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Year 3 Conditions > Renal > Flashcards

Renal Flashcards

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1
Q

What is normal GFR

A

over 90ml/min and over 60 in elderly

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2
Q

Kidney extra functions other than excretion

A 
EPO
Ca and PO3
Acid base control
BP
Electrolyte management
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3
Q

What is a cystogram

A

Used to view bladder by giving contrast people urinate out

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4
Q

Symptoms people may describe alongside renal syndromes

A 
Symptoms of UTI
Pain
Oligouria, anuria, polyuria, nocturia
Oedema, SOB
Fatigue
Pain from bone breaks
Headaches from HTN
Muscle weakness
Itching and nausea etc
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5
Q

Where are prostaglandins and bradykinins made

A

Kidney

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6
Q

What is wrong with serum creatinine

A

People with same creatinine can have very different clearing functions

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7
Q

What 2 substances do we use to measure GFR

A

Cystatin C

Creatinine

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8
Q

What is eGFR

A

Equation using serum creatinine that also uses body weight sex etc

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9
Q

Limitations for eGFR

A

Only useful in stable patients so AKI not useful and dependant on muscle mass

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10
Q

What is simplest kidney function test

A

Urine dipstick

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11
Q

What un pathological sources can make urine go red

A

Beetroot
Dyes
Porphyria
Rifampicin

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12
Q

What pathological sources make urine go red

A

Myoglobin

Blood

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13
Q

What does proteinuria normally indicate about site of problem

A

Glomerular problem

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14
Q

What must you always do if dispstick positive

A

Quantitate it- work out protein creatinine ratio

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15
Q

Define AKI- old

A

Rapid decline in renal function over hours or days with accumulation of waste productions with or without change in urine output

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16
Q

AKI research definition

A

Serum creatinine rise by 26umol/L within 24 hrs
Or
Serum creatinine rise by x1.5 from reference value which is presumed to have happened within a week
Or
Urine output of less than 0.5ml/kg/hr for 6 consecutive hours

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17
Q

How are AKI staged

A

1-3

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18
Q

Stage 1 AKI criteria

A

Definition for AKI

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19
Q

Stage 2 AKI criteria

A

SCr increase of 2-3 from baseline or less than 0.5mL/kg/hr for 12 hours

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20
Q

Stage 3 AKI criteria

A

SCr increase of over 3 from baseline or less than 0.3mL/kg/hr for 24 hours, anuria for 12 hours
Or been started on RRT

