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Disease summaries > Renal > Flashcards

Renal Flashcards

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1
Q

What is the only protein found in the urine

A

Tam horsfall

- Secreted by thick loop

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2
Q

Nervous control of urine storage

A

Sympathetic - Hypogastric nerve

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3
Q

Nervous control of voiding urine

A

Parasympathetic - Pelvic nerve

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4
Q

Nervous control of voluntary urine passage

A

Pudendal nerve

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5
Q

Criteria for AKI diagnosis

A

Rise in creatnine >26mincrmol/L in 48hrs

Rise in creatnine > 1.5x baseline in 7 days

Decreased urine output <0.5ml/kg/h for 6hrs

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6
Q

AKI risk factors

A 
Age > 65
pre existing CKD
DM 
HF 
Dehydration
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7
Q

AKI

- Pre renal causes?

A 
ARB/ACEi
NSAIDs
Anaphalaxis 
Sepsis 
CCF 
Trauma
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8
Q

AKI

- Renal causes?

A

Glomerulonephritis - SLE / Infection
Vasculitis - SLE
HTN
Acute tubular necrosis

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9
Q

AKI

- Post renal

A

Stone
stricture
BPH
Pelvic malignancy

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10
Q

Causes of acute tubular necorsis

A 
Gentamicin 
NSAIDs
ACEi
Pancreatitis 
MI
Diuretics
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11
Q

AKI signs and sx

A

sx

  • oliguria
  • vomitting
  • nausea
  • weakness

signs

  • tachycardia
  • breathlesness
  • arrhythmias
  • hypocalcaemia
  • dehydration
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12
Q

AKI investigations

A
  • Bloods
  • Urinalysis
  • Rectal US - post renal obstruction
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13
Q

AKI tx

A

Pre - fluids
renal - stop nephrotoxic drug
post - catheter

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14
Q

AKI complications

A
  • Hyperkalaemia
  • Acute pulmonary oedema
  • Metabollic acidosis
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15
Q

Hyperkalaemia ECG findings

A

Tall tented t waves
no p waves
Wide QRS complex

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16
Q

What is BPH

A

Non cancerous growth of prostate gland

Transitional zone enlargement

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17
Q

BPH presentation

A

SHED
FUND

Haematuria
Overflow incontinence

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18
Q

How to spot metabollic acidosis

A

Kussmauls breathing

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19
Q

BPH investigations

A 
PSA 
Urinalysis 
- dipstick 
- MSU
DRE 
Rectal Ultrasound + biopsy
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20
Q

