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RENAL SYSTEM Flashcards

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1
Q

are urinary tracts more common in males or females?

A

females

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2
Q

in elderly men, UTIs are most commonly caused by what other condition?

A

prostatitis

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3
Q

what is the most common causative organism for UTIs?

A

e coli

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4
Q

give 3 other organisms that could cause UTIs

A

proteus iribalis
klebsiella
e. faecalis
staph saprophyticus

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5
Q

what is the name for bladder and urethral inflammation?

A

cystitis

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6
Q

how many infective organisms must be present in the urinary tract for it to be classed as an infection?

A

over 10^5

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7
Q

give 6 symptoms of a UTI

A 
frequency
urgency
nocturia
foul smell
suprapubic pain
tenderness
haematuria
confusion (if elderly)
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8
Q

What are risk factors for UTI?

A 
Female
long term catheter
Sexual intercouse
Malformations and obstructions
Spermicide
Pregnancy 
Menopause
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9
Q

what is a relapse UTI?

A

recurrence of symptoms caused by same organism within a week of finishing antibiotics

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10
Q

what is a reinfection UTI?

A

recurrence of symptoms after 14 days of finishing antibiotics, can be caused by a different organism

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11
Q

give 2 causes of sterile pyuria

A

TB

chlamydia

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12
Q

how long would you recommend giving antibiotics for a UTI?

A

3-5 days

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13
Q

suggest 3 antibiotics you could give for UTI treatment

A

trimethoprim
nitrofurantoin
amoxicillin

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14
Q

what antibiotic would you use for resistant bacteria UTI?

A

co-amoxiclav

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15
Q

give 2 complications of UTIs

A

calculi

pyelonephritis

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16
Q

what two symptoms would you use to distinguish a UTI from pyelonephritis

A

loin pain

fever

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17
Q

what percentage of 80 year old men have benign prostatic hypertrophy?

a) 10%
b) 20%
c) 50%
d) 80%

A

d) 80%

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18
Q

is BPH more or less common in asians?

A

less

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19
Q

give 4 common symptoms of BPH

A

frequency
nocturia
dribbling
overflow incontinance

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20
Q

give 3 causes of haematuria in BPH

A

bacteraemia
stones
venous rupture

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21
Q

what medical imaging test is important to rule out cancer in BPH?

A

transrectal ultrasound (maybe + biopsy)

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22
Q

what treatment would you recommend for acute retention in BPH?

A

catheter

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23
Q

what 2 surgical procedures can be used in BPH?

