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Med School Finals > Nephrology & Urology > Flashcards

Nephrology & Urology Flashcards

1
Q

Indications for IV fluids?

A

Resuscitation
Maintenance
Replacement

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2
Q

Management of fluid resuscitation?

A

500mL 0.9% NaCl or Hartmann’s STAT
→ 250mL if at risk of fluid overload
250-500mL boluses up to 2000mL if needed

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3
Q

Daily water vs Na/K/Cl vs glucose requirement?

A

Water = 25-30mL/kg/day
Na/K/Cl = 1mmol/kg/day
Glucose = 50-100g/day

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4
Q

A 1L bag of IV fluid e.g. 0.9% NaCl contains how much water?

A

1L (you dumbass)

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5
Q

Caution with 0.9% NaCl vs Hartmann’s vs dextrose 5%?

A

0.9% NaCl = risk of hypernatraemia and hyperchloraemic metabolic acidosis
Hartmann’s = risk of hyperkalaemia
Dextrose 5% = do not use for fluid resuscitation

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6
Q

Maximum rate of K infusion?

A

No more than 10mmol/kg/hour

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7
Q

Features and most common cause of nephrotic vs nephritic syndrome?

A

Nephrotic = oedema, proteinuria (“frothy urine”), hypoalbuminaemia, hypercholesterolaemia,
→ minimal change disease (kids), FSGS (adults)
Nephritic = haematuria, hypertension, mild proteinuria, oliguria
→ IgA nephropathy

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8
Q

What causes hypercoagulability in nephrotic syndrome?

A

Antithrombin III loss via urine

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9
Q

Definition of AKI?

A

Rapid onset reduction in renal function causing oliguria and elevated serum urea + creatinine

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10
Q

Cause of pre-renal vs intrinsic vs post-renal causes AKI?

A

Pre-renal (most common) = ischaemia
Intrinsic = kidney damage
Post-renal = obstruction

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11
Q

Urine osmolality and urine sodium in pre-renal vs intrinsic AKI and explain?

A

Pre-renal = urine osmolality high, urine sodium low
→ kidneys concentrate urine and retain sodium to increase blood pressure
Intrinsic = urine osmolality low, urine sodium high
→ damaged kidneys fail to concentrate urine or retain sodium

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12
Q

Investigations for AKI?

A

U&Es
Urinalysis
Renal tract USS (if no cause found)

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13
Q

Biochemical features of AKI?

A

Hyperkalaemia
Hyperphosphataemia
Hyperuricaemia
High creatinine
Metabolic acidosis

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14
Q

Staging of AKI?

A

I = 1.5x creatinine baseline or reduction in urine output to < 0.5mL/kg/hour for ≥ 6 hours
II = 2.5x creatinine baseline or reduction in urine output to < 0.5mL/kg/hour for ≥ 12 hours
III = ≥ 3 x creatinine baseline or reduction in urine output to < 0.3mL/kg/hour for ≥ 24 hours

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15
Q

Management of AKI?

A

Stop nephrotoxic drugs!
Treat hyperkalaemia (if present)
Pre-renal = IV fluid challenge
Intrinsic = treat underlying cause, nephrology referral
Post-renal = catheterise, urology referral

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16
Q

Drugs which should be stopped in AKI?

A

NSAIDs (except aspirin at cardioprotective dose)
Aminoglycosides
ACEi/ARBs
Diuretics

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17
Q

Drugs which may become toxic in AKI?

A

Metformin
Digoxin
Lithium
Opioids

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18
Q

Management of hyperkalaemia?

A

< 6mmol/L = supportive, adjust medication
> 6mmol/L = ECG then treat if abnormal
≥ 6.5mmol/L = urgent treatment
→ IV calcium gluconate + IV insulin/dextrose or + nebulised salbutamol

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19
Q

Most common intrinsic AKI and causes?

A

Acute tubular necrosis
→ ischaemia or nephrotoxins

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20
Q

Urinalysis features of acute tubular necrosis?