BPH management - lifestyle

A

Avoid caffine / alcohol
relax when voiding
bladder training

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21
Q

BPH medications

A

1st - Tamsulosin
2nd - Finasteride
3rd - surgery

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22
Q

Tamsulosin S/E

A

Postural hypotension
Dizziness
Dry mouth
Ejacualtory failure

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23
Q

Finasteride S/E

A

Impotence

decreased libido

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24
Q

Transurethral resection of prostate complications

A

bleeding
infection
erectiel dysfunction
urethral strictures

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25
CKD causes - primary - secondary
Primary - Minimal change disease - UTI - Pyelonephritis - stones Secondary - HTN - DM - Amyloidosis - HF - Sarcoidosis
26
CKD classification stages
``` 1 - > 90 2 - 60- 89 3a - 59 - 45 3b - 44 - 30 4 - 29 - 15 5 - <15 ```
27
CKD Presentation
Protein loss and Na+ retention - Polyuria - nocturia - oliguria - S.O.B - peripheral oedema Uraemia - Pruritus - weightloss - paraesthsia - confusion
28
CKD Signs
Anaemia Hypertension Bone disease - osteomalacia Pruritus
29
CKD tx
Treat complications - EPO - Vit D - Loop diuretics for oedema BP control - ACEi Glycaemic control Renal replacemnt therapy Reduce CVS risk - statins
30
CKD complications
``` Anaemia Bone disease - osteoperosis Peripheral neuropathy MI/Stroke Pericarditis - uraemia Pericardial effusion - uraemia ```
31
CKD investigations
- Bloods - Urinalysis A:C > 3mg/mmol Dipstick - Haematuria - US Small kidneys
32
CKD Management
Conservative - excercise/ diet / weight control - stop smoking Medical - Optomise DM and HTN control - dialysis Surgical - transplant
33
Why does metabollic acidosis occur in CKD and tx
Decreased H+ secretion and HCO3- reabsorption Tx - sodium bicarbonate
34
Main cause of Cystitis infection
E coli
35
Cystitis presentation
``` cloudy urine haematuria suprapubic pain urgency dysuria frequency abdo tenderness ```
36
Cystitis investigations
Urine dipstick MSU sample - MC&S
37
Cystitiis tx
1st - Trimethorpim | 2nd - Co-amoxiclav
38
Prostatitis presentation
``` fever malaise voiding luts - SHED pelvic pain perianal oain pain on ejacualtion ```
39
prostatitis investigations
Dipstick - lecoytes + nitrites positive DRE - tender and hot MSU - MC&S STI screen
40
Prostatitis tx
1st - Gentamicin + co-amoxiclav 2nd - Trimethoprim
41
Nephritic syndrome features
``` Oedema HTN Proteinuria Haematuria - red cell casts Oliguria ```
42
Nephritic syndrome causes
``` ANCA positive vasculitis SLE Post strep glomerulonephritis IgA nephropathy Anti-GBM disease (Good pasture's disease) ```
43
Nephritic syndrome presentation
``` Haematuria Sterile pyuria HTN Oedema Oliguria Uraemia - pruritus - lethargy ```
44
Nephritic syndrome Ix
Dipstick - protein/hamaturia Urine - MC&S - RBC casts - Bence jones proteins Bloods Renal biopsy
45
Nephritic syndrome tx
Tx underlying cause Reduce proteinuria - ACEi/ARB
46
Common features of diseases causing glomerulonephritis
``` Haematuria Proteinuria Diagnosed on renal biopsy Can cause CKD Deteriorating kidney function ```
47
Minimal change disease - common in - observation on electron microscopy - tx
Common in children loss of large amounts of protein lost due to podocyte damage - fused podocytes Tx - Prednisolone
48
IgA nephropathy - Pathophysiology - presentation - tx
IgA deposition in mesangium HTN High creatnine haematuria proteinuria BP control - ACEi
49
Nephrotic syndrome causes | - primary
Primary - Focal glomerular sclerosis - Minimal change disease - Membranous nephropathy]
50
Nephrotic syndrome triad
``` Proteinuria - frothy urine Hypoalbuminaemia Oedema - - peripheral - periorbital - ascites ``` Hyperlipidaemia
51
Nephrotic syndrome causes - secodnary
``` DDANI D - DM D - Drugs (NSAIDs) A - AI - SLE N - Neoplasia - Myeloma I - Infection - Hep B/C ```
52
Nephrotic syndrome investigations
Bloods - U+E - Creatnine - elevated - Increased clotting factors - Hyperlipidaemia - Hypoalbuminaemia Urinalysis - Proteinuria - A:C ratio RAISED
53
Nephrotic syndrome differential dx
CCF - oedema - raised JVP Cirrhosis - hypoalbuminaemia - Oedema
54
Nephrotic syndrome management
- High dose oral steroids - Tx underlying cause - Rampiril Reduce proteinuria
55
Nephrotic syndrome symptomatic tx
Oedema - furosemide - fluid and salt restriction Prophylactic LMWH Simvastatin Pneumococcal vaccinations
56
Nephrotic syndrome complications
Thromboembolism Infection - decreased IgG - decreased compliment activity Hyperlipidaemia
57
Why is someone with nephritic syndrome at risk of sepsis
Immunoglobulins lost in urine
58
What is prostate cancer
Peripheral zone prostate neoplasia - Adenocarcinoma
59
Risk factors for prostate cancer
