANCA, anti-dsDNA, anti-GBM
culture
288
what are secondary causes of nephrotic syndrome
DM,
amyloid
myeloma
lupus nephrtitis
289
what are the terms for the inflammation of; bladder, prostate, urethera, kidney, testis
cystitis, prostatitis, urethritis, pyelonephritis, orchitis
290
what are signs of circulatory volume depletion and overload
depletion - orthostatic BP, skin turgor/ temperature
| overload - raised JVP, crepitations, ascites, oedema
291
how are patients prepared for RRT
```
education
select modality
planning access
decide when to start
multidisciplinary team
```
292
what imaging test would you do to investigate AKI
renal USS
293
what are the symptoms of locally invasive prostate cancer
haematuria
incontinence
perineal / suprapubic pain
haemospermia
294
how does the Gleason pathological grading system classify grades of cancer
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
what are disadvantage of haemodialysis
slower filtration
| only fluid removal when treatment
296
how do alpha blockers help BPO
smooth muscle relaxation - prostate innervated by sympathetic alpha adrenergic nerves
(can be selective/ non selective/ highly selective)
297
what are post renal causes of AKI (seen on ultrasound)
obstruction - intraluminal, intramural, extramural
298
what are complications of ureteric calculi
haematuria, fever, perforation , reflux, stricture formation
299
why should you always sterilise a catheter before inserting
can move lower urethral flora up the tract
300
list some storage LUTS
frequency, nocturia, urgency, urge incontinence
301
what may focal and segmental glomerulonephritis be secondary to
HIV, heroin, lithium, lymphoma
302
at what % of GFR will creatinine levels begin to drop
60%
303
how would you investigate a stone in the urinary tract
```
CT KUB
USS
Urinalysis and culture
bloods
24 hour urine collection (high Ca)
```
304
what is the differential diagnosis for a painless lump in testes
infection (epididymo-orchitis)
epidymal cyst
hydrocele
hernia - can't get above lump
305
what is the prognosis of each stage of testicular cancer
good, 5 year survival:
1 - 99%
2/3 - 96%
4 - 73%
306
how may an obstruction in the urinary tract lead to an infection
slow urine flow can't flush out the bacteria
| or sediments form stone with cause more obstruction
307
what is the prognosis of membranous nephropathy
resolves spontaneously in 1/3
25% on dialysis on 10 years
good prognosis if proetinura resolves
308
what is the difference between primary and secondary glomerulonephritis
primary - only in glomerulus
| secondary - other body systems affected (SLE, wagerers etc.)
309
what is the difference between diffuse and focal glomerulonephritis
diffuse - >50% glomeruli affected
| focal - <50% glomeruli affected
310
list some blood flow/vessel causes of CKD
1 - renal vasculitis, renal artery stenosis
| 2 - heart failure, hypertension
311
what is the name of the zones used the describe locations in the prostate
McNeals
312
what is produced in excess in myeloma
light chains and immunoglobulins - by plasma cells
313
describe the 2 forms of T staging a bladder tumour
Tis-T1 - non invasive of detrusor muscle
| T2-4 - invade the detrusor muscle
314
what is the microbiological evidence of a UTI
bacterial count of 10^5 cfg/ ml from MSSU specimen
315
is there is frank haematuria, what is the res of malignancy in >50s
25-35%
316
how does testicular cancer usually present
a painless lump (can be tender or inflammed)
