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Belle Phase 2a > Renal > Flashcards

Renal Flashcards

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1
Q

Benign prostatic hyperplasia Px

A

Old Age
Nocturia
Hesistancy
Weak stream

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2
Q

Testicular torsion presentation

A

MEDICAL EMERGENCY
Typically teenage male

Acute, severe pain in groin area
Red and swollen scrotum (unilateral)
Cremasteric reflex ABSENT on affected side
Prehns sign NEGATIVE

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3
Q

Epididymitis and testicular torsion differential

A

Prehn’s sign is positive in epididymitis (relief of pain) and negative in testicular torsion (exacerbation of pain)

Cremasteric reflex (stroke thigh = testicle contracts and rises) is negative in testicular torsion

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4
Q

Kidney stone presentation and gold standard investigation

A

Unilateral severe pain down the side of abdomen
Episodic with episodes not lasting too long
“worst pain ever felt”
Nausea with pain

GOLD STANDARD investigation: non-contrast CT of the kidneys, ureter and bladder (NCCT-KUB)

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5
Q

CKD GFR stages

A 
G1: >90 (normal)
G2: 60-90
G3a: 45-59
G3b: 30-44
G4 (severe): 15-29
G5: <15 = dialysis or kidney transplant
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6
Q

IgA nephropathy

A

Haematuria
Hypertension
Urinalysis: mild proteinuria with RBC casts (nephritic)

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7
Q

Nephritic syndrome causes

A

Renal:
IgA nephropathy

Systemic:
Post-streptococcal glomerulonephritis
Goodpasture’s
SLE

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8
Q

Nephrotic syndrome causes

A

Renal disease disrupting kidney function:
Minimal change disease
Focal segmental glomerulosclerosis
Membranous nephropathy

Secondary causes: DDANI (Diabetes, Drugs, Autoimmune, Neoplasia, Infection)

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9
Q

Pyelonephritis (summary)

A

Fever, nausea (systemically unwell)
Unilateral back pain
Dipstick urinalysis: positive for leukocytes, nitrites, blood

Empirical Abx: Ciprofloxacin

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10
Q

AKI secondary to sepsis Tx

A

Insulin + dextrose (HYPERKALAEMIA)
Stop aspirin
Give fluids (dehydration)
Sodium citrate (acidosis)

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11
Q

Gonorrhoea

A

Organism: Neisseria gonorrhoea

Gram stain appearance: Gram negative (pink) diplococci

Presentation: dysuria, discharge

Treatment: ceftriaxone IM

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12
Q

Nephrotoxic drugs contraindicated in AKI

A

NSAIDs: reduce prostaglandin production = vasoconstriction of afferent arteriole = reduced perfusion = decreased GFR

ACEi/ARB: Blood pressure drops = less blood forced into bowman’s capsule = decreased GFR

Aminoglycosides

Loop diuretics

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13
Q

Renal AKI

A

Glomerulonephritis
Small vessel vasculitis
Acute tubular necrosis
Acute interstitial nephritis

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14
Q

Post-renal AKI

A

BPH
Kidney stones
Ureter strictures

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15
Q

Bladder cancer Px and Ix

A

Haematuria
Frequency
Weight loss without pain

Investigation: cytoscopy

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16
Q

Bladder cancer

A

Px: painless haematuria, frequency, weight loss

Ix: flexible cystoscopy

Mx:

surgical: TURBT (low grade, non-muscular), radical cystectomy (severe, muscular)
medical: chemotherapy

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17
Q

Most common cause of glomerulonephritis

A

IgA nephropathy (Berger’s disease)

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18
Q

Oxybutynin in urge incontinence

A

Anti-muscarinic/cholinergic drug

Inhibits PNS - decreases detrusor excitability, preventing symptoms of urgency

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19
Q

Side effects of oxybutynin

A 
SNS:
Constipation
Dry mouth
Dry eyes
Dilated pupils/blurred vision
Tachycardia
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20
Q

Prostate cancer Px and Ix

A

Urgency, nocturia, weight loss, pain

GOLD STANDARD investigation: Transrectal US guided biopsy (Gleason grading)

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21
Q

PSA screening: positives and negatives

A

Non-specific (false positives), over-treatment

Inexpensive, convenient, early detection

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22
Q

Grading vs staging in cancer

A

Grade: microscopic appearance

Staging: size and spread of tumour

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23
Q

Four functions of the kidney

A

Water/hormone homeostasis
Removal of waste/toxins
RBC production (erythropoietin)
Activate Vitamin D