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21
Q

Why is even slight AKI critical

A

Minor changes in serum creatinine shown to have massive prognostic implications

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22
Q

What is important to do in patients at risk of AKI

A

Ensure hydration
Take off nephrotoxic drugs
More frequent monitoring

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23
Q

Who is at risk of AKI

A

Recent major surgery

Acutely ill

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24
Q

Risk factors for AKI

A 
CKD
Previous AKI
Diabetes
Low BP
Over 75
HF
Liver disease
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25
Categorising cause of AKI
Pre renal Intrinsic Post renal
26
How to exclude post renal cause of AKI
US
27
What sort of things cause pre renal AKI
Low CO Hypovolaemia Renal artery thrombosis Hypotension
28
What sort of things cause post renal AKI
Bladder tumour Uereteric or urethral obstruction Blocked urinary catheter
29
What sort of things cause renal AKI
``` ATN Glomerulonephritis Vasculitis Myeloma Toxins- rhabdomyolysis Malignant HTN TTP Interstitital nephritis ```
30
What is ATN
Acute tubular nephritis
31
Difference between AKI and CKD
AKI reversible
32
What is first thing to do when see rediced eGFR or SCr raised
Is it acute or chronic
33
Questions to ask when faced with AKI
What is cause and is it treatable
34
Questions to ask when faced with CKD
Cause? Can we slow progression How to control and treat complications Make plan for RRT
35
How does AKI present
``` Non specific Uraemia symptoms Underlying disease sx Reduced output Systemic features like myalgia, rash, arthralgia Change in electrolytes, volume pH ```
36
Uraemia Sx
Anorexia Nausea Vomiting
37
AKI history
``` Duration Systemic featurs PMH- vascular, UTIs, diabetes Fx- strokes, sudden death Dx- anything new including herbal, over the counter, recreational drugs ```
38
AKI examination
``` BP, volume status Systemic disease features Bladder Palpable kidneys? Urinalysis and dispstick ```
39
What would you see in urine of someone with glomerular disease
Red cells Red cell casts Proteinuria
40
What would you see in urine of someone with tubular disease
Minimal blood Small protein White cell casts
41
What would you see in urine of someone with pre renal disease
No blood or protein
42
Investigations for someone with AKI
``` Previous renal baseline Electrolytes US CXR to see if fluid overload Urinalysis CK Autoimmune screen ```
43
Difference in size of kidney between AKI and CKD
CKD a lot smaller
44
What are main complications of AKI
``` Pulmonary oedema Potassium variations Acidosis HTN Uraemia affect brain, nerves and heart ```
45
What would cause CKD in childhood
Congenitally abnormal kidneys | Childhood reflux nephropathy
46
How is CKD staged
1-5 based on GFR
47
Who is at risk of CKD
``` Elderly HTN Black people IHD Diabetes Obesity ```
48
Causes of CKD
Diabetes Chronic glomerulonephritis Vacular diseases Polycystic kidney disease
49
Preventing CKD progression
BP control- ACEi, ARBS SGLTi drugs Minimising CVS risk factors- hard to do when have no sx Encourage hydration
50
What do you get with nephrotic syndrome
Heavy proteinuria Oedema Hypoalbuminaemia
51
Sx of nephrotic syndrome
Swollen legs Limited walking Painful legs
52
Normal protein in urine
Up to 300mg/day
53
What is nephrotic syndrome threshold for proteinuria
Over 3g/day
54
What is main indication of proteinuria
Glomerular disease
55
What are common glomerular pathologies
Diabetes Membranous nephropathy Amyloid SLE
56
How to control oedema
Low salt diet | Diuretics
57
Proteinuria management
Control odema ACEi/ARB Treat cause
58
Haematuria with pain investigations
Stones and cancer likely so imagining
59
Haematuria age considerations
Over 40 must rule out cancer | Under 40 most likely IgA nephropathy
60
Investigation for renal stones
CT KUB
61
What is a CT KUB
Kidney
62
Findings of nephrotic syndrome
Hypoalbuminaemia Oedema Proteinuria
63
What is nephrotic syndrome
Increased permeability of GBM
64
What is active urinary sediment
Protein and blood in urine
65
Categories of AKI
Pre renal Renal Post renal
66
Pre renal causes of AKI
Hypovolaemia | Sepsis
67
Renal causes of AKI
Drugs | Glomerulonephritis
68
Post renal causes of AKI
Obstruction
69
How to diagnose renal artery stenosis
Magnetic Resonance Angiogram and will see unequal perfusion bilaterally
70
What is treatment of hyperkalaemia
Calcium chloride (calcium gluconate also) followed by insulin and dextrose- calcium chloride stabilises the myocardium and glucose important to open cellular trasnporters to shift potassium into cells
71
What are 4 indications for urgent haemodialysis
Uraemic encepaholopathy(over40) Hyperkalaemia resistant to treatment after 4 hours of insulin/dextrose Metabolic acidosis that doesnt respond to IV fluids Pulmonary oedema with oligouria Can be drugs
72
Treatment for metabolic acidosis
IV NaCl | IV sodium bicarb
73
Why can pulmonary oedema occur with oligouria
After fluid resus post AKI it is possible to not regain urine output ability leading to fluid overload
74
What presents with shortness of breath, haemoptysis and renal issues
Goodpastures
75
What is goodpastures syndrome
Presence of autoantibodies to the alpha-3 chain of type IV collagen
76
What causes pulmonary renal syndrome with rapid degeneration of glomerulonepthritis
Goodpastures | ANCA vasculitis
77
What does pulmonary renal syndrome consist of
Haemoptysis and glomerulnephritis
78
What blood findings suggest chronic renal failure as opposed to AKI
Low Hb Elevated phosphate Low calcium
79
Differences between chronic and acute presentation of bladder outflow obstruction
Bladder smaller in acute- chronic obstruction gives time for bladder to grow Acute very painful
80
Treatment of bladder outflow obstruction
