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S2.6 Renal > General Kidney/Urinary Disease > Flashcards

General Kidney/Urinary Disease Flashcards

1
Q

What are the different organs that may be affected in apparent kidney/urinary diseases?

A

Kidneys
Ureters
Bladder
Bladder outflow tract - inc prostate, sphincters, foreskin

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2
Q

What are the general different types of disorders affecting the kidneys/urinary tract?

A 
AKI
CKD
Ureteric disease
Bladder disease - LUTS
Bladder outflow disease - acute/chronic retention
UTI
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3
Q

What are the various causes of renal disease?

A

Infection - pyelonephritis
Inflammation - glomerulonephritis, tubulointerstitial nephritis
Iatrogenic - nephrotoxicity, PCNL
Neoplasia
Trauma
Vascular - atheroma, hypertension, diabetes
Hereditary - polycystic kidney disease, nephrotic syndrome

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4
Q

What are the different causes of ureteric disease?

A 
Infection - ureteritis
Iatrogenic/trauma - cut during surgery
Neoplasia (TCC, prostate causing blockage, other pelvic tumour/lymphadenopathy
Hereditary - PUJ obstruction, VUJ reflux
Obstruction
- intraluminal (stone, clot)
- intramural (scar, TCC)
- extra-mural (pelvic mass, lymph nodes)
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5
Q

What are the different causes of bladder disease?

A

Infection - cystitis
Inflammation - e.g. interstitial cystitis
Iatrogenic/trauma
Neoplasia - TCC/SCC of bladder
Idiopathic - overactive bladder syndrome
Degenerative - chronic urinary retention
Neurological - neurogenic bladder dysfunction

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6
Q

What can cause bladder outflow disorders?

A 
Infection/inflammation - prostatitis, balanitis
Iatrogenic/trauma
Neoplasia - prostate/penile cancer
Idiopathic - chronic pelvic pain syndrome
Obstruction
- primary bladder neck obstruction
- BPE
- urethral stricture
- meatal stenosis
- phimosis
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7
Q

What are the risk factors/causes of UTIs?

A

Female (short urethra)
Sexual intercourse with poor voiding habits
Congenital abnormalities e.g. duplex kidney
Stasis of urine e.g. due to poor bladder emptying
Foreign bodies - catheters, stones
Oestrogen deficiency in post-menopausal
Fistula between bladder/bowel
Spermicide coated condoms/diaphragms

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8
Q

What are some systemic diseases that may cause renal disease?

A

Diabetes - most common single cause of end-stage renal failure
CVD
Infection - sepsis, infective endocarditis
Vasculitis
Myeloma

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9
Q

What are some drugs that can be nephrotoxic?

A 
Aminoglycosides
ACEis
Penicillamine
Gold
NSAIDs
Radiocontrast
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10
Q

What are common organisms in infective endocarditis that may affect the kidneys?

A

SA
Viridans streptococci
Enterococci
Leads to glomerulonephritis - immune complex formation

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11
Q

What are some symptoms/signs of renal disease?

A 
Pain
Pyrexia
Haematuria
Proteinuria
Pyuria
Palpable mass
Renal failure
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12
Q

Define oliguria, anuria, polyuria, nocturia

A 
Oliguria = output <0.5mL/kg/hour
Anuria = no output (<100mL/24hr)
Polyuria = output >3L/24hr
Nocturia = waking up >1 per night
Nocturnal polyuria = >1/3rd of total urine output at night
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13
Q

What are some symptoms/signs of chronic renal failure?

A 
Tiredness
Anaemia
Oedema
High BP
Bone pain if renal bone disease
Pruritus
Nausea/vomiting
SOB
Pericarditis
Neuropathy
Coma
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14
Q

What are some symptoms/signs of ureteric disease?

A 
Pain e.g. renal colic
Pyrexia
Haematuria
Palpable mass i.e. hydronephrosis
Renal failure (only if bilateral or only 1 kidney)
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15
Q

What are some symptoms/signs of bladder disease?

