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Treatments > Renal > Flashcards

Renal Flashcards

1
Q

Hydronephrosis

Urine back pressure into calyces compresses the nephrons within the medullary pyramids

  • can lead to renal failure
  • kidneys are enlarged and palpable
A

Treat causes:

Upper tract:

  • Acute: insertion of a nephrostomy tube
  • Chronic: insertion of a ureteric stent or a pyeloplasty

Lower tract: insertion of a urinary catheter or a suprapubic catheter

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2
Q

Pyelonephritis

Pyelonephritis is a kidney infection that occurs when bacteria from a urinary tract infection spreads to the kidney.

A

Amoxicillin (IV) + Gentamicin (IV)

Penicillin allergic: Switch Amoxicillin with Co-trimaxazole (IV)

Step down to: Co-trimaxazole (IV)

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3
Q

Chronic Kidney Disease

  • reduced GFR

Stage 1: GFR >90 + evidence of kidney damage
Stage 2: GFR 60-90 + evidence of kidney damage
Stage 3: GFR 30-60
Stage 4: GFR 15-30
Stage 5: <15 or on RRT

A

Slow progression and reduce cardio risk:

  • Reduce BP (ACEis/ ARBs)
  • Statins
  • Stop smoking
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4
Q

Nephrotic Syndrome

Non-proliferative process affecting podocytes
Symptoms: Oedema
Increased protein in the urine and decreased protein (albumin) in the blood, with increased fat in the blood.

A 
Fluid restriction
Salt restriction
ACEi/ ARBs
Anticoagulants 
IV Albumin
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5
Q

Glomerulonephritis

Immune mediated disease of the kidneys affecting glomeruli

Non-proliferative: Minimal change, FSGS, Membranous
- can cause Nephrotic syndrome
Proliferative: IgA, Rapidly progressive, post-infective
- can cause Nephritis syndrome

A 
All GNs: 
Dietary changes 
Stop smoking
ACEs/ARBs
Statins

Treat underlying type

Severe: RRT

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6
Q

Minimal change GN
Non-proliferative
Nephrotic

  • Oedema
  • Proteinuria
  • Decrease in blood protein
  • Increase in blood lipids
A

Corticosteroids

Does not lead to CKD

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7
Q

Minimal change GN
Non-proliferative
Nephrotic

  • Oedema
  • Proteinuria
  • Decrease in blood protein
  • Increase in blood lipids
A

Corticosteroids
Cyclophosphamide

Does not lead to CKD

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8
Q

Focal segmental glomerulosclerosis (FSGN)
Non-proliferative
Nephrotic

Characterised by a sclerosis of segments of some glomerules, associated with conditions such as HIV and heroin abuse, or inherited as Alport syndrome.
Increase in hyalin and lipids. Low albumin.

A

Corticosteroids

Leads to CKD

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9
Q

Membranous (MGN)
Non-proliferative
Nephrotic/ nephritic

Associated with auto-antibodies to phospholipase A2 receptor, cancer, Hep B/c, Malaria, Syphilis, and SLE.

A

Corticosteroids

1/3 lead to CKD

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10
Q

IgA Nephropathy GN
Proliferative
Nephritic

The most common type of glomerulonephritis

  • several days after a respiratory infection
  • characterised by deposits of IgA in the space between glomerular capillaries
  • Haematuria
  • Low grade proteinuria
A

Self resolving
Omega 3 oil

Leads to CKD

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11
Q

Henoch–Schönlein purpura

A form of IgA nephropathy, typically affecting children, characterised by a rash of small bruises affecting the buttocks and lower legs, with joint pain and abdominal pain

A

Analgesia

Self sesolving

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12
Q

Post-infectious GN
Proliferative
Nephritic

Classically occurs after infection with the bacteria Streptococcus pyogenes. 1–4 weeks after a pharyngeal infection.
Presents with malaise, a slight fever, nausea and increased blood pressure, gross haematuria, and smoky-brown urine

A

Steroids

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13
Q

Rapidly progressive (PRGN)
Proliferative
Nephritis

Characterised by a rapid, progressive deterioration in kidney function.