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24
Q

AKI Diagnostic criteria

A

Any one:

  • rise in creatinine of >26 in 48 hours
  • > 50% rise in creatinine in 7 days
  • fall in urine output to less than 0.5 for more than 6 hours (stage 1) or 12 hours (stage 2)
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25
Px: T2DM, HTN, low urine osmolality, high urine Na, hyperkalaemia Pre-renal, renal, post-renal?
Renal
26
Px: Normal Na, raised urea, raised creatinine, responds well to fluid therapy Pre-renal, renal, post-renal?
Renal
27
Px: Loin to groin acute colicky pain, microscopic haematuria Pre-renal, renal, post-renal?
Post-renal
28
AKI Mx
Fluid balance Treat HYPERKALAEMIA Treat underlying cause
29
CKD Mx
Slow the progression - DM Tx - HTN Tx - Glomerulonephritis Tx Reduce CVD risk - Atorvastatin Manage complications e.g. - Mineral bone disease (low Vit D) - HTN - Proteinuria - Anaemia
30
Lower urinary tract symptoms
Storage: frequency, urgency, nocturia, incontinence Voiding: hesitancy, poor stream, straining, terminal dribble Haematuria DDx: UTI, BPH, prostate cancer
31
BPH Ix
DRE (SMOOTH enlarged prostate) PSA Mid stream sample (exclude infection) Biopsy (exclude malignancy)
32
Prostate cancer treatment
Localised: radical prostatectomy Advanced: GnRh agonist (Zoladex)
33
Most common type of prostate cancer
Adenocarcinoma
34
Hydrocele
Abnormal collection of fluid in the tunica vaginalis Soft, non-tender swelling Mx = Conservative (most resolve by 2 years old)
35
Varicocele
Abnormal enlargement of the testicular veins “bag of worms” Ix: US and Doppler Mx: Conservative Note: left testicular vein drains into left renal vein, right testicular vein drains into inferior vena cava
36
Testicular torsion complication
Infarction of the testicle
37
Ratio used to calculate renal function
Urea:creatinine
38
CKD dietary changes
``` Low protein (ammonia excretion) Low potassium (cardiac arrythmias) Low sodium (hypertension) ```
39
CKD risk factors
``` Older age DM HTN Progressive AKI FHx ```
40
BPH Tx
1st line: Tamsulosin (alpha blocker) | 2nd line: Finasteride (5 alpha reductase inhibitor)
41
Epididymal cyst (summary)
Most common cause of scrotal swelling Lump found in posterior aspect of testicle Ix: US Mx: dissolve in 10 days
42
Testicular cancer (summary)
Painless lump Hydrocele Gynacomastia Ix: US Tx: chemo
43
Nephritic syndrome
INFLAMMATION within the kidney Defining features: - Haematuria - Oliguria (due to reduced GFR) - Hypertension (due to fluid overload) - Proteinuria (but less than nephrotic)
44
Nephrotic syndrome
Issue with the filtration barrier (pOdOcytes = nephrOtic) = leaking of proteins into the urine Triad of characteristics: - Proteinuria - Hypoalbuminaemia (due to loss in urine) - Oedema (due to loss of oncotic pressure)
45
Px of nephrotic syndrome
``` Oedema Frothy urine (proteinuria) ```
46
Nephrotic syndrome Ix
Urinalysis Urine protein:creatinine ratio (degree of proteinuria) Blood tests (renal function, elevated lipids) Renal biopsy (to look for cause)
47
Nephrotic syndrome Mx
``` Fluid and salt restriction Loop diuretics (oedema) Treat cause ACEi/ARB (reduce protein loss) Manage complications ```
48
Complications of nephrotic syndrome
Hyperlipidaemia: loss of albumin = increased cholesterol formation (Tx = statins) VTE: due to increased clotting factors (Tx = heparin)
49
Nephritic syndrome Ix
Diagnostic test: kidney biopsy Urinalysis (haematuria) Bloods (elevated ESR and CRP; anaemia reflecting systemic disease)
50
Nephritic syndrome Mx
Treat underlying cause ACEi/ARB (reduces proteinuria and preserves renal function) Corticosteroids (reduce inflammation causing damage)
51
Causes of glomerulonephritis
IgA nephropathy Goodpastures disease Post-streptococcal glomerulonephritis Henoch Schoenlein purpura
