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1
Q

What does haematuria in the urine at different parts of the stream indicate? Start/end/throughout?

A 
start = urethral disease
end = prostate/bladder base bleeding
throughout = source above bladder
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2
Q

What is macroscopic and microscopic haematuria?

A

Blood in urine
Macroscopic = visible
Microscopic = dipstic +ve

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3
Q

Transient causes of haematuria?

A

UTI, menstruation, vigorous exercise, sex

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4
Q

Causes of haematuria?

A

cancer of urinary tract, stones, BPH, prostatitis, urethritis, IGA nephropathy, nephritic syndrome

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5
Q

Ix of haematuria?

A

exclude transient causes, urine microscopy
Plasma Cr (calculate eGFR), protein/creatinine ratio
renal tract imaging, cystoscopy

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6
Q

What is the triad of nephrotic syndrome?

A

proteinuria, hypoalbuminaemia, oedema

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7
Q

name 2 causes of nephrotic syndrome?

A

minimal changes disease, membranous nephropathy

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8
Q

What are some causes of membranous nephropathy?

A

Drugs - penicillame, gold, NSAIDS
Autoimmune - SLE
Neoplastic - lung, colon, breast
Infection - hep B & C

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9
Q

How do you diagnose minimal changes disease?

A

electron microscopy of kidney biopsy - shows fusion of podocytes

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10
Q

How do you manage nephrotic syndrome?

A

Oedema - salt restriction and a thiazide diuretic
Proteinuria - ACEi
DVT prophylaxis

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11
Q

Ix of Nephrotic/Nephritic synd?

A

eGFR, urinary protein, serum UEs, serum albumin, urine microscopy (red casts?), strep throat swab, BG, CXR, US kidneys, renal biopsy
Abs - ANA, DNA, ANCA, GMM, Hep B and C, HIV

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12
Q

Complications of nephrotic syndrome?

A 
Thrombosis - loss of clotting factors in urine
Sepsis - loss of Igs
AKI
hyperlipidaemia
CKD
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13
Q

Triad of nephritic syndrome?

A

Haematuria, Proteinuria, Hypertension

+/- oliguria, uraemia

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14
Q

causes of nephritic syndrome?

A

post-strep glomerulonephritis, infective endocarditis, SLE, HSP

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15
Q

how do you manage nephritic syndrome?

A

HTN - loop diuretic, Na restriction

Monitor fluid balance

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16
Q

Commonest cause of a UTI?

A

E.Coli

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17
Q

What increases the risk of a UTI?

A

female, urinary obstruction and stasis, previous bladder damage, bladder stones, reduced bladder emptying

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18
Q

UTI symptoms?

A

frequency, dysuria, suprapubic pain, tenderness, haematuria, smelly urine

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19
Q

Pyelonephritis symptoms?

A

loin pain, tenderness, N&V, fever

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20
Q

What makes a UTI complicated?

A

abnormal tract (stone/obstruction), systemic disease invovling kidney (DM/sickle cell), men, pregnancy

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21
Q

Ix for UTI?

A

urine dipstick (leucocytes and nitrates)
urine microscopy and culture
renal tract imaging

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22
Q

Management of a UTI?

A

Nitrofuratoin, Trimethoprim = first line

high fluid intake, search cause if it is an underlying infection

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23
Q

What is renal HTN?

A

Narrowing of the renal arteries due to atheroma. This causes reduced renal perfusion and renal ischaemia. The reduced pressure in afferent glomerular arterioles causes activation of RAAS.

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24
Q

How do you investigate renal HTN?

