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Flashcards in Genitourinary Deck (378)
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151

How is circulating active vitamin D produced?

by 1a hydroxylation in the proximal tubule

152

How does CKD affect vitamin D production?

increased FGF-23 production which inhibits 1a-hydroxylation, inhibiting vitamin D production

153

Function of calcitrol?

increases calcium and phosphate absorption from the gut and suppresses the parathyroid hormone

154

What causes calcitrol deficiency?

advanced CKD, leading to secondary hyperparathyroidism

155

What nerves drive detrusor contraction?

PNS s3-5 (cholegenic)

156

What nerves inhibit detrusor contraction?

SNS t10-l2 (noradenergic)

157

How much fluid can a full bladder hold?

400-600ml

158

How much is in an empty bladder?

159

Who is more likely to become incontinent and why?

women, due to a shorted urether, so less resistance and higher pressure

160

What is acute renal failure?

a reversible decrease in GFR caused by damage to the kidneys, leading to a rise in serum urea and creatinine and loss of normal water and solute homeostasis

161

Main causes of acute renal failure?

pre renal (40-70%) - failure of cardiac/liver/skin/vascular, sepsis, infection, haemorrhage, thrombosis

intrarenal (10-15%) - renal vascular, glomerulinephritis, nephrotic syndrome, nephrotoxis drugs, microangiopathy, hypertension, inflammation, autoimmune disease

post renal (10-25%) - urinary tract obsturction, stones, tumour, prostatic hypertrophy, extrinsic compression

162

Stages of acute renal failure with serum creatinine and urine output?

early - creatinine >26.5umol/L or 1.5-2xrise - urine output 6h

moderate - creatinine 2-3x baseline - urine output 12h

severe - creatinine >3x baseline or >350u/mol/L or start RRT - urine output 24h or >12h anaemia

163

In who is acute renal failure common?

hospital admissions, elderly, critically ill

164

Mortality of acute renal failure?

25-30%

165

Risk factors of acute renal failure?

>75yrs, CKD, HF, Chronic liver disease, diabetes, new drugs, spesis, poor fluid intake, history of urinary symptoms, blockage of urinary tract, dehydrated, infection, aminoglycosides

166

Most common cause of acute renal failure and types of this?

intra renal

acute glomerularnephritis - from SLE, erythromyetosis

acute tubular necrosis (50% of AKI)

acute interstitial nephritis - in allergic reactions and infection

vascular

167

Pathophysiology of acute renal failure?

vascular change causes inflammation and tubular change causes back leakage of urine

168

What do investigations show in acute renal failure?

decrease GFR and urine output, increase nitrogenous waste in blood (urea, creatinine)

apoptosis, loss of adhesion

pericardial rub, suprapubic percussion dull

CT, CXR, avoid imaging with contrast, US (priotity if anuric)

169

Symptoms of acute renal failure?

lethargy, nausea, anorexia, itch, confusion, rash, joint pain, red eyes, nasal stiffness, GI bleeding, haemoptysis, reduced urine output, impaired platelet function, abdominal flank pain, oedeme, pruritis

170

Treatment of acute renal failure?

treat underlying cause, stop nephrotoxins, fluid, electrolytes, improve perfusion, restrict sodium and potassium, prevent pressure sores, antibiotics, dialysis, nutrition, sequele, prevent further complications, MDT, catheter if obstruction, percutanous nephrostomy, prevent ischemic renal injurt

171

When should you use dialysis in acute renal failure?

AEIOU

acidosis -metabolic
electrolyte abnormalities e.g. K
ingestions of toxins - salicylates, methanol, barbityrates
overload of fluid
uremic symptoms e.g. pericarditis

172

What is the classification of acute renal failure?

RIFLE

risk, injury, failure, loss, end stage

173

When would you do a urology referral in acute renal failure?

infected or obstructed urinary tract, renal stone, urological malignancy, renal trauma, frank haematuria,

174

Management of pulmonary oedema?

o2, diureticsm nitrates, opiates, venesection, haemodialysis, ventilatory support

175

What complications can acute renal failure lead to?

metabolic acidosis, hyperkalaemiam hyperphosphataema, pulmonary oedema

176

What does prognosis of acute renal failure depend on?

underlying cause, most common cause of death is sepsis from impaired immune defence from uaemia, malnutrition or dialysis//catheters

it is reversible

cortical necrosis can heal with scar tissues, tubule regenerate

177

What can you use to determine pre renal or intra renal acute renal failure?

urine specific gravity and urine osmolarity are higher in pre renal, urine sodium and fractional excretion of sodium are less in pre renal

178

What is the onset like in post renal AKI?

insidious rather than acute

179

What are the 2 phases in acute tubular necrosis?

initialoliguric phase from decrease GFR, microvascular vasoconstriction, ischemia, but then tubular cells can regenerate , reversing it

diuresis during recovery phase - improved GFR but still impaired tubular reabsorpton

180

How does acute tubulointerstitial nephritis cause acute renal failure?

interstitial inflammation with oedema and tubular damage, occurs do to infection (acute pyelonephritis) or hypersensitivity reaction to drugs (penicillin, NSAIDs)