``` Increasing age Black - increased testosterone Family hx Genetics - HOXB13 gene - BRCA2 gene ```
60
Location of metastatic spread of prostate cancer
Bone - sclerotic bone lesions Lymph nodes - para aortic - inguinal
61
Prostate cancer presentation
SHED FUND Visiable haematuria weight loss Anaemia Urinary retention - obstruction
62
Prostate cancer investigations
PSA DRE - nobbly - hard irregular lump Transrectal US + biopsy
63
Why must multiplebiopsies be taken in prostate cancer
Multi focal tumour
64
What grading is used in prostate cancer
Gleason grading
65
Radical tx complications of prostate cancer
erectile dysfunction urianry incontinece urethral strictures
66
Causes of increases PSA
BPE Prostate cancer UTI Prostatitis
67
Organisms that cause pyelonephritis
E.coli - tranurethral Klebsiella Enterococcus S.aureus - haemotogenous from IE
68
Pyelonephritis presentation
Loin pain + fever + Pyuria - Loin to groin pain - Dysuria - Frequency - Haematuria - Vomitting - Pain on palpation over kidney
69
Pyelonephritis Investigations
``` Urine dipstick MSU culture Bloods Imaging - Contrast enhanced CT ```
70
Pyelonephritis tx
Abx - Co-amoxiclav Analgesia Hydration Blood + urinary cultures
71
What cells does renal cell carcinoma arise from
Proximal convoluted tubular epithelium
72
Renal cell carcinoma risk factors
``` Smoking Obesity Von hippel lindau syndrome Long term dialysis Leather tanners Asbestos ```
73
Renal cell carcinoma presentation
Haematuria + flank pain + mass weight loss night sweats fatigue
74
Renal cell carcinoma investigations
Urinalysis - Dipstick - MSU - Cytology US - cyst or tumour CT with contrast - Sensitive for mass detection MRI - Staging Bloods
75
Renal cell carcinoma metastases
Lung - Cannon ball mets | Bone
76
Renal cell carcinoma complications
- Left sided varicoceles - IVC invasion - Paraneoplastic syndromes
77
Renal cell carcinoma paraneoplastic syndromes
EPO --> Polycythaemia Renin --> HTN PTHrp --> Hypercalcaemia ACTH --> Cushings
78
3 locations where a stone can lodge
Pelviureteric junction pelvic brim vesicoureteric junction
79
types of stone
``` Calcium oxalate calcium phosphate struvite uric acid cystine ```
80
what are the 2 stone forming inhibitors
citrate | mg
81
Stone composition | - calcium oxalate
High dietary oxalate intake - tea - rhubarb - spinach chronic intestinal malabsorption - chrons Primary hyperoxaluria
82
Stone composition | - calcium phosphate
Hyperparathyroidism excess Ca2+ intake PCKD
83
Stone composition | - struvite
Magnesium Ammonium Assosciation with UTIs
84
Renal colic presentation - sx
Loin to groin pain - stabbing nausea vomitting sweating
85
Renal colic presentation - signs
``` can;t lie still nausea haematuria stranguary dysuria ```
86
How can you tell the difference between a bladder stone and a urethral stone
Bladder - Increased urinary frequqency Haematuria Urethral - bladder outflow obstruction Anuria + painful bladder distension
87
Renal colic investigations
Urine dipstick - haematuria MSU sample - MC&S - Measure electrolytes Abdo X-ray Non contrast CT - Dx
88
What is the diagnostic Ix for Renal colic
Non contrast CT
89
Renal colic tx
- Diclofenac - fluids - Tamsulosin
90
Stone composition | - uric acid
Hyperuricaemia acidic urine
91
Prevention methods for recurrent stones
Hydration normal dietary calcium Thiazide diuretic - reduces urine calcium levels
92
Uric acid stone preventiol
Allopurinal
93
Oxalate stone prevention
Pyridoxine
94
Scrotal disease testicular + cystic
Hydrocele
95
Scrotal disease Testicular + solid
Tumour Orchititis Haematocele
96
Scrotal disease Separate + solid
Epididymitis varicocle
97
Scrotal disease Separate + cystic
Epididymal cyst
98
What is an epididymal cyst
- contains clear milky fluid - soft lump - fluctuance - well defined - transilluminate
99
What is a hydrocele
- transilluminate - soft - fluctuant - Lies anterior and below testis - due to patent proccesus vaginalis - testis palpable
100
Which scrotal disease is associated with testicualr disease
Hydrocele
101
What is a varicocele
Abnormal dilatation of testicular veins in pampiniform plexus due to venous reflux - Left sided more common - Bag of worms - dulla ache - scrotum hangs lower on affected side
102
What is testicualr torsion
Urological emergency - twisting of spermatic cord leading to ischaemia and infarction - Sudden onset testicualr pain - Pain on walking - pain during physical acitvity - Testes - hot / tender / swollen - abdo pain - nausea - vomitting
103
STI | - Organisms that cause discharge
- Chlamydia | - Gonorrhoea
104
STI - | - Organisms that cause genital ulcers
- Syphillis | - Herpes
105
STI investigations
- Nucleic acid amplification test - MC&S Male - First void urine Female - Vaginal swabs
106
Management - Chlamydia - Gonorrhoea - Syphillis
- Azithromycin - Ceftriaxone - Penicillin
107
Risk factors for testicular tumour
Undesecended testes