A

renal arteriography, doppler US, CT + IV contrast

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25
Management for renal HTN?
treat atherosclerosis - exercise, stop smoking, statins, antiplatelets, control `bp Stent if necessary
26
Comonest type of renal calculi?
Calcium oxalate
27
Causes of hypercalcaemia?
hyperparathyroidism, increased dietary intake, increased bone resporption (cancer/immobilisation)
28
Causes of hyperoxaluria?
high oxalate diet (spinach/rhubarb) | enzyme deficiencies
29
What condition is associated with hyperuricaemia?
gout
30
what GI condition is associated with uric acid stones?
ileostomy, due to loss of carbonate
31
which UTI organisms are associated with infection - induced calculi? Why do they increase the risk?
proteus, klebsiella. The bacteria produces urea which converts to ammonia and increases the pH of the urine which favours stone formation.
32
Renal calculi symptoms?
``` colicky pain (loin to groin) N&V, sweating, UTI, pyelonephritis, bladder outflow obstruction, haematuria ```
33
Ix for renal calculi?
urine dipstick and culture, serum UE, Cr, Ca, urate | FBC, CRP, non contrast CT KUB
34
management of renal calculi?
PAIN RELIEF - Diclofenac - <5mm stones usually pass spontaneously REMOVAL - shock wave lithotripsy, ureteroscopy, open surgery
35
how to prevent recurrence of renal calculi?
normal Ca diet, high fluid intake Allopurinol for uric stones cystine stones - need to drink 5L water a day
36
Common causes of an urinary tract obstruction?
LUMEN - calculi, tumour, blood clot WALL - congenital abnormality, stricture, neuropathic bladder OUTSIDE PRESSURE - BPH, prostate or pelvic tumour, phimosis
37
Symptoms of a upper urinary tract obstruction?
dull ache in flank, anuria
38
Symptoms of a bladder outlet obstruction?
hesitancy, poor stream, terminal dribbling, felling of incomplete emptying
39
What is an AKI?
sustained rise in urea and creatinine due to a rapid decline in GFR leading to loss of normal water and solute homeostasis
40
Causes of AKI?
PRE-RENAL - hypovolaemia, reduced BP, reduced cardiac pump efficiency, renal stenosis RENAL - NSAIDS, ACEi, acute tubular necrosis POST RENAL - enlarged prostate or pelvic masses
41
Ix for AKI?
Bloods - FBC, ESR, cultures, Ca, Ph, uric acid Urine dipstick - MS&C, culture, urinary electrolytes renal US/CT ANCA Ab/complement levels Hep/HIV Abs
42
What is CKD?
progressive renal impairment over >3 months
43
Causes of CKD?
``` diabetic nephropathy Chronic glomerulonephritis (SLE) chronic pyelonephritis HTN Schistomiasis ```
44
Features of CKD and why?
ANAEMIA - reduced EPO production by diseased kidney and haematuria means more losses BONE DIS - due to tertiary hyperparathyroidism. renal Ph retention means reduced Ca and increased PTH NEURO - polyneuropathy CVD - increased risk of MI/HF/CVA due to HTN and dyslipidaemia
45
How do you manage CKD?
Renoprotect (optimise BP) - usual pathway Reduce CVS RF - optimise BP, statins, smoking, diabetes, normal protein diet. Treat complications; 1. HYPERKALAEMIA - dietary restriction, stop spironolactone 2. dietary phosphate restriction, synthetic Vit D 3. Recombinant EPO for anaemia 4. Sodium bicarbonate for acidosis 5. Infections - influenza and pneumococcal vaccine
46
What is dialysis and how does it work?
uraemic toxins are removed from blood by diffusion across semipermeable membrane towards low concentrations in dialysis fluid. Gradient maintained by replacing dialysis fluid.
47
What is autosomal dominant PKD?
multiple cysts throughout kidneys, the cysts increase with age causing destruction of kidney tissue and reduced renal function.
48
mutations in which gene cause ADPKD?
PKD1/PKD2
49
Features of ADPKD?
``` acute loin pain if haemorrhage abdo discomfort HTN progressive renal impairment REMEMBER: liver cysts, SAH, MV prolapse ```
50
Ix for ADPKD?
Exam - large irregular kidneys, HTN, hepatomegaly US kidneys family history
51
mangement of ADPKD?
monitor BP, control Measure creatinine regularly dialysis offer US to family members
52
Where does renal cell carcinoma normally arise?
proximal tubular epithelium?
53
Features of RCC?
haematuria, loin pain, mass in flank +/- malaise, fever, weight loss
54
Ix for renal tract cancers
US, CT KUB, bloods, PET scan, prostate exam
55
Where do urothelial tumours usually arise?
transitional cell epithelium
56
What is BPH?
hyperplasia of the glandular and connective tissue of the prostate
57
Features of BPH
frequency, nocturia, delayed initiation, post void dribble, acute retention
58
Ix for BPH
US, examination, serum UE, PSA
59
Name 2 medications and their classes used to treat BPH? name some adverse effects for each
A1 antagonist - Tamsulosin A/E - dizzy, postural hypotension, dry mouth 5a reductase inhibitors - Finasteride A/E = ED, reduced libido, ejaculation problems
60
Features of Prostate cancer?
the same as BPH, bone pain, weight loss, malaise, bladder outflow obstruction
61
Ix for bladder cancer?
transrectal US of prostate, PSA levels, MRI to stage tumour
62
Mx of prostate cancer? Name 2 drugs and their action
radical prostatectomy LH analogues e.g. goserelin antiandrogens - Cyproterone acetate

Finals (21 decks)

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