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CP3 Medicine > RENAL - Infections, Stones and Malignancy > Flashcards

RENAL - Infections, Stones and Malignancy Flashcards

(66 cards)

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1
Q

PS Acute pyelonephritis (6)

A 
High fever
Loin pain w/ tenderness 
Bacteruria 
Rigors
Vomiting 
Oliguria
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2
Q

Complications of pyelonephritis (3)

A

Sepsis
Abscess
Papillary necrosis

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3
Q

What does chronic pyelonephritis lead to

A

Scarring + progressive renal impairment –> ESRD

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4
Q

Appearance of kidney chronic pyelonephritis

A

Shrunken
Scarred
Capsule thickened and internal plumbing distorted and distended

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5
Q

What does chronic pyelonephritis occur in the presence of

A

Vesicoureteric reflux

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6
Q

Cystitis S+s (7)

A 
Freq + nocturia 
Dysuria 
Urgency 
Haematuria 
Smelly urine
Suprapubic pain/tenderness 
Strangury
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7
Q

What is Strangury

A

Painful frequent urination of small volume, expelled only by straining despite a severe sense of urgency

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8
Q

What specific Sx do older pt w/ cystitis present with?

A

Confusion

+/- incontinence

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9
Q

What specific Sx do children w/ cystitis present with (3)

A

FTT
Fever
Poor feeding

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10
Q

Predisposing factors cystitis (6)

A 
Female
Pregnancy
Menopause
Obstructive/tract malformation 
Catheter
Diabetes
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11
Q

Most common causative agent cystitis

A

E.Coli (75%)

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12
Q

Ix cystitis (5)

A 
Urine dipstick 
Midstream urine MCS
USS
CT/IV urography 
MSU
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13
Q

Causes of sterile pyuria (5)

A 
Recently Tx UTI
Appendicitis 
TB
Chlamydia 
Bladder Cancer
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14
Q

Tx cystitis

A

Nitrofurantoin 100mg BD 3 days

+ lifestyle advice

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15
Q

Tx pyelonephritis

A

IV Tazocin 4.5g tds for at least 7 days

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16
Q

Recurrent UTI’s advice + Tx (5)

A 
High fl intake 
Freq voiding (esp after sex)
Avoid spermicidal jellies 
Avoid constipation 
Prophylactic Abx at night
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17
Q

3 Tx outcomes of UTI

A

Eradication
Elapse - rec infection within 7 days
Reinfection - bacteria absent 14 days then reoccur

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18
Q

What does acute ureteric obstruction lead to

A

Enlargement of UT superior to obstruction

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19
Q

Sx of upper ureteric obstruction (3)

A

Loin pain
Palpable kidney (hydronephrosis)
Infection due to stasis

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20
Q

Sx lower ureteric obstruction (5)

A 
Suprapubic pain 
Palpable bladder 
Frequency 
Slow to start 
Slow to finish
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21
Q

Luminal causes ureteric obstruction (5)

A 
Calculus 
SLoughed renal papilla 
Blood clot 
TCC renal pelvic/ureter 
Bladder. tumour
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22
Q

Mural causes ureteric obstruction (3)

A

Ureteric stricture
Congenital pelviureteric NM dysfunction
Congenital megaureter

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23
Q

Extramural causes ureteric obstruction (4)

A 
Compression due to
External tumours 
Diverticulitis 
AAA
Retroperitoneal fibrosis
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24
Q

Ix ureteric obstruction (5)

A 
Urine MCS
USS confirm dilatation 
Abdo XR
Non-contrast CT 
Retrograde pyelogram
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25
Medical Mx ureteric obstruction
``` A-E 75mg diclofenac IM IM metocloperamide if severe N/V Iv ABx if severe infections Assess whether admission is req ```
26
When to admit - ureteric obstruction (4)
Still severe pain after 1hr Risk of AKI Signs shock/infection Uncertainty over diagnosis
27
Indications for active Tx ureteric obstruction (5)
``` Low chance spontaneous passage Persistent pain Ongoing obstruction Signs infection Renal insufficiency ```
28
Surgical Mx options ureteric obstruction (4)
``` ESWL Uterscopy Percutaneous nephrolithotomy Nephrostomy Stenting ```
29
Which drugs incr rate of expulsion in ureteric obstruction
Tamulosin | Nifedipine
30
What % of stones pass naturally
80%
31
Follow up ureteric obstruction
send 1st stone for analysis | Rx urology within 1 week
32
Where are the 3 classic sites of renal stones
Pelvicoureteric jct = renal pelvis Pelvic brim Vesicoureteric jct
33
What is the most common composition of renal stones
Calcium oxaolate (75%)
34
Peak age of kidney stones
20-40 y/o
35
M:F kidney stones
3:1
36
What are the 3 types of kidney stones
Staghorns Renal pelvis stone Ureteric stone
37
PS kidney stones
Renal colic - loin to groin spasms Pt can't lie still N/V UTI
38
When does renal colic occur w/ kidney stones
If stone impacted in ureter
39
When does a dull loin pain occur w/ kidney stones
If stone in major/minor calyx
40
RF KIDNEY STONES (4)
Obesity Dehydration FHx/PHx Anatomical abnormalities
41
When are stones are emergency
If there is both obstruction and infection
42
Ix kidney stones
``` Bloods - Ca,PO4, gluc, HCO3, urate Urine dip -95% blood bHCG MCS + pH AXR Non contract CT ```
43
What % of kidney stones are visible on AXR
80%
44
What % of kidney stones are visible on non-contrast CT
99%
45
Mx kidney stones (4)
Analgesia PCNL/lithotripsy Diet advise - high fl, low salt, low animal protein, drink citrus. fruit juice Exercise + W loss
46
Causes of bladder calculi (3)
Bladder flow obstruction Presence of FB Upper UT stone passing down
47
Sx bladder calculi
Sx UTI; signif bacturia, poor flow, terminal dribble + Haematuria + pain gen at end of micturition as bladder contracts Male - pain at tip penis Perineal pain
48
When is there perineal pain w/ a bladder calculi
If = trigonitis
49
Ix bladder calculi
As per upper UT stone
50
Mx bladder calculi
Medical expulsive therapy ESWL (lithotripsy if large) Immediate analgesia
51
Complications bladder calculi
Predispose to SCC
52
What is a renal cell carcinoma
Vascular tumour from PCT
53
What % of renal tumours are renal cell carcinomas
90%
54
Main RF RCC
Prolonged haemodyalysis
55
PS RCC
50% incidential 10% - Haematuria, loin pain, abdo pass, B Sx Signs polycythaemia or HTN (if EPO secretion)
56
Ix RCC (5)
``` Urine cytology USS CT/MRI CXR REnal angiography ```
57
Why do CXR for renal cell carcinoma
Assess for cannon ball mets in the lungs
58
Mx renal cell carcinoma (2)
Radical / partial nephrectomy | Post op chemo
59
What is a Wilms tumour
Undifferentiated mesodermal mass
60
What age to Wilms tumours PS
3.5y
61
Sx Wilms tumour (2)
Flank pain | Abdo mass
62
What must you NOT do w/ a WIlms tumour
Biopsy
63
Mx Wilms tumour
Nephrectomy | Post-op chemo
64
What % of 50 y/o have renal cyst
50%
65
Sx renal cysts (3)
Asymp | Or cause haematuria + pain
66
What are the 3 most common causes of renal cysts
PKD Medullary cystic disease Medullary spongy disease

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