A

Muddy brown casts
Renal epithelial cell casts

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21
Q

Most common cause of acute interstitial nephritis?

A

Drugs (especially antibiotics)

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22
Q

Features of acute interstitial nephritis?

A

AKI
Hypertension
Rash, fever
Eosinophilia

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23
Q

Most common type of glomerulonephritis?

A

IgA nephropathy

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24
Q

Outline management of glomerulonephritis?

A

1st line = supportive management
2nd line = ACEi/ARB
3rd line = steroid

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25
Features of IgA nephropathy?
12-72 hours post-URTI Nephritic syndrome (haematuria dominant)
26
Features of post-streptococcal glomerulonephritis?
7-14 days post-URTI Nephritic syndrome (proteinuria dominant)
27
Investigation for IgA nephropathy vs post-streptococcal glomerulonephritis?
IgA nephropathy = renal biopsy Post-strep = anti-streptolysin O titre
28
Biopsy features of membranous glomerulonephritis?
Thickened basement membrane IgG and complement deposits "Spike and dome" appearance
29
Biopsy feature of minimal change disease?
Fusion of podocytes
30
Biopsy feature of rapidly progressive glomerulonephritis?
Epithelial crescents
31
Biopsy features of FSGS?
Focal and segmental sclerosis
32
Features of Henoch-Schönlein purpura (HSP)?
Post-URTI Vasculitis → purpuric rash Abdominal pain Arthralgia/Arthritis IgA nephropathy
33
Monitoring of Henoch-Schönlein purpura (HSP)?
BP and urinalysis for 6-12 months
34
Features of rhabdomyolysis?
AKI PMH trauma e.g. long lie Muscle pain and swelling Red/brown "tea coloured" urine
35
Biochemical features of rhabdomyolysis?
Severely raised CK Raised LDH Hypocalcaemia (Ca absorbed by muscle) Hyperkalaemia/phosphataemia/uricaemia
36
Features of haemolytic uraemic syndrome (HUS)?
Triad of: → AKI → microangiopathic haemolytic anaemia → thrombocytopaenia
37
Blood film features of HUS?
Reticulocytes Schistocytes
38
Most common causes of CKD?
Diabetes Hypertension Chronic glomerulonephritis Polycystic kidney disease
39
Staging of CKD?
I = GFR > 90ml/min with evidence of kidney damage II = GFR 60-90ml/min with evidence of kidney damage III = GFR 30-59ml/min IV = GFR 15-29ml/min V = GFR < 15ml/min N.B. patients are usually asymptomatic until IV or V
40
eGFR variables?
CAGE: Creatinine Age Gender Ethnicity
41
Investigation and management of CKD proteinuria?
Albumin:creatinine ratio Management = ACEi/ARB
42
Complications of CKD?
Fluid overload → hypertension, oedema Hyperkalaemia → arrhythmias Hyperuricaemia → itch, pericarditis, encephalopathy Low EPO → anaemia → LVH Low vitamin D → hypocalcaemia/hyperphosphataemia → bone disease, secondary/tertiary hypoparathyroidism
43
Management of CKD anaemia?
1st line = correct iron deficiency (oral or IV) 2nd line = EPO injections
44
Management of CKD bone disease?
1st line = low phosphate diet 2nd line = phosphate-binders (sevelamer) + vitamin D analogue (alfacalcidol) Total parathyroidectomy for tertiary hyperpathyroidism
45
Renal USS feature of CKD and exception?
Bilateral small kidneys Enlarged in early diabetic nephropathy
46
Renal failure definition?
eGFR < 15mL/min (stage V CKD)
47
Management of renal failure and options?
Renal replacement therapy (RRT) → haemodialysis → peritoneal dialysis → renal transplant
48
Indications for dialysis?
AEIOU: Acidosis (pH <7.2) Electrolyte (hyperkalaemia >7) Intoxication (poisoning) Oedema (pulmonary) Uraemia (uraemic pericarditis, encephalopathy)
49
Surgery required prior to haemodialysis and timescale?
Creation of arteriovenous fistula At least 8 weeks before
50
