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Overview Flashcards

1
Q

Where are the kidneys located anatomically?

A

Retroperitoneal

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2
Q

Which muscles surround the kidneys?

A

Quadratus lumborum

Psoas major

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3
Q

In relation to the spine where do the kidneys lie

A

Right - L1 -L3

Left T12 -L2

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4
Q

Are the floating ribs anterior or posterior to the kidney?

A

Posterior

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5
Q

Where does renal lymph drain to?

A

Lumbar nodes

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6
Q

Where does ureter lymph drain?

A

Lumbar and iliac nodes

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7
Q

At what level do the ureters turn medially?

A

Ischial spine

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8
Q

What zone of the prostate is felt on DRE?

A

Peripheral

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9
Q

Name the three types of male urethra

A
  • membranous
  • prostatic
  • spongy
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10
Q

Describe the male ejaculation pathway

A 
Seminiferous tubules 
Epididymis 
Vas deferens 
Prostatic urethra 
Spongy urethra
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11
Q

What makes up the spermatic cord?

A 
Purple dicks contribute to a  good sex life 
Pampiniform plexus 
Ducutus deferens 
Cremasteric artery 
Testicular artery 
Artery of ductus deferens 
Genitofemoral nerve 
Sympathetics 
Lymphatics
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12
Q

What is the blood supply to the penis?

A

Internal pudendal artery

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13
Q

What is the lymph drainage of the penis?

A

Superficial inguinal

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14
Q

What is the lymphatic drainage of the testes?

A

Lumbar nodes around abdominal aorta

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15
Q

What cells line the prostate?

A

Columnar secretory epithelium

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16
Q

State the five stages of CKD

A 
Stage 1 >90 
Stage 2 60-89
Stage 3 30-59
Stage 4 15-29
Stage 5 <15 
>3 months
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17
Q

What is the commonest cause of CKD?

A

Diabetes

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18
Q

What is uraemic frost?

A

Urea deposits from sweat crystallise on skin

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19
Q

Describe CKD management

A

ACEi/ARB

Renal replacement therapy

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20
Q

What are the complications of CKD?

A

Anaemia

Renal bone disease

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21
Q

How is CKD anaemia treated?

A

Optimise iron status

EPO weekly injection

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22
Q

How is renal bone disease managed?

A

Reduce phosphate and PTH

  • phosphate binder
  • vitamin D
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23
Q

Describe haemodialysis and the associated risks

A

3 sessions/week
requires a fistula in lower arm
Risks - infection, endocarditis, stenosis, hypotension, arrhythmia, thrombus, air embolus, steal syndrome, disequilibrium