A

prostatectomy

TURP

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24
Q

suggest 2 drugs that could be used in BPH

A 
tamsulosin= alpha blocker
finasteride= 5 alpha reductase inhibitor
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25
why is tamsulosin used in BPH?
alpha blocker, lowers smooth muscle tone of prostate and bladder necker
26
why is finasteride used in BPH?
Prevents the conversion of testosterone to adrogen DHT
27
give 2 complications of BPH
incontinance retention SEVERELY renal failure
28
is AKI more or less common than CKD?
less
29
what is acute kidney injury defined generally by?
significant decrease in renal function over hours to weeks
30
is AKI reversible?
yes
31
what blood markers would rise during AKI?
urea | creatinine
32
What are the signs and symptoms of AKI?
``` Weakness Fatigue Confusion Skin pallor Hypertension Abdominal pain Tachycardia Oliguria Fever Rash ```
33
what blood test specifically would be very reduced in AKI?
eGFR
34
What scan should you do in the first 24 hours of a patient having suspected AKI and why?
Renal tract ultrasound to see if their is any obstruction and the size of the kidneys
35
what signs on an ECG might you see in hyperkalaemia caused by AKI?
tall tented T waves
36
what is the cause of pre-renal AKI?
Kidney usually gets 20% of normal cardiac output | So caused by hypovolemia or reduced cardiac output
37
give 4 causes of hypo perfusion in pre-renal AKI
``` Haemorrhage= loss of blood hypovolaemia and hypotension sepsis= vasodilation Over diuresis with diuretics Diarrhea and vomiting Severe burns CCF liver cirrhosis renal artery stenosis ```
38
What is the most common cause of intrinsic AKI?
acute tubular necrosis
39
How can pre renal AKI lead to acute tubular necrosis?
Prolonged reduced perfusion of the kidney can damage the tubular cells
40
give 3 vascular causes of acute tubular necrosis
``` vasculitis hypotension Reduced cardiac output Sepsis haemolytic uraemia syndrome cholesterol emboli ```
41
give an example of an exogenous nephrotoxin which could cause acute tubular necrosis in AKI
radio contrast drugs
42
give 2 examples of endogenous nephrotoxins which could cause acute tubular necrosis in AKI
pigments crystals (urate) immunoglobulins
43
Post renal AKI is caused by renal tract obstruction from the renal pelvis to the urethra. Give examples of causes of obstructions
``` BPH Bladder carcinoma Cervical carcinoma Retroperitoneal fibrosis Renal stone disease ```
44
What is the initial treatment for AKI?
Iv fluids for fluid loss Stop nephrotoxic drugs Treat the underlining cause
45
when should acute dialysis be considered for AKI? (3 instances)
persistant hyperkalaemia metabolic acidosis uraemic encephalopathy pericarditis
46
give 3 risk factors for the development of AKI into CKD
diabetes hypertension Small kidneys
47
Chronic kidney disease is 4 times more common in what race?
afro-carribean
48
what is the most common cause of CKD in the uk?
Diabetes= secondary cause of glomerular disease
49
give 4 other causes of CKD
urinary tract obstruction= Renal stone disease and prostatic disease Autosomal dominant polycystic kidney disease Membranous Glomerulonephritis Atherosclerosis of renal arteries malaria nephropathy Hypertension Residual injury from AKI Drugs causing tubular interstital disease
50
give 3 skin symptoms of CKD
epistaxis skin pigmentation pruritis
51
give a blood symptom of CKD
anaemia
52
give 2 genital/sexual symptoms of CKD
amenorrhoea | erectile dysfunction
53
give 2 circulatory/cardiovascular symptoms of CKD
heart failure | pericarditis
54
give 2 renal symptoms of CKD
nocturia | oedema
55
give 3 infective risk factors for CKD
TB, malaria, schistosomiasis
56
give 4 systemic disease risk factors for CKD
``` SLE wegener's amyloidosis polycystic kidney disease sickle cell disease thrombotic thrombocytopenia purport ```
57
would these blood tests be raised, lowered or normal in CKD? a) urea b) creatinine c) ALP d) eGFR e) calcium f) phosphate g) Hb
a) high b) high c) high d) low e) low f) high g) low= anaemia
58
in which two conditions that can lead to CKD would you suggest immunosuppression?
systemic vasculitis | goodpastures
59
give 3 risk factors for the development of hydronephrosis
pregnancy cancer Urinary tract obstruction
60
the incidence of hydronephrosis is 1 in 300 ____ per year and 1 in 600 ____ per year
unilateral | bilateral
61
what type of hydronephrosis is characterised by loin pain that radiates to the groin, with an enlarged kidney?
acute upper