Most common cause of peritoneal dialysis peritonitis?
Staphylococcus epidermidis
51
Management of hyperacute (minutes) vs acute (<6 months) renal transplant rejection?
Hyperacute = removal of graft Acute = steroids/immunosuppressants
52
Post-surgical infection vs malignancy linked to renal transplant?
Infection = CMV Malignancy = SCC
53
Features of ADPKD?
Renal failure Haematuria Flank pain Hypertension Palpable kidneys
54
Extra-renal manifestations of ADPKD?
Liver cysts (most common) Berry aneurysms Heart valve disease
55
Investigation and management of ADPKD?
Investigation = renal USS Management = anti-hypertensives, tolvaptan (slows cyst formation)
56
Most common renal malignancy?
Renal cell carcinoma (clear cell)
57
Features and management of renal cell carcinoma?
Frank haematuria Flank/loin pain Palpable abdominal mass Left-sided varicocele Management = partial or total nephrectomy
58
Paraneoplastic features of renal cell carcinoma?
Polycythaemia Hypertension Hypercalcaemia Stauffer syndrome (deranged LFTs)
59
Renal malignancy seen in children?
Nephroblastoma (Wilm's tumour)
60
Features and investigation of renal colic?
Loin to groin pain Haematuria N&V Investigation = non-contrast CT KUB
61
Most common composition of renal stone?
Calcium oxalate
62
Investigation and management of renal stone?
Investigation = non-contrast CT KUB Management = NSAID (e.g. diclofenac), < 5mm should pass on their own, medical management (e.g. tamsulosin) or shockwave lithotripsy/nephrolithotomy
63
Invasive management of choice for renal stone in pregnancy?
Ureteroscopy
64
Management of ureteric obstruction?
Urgent surgical decompression e.g. stent
65
Most common causes of UTI?
E.Coli (most common) Klebsiella Enterococcus Pseudomonas Staphylococcus saprophyticus
66
Features of a UTI?
Dysuria Smelly urine Urinary frequency/urgency/hesitancy Suprabubic/back pain or discomfort
67
Urine dipstick features of UTI?
Leukocytes Nitrites Haematuria
68
Who needs a urinalysis to confirm UTI?
Children Pregnant Men Catheterised
69
Management of UTI in women?
Non-pregnant = nitrofurantoin or trimethoprim 3 days Pregnant = nitrofurantoin (1st line), amoxicillin or cefalexin (2nd line)
70
Management of UTI in men?
Nitrofurantoin or trimethoprim 7 days
71
Management of UTI in catheterised patients?
Only treat if symptomatic Remove or change the catheter
72
Features, investigation and management of pyelonephritis?
Fever N&V Flank/loin/back pain UTI symptoms e.g. dysuria Investigation = MSU Management = broad-spectrum antibiotics
73
Investigation and management of hydronephrosis?
Investigation = renal tract USS Management = nephrostomy tube
74
Most common bladder cancer?
Transitional cell carcinoma
75
Risk factors for transitional cell carcinoma?
Smoking Aniline dye exposure Cyclophosphamide
76
Investigation and management of bladder cancer?
Investigation = cystoscopy Low grade = TURBT +/- chemotherapy High grade = surgery e.g. cystectomy
77
Features of acute vs chronic urinary retention?
Acute = anuria, suprapubic pain, confusion Chronic = typically painless
78
Investigation and management of acute urinary retention?
Investigation = bladder USS Management = treat underlying cause, catheterise
79
Complication after relieving urinary retention?
Post-obstruction diuresis
80
Voiding vs storage symptoms?
Voiding = hestitancy, straining, spraying, weak or intermittent flow, terminal dribbling, incomplete emptying Storage = frequency, urgency, nocturia, incontinence
81
Investigation for lower urinary tracy symptoms (LUTS) in men?
Urodynamic studies
82
Drug options for overactive bladder?
1st line = antimuscarinic e.g. oxybutynin, tolterodine 2nd line = mirabegron
83
Features of BPH?