52
IgA nephropathy (summary)
Deposition of IgA into the mesangium of the kidney = activates complement pathway = glomerular injury Develops during infection of mucosal lining (IgA mediated) Presents asymptomatically with microscopic haematuria Diagnosis: biopsy
53
Minimal change disease
Makes up 25% of adult cases of nephrotic syndrome Most common type seen in children Normal appearance on microscopy but abnormal function Diagnosis: biopsy Tx: high dose steroids (prednisolone)
54
Focal segmental glomerulosclerosis (summary)
Aetiology: can be idiopathic or secondary to HIV, heroin, lithium Diagnosis: biopsy (presence of scarring of the glomeruli i.e. focal sclerosis) Tx: steroids in idiopathic, ACEi/ARB for BP control
55
Membranous nephropathy
25% of adult nephrotic syndrome Immunologically mediated (IgG) Diagnosis: renal biopsy (thickened glomerular basement membrane) - Antiphospholipase A2 receptor antibody found in 70-80% of patients Tx: ACEi/ARB, in patients with high risk of progression: prednisolone and cyclophosphamide
56
Bladder cancer risk factors
Smoking (increases risk 2-4 times) - accounts for HALF of male cases Age >55 Pelvic radiation Exposure to occupational carcinogens Bladder stone (due to chronic inflammation)
57
Most common cause of nephritic syndrome in high income countries
IgA nephropathy
58
Henoch Schoenlein purpura
Small vessel vasculitis that affects the kidney and joints due to IgA deposition More common in males post upper resp tract infection PURPURIC RASH on legs, NEPHRITIC symptoms, and joint pain Diagnosis: kidney biopsy Mx: corticosteroids and ACEi/ARB
59
Post-streptococcal glomerulonephritis
Nephritic syndrome following an infection (3-6 weeks prior, impetigo or strep throat) Usually affects children Deposition of strep antigen complexes in the glomeruli = inflammation and damage Dx: evidence of strep infection + haematuria Tx: Abx and supportive care
60
Bladder cancer Px
PAINLESS HAEMATURIA Pelvic mass UTI symptoms without bacteriuria
61
Bladder cancer Ix
Urinalysis (sterile pyuria) Diagnostic: cystoscopy and biopsy CTT urogram: allows staging
62
1st line Tx bladder cancer
Transurethral resection or local diathermy
63
Renal cancer
90% = proximal tubular epithelium (renal cell carcinomas) Age 55, F > M Spread to bone, liver, lungs
64
RF Renal Cell Carcinoma
Haemodialysis Smoking Hypertension
65
Px Renal Cell Carcinoma
Haematuria Flank pain Palpable abdominal mass
66
Renal Cell Carcinoma Ix
CT/MRI Bloods: polycythaemia (erythropoietin secretion) Raised BP (increased renin secretion) Ultrasound
67
Bladder cancer parasite
Schistosomiasis
68
Score to predict survival in RCC
Mayo score stage 1: partial or radical nephrectomy stage 3: radical nephrectomy and adrenalectomy
69
5 most common pathogens in UTIs
``` KEEPS: Klebsiella (PREGNANT WOMEN) E. coli (MOST COMMON CAUSE) Enterococci Proteus Staphylococcus coagulase -ve ```
70
UTI Px
Voiding: FUND | - Frequency, Urgency, Nocturia, Dysuria
71
Pyelonephritis
Infection and inflammation of the kidney | Most often due to ASCENDING UTI
72
Pyelonephritis Px
Triad: Loin pain Fever Polyuria
73
Gold standard for Dx of causative agent in UTIs
Mid stream urine and culture
74
Pyelonephritis Ix
Urinalysis (WCC and microscopic haematuria) Mid stream urine and culture Bloods (elevated CRP) Renal USS (rule out urinary tract obstruction/stones)
75
Pyelonephritis Tx
Cefalexin (7-10 days) | Trimethoprim or amoxicillin if sensitive
76
Cystitis Tx
Trimethoprim or nitrofurantoin (3 days) AVOID trimethoprim in pregnancy - Avoid nitrofurantoin at term in pregnancy
77
Cystitis
Urinary bladder infection | Most common in young sexually active women
78
Cystitis RFs
