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4th Year SB > Renal > Flashcards

Renal Flashcards

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1
Q

Pre-renal causes of acute kidney injury

A 
dehydration 
haemorrhage 
sepsis
cardio-renal
hepato-renal
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2
Q

Renal cause of AKI

A

glomerulonephtis
interstitial nephritis
acute tubular necrosis
vascular - renal vein thrombosis

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3
Q

post-renal cause of AKI

A

renal stones
prostate hypertrophy
bladder/cervical/prostate cancer

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4
Q

what is interstitial nephritis typically related too

A

new medications

e.g. antibiotics, NSAIDs, diruetics

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5
Q

what is a buzzword for interstitial nephritis

A

urine eosinophilia

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6
Q

what is typical history of acute tubular necrosis

A

Hx of hypotension, fluid depletion, nephrotoxics

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7
Q

what is common results of acute tubular necrosis

A

low urine osmolality [due to impairment in concentrating urine]

increased urinary sodium

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8
Q

how does renal vein thrombosis present

A

flank pain + haematuria

often mistaken for renal calculi

think if patient is at risk i.e. SLE

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9
Q

Mx of AKI

A

catheterise + accurate fluid balance

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10
Q

causes of chronic kidney disease [6 causes]

A 
hypertension 
renovascular 
diabetes 
reflux 
glomerulonephritis 
PCKD
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11
Q

how is secondary hyperparathyroidism Tx

A

due to Vit D deficiency

i.e. replace Vit D

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12
Q

how is tertiary hyperparathyroidism Tx

A

phosphate binders

parathyroidectomy

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13
Q

how does hypertensive disease affecting the kidneys present

A

proteinuria [NOT haematuria]

both kidneys will be similar in size

Mx = control BP

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14
Q

how does renovascular kidney disease present

A

older patients, M > F
abdominal bruit
majority present with chronic renal failure

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15
Q

what might precipitate someone with renovascular kidney disease presenting with AKI

A

starting nephrotoxic drug ie. ACEi

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16
Q

Ix for renovascular kidney disease and results

A

1st line = renal ultrasound (see different size kidneys)

Gold standard = MR Renal Angiography

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17
Q

Mx for renovascular kidney disease

A

Conservative e.g. statin, manage BP

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18
Q

how does diabetic kidney disease present

A

microalbuminaemia [NO haematuria]

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19
Q

IX and Mx for diabetic kidney

A

Ix = Urine albumin to creatinine ratio

Mx = glycaemic control, anti-hypertensives (ACEi)