Put in a catheter
81
What cant be done before checking PSA
Catheter be put in
82
Important investigations in outflow obstruction
US | Then CT to see if ant mets
83
What causes itching from kidney pathology
Hyperphosphataemia
84
How does high phosphate from kidney failure lead to hypocalcaemia and hypoparathyroidism
Negative feedback directly on PT gland
85
Additional treatments of hyperkalaemia
Salbutamol nebs Haemodialysis if required Haemofiltration
86
What does epistaxis, skin rash and unilateral deafness imply
Vasculitis
87
How does nephrotic syndrome present
Leg oedema Facial swelling Scrotal swelling Ascites
88
When does nephrotic syndrome only cause pulmonary oedema and raised JVP
Renal or cardiac failure is present
89
What gives frothy urine
Proteinuria
90
What is most common cause of nephrotic syndrome in men
Membranous glomerulonephritis
91
Can diabetes cause nephrotic syndrome
Yes but only after a few years of disease
92
What tends to cause nephrotic syndrome in women
SLE
93
Causes of nephrotic syndrome
Membranous glomerulonephritis Minimal change glomerulonephritis- common in children SLE Diabetes
94
Why must avoid contrast CT in renal patients
Contrast can be nephrotoxic
95
Symptoms of chronic renal disease
``` Impotence Pruritus Weight loss Pleural effusion Bone pain ```
96
Why do you check PTH in kidney patients
Can get secondary hyperparathyroidism due to renal failure
97
What are US findings of outflow obstruction
Smaller kidneys with cortical thickness | Thick walled bladder
98
Why get bone pain in renal failure
Osteodystrophy
99
Bloods to look out for in chronic kidney disease
Phosphate Calcium Potassium PTH
100
Nephrotic syndrome triad
Oedema Hypoalbuminaemia(less than 30) Heavy protein loss (more than 3g/24hrs urine collection or PCR over 300)
101
Different ways to determine protein loss
PCR | 24hr urine collection
102
What is normally associated with heavy protein loss
Hypercholesterolaemia due to increased hepatic synthesis
103
Most common cause of nephrotic syndrome
Diabetes
104
What happens to INR in nephrotic syndrome
Clotting factors are protein bound so these are lost into urine making patient hypercoagulable
105
What are people with nephrotic syndrome more susceptible to
DVT due to loss of clotting factors | Infection due to loss of Ig
106
Differentials for elevated urea
Dehydration Upper GI bleed High protein diet
107
Pre renal causes of AKI
``` Hypoperfusion from: Sepsis Hypovolaemia HF Renal artery stenosis ```
108
Renal causes of AKI
``` Glomerulonephritis Acute intersitial nephritis Nephrotoxic drugs Vasculitis Nephrotoxic drugs Rhabdomyolysis ```
109
Post renal causes of AKI
Stone Protastatic hypertrophy Cancer
110
Management of renal problems according to the renal pathology
Modify risk factors such as antihypertensives Fluid balance with salt and fluid restriction EPO stimulating agents for anaemia Phosphate binders and vit d supplements for hypocalcaemia
111
When is renal replacement therapy used
Stage 5 kidney disease
112
Problems for patients with haemodialysis
Have to go into hopsital 4/7 | Complications include infection, cardiovascular disease, fluid balance irregularities
113
Problem for patients with peritoneal dialysis
Massive risk of infection
114
Benefit of peritoneal dialysis for patients
Done at home
115
Benefit of renal transplant for patients
Lasts 10-20 years no hospital trips
116
Problems of renal transplant for patients
Rejection Massive operation Immunosuppression Recurrence
117
Difference between nephrotic and nephritic
In nephritic get blood and protein in urine but in nephrotic just protein
118
Definition of nephritic
Related to inflammation of glomerulus and nephrons | Definition of nephrotic syndrome
119
Definition of nephrotic syndrome
Urinary protein loss of over 3.5g/day
120
Causes of nephritic syndromes
``` IgA nephropathy Post streptococcal glomerulonephritis Henoch-schonlein purpura Haemolytic uraemic syndrome SLE Goodpastures syndrome ```
121
Causes of nephrotic syndrome
Minimal change disease Focal segment glomerulosclerosis Membranous glomerulonephritis Diabetes nephropathy
122
When do you get IgA nephropathy
Few days post URTI
123
When do you get post streptococcal glomerulonephritis
4-6 weeks post strep infection
124
When do you get HUS
Post E coli infection (0157)
125
What is henoch-schonlein purpura
IgA vasculitis that commonly affects children
126
Triad of symptoms for henoch schonlein purpura
Purpura on buttocks Abdo pain Arthritis
127
Way to remember Sx of SLE
SOAP BRAIN MD
128
What is an urinary tract calculi
Crystal deposition within UT
129
Presentation of UTC
Severe loin to groin pain
130
What are 4 types of UTC stones
``` Calcium oxalate- most common!! Calcium phosphate Magnesium ammonium phosophate Uric acid Cysteine ```
131
Bedside investigations for UTC
Urine dispstick | Bloods for U&Es
132
Urine dipstick finding of UTC
Haematuria
133
Gold standard diagnosis for UTC
CT KUB
134
Management of UTC
First determine if its infected or obstructed- nephrostomy Then determine if stone smaller or greater than 5mm. If smaller allow to pass spontaneously and retain it for analysis. If larger intervention needed
135
Interventional methods for UTC
Uteroscopic lithotripsy Extracorporeal shockwave lithotripsy Percutaneous nephrolitomy
136
What happens in uteroscopic lithotripsy
Camera put through urethra and stone is crushed
137
What happens in extracorporeal shockwave lithotripsy
Ultrasound shockwaves used to break up stone
138
What happens in percutaneous nephrolitomy
Hole made in back under general anaesthetic and stone removed or cut up
139
What happens in nephrostomy
Drain put in to drain urine that cant pass
140
What is way to remember symptoms relating to lower UT
FUND- to do with storage | HIPS- to do with voiding
141