A 
Pain (suprapubic)
Pyrexia
Haematuria
LUTS (Storage, voiding)
Recurrent UTIs
Chronic urinary retention
Urinary leak from vagina
Pneumaturia
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16
Q

What is ‘LUTS’?

A

Storage LUTS
- frequency, nocturia, urgency, urge incontinence

Voiding LUTS
- poor flow, intermittency, terminal dribbling

Incontinence
- stress, urge, mixed, overflow, neurogenic, dribbling

17
Q

What are some signs/symptoms of bladder outflow disease?

A 
Pain - suprapubic or perineal
Pyrexia
Haematuria
LUTS - voiding due to BPO, overflow/stress incontinence
Recurrent UTIs
Acute/chronic retention
18
Q

What are the signs/symptoms of a UTI?

A

Presentation depends on organs affected

Fever
Loin/flank pain/tenderness
Suprapubic pain/tenderness
Urinary frequency
Urinary urgency
Dysuria
19
Q

What are some clinical signs that may be found on examination of someone with renal disease?

A

Hands - splinter haemorrhages, purpura, Raynaud’s
Face - scleritis, uveitis, nasal cartilage deformity, retinal vasculitis, hypertensive retinopathy
Skin - vasculitic rash, scleroderma
CVS - hypertension, murmur
Chest - crepitations, haemoptysis
Locomotor - joint swelling, tenderness
CNS - stroke, encephalopathy

20
Q

What are the signs/symptoms of granulomatosis with polyangiitis (Wegener’s)? Why is this relevant in renal medicine?

A

URT
- epistaxis, nasal deformity, sinusitis, deafness

LRT

  • cough, SOB, haemoptysis
  • pulmonary haemorrhage
Kidney - glomerulonephritis
Joints - arthralgia, myalgia
Eyes - scleritis
Heart - pericarditis
Systemic - fever, weight loss, vasculitic skin rash

Systemic vasculitis that most commonly affects the respiratory tract and kidneys

21
Q

What are the clinical features of multiple myeloma? Why is this relevant in renal medicine?

A

Clinical features

  • markedly elevated ESR
  • anaemia
  • weight loss
  • fractures
  • infections
  • back pain/cord compression

Renal failure in myeloma

  • cast nephropathy - ‘myeloma kidney’
  • light chain nephropathy
  • amyloidosis
  • hypercalcaemia
  • hyperuricaemia

Important cause of renal disease

22
Q

What general investigations might be done in suspected renal/urinary disease?

A 
Urine/Plasma osmolality
eGFR (creatinine)
MSSU
Urine dipstick - blood, leucocytes, proteins, nitrites
Microbiology - urine culture
USS, IVU, Isotope studies
Biopsy
U+E
FBC, CRP
Erythropoietin
Blood gases
Alkaline Phosphatase
Antibodies
Bone scan
General imaging
23
Q

What test is used in vasculitis?

A

ANCA
C-ANCA = cytoplasmic
P-ANCA = perinuclear

24
Q

How is myeloma diagnosed?

A

Diagnosed by

  • bone marrow aspirate >10% clonal plasma cells
  • serum paraprotein +/- immunoparesis
  • urinary Bence-Jones protein (BJP)
  • skeletal survey - lytic lesions
25
Q

How is acute urinary retention treated?

A

Immediate treatment is catheterisation
Treat underlying trigger if present

If due to BPE and no renal failure, start alpha blocker immediately and remove catheter in 2 days (60% will void successfully), if failure to void recatheterise and organise TURP (after 6 weeks)

26
Q

How is chronic urinary retention treated?

A

Immediate treatment is catheterisation (either urethral or suprapubic initially, followed by CISC if appropriate)

Asymptomatic patients with low residuals do not necessarily need treatment

27
Q

How does renal function affect drug metabolism?

A

If renal function is impaired then there will be a rapid build-up of

  • active drug
  • toxic or active metabolites

This can be a problem in drugs with narrow therapeutic indices

28
Q

What should be done when prescribing potentially toxic drugs in those renally impaired?

A

Reduce dosage
Increase dose interval
TDM monitor blood levels for toxic drugs like gentamicin, lithium, digoxin, vancomycin

S2.6 Renal (8 decks)

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