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24
Q

Describe the two types of peritoneal dialysis

A

Continuous - drained every few hours

Automated - drained overnight

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25
What immunosuppression is needed after a kidney transplant?
Ciclosporin/tacrolimus Monoclonal antibody MMF or sirolimus
26
What drug is given in acute transplant rejection?
Steroids
27
Name the three types of rejection of renal transplant
Hyperacute Acute Chronic
28
What will a biopsy of diabetic nephropathy look like?
Kimmelstein Wilson lesions - nodular glomerulosclerosis
29
What is the most common cause of chronic pyelonephritis?
Vesicle-ureteric reflux usually presents in childhood with recurrent infection
30
What causes renal artery stenosis?
Atherosclerosis | Fibromuscular dysplasia
31
How does renal artery stenosis present?
HTN, AKI, flash pulmonary oedema, CKD, renal bruit, different sized kidneys
32
How do you treat renal artery stenosis?
Statin ACE inhibitor Anti-platelet
33
What is the appearance of fibromuscular dysplasia on angiography?
String bean
34
How does endothelial or mesangial cell damage present?
Haematuria
35
How does podocyte damage present?
Proteinuria
36
Describe nephrotic syndrome
Proteinuria Hypo-albuminaemia Oedema
37
Describe nephritic syndrome
Oliguria Haematuria - red cell casts Hypertension
38
Describe IgA nephropathy
Most common Haematuria in young males post URTI HSP and coeliac IgA and C3 deposits
39
How do you treat IgA nephropathy?
BP control - ACEi/ARB
40
Describe minimal change nephropathy
Children with nephrotic syndrome T cell damage - podocytes Podocyte fusion
41
How do you treat minimal change nephropathy ?
Steroids
42
Describe focal segmental glomuerulosclerosis
Young adults with nephrotic syndrome Primary Secondary - HIV, reflux/IgA, heroin, Alports, sickle cell Sclerosis and complement
43
Describe membranous nephropathy
Adults with proteinuria and nephrotic Anti-PlA2 Secondary - infection, malignancy, NSAIDs, systemic disease Thick BM with sub-epithelial deposits
44
How is focal segmental glomerulosclerosis treated?
Steroids Immunosuppression 50% ESRF
45
How is membranous nephropathy treated?
ACEi/ARB Immunosuppression - steroids, mab, cyclophosphamide 30% ESRF
46
Describe rapidly progressive glomerulonephritis
Granular casts AKI Nephritic syndrome ANCA or goodpastures/SLE
47
How is RPG treated?
Immunosuppression Plasmaphoresis RRT
48
Describe post strep GN
Young children 7-14 days post strep Immune complex deposition in glomeruli Headache, malaise, haematuria, proteinuria, HTN, low C3 'starry sky'
49
Which chromosomes are linked to polycystic kidney disease?
Autosomal dominant - 16 and 4 | Recessive - 6
50
Describe autosomal dominant kidney disease
Presents with HTN, recurrent UTI, abdominal pain, stones, CKD, berry aneurysms, cysts, valve prolapse
51
What drug can be used in PCKD?
Tolvaptan
52
Describe Alport's
X linked dominant type IV collagen | Microscopic haematuria, renal failure, sensorineural hearing loss (bilateral), ocular manifestations
53
What will biopsy of Alports show?
Longitudinal splitting of lamina dense
54
Name the stages of AKI
1 - 2- 3-
55
How does AKI present?
Reduced urine output Oedema Uraemia Arrhythmias
56
State the indications for dialysis in AKI
Hyperkalaemia >7 Severe acidosis Fluid overload Urea >40
57
Name the pre-renal causes of AKI
Hypovolaemia Hypotension Renal hypo perfusion
58
What can untreated AKI lead to?
Acute tubular necrosis | - muddy brown casts
59
How do you treat pre-renal AKI?
Fluid bolus
60
Name the renal causes of AKI
Vascular - vasculitis Glomerular - GN, systemic Interstitial nerphritis Tubular injury
61
What causes interstitial nephritis?
Drugs Infection -TB Systemic - sarcoidosis
62
What causes tubular injury?
Ischaemia Drugs - gentamicin Contrast Rhabdomyolysis
63
Describe interstitial nephritis
Penicillin, NSAIDs, allopurinol, furosemide, PPI | Fever, rash, eosinophilia, renal impairment , hypertension
64
What causes post renal AKI?
Obstruction - calculi - stricture - cancer - extrinsic
65
How do you treat hyperkalaemia?
ECG and IV Calcium gluconate Insulin/nebulised salbutamol
66
How does hypokalaemia present?
Muscle weakness, hypotonia
67
What is the antidote to ethylene glycol?
Ethanol
68
What drugs should be avoided in AKI?
``` ACEi/ARB Diuretics NSAIDs Gentamicin Trimethoprim Contrast ```