FUND symptoms of LUT
Frequency Urgency Nocturia Dsyuria
142
HIPS symptoms relating to LUT
Hesitancy Incomplete emptying Poor stream Straining
143
What is benign prostatic hyperplasia
Slowly progressive hyperplasia of periurethral zone of prostate gland
144
Management of benign prostatic hyperplasia
If in acute retention immediately catheterise | Then have conservative, medical and surgical options
145
Conservative management of benign prostatic hyperplasia
Watchful waiting
146
Medical management of BPH
Alpha blocker- tamsulosin 5a-reductase inhibitor- finasteride Anti-cholinergic
147
Surgical management of BPH
TURP Incision into prostate Open prostatectomy
148
What is TURP
Transurethral resection of prostate
149
When feeling scrotal mass first question ask
Can you feel above the mass- no then is inguinal hernia
150
If can feel above a scrotal mass what is next question to ask
Can the swelling be separated from the testicle
151
What is implied if mass can be separated from the testicle
Epididymal cyst | Varicocele
152
If cant separate testicle from mass what is next thing to ask
Is it tender
153
What does tender scrotal mass suggest
Epididymitis | Orchitis
154
What does non tender mass that cant be separated from testicle suggest
Hydrocele | Tumour
155
How to differentiate between tumour and hydrocele
Is it transilluminable
156
What is a hydrocele
Collection of serous fluid in tunica vaginalis
157
Investigations for scrotal mass
Consider secondary causes US Testicular tumour markers Urine cultures
158
Causes of hydrocele
Primary- congenital patent vaginalis | Secondary- trauma, malignancy, infection/inflammation
159
What is a varicocele
Distended veins of pampiniform plexus
160
Where are varicoceles normally found
Left testicle
161
What complications are there for varicocele
Renal cancer risk | Infertility risk
162
What does swelling on lying down suggest with scrotal mass
Varicocele
163
What re the tumour markers for testicular cancer
Afp B-hCG LDH
164
Important investigations for testicular cancer
CT for staging
165
What is most common malignancy in males aged 20-40
Testicular
166
Where does testicular cancer normally metastasize
Para-aortic nodes
167
What can hydrocele be a sign of
Cancer in testicle | Epididymo orchiditis
168
What testicular mass will transilluminate
Hydrocele | Epididymal cyst
169
Where would pain be in LUT infection
Suprapubic
170
Management of renal colic
IV fluids and anti-emetics | PR diclofenac or IV paracetamol
171
In which sex are renal colics more common
Men
172
Are AXR good for renal stones
80% picked up
173
Which renal stones are radio-opaque on AXR
Calcium oxalate Calcium phosphate URATE IS NOT
174
Specifity of CT KUB for stones
97%
175
AXR findings of renal colic
Pelvicalcyeal dilation | Dilation of ureter
176
Where are common points for renal stone to be stuck
Pelvi-uteric junction (at start of ureter) Vesicourteric junction (where ureter enters bladder or ureter inside bladder) Where urter crosses iliac vessels
177
What is pyonenephrosis
Backing up of septic pus and sediment into kidney
178
Management of pyonephrosis
IV paracetamol IV abx IV fluids
179
Why is stone removal not indicated in pyonephrosis
Uretal wall very fragile
180
What are staghorn renal stones
Branched stones that fill the renal pelvis
181
What is urgency urinary continence
Pressing desires to go to toilet and can lead to leakage of urine if dont make it in time
182
What is overactive bladder syndrome
Urinary urgency without or without urinary incontinence associated withincreased frequency and nocturia
183
What is stress urinary incontinence
Leaking or dribbling of urine post sneeze or cough that arises from increased abdo pressure
184
What is post-micturition dribble
When small amounts of urine in bulbar urethra pass leak out when moving post urination
185
Who is post-micturition dribble very common in
Elderly men
186
How is diagnosis of overactive bladder syndrome made
Bladder diary
187
What is treatment of OAB
Fluid advice Bladder training Anti-cholinergics like oxybutinin
188
What can happen to inguinal hernia when patient lies down
Will disappear
189
Features of testicular torsion
Excruciating sudden onset pain | High lying testicles
190
What normally causes epididymo orchiditis
UTI | Medical instruments
191
What are 2 most common testicular cancers
Seminoma | Testicular teratoma
192
What do seminomas produce
Placental ALP
193
What does raised PALP suggest
Seminoma
194
What do only teratomas produce
AFP
195
Peak age differences between seminoma and teratoma
Teratoma- 20-30 | Seminoma 30-40
196
Differences between teratoma and seminoma in preferred met route
Seminoma- lymphatics | Teratoma- blood
197
What metastases do seminomas often cause
Cannonball lung mets
198
In a young man what is a testicular mass until proven otherwise
Tumour
199
If diagnosis of testicular tumour is made what further investigations should be made
CT abdo | CXR
200
What do germ cell tumours of testes produce
hCG
201
What HcG is measured for testicular cancer marker
Beta as the alpha chain is very similar to that of pituitary hormones
202
Tumour markers for testicular cancer
AFP LDH Beta HCG PALP
203
Side effect of ectopic HCG production
Gynaecomastia
204
Gold standard diagnosis for kidney cancers
CT urogram
205
Most common group for testicular torsion
11-30
206
Management of testicular torsion
Analgesia then surgery immediately with potential orchidectomy
207
What can be done to further engorge the veins in varicocele
Valsalva
208
What can make varicocele disappear
Lying supine
209
Gold standard investigation for varicocele
Scrotal US
210
What is rare association of varicocele
Renal carcinoma
211
Associations of renal cell carcinoma
Smoking Von-hippel Lindau disease Industrial dyes
212
What happens to magnesium in CKD
