Renal Flashcards
(82 cards)
1
Q
Massive bilateral renal enlargement, adult in 50s, chromosome 16&4, hepatic cysts, berry aneurysms
A
Autosomal dominant Polycystic kidney disease
2
Q
Bilateral and symmetrical cysts on kidneys, childhood, chromosome 6, congenital hepatic fibrosis, ESRD by adolescence
A
Autosomal Recessive Polycystic Kidney disease
3
Q
“Potato tumour”, PLAP, v.sensitive to radiotherapy
A
Seminoma
4
Q
Primitive cells, b-HCG, younger than seminomas, variable appearance: solids, cysts, haemorrhage, necrosis
A
Teratoma
5
Q
BHCG
A
Teratoma
6
Q
AFP
A
Never raised in pure seminoma
7
Q
PLAP
A
Seminoma
8
Q
Particular risk factor for testicular cancer
A
Testicular maldescend
9
Q
A glycoprotein enzyme produced by secretory epithelial cells of the prostate
A
PSA
10
Q
Prostate cancer:
- Organ confined
- Locally advanced
- Metastatic
A
- Watchful waiting
- Watchful waiting/hormonal therapy
- Androgen deprivation therapy
11
Q
Painful swelling of foreskin distal to phimotic ring
A
Paraphimosis
12
Q
Prolonged erection >4hrs with no sexual arousal
A
Priapism
13
Q
Necrotising Fasciitis in male genital region
A
Fournier’s gangrene
14
Q
UTI micro: bacteria associated with calculi
A
- Proteus
- Produces erase which breaks down urea to form ammonia
15
Q
UTI micro: bacteria in women of child bearing age
A
Staphylococcus Saphyticus
16
Q
UTI micro: catheters and sensitive to Ciprofloxacin
A
Pseudomonas Auruginosa
17
Q
UTI micro: Kass’ Criteria in Women bearing age
- > 10^5 organisms
- 10^4 organisms
A
- Probable UTI
- Not significant bacteria
- Repeat specimens, contaminated
18
Q
UTI micro: Pure growth is more significant than mixed growth T/F?
A
True
19
Q
Resistant to all Abx
A
CPE
20
Q
Resistant to all cephalosporins and almost all penicillins
A
ESBL
21
Q
UTI micro: Abx which inhibits bacterial folic acid synthesis, avoid in 1st trimester
A
Trimethoprim
22
Q
UTI micro: Abx which cannot be used to treat pyelonephritis as it only reaches effective conc in bladder urine, only useful in uncomplicated lower UTI
A
Nitrofurantoin
23
Q
UTI micro: max number of days Gentamicin can be used for
A
3 days
24
Q
UTI micro: Abx for female lower UTI
A
Trimethoprim or Nitrofurantoin orally for 3 days
25
UTI micro: Abx for male UTI
Trimethoprim or Nitrofurantoin orally for 7 days
26
UTI micro: Complicated UTI or Pyelonephritis (GP)
Co-amoxiclav or Co-trimaxazole for 14 days
27
UTI micro: Complicated UTI or Pyelonephritis (hospital)
Amoxicillin and Gentamicin IV for 3 days
28
Criteria for Nephritic Syndrome
- Proliferative process
- Damage to mesangial cells
- "Blood in urine"
- Acute renal failure
- Oliguria
- Oedema
- Hypertension
- Acute urinary sediment
29
Criteria for Nephrotic Syndrome
- Non proliferative
- Damage to podocytes
- "Protein in urine"
- Proteinuria >3g/day
- Hypoalbuminuria
- Oedema
- Normal renal function
- Hypercholeaemia
30
Urinary incontinence: Bladder chronically distended, men with BPH, huge palpable bladder, insidious onset, catheter to relieve obstruction
Overflow
31
Urinary incontinence: Detrusor overactivity, increased bladder pressure, idiopathic or neurological, small volume of voided urine, avoid caffeine and bladder retraining
Urge
32
Urinary incontinence: Increased abdominal pressure, weak pelvic floor due to childbirth, triggered by cough, sneezing or exertion, lose weight, stop smoking, pelvic floor exercises
Stress
33
Urinary incontinence: Mixed
Stress + Urge
34
Majority are transitional cell carcinomas in the trigone area leading to ureteric obstruction, 80% have "stippled" appearance, "halo" sign
Urinary bladder cancer
35
Prostate: transitional oestrogen sensitive part is involved. Irregular proliferation of both glandular and stromal prostatic tissue
BPH
36
Prostate: Peripheral ducts and lobes, particularly posterior lobe
Carcinoma of the prostate
37
eGFR
- Overestimates when ____
- Underestimates when ____
- Overestimates if muscle mass is low
| - Underestimates when muscle mass is high
38
Stages of CKD
```
Stage 1: >90 with kidney damage
Stage 2: 60-90 wit kidney damage
Stage 3a: 45-60
Stage 3b: 30-45
Stage 4: 15-29
Stage 5:
```
39
Causes of CKD
```
Diabetes
Hypertension
Vascular disease
Chronic glomerulonephritis
Polycystic kidneys
```
40
Symptoms of CKD
Non specific: tiredness, poor appetite, sleep disturbance
41
Complications of CKD
- Anaemia: give IV iron or subcut erythropoietin
| - Bone disease: phosphate binders and alfacalcidol