History of UTI Diabetes Frequent sexual intercourse Pregnancy
79
Prostatitis
Inflammation and swelling of the prostate gland | Most common causative agent: E. Coli
80
Prostatitis Px
DRE: VERY TENDER prostate Systemic Sx: fever, chills, malaise VOIDING symptoms
81
Prostatitis Ix
Urinalysis and culture (blood, WBCs, bacteria)
82
Prostatitis Tx
Ciprofloxacin or levofloxacin (14 days)
83
Most common bacterial STI and causative organism
Chlamydia trachomatis
84
Chlamydia symptom in men
Testicular pain | 50% are ASx
85
Chlamydia symptom in women
Vaginal discharge and dysuria | 70% are ASx
86
Chlamydia diagnostic test
Nucleic acid amplification testing
87
Chlamydia Mx
1st line: DOXYCYCLINE Breastfeeding, pregnancy, allergy: AZITHROMYCIN Avoid sex until Tx finished Contact tracing
88
Second most common STI in UK and causative organism
Neisseria gonorrhoea (Gram -ve diplococci)
89
Gonorrhoea Ix
Nucleic acid amplification testing (NAAT) | Microscopy and culture (G-ve diplococci)
90
Gonorrhoea Tx
1st line: Ceftriaxone IM dose | 2nd line: azithromycin
91
Syphilis Tx
Benzanthine penicillin + azithromycin
92
Urolithiasis
The presence of crystalline stones in the urinary tract | OKA: renal calculi, nephrolithiasis
93
Three places where you find renal stones
Where the ureter narrows: - Pelvicoureteric junction - Pelvic brim - Vesicoureteral junction
94
Composition of renal stones
Crystals in supersaturated urine = CALCIUM oxylate (80% of cases)
95
Renal stones RFs
Think anything that increases calcium, oxalate or phosphates ``` Dehydration High salt intake Hypercalcaemia Obesity (lowers pH) Oxalate rich diet Gout (Uric acid stones) Thiazide (Uric acid reabsorption) ```
96
Diclofenac
NSAID
97
Adrenal gland layers
98
Renal stones Px
``` Most are asymptomatic SEVERE COLICKY UNILATERAL PAIN from LOIN to GROIN Writhing around in pain Associated with nausea and vomiting ASSUME AAA until proven otherwise! ```
99
Renal stone 1st line diagnostic imaging technique
KUB X-Ray (diagnostic for 80% of cases)
100
Renal stone Gold standard imaging technique
Non-contrast CT KUB
101
Renal stones Mx
STRONG analgesia: diclofenac Antibiotics Tamsulosin: relaxes smooth muscle and helps expulsion Percutaneous nephrolithotomy: used to expel stones over 10mm Prevention: - thiazide diuretics (helps with recurrent stones by reducing calcium levels) - hydration, reduce salt and oxalate intake
102
AKI stages
``` Stage 1: risk Stage 2: injury Stage 3: failure Loss ESKD ```
103
CKD Px
Pruritis Fatigue Oedema Polyuria
104
2nd line to ACEi due to cough SE
Angiotensin II receptor blockers E.g. candesartan
105
Post-strep glomerulonephritis Ix
Blood tests (renal function + eGFR) Urinalysis (blood + protein) Biopsy (dead bacterial cell + antibodies) USS
106
Granulomatosis with polyangiitis Px
Nasopharynx: saddle nose Lung: Dyspnoea, Haemoptysis Kidneys: decreased urine output
107
Goodpastures Px
Reduced urine output Haemoptysis Oedema Dyspnoea
108
Testicular seminoma
Germ cell tumour | Seminoma cancers NEVER secrete alpha-fetoprotein (AFP)
109
Radiolucent vs radiopaque
Radiolucent: allow X-Rays to penetrate through them and expose the receptor Radiopaque: bony in origin (absorb/stop the penetration of the X-Rays and therefore do not reach the receptor)
110
Uric acid stones on X-Ray
Radiolucent
111
Treatment with prognostic benefit in prostate cancer
Finasteride: inhibits conversion of testosterone to dihydrotestosterone
112
Uncomplicated UTI
Non-pregnant women | Children over 3 months
113
Autosomal dominant polycystic kidney disease mutations
PKD1 mutation | PKD2 mutation
114
ADPKD complications
Kidney stones Renal insufficiency Berry aneurysms Heart failure (aortic root dilation)

Belle Phase 2a (14 decks)

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