62
what type of hydronephrosis is characterised by flank pain, renal failure and polyuria?
chronic upper
63
what kind of hydronephrosis is characterised by suprapubic pain, distension, dullness and retention?
acute lower
64
what type of hydronephrosis is characterised by freq, hesitancy, overflow incontinence and distension?
chronic lower
65
give 10 causes of hydronephrosis
``` Obstruction Back flow from bladder to the kidney strictures of the ureter BPH Pregnancy = enlarged womb Cancer of the prostate, cervical, colon, bladder, womb, kidney and ovarian Kidney stones clots/tumour schistosomiasis ```
66
why are neonates given a routine kidney ultrasound?
can get hydronephrosis | normally self limiting
67
what is hydronephrosis?
Caused by urinary tract obstruction preventing outflow of urine from the kidney or abnormal flow of urine up the tract causing build up of urine in the kidney. Leading to stretching and swelling of the kidney. Dilation above blockage and renal pelvis
68
what treatment would you recommend for a stricture in hydronephrosis?
stent or pyeloplasty
69
give 2 complications of hydronephrosis?
kidney scarring | kidney failure
70
what is the second most common cancer death cause of males in the UK?
prostate cancer
71
what percentage of over 80s have dormant malignant changes in their prostate? a) 10% b) 20% c) 50% d) 80%
d) 80%
72
On PR what would a cancerous prostate feel like?
hard, irregular
73
symptoms of what other physiological condition present with prostatic cancer?
lower urinary tract obstruction symptoms: Increase frequency and urgency, haematuria, cannot fully empty etc
74
What factors in a diet are risk factors for developing prostate cancer?
Reduce vitamin D intake | High calcium intake
75
What are the risk factors for prostate cancer?
Infections:chlamydia, gonorrhoea, syphillis Age >50 Fhx (especially if they have Prostate cancer under 60) Ethnicity= ^ African/African-carribean Low amount of exercise Obesity
76
What are the signs of prostate cancer has metastasised?
Weight loss Anaemia Back pain
77
what kind of cancer is prostate cancer?
adenocarcinoma
78
what medical imaging might you suggest in suspected prostate cancer?
transrectal ultrasound
79
what staging is used for prostate cancer?
Gleason score = the most common grade + the highest other grade in the samples Grade is 1-5
80
when would you perform an orchidectomy (removal of testicles) in prostate cancer?
if metastatic
81
Testosterone is involved in the growth of the prostate cancer. What hormonal therapy is recommended for treatment with radiotherapy to slow down the growth of the cancer?
(LHRH + anti adrogen treament ) with radiotherapy
82
what surgery would you recommend in prostate cancer?
radical prostatectomy
83
give 2 complications of prostate cancer
metastasis urinary incontinence sexual dysfunction
84
Who is most at risk of pyelonephritis?
Women and children
85
What is the pathology of pyelonephritis?
Same organism that cause LUTI= E.coli, Klebsiella, Pseudomonas, enterococcus travel up the ureter and cause infection of the kidneys
86
what 2 signs may you expect in the kidneys in pyelonephritis?
renal cortical abscesses | pus in medulla
87
What are the symptoms of pyelonephritis?
``` 1-2 days onset Loin/flank pain unilaterally or bilaterally fever Nausea and vomiting Tenderness Haematuria +/- LUTI symptoms ```
88
How do you diagnose pyelonephritis?
A patient with proven UTI infection + loin pain and or fever
89
What are the risk factors for pyelonephritis?
``` Catheter Immunosuppression (DM2) Female and sexually activity Urinary obstruction Age >65 Pregnant Prostatitis Prostate enlargement Renal structural abnormalities ```
90
What test are done to identify pyelonephritis?
Urine dip stick test to confirm UTI= leucocytes, protein, nitrates and blood Mid urine stream= culture CT
91
What is the treatment for pyelonephritis?
Oral ciprofloxacin/ co-amoxiclav or trimethoprim if sensitive for 7-14 days Fluids Painkillers
92
what is the name for chronic pyelonephritis?
reflux nephropathy
93
reflux nephropathy is caused by what?
vesicoureteric reflux (back flow from valve between ureter and bladder)
94
give an example of a situation where asymptomatic bacteraemia in urine should be treated
pregnancy
95
why should tetracycline, trimethoprim, sulphonamides and quinolone be avoided in treating pyelonephritis in pregnancy?
teratogenic
96
Suggest a antibiotics that could be used to treat pyelonephritis in pregnancy
Cefalexine (cephalosporins)
97