Type 1: Goodpastures syndrome. IgG antibodies directed against the glomerular basement membrane trigger an inflammatory reaction. Haemoptysis.

Type 2: immune-complex-mediated damage, and may be associated with systemic lupus erythematosus, post-infective glomerulonephritis, IgA nephropathy, and IgA vasculitis

Type 3: associated with causes of vascular inflammation including granulomatosis with polyangiitis (GPA) and microscopic polyangiitis. ANCA antibody.

A

Steroids
Cyclophasphamide, azathioprine, mycophenolate
Plasmaphoresis

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14
Q

Diabetic Nephropathy

Protein loss in the urine due to damage to the glomeruli may become severe, and cause a low serum albumin with resulting oedema resulting in nephrotic syndrome. GFR may progressively fall to less than 15.

Damage to the glomerular basement membrane allows proteins in the blood to leak through, leading to proteinuria. Deposition of abnormally large amounts of mesangial matrix causes periodic-acid schiff positive nodules called Kimmelstiel–Wilson nodules.

A

ACEis
Manage Diabetes

Leads to ESKD
- RRT

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15
Q

Ischaemic Nephropathy

Decrease in GFR and kidney perfusion.
Caused by: HTN, artherosclerosis, Vascular disease, fibromusclular dysplasia

Symptoms:

  • Flash pulmonary oedema
  • Abdominal bruits
  • Artherosclerosis
A

ACEi
Angioplasty/ stent
Statin
Anti-platelets

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16
Q

Lupus Nephritis Class I
Minimal mesangial GN

Mesangial deposits are visible under an electron microscope

A

Hydroxychloroquine

KF rare

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17
Q

Lupus Nephritis Class II
Mesangial proliferative GN

Mesangial hypercellularity and matrix expansion. Microscopic haematuria with or without proteinuria may be seen.

A

Hydroxychloroquine
Corticosteroids
Tacrolimus

KF rare

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18
Q

Lupus Nephritis Class III
Focal glomerulonephritis

Indicated by sclerotic lesions involving less than 50% of the glomeruli.
Immunofluorescence reveals positively for IgG, IgA, IgM, C3, and C1q.
Haematuria and proteinuria are present.

A

Hydroxychloroquine
Corticosteroids
Acute: Cyclophosphamide / MMF (mycophenolate mofetil)
Chronic: Azathioprine/ MMF

KF rare

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19
Q

Lupus Nephritis Class IV
Diffuse proliferative nephritis

Most severe, and the most common subtype. More than 50% of glomeruli are involved.
Haematuria and proteinuria are present, frequently with nephrotic syndrome, hypertension, hypocomplementemia, elevated anti-dsDNA titres and elevated serum creatinine.

A

Hydroxychloroquine
Corticosteroids
Acute: Cyclophosphamide / MMF (mycophenolate mofetil)
Chronic: Azathioprine/ MMF

KF rare

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20
Q

Lupus Nephritis Class V
Membranous (MGN)

Diffuse thickening of the glomerular capillary wall and membrane thickening. Signs of nephrotic syndrome. Microscopic haematuria and hypertension.

A

Hydroxychloroquine
Corticosteroids
Cyclophosphamide + Tacrolimus/ MMF/ Azathioprine

KF rare

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21
Q

Lupus Nephritis Class VI
Advanced sclerosing lupus nephritis

Sclerosis involving more than 90% of glomeruli.

A

Hydroxychloroquine

Poor response to therapy.
They’re fucked.