69
What bug usually causes prostatitis?
E.coli
70
How is bacterial prostatitis treated?
Quinolones
71
What is balanitis?
Inflammation of the glans
72
What infections can cause balanitis?
Candida | Staph
73
How do you treat BPH?
Alpha 1 antagonists - tamsulosin 5 alpha reductase inhibitor -finesteride TURP surgery
74
What can cause acute urinary retention?
BPH Obstruction Anticholinergic drugs Neurological cause
75
What is the most common type of prostate cancer?
Adenocarcinoma
76
How is prostate cancer investigated?
PSA and DRE | MRI and biopsy
77
What grading scale is used in prostate cancer?
Gleason's
78
How do you treat prostate cancer?
Prosatectomy Radiotherapy Hormone treatment
79
What hormone therapy can be used in prostate cancer?
Synthetic GnRH agonist Anti-androgen Bilateral orchidectomy
80
What is the most common bladder cancer?
Transitional cell
81
What is the biggest risk factor for bladder cancer?
Smoking | Occupation risk - hydrocarbon dyes
82
What is schistosomiasis infection associated with?
Squamous cell carcinoma
83
How does bladder cancer present?
Painless macroscopic haematuria | LUTS
84
How is bladder cancer investigated?
Flexible cystoscopy and biopsy MRI CT PET
85
How is bladder cancer treated?
Chemo Cystectomy Radiotherapy
86
What are the red flags in terms of bladder cancer?
Age >45 - visible haematuria Age >60 - visible haematuria and dysuria/raised WCC - recurrent or persistent unexplained UTI
87
How do you investigate macroscopic haematuria?
>50 - CT urography flexible cystoscopy <50 USS and flexible cystoscopy then CT urography Pregnancy - MR urography
88
Name benign renal tumours
Cysts Oncocytoma Angiomyolipoma
89
Name three malignant tumours of the kidney
Transitional cell - renal pelvis Renal cell carcinoma - parenchyma Embyrogenic - nephroblastoma
90
What is the common renal cell carcinoma?
Clear cell
91
Who gets renal cell carcinoma?
Middle aged men | Smokers
92
What genetic disease is renal cell carcinoma associated with?
Von Hippel Lindau
93
State the features of renal cell carcinoma
``` Haematuria Loin pain Abdo mass Pyrexia Paraneoplastic syndrome Stauffer syndrome ```
94
What is the typical mets of renal cell carcinoma?
Haem spread to lungs causing cannot ball mets
95
How do you assess renal cell carcinoma?
USS CT Biopsy
96
How is renal call carcinoma treated?
Nephrectomy Ablative Abjuvant therapy
97
What is nephroblastoma called?
Wilm's tumour
98
Describe nephroblastoma
Present in first 4 years of life with a mass, haematuria, pyrexia
99
How is wilm's treated?
Nephrectomy
100
How does colic present?
Loin to groin pain with associated nausea, vomiting, haematuria/dysuria
101
What are the common sites of calculi?
Pelvic ureteric junction Pelvic brim Vesicoureteral junction
102
How do you investigate colic?
CT KUB | USS/MRI if pregnancy
103
How is colic treated?
``` NSAIDs <5mm pass spontaneously alpha blocker - tamsulosin Shock wave Lithotripsy Ureteroscopy - pregnancy Nephrolithotomy ```
104
How is colic treated in an emergency?
Nephrostomy and ureteric catheter and stent
105
What do struvite stones look like?
Stag horn calculi - proteus bacteria
106
What is the commonest cause of urethral stricture?
Catheterisation
107
How is hydronephrosis investigated and treated?
Ix - USS, CT KUB, | Nephrostomy
108
Describe hydrocele
Fluid in tunica vaginalis Soft non tender swelling confined to scrotum Transluminates USS and conservative
109
What causes hydrocele in newborns?
Patent processus vaginalis
110
Describe varicocele
Bag of worms, usually on the left USS and conservative. | Blockage of renal vein can be a cause
111
What type of cancer are most common in the testes?
Germ cell tumours
112
How do you investigate testicular cancer?
USS | CT
113
How is testicular cancer treated?
Surgery Seminoma - radiosensitive and surgery Orchidectomy
114
What are the tumour markers in testicular cancer?
PLAP - seminoma | AFT and HCG in teratoma
115
What are the two types of priapism and how are they managed?
Non-ischaemic - conservative | Ischaemic - emergency aspiration and phenylephrine then surgery
116
What is the most common penile cancer?
Squamous cell carcinoma
117
How does penile SCC present?
Red, raised, fumigating, foul smelling mass requires penectomy and reconstruction

Renal (20 decks)

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