42
AKI: Pre-renal causes
- Impaired perfusion
- Hypovolaemia
- Sepsis
- Dehydration/blood loss
43
AKI: Renal causes
- Small vessel vasculitis
- Glomerulonephritis
- Necrosis
- Drugs
- Infection
44
AKI: Post renal causes
- Urinary calculi
- BPH
- Prostate/cervical cancer
45
Complications of AKI
- Hyperkalamia
- Pulmonary oedema
- Severe acidosis
- Pericardial effusion
46
Untreated pre-renal AKI
Risk of advancing to Acute Tubular Necrosis
47
Loss of "p" wave, Tall tented T waves, widened QRS
Hyperkalaemia
48
Treatment of hyperkalaemia
-10mls of 10% Calcium Gluconate every 2-3mins
to protect myocardium
-Insulin (10 units of rapid active) to drive K back into cells
-50mls of 50% dextrose (30mins)
49
Indications for haemodialysis in AKI
- Hyperkalaemia >7
| - Severe acidosis pH 40
50
Positive congo red staining showing apple green birefringence under polarised light
Amyloidosis
51
AKI, bone pain, normocytic anaemia, Bence Jones Protein, >50yrs, renal impairment at presentation in 50%
Myeloma
52
2 causes of Renovascular disease
Atherosclerotic disease or Fibromuscular dysplasia
53
Young woman, hypertension, carotid artery dissection, associated with Ehlers Danlos and Marfans, renovascular disease
Fibromuscular Dysplasia (rare)
54
Older patient with renovascular disease, risk factors for generalised atherosclerosis
Atherosclerotic Renovascular disease (more common)
55
Flash pulmonary oedema
Renal artery stenosis
56
What drug do you not give in Renal artery stenosis?
ACEi
57
Kimmelstein-Wilson lesion on kidney biopsy
Diabetic Nephropathy
58
How is the diagnosis of Diabetic Nephropathy made?
- Retinopathy +proteinuria= no biopsy
| - Rapid decline in GFR= biopsy
59
Absolute contraindications to renal transplantations
- Malignancy (within 2years and 5 years for breast and colorectal)
- Untreated TB
- Severe Ischaemia heart disease
- Severe airways disease
- Active vasculitis
- Severe peripheral vascular disease
60
Types of kidney implant rejection
- Immediate (80%)
- Delayed (will work after 10-30days)
- Primary non function (will never work)
61
Late onset asthma, necrotising granulomatous inflammation, asthma and eosinophilia, lung most commonly involved
Churg Strauss
62
cANCA PR3
Wegener's
63
pANCA MPO
Churg Strauss
64
Lupus Nephritis Classification I-VI
```
Class I: Minimal
Class II: Mesangial Proliferation
Class III: Focal proliferative
Class IV: Diffuse proliferative
Class V: Membranous
Class VI: Advanced sclerosing
```
65
3 most common locations of Renal Stones
- Pelvicoureteric junction
- Vesicoureteric junction
- Within ureter at pelvic brim
66
Investigation for renal colic
CTKUB of kidneys, ureters and bladder
67
Drug reaction: dose dependent and predictable, pre-renal/renal/post renal drug interactions, Drug-drug, drug-disease, drug-food
Type A
68
Drug reaction: dose independent and unpredictable, high mortality
Type B
69
Drug reaction: Prolonged therapy e.g. long term Beta blockers or steroids
Type C
70
Drug reaction: delayed, many years after prescribing med
Type D
71
Drug reaction: when a drug is suddenly stopped--> rebound effect
Type E
72
X-linked, disorder of Type IV collegen, haematuria, bilateral sensorineural hearing loss and visual problems
Alports Syndrome
73
Most common cause of Nephrotic Syndrome in children, IL-13, good treatment with oral steroids, T cell and cytokine mediated damage to GBM
Minimal Change Nephropathy
74
Most common cause of Nephrotic Syndrome in adults, HIV/heroin/obesity/reflux
Focal Segmental Glomerulonephritis
75
2nd most common cause of Nephrotic Syndrome in adults, Anti-PLA2r antibody, "spike and dome" appearance, 1/3rd spontaneous remission, 1/3rd proteinuria, 1/3rd ESRF
Membranous Glomerulonephritis
76
Nephritic Syndrome, haematuria, Sore throat 1-2days after URTI, Henoch-Schoelin purpura, IgA deposits in mesangial cells
IgA Nephropathy
77
Develops 1-2weeks after URTI, proteinuria, low complement, lumpy immune complexes on electron microscopy
Post Streptococcal Glomerulonephritis
78
What is autosomal recessive kidney disease associated with?
Congenital hepatic fibrosis
79
What is a renal Angioyolipoma associated with?
Benign tumour, associated with Tuberose Sclerosis
80
Cancer which affects the renal pelvis?
Transitional cell carcinoma
81
Cancer which affect the parenchyma?
Renal cell carcinoma
82
Benign tumour which can mimic RCC, has a central scar
Oncytoma