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22
Q

Acute Kidney Injury

A decrease in urine output

Stage 1: <0.5 ml/kg/h for >6hrs
Stage 2: <0.5 ml/kg/h for >12hrs
Stage 3: <0.3 ml/kg/h for >24hrs, or 12hrs of anuria

Due to:

  • blood vessel damage (vasculitis, renovascular diseases)
  • glomerular disease
  • interstitial injury (infection, TB, Sarcoid, SLE)
  • tubular injury (ischaemia, rhabdomyolysis, gentamicin)
A

Fluid Resuscitation (0.9% crystalloid bolus, then repeat if necessary)
If low BP then use inotropes/ vasopressors
Treat underlying causes
RRT

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23
Q

Hyperkalaemia

Muscle weakness and abnormal heart rhythms

Normal: 3.5-5
Hyper: >5.5
Life threatening: >6.5

A

Protect myocardium: 10ml 10% calcium gluconate IV

Influx of K into cells: 
Insulin (Actrapid) with 50ml 50% dextrose
Salbutamol Neb (90 mins)

Long-term: Calcium resonium (prevents absorption from GI tract)

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24
Q

Autosomal Dominant Polycystic Disease

Small, fluid-filled sacs called cysts to develop in the kidney
Symptoms:
- abdominal pain, HTN, haematuria, UTIs, kidney stones

A

HTN control
Tolvaptan
RRT

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25
Q

Alport’s Syndrome

- thickening of glomerular BM

A

HTN control

RRT

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26
Q

Anderson Fabry’s Disease

- deficiency in a-galactosidase A that causes a build of of fat

A

Fabrazyme (enzyme replacement)

27
Q

Medullary Cystic Kindey

Small, fluid-filled sacs called cysts form in the center of the kidneys. These cysts scar the kidneys and cause them to malfunction

A

Transplant

28
Q

Medullary Spongy Kidney

Congenital disorder of the kidneys characterized by cystic dilatation of the collecting tubules in one or both kidneys. Individuals with medullary sponge kidney are at increased risk for kidney stones and urinary tract infection (UTI)

A

Maintaining adequate fluid intake, with the goal of decreasing the risk of developing kidney stones

Pain management:
ureteroscopic laser papillotomy

29
Q

Cystitis

Inflammation of the bladder

A

Antibiotics

Phenazopyridine

30
Q

Urinary retention

Inability to urinate, with increased pain

Due to obstruction

A

Catheter

Alfuzosin/ Tamulosin - relaxes muscles in bladder/prostate

31
Q

Acute Loin Pain

  • colic pain mediated by prostiglandins in ureter
A

Mild: Analgesia (NSAIDs
Severe: Ureteric stent/ stone removal/ fragmentation

32
Q

Epididymitis

Inflammation of the epididymis
- Common in chlamydia

A

Analgesia + bed rest
Send MSSU, gonorrhoea & chlamydia tests.

If STI likely (<35 or new partner in last 3mth): Doxycycline
If UTI likely (>35 and no new partner): Ofloxacin or Ciprofloxacin

33
Q

Paraphimosis
Swelling of glans of penis while the foreskin is retracted
- Common in cathetirisation / cystoscopy

A

Manual compression of glans (with iced glove if necessary)

Dorsal slit

34
Q

Priapism

Erection lasting longer than 4hrs

A

Aspiration
Phenylephrine injection (1 mL injections made every 3 to 5 minutes for approximately one hour)
Surgical shunt
Spontanous resolvement

35
Q

Fournier Gangrene

Necrotising fasciitis around male genitals

A

Antibiotics

Debridement

36
Q

Emphysematous pyelonephritis (EPN)

Is a severe infection of the renal parenchyma that causes gas accumulation in the tissues. EPN most often occurs in persons with diabetes mellitus, especially women.