give 3 features of bladder carcinoma
Painless haematuria = most common Burning sensation wheen peeing frequency urgency
98
give 2 symptoms of advanced bladder cancer
``` referred boneand pelvic pain oedema flank pain palpable mass Weight loss ```
99
what type of cancer accounts for 90% of bladder cancer
transitional cell carcinoma/ urepithelial cells
100
name 3 other types of cancer which make up the remaining 10% of bladder cancers
squamous cell adenocarcinoma sarcoma
101
name 2 common causes of bladder cancer
smoking occupational carcinogen exposure genetic mutation
102
what medical imaging might you use to diagnose bladder cancer?
cytoscopy and take biopsy
103
What is the treatment for non muscle invasive bladder cancer?
TURBT (transurethral resection of bladder tumour) via cystoscopy and then chemotherapy Depends on staging and grading
104
When is cystectomy done for bowel cancer?
In muscle invasive bladder caner
105
what are 5 year survival rates for bladder cancer? a) 5% b) 25% c) 50% d) 75%
d) 75%
106
what is the most common (80%) type of renal carcinoma?
renal cell carcinoma = mainly clear cell type
107
what type of cancer makes up 20% of renal carcinoma cases?
transitional cell carcinoma
108
what type of renal carcinoma is rare and occurs mainly in infants?
Wilm's
109
give 4 risk factors for development for renal cancer
``` Age affects 60-70s olders rare to affect 50s Smoking NSAIDs obesity CKD (dialysis) Hypertension hepatitis C FHx ```
110
what are 5 year survival rates for renal cancer? a) 5% b) 25% c) 50% d) 70%
d) 70%
111
What are the symptoms of urinary tract stones?
``` Usually asymptomatic Lower abdo/back pain Pain and difficulty urinating Fever haematuria stagnant urine ```
112
what are whewellite and weddellite urinary calculi made of?
calcium oxalate
113
Gout can cause what type of renal stone to develop?
Urate (uric acid)
114
how can concentrated urine cause calculi
dehydration of urine causing minerals to crystallise into stones
115
Give risk factors for the development of renal calculi?
``` Fhx Recurrent UTI Gout Hypertension Drugs= aspirin, NSAIDS, Diuretics Bed bound High protein low fibre diet Hyperparathyroidism Hypercalciuria Renal structural abnormalities Dehydration ```
116
what surgical treatment might you recommend for urinary calculi?
cytolithotomy | fragmentation using cystoscope
117
In a urine dipstick test what would be positive for UTI?
Nitrates and leukocytes
118
What is sterile pyuria?
Elevated WCC count even though standard culture techniques indicate the urine is sterile
119
What is stage 1 AKI?
1.5-1.9 fold from baseline serum creatinine level | Urine output = <0.5ml/kg/hr for >6 hours
120
What is stage 2 AKI?
2-2.9 fold from baseline serum creatinine level | Urine output= <0.5ml/kg/hr for >12 hours
121
What is stage 3 AKI?
>3 fold from baseline SCR level or started renal replacement therapy (regardless of level) Urine output <0.3ml/kg/hr for >24 hours or anuria for >12hrs
122
What happens in intrinsic AKI?
Damage structurally to the kidney tissue causing leakage of blood and protein through the kidney. Can be detected by urine dipstick test
123
What is more common Pre renal AKI or renal AKI?
Pre renal AKI
124
What muscle condition can lead to intrinsic AKI?
Rhabdomylsis
125
What are other causes of intrinsic AKI other than Acute tuberculosis necrosis?
Acute glomerulonephritis Acute interstitial nephritis (AIN)= caused by NSAIDS Nephrotoxic medication such as contrast
126
What are the risk factors for AKI?
``` Age >75 years as GFR reduces with age DM Cardiac failure Liver disease CKD Nephrotoxic drugs Hypovolemia Sepsis ```
127
What are systemic presentation of AKI caused by vasculitis?
Rash Fever Joint pain
128
What are the early signs of AKI?
Usually asymptomatic with only reduction in urine output
129
What are the complications of AKI?
Hyperkalaemia--> lead to arrhythmia Pulmonary oedema--> see on Cxray Metabolic acidosis Uraemia = pericarditis, neuropathy and encephalopathy
130
What are the stages of CKD?
Stage 1= >90 GFR= Normal kidney function but urine finding or abnormal structure indicate kidney disease stage 2= 60-90GFR= Mild reduction in kidney function plus abnormal finding Stage 3a= 45-59= moderate reduction in kidney function stage 3b= 30-44GFR= moderate reduction in kidney function stage 4= 15-29 GFR= severely reduced kidney function stage 5= <15 or dialysis= end stage
131
What are 3 neurological symptoms of CKD?
Insomnia Restless leg Paraesthesia of legs
132
How common is it for the presentation of symptoms in CKD?