Elevated as reduced excretion
213
What are 5 types of incontinence
``` Stress Overflow Urge Neuropathic Mixed ```
214
What is most common cause of stress incontinence in men
BPH
215
What is most common cause of stress incontinence in women
Hypermobility of sphincter
216
What causes hypermobility of sphincter in women
Pregnancy and labour can cause damage to connective tissue surrounding bladder that doesnt support them in cases of extreme pressure Or damage to nerve affects sphincter control
217
Investigations you would do for stress incontinence
Stress test where ask to cough PAD test Urodynamics
218
What happens in pad test
Person wheres pad then weigh how much it is after from how much urine has been leaked into it
219
What are 2 categories causing overflow incontinence aand examples
Outflow obstruction- BPH, cystocele, organ prolapse, urethral stricture Reduced detrusor action- medication, long standing distension
220
Investigation for overflow obstruction
Post voiding US
221
What are 2 categories causing neuropathic incontinence
Spasticity of detrusor muscle- stroke, MS | Inability to control external sphincter- cauda equina or anything affecting S2-S4
222
Main symptoms of BPH
Hesitancy Poor flow Post micturition drip Pis en deux
223
What is pis en deux
Incomplete voiding so need to go again just after have been
224
Investigations for BPH in order
Take blood for PSA Then do DRE Dipstick Cystoscopy
225
Why are UTIs more common in women
Their urethra is much shorter so less distance for bacteria to travel
226
What does acute urinary retention lead to increased risk of
Hydronephrosis UTI Renal stones
227
How does rhabdomyolysis present
Muscle pain and weakness | Dark urine
228
What does nephrtic syndrome consist of
HTN Haematuria Proteinurea Oedema
229
Extreme signs of nephritic syndrome
Oligouria | Uraemia
230
Presentation of renal cell carcinoma
Pain Haematuria Mass in flank FLAWS
231
Where do renal cell carcinomas originate from
Proximal tubular epithelium
232
What is other name for a renal cell carcinoma
Von Grawitz tumour
233
Which antibiotic should be especially avoided in pregnant women with UTI
Trimethoprin as a folic acid antagonist Fluoroquinalones Tetracyclines- these both teratogens
234
When would phosphate deficiency be suggested
Signs of osteoporosis Anorexis Weight loss
235
Signs of acute renal failure
``` Uraemia Hyperventilation Easy bruising SOB due to increased fluid Oligouria ```
236
How does uraemia present
Nausea and vomiting | Confusion in extreme cases
237
How does acidosis present in renal failure
Hyperventilation
238
How can a kidney patient be SOB
Fluid in lungs | Anaemia from EPO dysfunction
239
How do kidney patients present woth easy bruising
Haemostasis impaired
240
What is criteria used to determine whether kidney injury is chronic, acute or acute on chronic
RIFLE
241
How can teratomas be classified
Mature or immature
242
Difference in teratoma between men and women
Malignant in men but normally benign in women
243
Difference in malignancy between mature and immature teratomas
Mature normally benign | Immature malignant
244
What can see in immature teratomas
Immature nerual tissue containing skin and teeth etc
245
How are mature teratomas classified
Cystic and solid
246
What is different about solid teratomas
Can undergo transformation to carcinoma
247
Complications of renal colic that would make you consider fast tracking management
Infection Cant keep fluids down where nauseous AKI Constant pain
248
Haematuria ddx
``` Kidney - cancer - glomerulonephritis - pyelonephritis Bladder - cancer Prostate - BPH - prostatits - cancer Ureter and urethra - UTI -stone ```
249
Physiological causes of microscopic haematuria
Vigorous exercises | Sex recently
250
Signs of bladder cancer urinalysis
Blood | WCC
251
Sx bladder cancer
Dysuria Polyuria Blood in urine
252
Investigations for bladder cancer
Urinalysis Urine cytology Cystoscopy CT urogram
253
What does blood in urine throughout voiding suggest
Kidney or bladder problem
254
What does blood at end of urinating suggest
Prostate or distal bladder problem
255
What does blood at beginning of urinating suggest
Urethral problem
256
What can give fake positive for blood on dipstick
Hb | Myoglobin
257
What is another name for IgA nephropathy
Bergers disease
258
What is urine blood in Bergers
Macroscopic
259
In daibetic nephropathy what is proportions on dipstick
Protein> blood
260
Post surgery what is cause of hyponatraemia
Poor fluid control
261
What happens in diabetic nephropathy
Initially increased GFR and GBM hypertrophy -> glomerulosclerosis due to ECM buildup-> BM destruction so protein loss
262
What happens when give too much insulin in blood
Hypo | Hypokalaemia
263
How does excess insulin present
Sweating | Irritable
264
What tends to cause acute tubulointerstitial nephritis
Drug hypersensitivity from NSAIDS and penicillin commonly
265
How does acute tubulointerstitial nephritis present
Painful joint Fever Rash Nephritic syndrome
266
Blood findings of acute tubulointerstitial nephritis
Eosinophilia
267
What is problem of using MRI for UTC
Cant differentiate between stones, tumours and clots
268
How does TB affecting kidney present
Pain in flank going to back Nocturia Polyuria
269
How is TB affecting kidney found
Pyuria that wont colonise
270
Main risk factor for bladder cancer
Dyes | Inks
271
Triad of renal cancer
Haeamturia FLAWS Flank pain and mass
272
Hypercalcaemia symptoms of kidney
Polyuria Nocturia Polydipsia
273
Vasculitides affecting kidney
Henoch schonlein purpura Granulomatosis with polyangiitis Microscopic polyangiitis Eosinophilic granulomatosis with polyangiitis
274
What is BPE
Benign prostate enlargement that is common as grow older
275
What is BPH
Enlargement of prostate with histological diagnosis of hyperplasia
276
What is BOO