A

Nephrectomy

37
Q

Perinephric Abscess

Rupture of acute cortical abscess into the perinephric space

A

Antibiotics and drainage

38
Q

Bladder Injury

  • due to pelvic fracture
A

Large bore catheter

Antibiotics

39
Q

Urethral injury

  • ## fracture of pubic rami
A

Sub pubic catheter

Reconstruction

40
Q

Penile Fracture

  • popping sound
  • 20% urethral injury
A

Exploration and repair

41
Q

Testicular Injury

  • pain and nausea
A

Exploration and repair

42
Q

Benign prostatic hypertrophy

A

Alpha blockers
Finasteride (5 alpha reductase inhibitor)
Transurethral resection of the prostate (TURP)

43
Q

Urethra Stricture

A

Urethrotomy

44
Q

Meatal urethral stenosis

A

Dilation

45
Q

Prostate Cancer

  • 95% adenocarcinoma
  • sclerotic bone lesions on XR
  • haematuria/haematospermia
  • 70ish
  • peripheral zones
A

Metastatic:

  • Androgen deprivation
  • Goserelin (Zoladex): GnRH agonist
  • Cyproterone acetate
  • Diethylstilbestrol
  • Cytotoxic chemotherapy

Organ confined:

  • Prostatectomy
  • Radiotherapy
46
Q

Renal Cell Carcinoma

  • loin pain, haematuria, renal mass
A 
Radial nephrectomy 
Partial nephrectomy 
Radio frequency ablation
IL-2 (Aldesleukin)
IFN-Alpha
Sunitinib
47
Q

Penis Cancer
- squamous cell carcinoma
- association with HPV,
Bowen’s Disease and Erythroplasia of Queyrat: In situ SCC

A 
Topical 5 flouracil 
Circumcision 
Radiotherapy 
Surgery
Amputation :(
48
Q

Testicular Tumours

Germ cell tumours:

  • 40% Seminomas (most common, pale macroscopic potatoe appearance, 30-50 years)
  • 40% Teratomas (solid cysts, necrosis, haemorrhage)
A

Radiotherapy

Orchidectomy

49
Q

Infection of catheterised adult

A

Do not treat unless signs and symptoms of infection.
Do not use urinalysis.
If you must: treat as complicated UTI

50
Q

Complicated UTI

A

Amoxicillin (IV) + Gentamicin (IV)

Penicillin allergic: Switch Amoxicillin with Co-trimaxazole (IV)

Step down to: Co-trimaxazole (IV)

51
Q

Female UTI

A

Nitrofurantoin or Trimethoprim for 3 days

52
Q

Male UTI

A

Nitrofurantoin or Trimethoprim for 7 days

53
Q

UTI or bacteriuria in pregnancy

A

1st-2nd trimester: Nitrofurantoin
3rd trimester: Trimethoprim

2nd line: Cefalexin

54
Q

Prostatitis

Inflamed prostate gland

A

Ofloxacin or Ciprofloxacin

High risk of C. difficile: Trimethoprim

55
Q

Renal Calculi <5mm

A

Diclofenac - Analgesia
Alpha blockers to aid ureteric stone passage

Stones < 5 mm will usually pass spontaneously. Lithotripsy and nephrolithotomy may be for severe cases.

56
Q

Stone burden of less than 2cm in pregnant females

A

Ureteroscopy

57
Q

Stone burden of less than 2cm in aggregate

A

Lithotripsy

58
Q

Complex renal calculi and staghorn calculi

- Proteus sp.

A

Percutaneous nephrolithotomy

59
Q

Oxalate stones

A

Cholestyramine reduces urinary oxalate secretion

Pyridoxine reduces urinary oxalate secretion

60
Q

Uric acid stones

A

Allopurinol

Urinary alkalinization e.g. oral bicarbonate

61
Q

Nephrogenic diabetes Insipidus

A

Thiazide diuretics

DI leads to the production of vast amounts of dilute urine which is dehydrating and raises the plasma osmolarity, stimulating thirst. The effect of the thiazide causes more sodium to be released into the urine. This lowers the serum osmolarity which helps to break the polyuria-polydipsia cycle.

62
Q

Overactive Bladder

A

Antimuscarinic drugs (oxybutynin, tolterodine and darifenacin)

63
Q

Nephroblastoma (Wilms Tumour)
Age <4
Haematuria

A

nephrectomy

64
Q

Hyperkalaemia causing Myeloma

A

NaCl Volume resus

IV Pamidronate

Treatments (13 decks)

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