108
Testicualr tumour presentation
``` Painless lump in testicle Haemospermia Hydrocele Back pain Lymphadenopathy ```
109
Testicular tumour Ix
Scrotal US - non tender - no fluctuace - no transillumination Bloods - Tumour markers
110
Tumour markers for testicualr cancer
Alpha fetoprotein - Raised in teratomas Beta - hCG Raised in both teratomas and seminomas
111
Transitional cell carcinoma investigations
Urinalysis - MC&S - Cytology Fexible cystoscopy with biopsy CT urogram - staging
112
Transitional cell carcinoma risk factors
- smoking - Aromatic amines - aldehydes - family hx - schistomiasis infection
113
Who is at risk of bladder cancer
hairdressers painers rubber industry
114
Transitional cell carcinoma presentation
Painless haematuria frequency urgency dysuria
115
Transitional cell carcinoma tx
No muscular invasion - TURB Muscle invasion Radical cystectomy with ileal conduit
116
What is urgency incontinece
Sudden urge to void due to detrusor instability - Overactive bladder
117
Urge incontinence Tx
Bladder diary - Bladder retraining - Increase intervals between urination - Cut out caffine and alcohol - Severe - Oxybutynin
118
What is stress incontinence
Urine leakage with increases in abdominal pressure - cough - sneeze - standing up - laughing
119
What is overflow incontinence
Leakage of small amounts of urine - voiding issue
120
Causes of overflow incontience
BPH Urethral stricture Mass
121
Neurological causes of imcontinence
``` DM - Autonomic neuropathy causing decreased detrusor excitability Parkinsons Multiple sclerosis Prostatectomy Hysterectomy ```
122
Common organisms causing UTIs
E.Coli Proteus mirabilis Klebsiella pneumonia
123
Lower UTI presetation
``` Cloudy smelly urine Dysuria haematuria suprapubic pain frequency tenderness ```
124
Upper UTI presentation
``` Loin pain tenderness - costavertebral angle N+V Oliguria Fever Systemically unwell ```
125
UTI investigations
Urinalysis - dipstick +ve = Emperical tx -ve but pt has sx = MSU for MC&S Bloods Imaging - bladder scan - Renal US
126
Urinary tract obstruction investigations
Bloods Urinalysis Ultrasound CT - hydronephrosis
127
What is polyuria
Partial blockage and loss of concetration mechanisms - Excess urination
128
What is anuria
Complete bilateral blockage - no urination
129
Upper urinary tract obstruction sx
Loin to groin pain worse with fluids Enlarged kidneys
130
4 complications of peritoneal dialysis
Infection peri catheter leak abdominal wall herniation Intestinal perforation
131
Name 3 isotonic solutions
5% Dextrose 0.9% Sailine Hartmans solution
132
Signs of ADPCKD
``` HTN haematuria polyuria abdo/loin pain palpable massess ```
133
ADPCKD tx
Treat HTN - Target = 130/80 Dialysis Increase H20 Reduce salt
134
ARPCKD Assosciated mutation
PKHD1 - chromosome 6
135
PCKD complications
Mitral valve prolpase Liver cysts SAH
136
What classification helps differentiate between benign cystic lesions and cancerous cystic lesiosn
Bozniak classification
137
4 causes og haematuria
Kidney - tumour - trauma - stones - cysts Urethral stones Bladder - Infection - Stones - Tumour BPH Prostate cancer
138
Trimethoprim MOA
Affects folic acid metabolism
139
Descibe the action of aldosterone
- Acts on the collecting ducts - Increases ENaC and H+/K+ pumps - Increases sodium absoprtion - K+ secretion - H20 retention - BP rise
140
3 functions of ANP
Renal vasodialtor Inhibits aldosterone Closes ENaC - decreases Na+ reabsorption
141
3 factors stimulate renin release
Sympathetic stimualtion Decreased BP Macula densa cells
142
Function of calcitrol
Suppression of PTH (-ve feedback) Increases Ca2+ and Phosphate absorption from the gut
143
How does PTH increases serum calcium levels - 3
- Increases bone resorption - Increases Ca2+ reabsorption from the kidneys - Stimulates alpha -1 hydroxylase activity so increases Ca2+ absorption from gut
144
which part of the loop of henle is water permeable
thick ascending limb
145
What is fanconi's syndrome
Failure of nephron to reabsorb essential ions Sugars / a.a. / bicarbonates appear in urine
146
2 signs of fanconi's syndrome
Sugar in the urine Acidosis Rickets / osteomalacia
147
2 Causes of Fanconi's syndrome
Myeloma Cystinosis
148
Name a drug that inhibits creatinine secretion and its effects on eGFR
Trimethoprim Increased eGFR
149
Equation for GFR
(Um X urine flow rate) / Pm. - Um = concentration of marker substance in urine. - Pm = concentration of marker substance in plasma.
150
What cancer does schistomiasis cause
SCC of bladder
151
What are LUTS sx in a male aged 50 likely to be
BPE
152
Describe tx for sepsis
``` Give high flow O2 Take blood cultures Give IV abx Give IV fluids Check lactate Monitor hourly urine output ```
153
How are urate stones visualised
Non contrast CT | Radiolucent

Disease summaries (9 decks)

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