Bladder outflow obstruction
277
From the prostate where does BPH occur
Transition zone
278
From the prostate where does cancer occur
Peripheral zone
279
What is significance of prostate cancer growing from peripheral zone
Tumour is already quite big by time it reaches the urethra
280
Difference between voiding and storage problems
Strong flow in storage symptoms
281
What causes voiding symptoms
Obstruction
282
What causes storage symptoms
Detrusor overactivity
283
What investigations would do for BOO
``` DRE Dipstick Flow rate and post voiding scan PSA, U&Es bloods Renal US Flexi cystoscopy ```
284
Why do you always do bladder scan post flow rate test
Chronic urinary retention common in elderly
285
How can prostate cancer present
``` LUTS Haematuria Dysuria Pain Bone pain FLAWS ```
286
Grading scale for prostate cancer
Gleason
287
What is best imagine for prostate cancer
MRI
288
When person is doing urology history what should be filled out
IPSS
289
In DRE how do you describe size of prostate
According to objects- walnut, ping pong ball, golf ball, clementine
290
How does renal failure increase risk of heart problems
Long QT from hypocalcaemia | Hyperkalaemia
291
What can lead to orcitis or epididymitis
STI UTI Post op
292
What is concern of patient who has varicocele
Slight chance of kidney cancer
293
What gene is linked to prostate cancer
BRCA2
294
What is used to pick up uric acid stones
CTKUB
295
What is main danger of stones
Can go into gram neg septicaemia
296
What would suggest uric acid stone on urinalysis
Low pH
297
Treatment for uric acid stones
Alkylysing the urine
298
What is NMP22 associated with in urine cytology
Bladder cancer
299
What is most commonl cause of PCKD
Mutation on PKD1 chromosome 16
300
How can PCKD present
Loin pain or diffuse abdo pain as kidneys hypertrophy Symptoms of kidney failure as disease progresses Bleeding or infection of cysts
301
What are some associations of PCKD
Mitral valve prolapse | Berry aneurysms
302
Best first line imaging for PCKD
US
303
Best imaging for PCKD
MRI
304
In question what is loin pain with mid systolic click
PCKD
305
Mainstay first line treatment of new onset proteinuria in daibetics
ACEi or ARBs
306
What are Kimmelstiel wilson nodules seen in
Diabetes nephropathy- nodular glomerulosclerosis
307
What is medullary sponge kidney
Congenital disorder of the kidneys that is characterized by the formation of cystic sacs within the papillary zone of the kidney creating a sponge-like appearance
308
Presentation of medullary sponge kidney
Cysts obstruct the outflow predisposing to UTIs, stones and haematuria
309
Associations of medullary sponge kidney
Hypercalciurua Hypertrophy Renal tubular acidosis
310
Effects of excessive NSAID use
Papillary necrosis | Tubulointerstitial nephritis
311
What does papillary necrosis and tubulinterstitial nephritis from NSAID use lead to
Anaemia UTIs Haematuria
312
What is best way to visualise papillary necrosis and tubulinterstitial nephritis from NSAID use
MRI
313
How do calcium oxalate stones appear on urinalysis microscopy
Envelope shaped
314
What is a healthy adult urinary rate
1ml/kg/hour
315
What is defined as oligouria
Less than 0.5mL/kg/hour
316
What can cause reduced local perfusion of kidneys
Stenosis Thrombosis Aneurysm
317
How can renal causes of AKI be classified
``` Vascular Tubular Glomerular Interstitial Complex ```
318
Vascular causes of AKI
``` TTP HUS DIC Malignant HTN Vasculitides Scleroderma ```
319
Glomerular causes of AKI
Glomerulonephritis
320
Complex causes of kidney damage
Amyloid | Myeloma
321
Interstitial causes of AKI
Interstitial nephritis from drugs
322
Infectious causes of AKI
Malaria Legionnaires Leptospirosis
323
How can post renal causes of renal failure be classified
Ureter Bladder Urethra
324
Ureteric causes of renal failure
Abdominal mass Bilateral stones Pelvic surgery complication Retroperitoneal fibrosis
325
Bladder causes of renal failure
Neuropathic bladder Anticholinergic or sympathomimetic drugs Bladder stones or tumour Uterovaginal prolapse in women
326
Urethral causes of renal failure
``` BPH Prostate cancer Urethral stricture Infection meaning too painful to urinate Blocked catheter ```
327
What is rate of required fluid
30-50ml/kg/day
328
What is volume of fluid required each day by body
3L
329
How much more fluid is needed per day in febrile patients per degree of body temp
500ml/ 1^C
330
What class of abx cause interstitial nephritis
Aminoglycosides | Glycopeptides
331
What are things to assess on examination of oligouria
If catherised check bag Signs of volume status- JVP, BP, lips, cap refill, narrow pulse pressure Signs of heart failure Palpable and dull on percussion bladder
332
What would cause post operative bilateral creps
Atelectasis
333
What is difference between acute and chronic retention on presentation
Chronic is painless
334
Management of acute urinary retention
``` Catheterise Measure how much is voided Fluids to replenish those lost in diuresis Assess renal function Assess cause of obstruction Do a TWOC if possible ```
335
What is a TWOC
Trial without catheter
336
What does over 1L being voided on catheterisation of acute retention
That it is an acute on chronic cause
337
What test cant you do when assessing cause of urinary retention
PSA as this will definetely be raised
338
When is only time people are eligible for TWOC following acute retention
If under 1L was voided upon catheterisation and has normal renal function
339
What happens in a TWOC
Given an alphablocker and a dose of ABx (to prevent UTI following catheterisation) Wait to see if actually urinates
340
If patient fails TWOC what happens to them
Given finasteride too with an indwelling catheter and booked in for a TWOC outpatient clinic
341