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20
Q

what is inheritance pattern for PCKD

A

autosomal dominant

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21
Q

Sx of PCKD

A

Abdo pain, Haematuria, Hypertension, Abdominal Mass

Typically have a FMHx of sudden death in exam questions

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22
Q

Ix for PCKD

A

1st line = renal USS

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23
Q

Mx for PCKD

A

control BP

analgesia - avoid NSAIDs

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24
Q

what is the 2 typical presenting symptoms of nephritic syndrome

A

haematuria

hypertension

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25
what is the 2 typical presenting symptoms of nephrotic syndrome
proteinuria | oedema
26
common nephritic syndromes
Rapidly progressive GN IgA nephropathy Alport syndrome
27
common nephrotic syndromes
Minimal change disease Membranous GN Focal Segmental Glomerulosclerosis Amyloidosis Diabetic Nephropathy
28
What causes a mixed nephritic and nephrotic picture
Diffuse proliferative GN Membranoproliferative GN Post-Strep GN
29
Presentation, causes, and treatment of Rapidly progressive GN
Presentation = rapid onset, AKI Causes - Goodpastures - ANCA positive vasculitis Tx - high dose steroids - cyclophosphamide
30
what antibody is associated with Goodpastures
Anti-GBM antibodies
31
what are the 2 ANCA positive vasculitis that cause Rapidly progressive GN
Granulomatosis with polyangiitis (formerly called Wegener's) Eosinophilic granulomatosis with polyangiitis (EGPA) (formerly called Churg Struss) - associated with pANCA
32
how does IgA nephropathy present and how is it treated
presentation = young adult, haematuria following URTI Tx = supportive
33
how does diffuse proliferative GM present
Post-streptococcal common in SLE or patients on drugs post-kidney-transplant
34
hows does membranoproliferative present
following renal transplant steroids may be effective
35
who gets minimal change nephrotic syndrome and what is Tx
children have normal biopsy result Tx = steroid
36
what is the commonest cause of nephrotic syndrome in the UK
membranous GN
37
what are causes of membranous GN
infections rheumatoid drugs (gold/pencillamine) malignancy 1/3 resolve 1/3 proteinuric 1/3 CKD
38
what is the Tx of membranous GN
Mx = steroids + immunosuppressants
39
what is the commonest cause worldwide of nephrotic syndrome and what is it associated with
focal segmental GM idiopathic secondary to HIV, heroin
40
Mx of focal segmental GM
steroids and immunosuppressants
41
what are people with nephortic syndrome at increased risk of and why
arterial and venous thrombus due to lack of anti-thrombin
42
what is a mnemonic to remember causes of haematuria
``` TITS tumour infection trauma stones + GM/PCKD ```
43
what does painless haematuria suggest
GM | Cancer
44
what does painful haematuria suggest
Infection | Stone
45
how is macroscopic haematuria investigated
if OVER 50 1st line = cystoscopy 2nd line = CT urography if UNDER 50 1st line = cystoscopy 2nd line = USS of kidneys 3rd line = only do CT if above Ix are normal
46
what is the typical presentation of renal cell carcinoma
triad = haematuria, abdo pain, mass left testicular vein >> variocele
47
Ix of RCC
1st line = USS Gold standard = CT + biopsy CXR = shows cannon ball mets
48
Mx of RCC
Radial Nephrectomy +/- radiotherapy, chemotherapy
49
what is the typical presentation of bladder cancer, most common type and risk factors
haematuria, recurrent UTIs Transitional cell carcinoma smoking, dye industry
50
Ix for bladder cancer
cystoscopy and biopsy
51
Mx for bladder cancer
TIS/Ta/T1 = resection of bladder tumour T2-3 = radial cystectomy T4 = palliative chemo/radiotherapy
52
what is the typical presentation of prostate cancer and most common type
Haematuria, LUTS, bone pain adenocarcinoma
53
how do you investigate prostate cancer
PSA and Digital Rectal Exam TRUS and biopsy
54
Mx of prostate cancer
organ confined = radiotherapy, prostatectomy, watching locally advanced = radiotherapy + hormonal therapy mets = hormonal therapy, orchidectomy
55
what are the two types of testicular cancer and what age groups do they present in
teratoma = 20-30 y/o seminoma = 30 + y/o
56
RF for testicular cancer
undescended testis | infant hernia
57
Ix for testicular cancer and tumour markers
USS + biopsy Teratoma = AFP, HCG Seminoma = PLAP, HCG
58
Mx of testicular cancer
Teratoma = chemo Seminoma = orchidectomy
59
buzzwords for hydrocele
on USS it transilluminates "can't get above it" on examination need to exclude tumour as hydrocele can develop secondary
60
what is a varicocele and how does it present
Dilated scrotal venous plexus Feels like sac of worms Left side more commonly affected
61
where is an epididymal cyst found and what is Ix
Found separate from the body of the testicle Usually posterior U/S main Ix
62
what is typical presentation of testicular torsion
Puberty Spontaneous – sudden onset O/E: Tender, swollen testis, reddening of skin, lifting testis increases pain Lack of cremastic reflex
63
what is seen on USS of testicular torsion
avascular
64
Mx of testicular torsion
Emergency surgery - orchidopexy
65
what does "blue dot" sign on upper pole of testis suggest
Torsion of appendage
66
what is presentation of Epididymitis
Hx of UTI/Catheterisation Cremastic reflex present Elevation of testis helps pain
67
Ix for Epididymitis
USS = shows increased blood flow Can be related to STI, so send urine for chlymadia
68
Mx for Epididymitis
Doxycycline < 35 (covers STI) | Ofloxacin >35
69
what anti-hypertensive drug is shown to slow the rate of decline in renal function in diabetics
ACEi - ramipril
70
Recent sore throat + nephritic syndrome = ?
IgA Nephropathy
71
Patient prescribed Amoxicillin + present later with nausea, SOB, diffuse rash + HTN + elevated eosinophil count = ???
Acute interstitial nephritis secondary to amoxicillin.
72
what is Cryoglobulinaemia
causes membranoproliferatuve glomerulonephritis i.e. presents as a mixed Nephritic/Nephrotic pic associated with Hep C
73
how does Cryoglobulinaemia present
gangrene = large leg ulcers purpura = multiple purpuric rashes SOB = due to PE. Increased risk of thrombus.
74
common nephritic syndromes
Rapidly Progressive GN IgA nephropathy Alport Syndrome
75
common nephrotic syndrome
Minimal change - kids Membranous GN - commonest cause in UK Focal segmental GN = commonest worldwide Diabetic nephropathy
76
common mixed nephrotic and nephritic syndromes
Diffuse proliferative GN Membranoproliferative GN Post-Strep GN
77
which test is useful when determining whether there is prerenal uraemia or acute tubular necrosis?
urinary sodium
78
what are the eGFR variables
CAGE = creatinine, age, gender, ethnicity
79
what do you see on microscopy in nephritis syndromes
red cast cells
80
what do "muddy brown casts" in the urine suggest
acute tubular necrosis
81
Ix for TCC
1st line = cystoscopy + biopsy 2nd line = CT urogram 3rd line = CT/MRI
82
Mx of BPH
1st line = alpha blocker e.g. doxazozin, tamsulosin 2nd line = 5 alpha reductase inhibitor e.g. dutasteride, finasteride
83
what are the most common types of renal stones
calcium oxalate
84
mx of renal stones
analgesia = IM or IV diclofenac stone < 5mm will pass spontanteously stone > 5mm requires medical explusion i.e. nifidipine or shockwave lithrotripsy
85
tumour markers for seminoma and teratoma
seminoma = PLAP and bhcg teratoma = AFP
86
patient with proteinuria + HTN = ?
ACE i
87
patient with AKI and hyperkalaemia = diagnosis
goodpastures
88
RA with GN
amyloidosis
89
HTN + IHD = ?
renal artery stenosis
90
what passes through cell membrane readily
cations
91
1st line Ix for hydrocele
doppler USS with colour
92
how do TZD work and what are there side effects
work by inhibiting sodium reabsorption at distal convoluted tubule s,e, = low na and potassium, high calcium, gout, impaired glucose tolerance, impotence
93
how do loop diuretics work and what are there side effects
work by inhibiting Na-K-Cl co transporter in the thick ascending loop of henle, reducing reabsorption of Na-Cl s.e. = low sodium, low potassium, low magnesium, low calcium, ototoxic, hyperglycaemia, gout
94
how do potassium sparing diuretics work and what are there side effects
sodium channel blockers or aldosterone antagonist s.e. = hyperkalaemia, gynaecomastia, metabolic acidosis
95
where does acetazolamide work on kidneys
proximal tubular and increases secretion of K, Na, and H2O

4th Year SB (22 decks)

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