Symptoms don't present until late stage CKD | Usually asymptomatic
133
What general systemic symptoms do you get in CKD?
Lethargy and nausea
134
What MSK symptoms you get with CKD due to being a metabolic bone disease?
Osteomalacia and general joint and bone pain
135
Why do you do urinalysis for CKD?
Haematuria or proteinuria indicate glomerular disease
136
What scan do you do for CKD?
renal tract US for obstruction
137
What screening do you do for CKD?
Myeloma screen
138
What is the duration of deterioration in a) AKI b) CKD
a) days to weeks | b) months to years
139
What is the main treatment for CKD?
BP under control and lowered Treat the underlining cause Prevent complications
140
What are the common complications of CKD and how do you treat them?
Hyperkelaemia = reduce dietary intake Anaemia = subcutaneous erythropoietin therapy Metabolic bone disease = Vitamin D and phosphate binders Acidosis= sodium bicarbonate Heart disease
141
What is treatment for end stage CKD?
Dialysis and transplant
142
What are the two types of bladder cancer?
1) When the cancer cells are in the lining of the bladder= Non-muscle invasive bladder cancer 2) Cancer wells have spread across the lining= Muscle invasive bladder cancer
143
How do you diagnose renal cancer?
Various scan | Cystoscopy and biopsy
144
What is the treatment for renal carcinoma?
Surgery and removal of whole or part of kidney Ablation = freeze and death of cancer cells Embolisation= cutting of the blood supply Biological therapy Radio/Chemo not effective
145
What is the treatment for Wilms tumour?
Radiotherapy and chemotherapy
146
What are general symptoms of hydronephrosis?
UTI symptoms of fever and pain Haematuria Loin pain Increase frequency to urinate
147
What is the initial treatment of hydronephrosis?
Treat underlining cause Surgical drainage Catheter to drain the urine
148
What is the initial response to prostate canecer?
Unless very symptomatic to watch and wait | Active surveillance
149
How is prostate cancer diagnosed?
PSA= very unreliable Digitial rectam exam Biopsy MRI and CT
150
What are the NICE staging of prostate cancer?
1) Local prostate cancer= within the prostate glands 2) Local advance PC= Attached to the prostate capsule but has advance outside the gland 3) Relapse after treatment or mets
151
In who is risk of renal abscess complication from pyelonephritis increased?
Patient with DM2
152
What is the rarest type of renal stones
Cysteine
153
What is the formation of struvite stones?
Mg/AL/CA phosphate stones | They occur after UTI and common in females
154
What is the most common type of renal stones?
Calcium oxolate
155
Why does hyperparathyroidism increae risk of calcium stone development?
Parathyroid involved in regulation of calcium
156
What is a) Nephrotic syndrome b) Nephritic syndrome?
a) Loss of a lot of protein in the urine | b) Loss of a lot of blood in the urine
157
What is the criteria for nephrotic syndrome?
1) Loss of 3.5 grams of protein/24 hrs 2) oedema= around legs and eyes 3) Hypoalbuminemia --> loss via urine
158
How does the liver compensate for Hypoalbuminemia in nephrotic syndrome?
Increase the production of lipids and cause hyperlipidaemia
159
What affect does nephrotic syndrome have on the urine output and the state of urine?
Urine is foamy and urine output is reduced due to the lack of oncotic pressure
160
What is the main cause of nephrotic syndrome in a) children b) adults
A) Minimal change disease | b) Diabetes
161
What are the two differentials for oedema?
Heart failure | Nephrotic syndrome
162
What test should you immediately do regarding kidney function if a patient has oedema?
Urine dip stick test
163
What is the criteria for nephritic syndrome?
1) Haematuria 2) Slight loss of protein 3) Mild hypertension 4) Urine output <300ml/day
164
What is the cause of nephritic syndrome?
Post-streptococcal glomerulonephritis--> appears weeks after a URTI
165
What surgery is done to treat urinary problems ascoiated with BPH?
Transuretheral resection prostate= trim away the excess prostate blocking the ureter
166
Why is pyelonephritis more common in females?
Due to the shorter ureter and because the anus and bladder are closer so easier for bacteria to travel between the two
167
Having AKI with jaundice can be indication of what cause?
Hepatorenal failure
168
Build up of what chemicals in the body lead to renal stones?
Ammonia Cysteine Calcium uric acid

Y3 CORE CONDITIONS (15 decks)

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