Voiding symptoms Storage symptoms Complications e.g. UTI
84
Investigations of BPH?
PSA Urinary dipstick Urine frequency-volume chart International prostate symptom score (IPSS)
85
Management of BPH?
1st line = alpha-agonist (e.g. tamsulosin) 2nd line = 5-alpha-reductase inhibitor (e.g. finasteride) 3rd line = combination therapy of above 4th line = surgery e.g. TURP
86
Alpha-agonist example, mechanism of action and side effects?
Example = tamsulosin Mechanism of action = reduces smooth muscle tone of the bladder and prostate Side effects = postural hypotension
87
5-alpha-reductase inhibitor example, mechanism of action and side effects?
Example = finasteride Mechanism of action = decreases prostate size by inhibiting conversion of testosterone to dihydrotestosterone Side effects = erectile dysfunction, gynaecomastia
88
Advice on starting finasteride?
Can take up to 6 months for improvement
89
Counselling on PSA test?
- PSA is a protein made by prostate cells - High levels may indicate prostate cancer - Disadvantages: raised PSA does not mean cancer, low PSA does not exclude cancer - If elevated, may indicate need for biopsy +/- treatment which may not be necessary
90
Factors which can elevate PSA?
Acute urinary retention Benign Prosthetic Hypertrophy Recent ejaculation PR examination Urethral instrumentation Urinary tract infection Prostatitis Prostate cancer
91
Investigations for prostate cancer?
Multiparametric MRI Prostate biopsy
92
Management of prostate cancer?
Low grade = watch and wait High grade = radiotherapy, prostatectomy, hormonal therapy
93
Posterior scrotal lump separate to the body of the testicle?
Epididymal cyst
94
Soft, non tender swelling of the hemi-scrotum which transilluminates?
Hydrocele
95
Patient with fertility issues with scrotum that feels like a bag of worms?
Varcicocele
96
Investigation for scrotal/testicular lumps?
USS or USS + doppler (varicocele)
97
Red, swollen testicle that has retracted upwards?
Testicular torsion
98
Management of testicular torsion?
Bilateral orchidopexy
99
Swollen testicle with dysuria and urethral discharge?
Epididymo-orchitis
100
Most common causes of epididymo-orchitis?
Young = STIs e.g. chlamydia Older = E.Coli
101
Investigation and managament of epididymi-orchitis?
Investigation = NAAT for STIs, MSU Management = treat underlying cause
102
Features to differenciate testicular torsion vs epididymo-orchitis?
Pain will ease on elevation of testis in epididymo-orchitis, not in testicular torsion Cremasteric reflex is lost in testiclar torsion
103
Features and management of acute bacterial prostatitis?
Generally unwell e.g. fever Penis/perineum/rectum/back pain Voiding symptoms Management = quinolone for 14 days
104
Management of balantitis?
Saline wash Topical steroid/antifungal/antibiotic Circumcision if recurrent
105
Phimosis vs paraphimosis?
Phimosis = tight foreskin can't be retracted Paraphimosis = foreskin stuck behind glans penis, medical emergency!!
106
What needs to be ruled out before circumcision?
Hypospadias
107
Investigations and management of erectile dysfunction?
Free testosterone (between 9am-11am) If low, repeat with FSH, LH and PRL Management = sildenafil
108
Prevention of contrast-induced nephropathy?
IV 0.9% NaCl infusion
109
Anion gap calculation and causes of normal vs raised?
(Na + K) - (Cl + HCO3) Normal = HCO3 loss e.g. diarrhoea, renal tubular acidosis, Addison's disease Raised = high lactate, high ketones, high urate, acid poisoning e.g. salicylate
110
Cause of type 1 vs type 2 RTA and biochemical complication?
Type 1 = poor H+ excretion Type 2 (Fanconi) = poor HCO3- reabsorption Hyperchloraemic metbaolic acidosis

Med School Finals (18 decks)

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