If patient urinates more than 1L on presentation or their renal function was raised on presentation what is management
they are immediate candidates for TURP
342
What causes urethral strictures
Repeated trauma to urethra often after cystoscopies
343
How can surgery lead to AKI
Fluid loss during surgery may have caused hypovolaemic perfusion of kidney
344
Management of renal cause oligouria patient
``` Stop fluids Assess need for dialysis Check drug chart and stop any drugs Blood tests to assess U&Es, Ca and PO to determine if chronic Renal US Urinalysis ```
345
What causes focal segmented glomerulosclerosis
Heroine | HIV
346
What is gold standard measurement of GFR
Inulin
347
What influences blood urea levels
Nutritional state Hepatic function GI bleed
348
What is renal function a measure of
Flow from the glomerulus to the bowmans capsule
349
What causes nausea and vomiting in AKI
Uraemia
350
Difference in whats used to measure AKI vs CKD
Creatinine in AKI | eGFR in CKD
351
What is defined as CKD
An eGFR of less than 60 for more than 3 months
352
What is an AKI a failure to manage
Fluid- oligouria leading to hypervolaemia Electrolytes- hyperkalaemia Acid base- metabolic acidosis
353
What are common symptoms of an AKI
``` N&V Confusion from uraemia SOB Dehydration Oligouria/anuria ```
354
What does an abrupt anuria suggest
Post renal cause whereas insidious suggest renal
355
What causes ATN
``` Toxins: Paracetamol Contrast Rhabdomyolysis NSAIDS Abx Hypoperfusion ```
356
What is ATN
Death of epithelial cells but wis reversible as cells can regro
357
What is pathognomonic for ATN
Muddy brown casts
358
What is seen on urinalysis ATN
Muddy brown casts | Epithelial cells
359
What is different about AKI in acute interstitial nephritis
Non oligouric
360
Causes of AIN
Drugs- often Abx, NSAIDS, PPIs, diuretics Infections- Ecoli, campylobacter, syphillis, measles, mumps, EBV, histoplasmosis Infiltration- lupus, sarcoid, sjogrens
361
Urinalysis findings of AIN
WC casts Sterile pyuria Proteinuria
362
Categorising causes of pre renal AKI
Hypovolaemia Systemic vasodilation Reduced cardiac output Intrarenal vasoconstriciton
363
How does myoglobin affect kidney
Acute tubular necrosis
364
Endogenous causes of ATN
Myoglobin Uric acid crystals Light chains in myeloma
365
Urine findings of rhabdomyolysis
Muddy brown casts | Myoglobinuria
366
What is urea:creatinine ratio in pre renal cause
Over 100:1
367
What is urea:creatinine ratio in post renal cause
40:1-100:1
368
What is urea:creatinine ratio in renal cause
Under 40:1
369
What is normal urea:creatinine ratio
40:1-100:1
370
Blood findings of rhabdomyolysis AKI
Hypocalcaemia Hyperphosphataemia Raised CK
371
Histopathological finding of ATN
Tubular necrosis
372
Primary causes of nephrotic syndrome
FSGS Minimal change disease Membranous nephropathy
373
Secondary causes of nephrotic syndrome
DM Amyloid SLE
374
What happens to renal function and complement levels in minimal change disease
Normal
375
What disease is associated with minimal change disease
Hodgkins lymphoma
376
What is primary cause of membranous nephrotic syndrome
Autoimmune
377
What are secondary causes of membranous nephrotic syndrome
Cancer- lung/colon adenoarcinoma SLE Hep B/C
378
Which ethnicity is normally affected by membranous nephrotic syndrome
Afro carribeans
379
Histopatholoical findings of diabetic nephropathy
Kimmelstiel wilson nodules | Nodular glomerulosclerosis
380
Histopathological findnigs of FSGS
Focal scarring | IgM deposits
381
Stain done for amyloid nephrotic syndrome and result
Congo red | Apple green birefringence
382
What is special about mesangiocapillary GN
A mix of both nephritic and nephrotic syndrome
383
Histopathological findings of MSCGN
Tram tracking | Mesangial proliferation
384
What conditions are assocaited with MSCGN
Hep C End stage renal failure C3 nephritic factor
385
What types of infection cause post strep GN
Lung | Skin- remember!!!
386
Blood findings of post strep GN
High anti-strep titres | Low C3
387
What is smoky urine seen in
Post streptococcal GN- described as cola like
388
What is primary cause of GN
Rapidly progressive glomerulonephritis
389
What are the 3 types of RPGN
Type 1- Anti- GBM Type 2- immune coplex deposition Type 3- Pauci immune
390
What causes type 1 anti GMN RPGN
Goodpastures
391
What causes type 2 immune complex deposition RPGN
SLE IgA Henoch schnolein purpura
392
What causes type 3 pauci immune RPGN
Wegners Granulomatosis with microscopic polyangiitis Churg strauss
393
Differnece in presentation of 3 causes of type 3 RPGN
Wegners- nose and lung Churg strauss- eosinophilia, asthma, mononeuritis multiplex Microscopic polyangiitis- purpuric rash
394
What would be done in renal workup of patient
Bedside- urinalysis with microscopy Bloods- urea:creatinine ratio, complement levels, autoimmune screen (ANCA, GBM), EBV and hep C serology, serum free light chains Imaging- renal USS and biopsy histology and immunofluorescence
395
Use of ACR vs PCR
Albumin creatinine ration used more for DM | PCR used more for nephrotic syndrome generally
396
Causes of proteinuria
``` Nephrotuc syndromes Amyloid HTN DM Myeloma ```
397
Causes of glucose in urine
DM Pregnancy Sepsis Tubular damage
398
Most common causes of CKD
``` DM HTN Atherosclerosis Chronic glomerulonephritis Stones/infection ```
399
Most common congenital cause of CKD
PCKD
400
What do you see on examination of CKD patient
``` AV fistula Finger BM Half and half nails Tremor- on immunosuppresion tacrolimus Gum hypertrophy from ciclosporin Parathyroidectomy scar Dialysis line Kidney transplant scar and mass (hockey stick scar) Uraemic fetor Pruritus ```
401
What are half and half nails also called
Lindsay nails
402
What must do if see AV fistula on examination
Examine for thrills and bruits- if blood flowing through then is active bruit
403
Consequences of CKD
``` Anaemia from EPO deficiency Renal bone disease Acidosis Hyperkalaemia Vascular calcifcation Uraemic pericarditis ```
404
How are CKD patients at greater risk of pericarditis
Uraemia
405
What investigations will do for CKD patient
``` Bedside Obs- looking at HTN in particular Urinalysis- haematuria and proteinuria Fundoscopy for HTN changes ECG for hyperkalaemia and LVH Bloods FBC- normocytic anaemia LFTs- albumin U&Es- eGFR, potassium, urea creatinine ratio VBG- metabolic acidosis from retention of acid or loss of bicarb Hba1c- likely to be on steroids Bone profile Blood tacrolimus Imaging CXR- pulmonary oedema or pericardial effusion USS check perfused Histology to check disease progression if getting worse ```
406
Limiting complications management of CKD
Control BP and glucose strongly- ACEi ideal | Diet- avoid high phosophate foods mainly dairy
407
Symptoms control CKD
Human EPO Sodium bicarb if acidotic Loop diuretics and restrict fluid for oedema Phosphate binders for hyperphosophataemia Vit D supplements Parathyroidectomy if tertiary parathyroidectomy
408
What is management of tertiary hyperparathyroidism
Parathyroidectomy
409
Why is BP control important if recently had renal transplant
Affects grafts ability to hold
410
Why is peritoneal dialysis not good for diabetics
Fluid used is full of glucose
411
Who is peritoneal dialysis contraindicated in
Diabetics
412
What bacteria is indicated in UTI from catheters
Proteus as very good at swimming up
413
Atypical organisms causing UTI typically in immunocompromised
Candida albicans Pseudomonas Klebsiella
414
What is presentation of PCKD
Often clincally silent for many years Acute loin pain Haematuria Stone formation
415
Examination findings of PCKD
Enlarged kidney HTN Haematuria
416
Investigations for PCKD
Obs FBC- raised Hb Deranged U&Es USS or could do MRI if positive fx or SAH or PCKD
417
What causes varicocele in renal cancer
Invasion of renal vein
418
Investigations for renal cancer
``` BP-obs showing HTN from increased renin FBC- polycythaemia sometimes ALP- bone mets Urinalysis- haematuria CXR- canonball mets CT/MRI IVU ```
419
What is IVU
Intravenous urogram
420
What flank pain can radiate to back
Pyelonephritis AIN TB affecting kidney
421
What presents following abx for CAP with pain radiating to back
AIN
422
Differentials for haematuria and a rash
SLE Vasculitide HSP
423
Rfs for UTC
``` Idiopathic Hypercalcaemia Hyperuricaemia Low water Lots of meat Structural kidney defects- medullary sponge kidney, PCKD ```
424
Which kidney stones can especially be seen on AXR
Uric acid
425
What forms staghorn kidney stones
Struvite
426
Which infection is often linked to struvite staghorn stones
Proteus
427
What tends to cause cysteine stones
Congenital defects- homocyteinuria
428
Investigations going to do for UTC
Bloods- renal damage Urine dip/MSU- blood Non contrast CT-KUB
429
What looking for on CT KUB for UTC
Where are stones How big Evidence of obstruction leading to hydronephrosis
430
When do you do US KUB instead of CT KUB for UTC
Pregnant | Under 16
431
Which stone gives microscopy shows crystals having a “coffin-lid” shaped appearance
Struvite
432
When do you do AXR for UTC
To track recovery
433
Conservative management of UTC
Lifestyle advice- more water | Modify RFs
434
Medical management of UTC
Diclofenac Anti-emetics Tamsulosin
435
What is done if UTC stone 5-10mm
Medical management using tamsulosin
436
What are indications for surgical management of UTC
``` Renal dysfunction Previous renal disease Infection Pain for over 48hrs Bilateral stones ```
437
What to do if stone 10-20mm
Uteroscopy lithotripsy
438
What to do if stone over 20mm
Percutaneous nephrolithotomy
439
Management of infected stone leading to pyonephrosis
Sepsis 6- co amox and gent | Nephrostomy
440
What is seen on US of varicocele
Dilated pampiniform plexus
441
Investigations for varicocele
US Colour doppler CT
442
Causes of epidiymitis and orchitis
In sexually active people is normally gonorrhoea or chlamydia In over 35s tends to be klebsiella or enterococcus from UTI In children is mumps orchitis
443
What causes orchitis in sexually active people
gonorrhoea or chlamydia
444
What causes orchitis in over 35s
klebsiella or enterococcus from UTI
445
What causes orchitis in very young
Mumps
446
What age group is orchitis mainly found in
Male 20-30
447
Symptoms of orchitis
Slow onset testicular pain Tender to touch LUTS sx Discharge from penis
448
O/E epididymitis
Testicular tenderness | Positive prehns sign
449
Investigations for orchitis and epididymitis
Urinalysis- mc&s Bloods- WBC, CRP Mumps serology
450
Management of orchitis
Abx and analgesia Scrotal support pants GUM referral with tracing of partners
451
Complications of orchitis
Reactive hydrocele Abscess Infertility
452
Risk factors for testicular cancer
Cryptorchidism, Klinefelter syndrome, hypospadias
453
What is cryptochordism
When one or two of testicles fail to descend
454
Symptoms of testicular cancer
Dullness in testes Ache Back ache from met spread Inguinal lymph nodes
455
How are testicular cancers classified
Germ cell tumour | Non germ cell
456
Examples of germ cell testicular cancer
``` Seminoma Teratoma Choriocarcinoma Yolk sac Embryonal carcinoma ```
457
Examples of non germ cell testicular cancer
Sertoli cell tumours | Leydig cell tumours
458
What is the marker very raised in choriocarcinoma
bHcG
459
What marker is very raised in yolk sac tumours
AFP
460
What testicular cancer has fried egg appearnce
Seminoma
461
What is most common testicular cancer
Seminoma
462
Management of testicular torsion
Analgesia Antiemetics Urgent orchidectomy and contralateral fixation
463
DDx for testicular torsion
Epididymo orchitis | Incarcerated inguinal hernia

Year 3 Conditions (33 decks)

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