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Renal & Urinary Flashcards

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1
Q

3 risk factors for developing kidney stone?

A 
metastable urine
- high calcium/oxalate/urate/cysteine
- high PTH -- high calcium 
- dehydration
- Dents disease -- high cysteine 
anatomical abnormality eg horseshoe kidney, trauma 
renal tubule acidosis
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2
Q

what 2 types of stones are the most common? in what kind of urine do they develop?

A

calcium stones – oxalate or phosphate – most common
ca oxalate in acidic urine
ca phosphate in alkaline urine

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3
Q

what are struvite stones associated with? how do they form?

A

infection
bacteria make ammonia
= alkaline urine
= precipitation of magnesium + phosphate

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4
Q

what is kidney stone pain like?

A 
severe
unilateral
loin to groin 
colicky 
sudden onset
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5
Q

apart from pain, 3 other features of kidney stone?

A 
urgency
frequency
writhing
frank or microscopic haematuria 
nausea/vom
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6
Q

what is the gold standard imaging for ?kidney stones? what would you see? 3

A

CT kidneys, ureter, bladder - without contrast
stone is bright white

fat stranding in perinephric tissues
inflammation
hydronephrosis
cortical thickening

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7
Q

best analgaesia for acute kidney stone?

A

paracetamol or diclofenac

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8
Q

3 surgical managements for kidney/ureter stones?

A

lithotripsy
percutaneous nephrolithotomy
ureteral stent

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9
Q

a treatment for uric acid stones?

A

alkalise the urine eg sodium bicarb

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10
Q

treatment for cysteine stones?

A

captopril (cysteine binder)

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11
Q

give 5 risk factors for AKI?

A 
Infection
dehydration
peripheral vascular disease
NSAIDS
diabetes 
heart failure
liver disease - causes decreased blood to kidney 
age over 65
contrast dyes 
hypovolaemia
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12
Q

3 pre-renal causes of AKI?

A 
Dehydration / diarrhoea
bleeding
shock
sepsis
heart failure
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13
Q

Renal causes of AKI?

A 
glomerular nephritis - nephritic/nephrotic syndromes 
acute tubular necrosis
acute interstitial nephritis - infection/ischaemia/connective tiss dis
infection 
NSAID
TTP 
vasculitis 
henoch-scholein purpura
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14
Q

3 post renal causes of AKI?

A 
kidney stone
mass in ureter
urethral stricture - post surgery
benign prostate hyperplasia
prostate cancer
problem with nerves so cannot urinate
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15
Q

what is the criteria for AKI?

A

increase in serum creatinine, more than 25mmol/l over 48 hrs or a 50% rise in last week
or less than 0.5ml/kg/hr urine output

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16
Q

3 complications of AKI?

A

hyperkalaemia, causes arrythmia
fluid overload, causes pulm hypertension
metabolic acidosis
uraemia, causes encephalopathy

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17
Q

what is a normal GFR?

A

60ml/min/1.73m2 +

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18
Q

what staging system is used for AKI?

A

KDIGO

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19
Q

renal cell carcinoma is what kind of cancer?

A

adenocarcinoma

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20
Q

risk factors for renal cell carcinoma?

A 
male
black
smoking 
haemodialysis
von hippel lindau
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21
Q

what is the most common type of RCC?

A

clear cell

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22
Q

4 places RCC commonly metastasises to?

A

lungs - cannonball
brain
bone
adrenals

local fat
renal vein

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23
Q

clinical presentation of RCC? - 5

A 
haematuria
loin pain
palpable mass 
fever
weight loss
varicocele 
enlarged lymph nodes
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24
Q

3 common paraneoplastic syndromes related to RCC?

A

renin = hypertension
EPO = polycythaemia
PTH-like molecule = hypercalcaemia

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25
stauffers syndrome is a triad of:
deranged LFT hypoglycaemia fever (stauffers syndrome is a paraneoplastic syndrome associated with renal cell carcinoma)
26
what is oncocytoma?
benign kidney mass | in the collecting duct
27
what is the most common bladder cancer?
transitional cell carcinoma
28
what is the epidemiology of transitional cell carcinoma?
smoking | PAH - hairdressers, rubber factory
29
when does squamous cell carcinoma in the bladder develop, give some risk factors?
irritation of the bladder -- transitional epithelium becomes squamous schistosomiasis catheter kidney stones
30
investigations for bladder cancers?
flexible cystoscopy
31
clinical presentation of bladder cancer? 3
painless haematuria dysuria raised WCC recurrent inf
32
surgery for bladder cancer?
TURBT - BCG + chemo | cystectomy
33
what is the actual function of the prostate?
produces seminal fluid | to sustain semen
34
what kind of cancer is prostate cancer normally?
adenocarcinoma
35
5 LUTS?
``` frequency urgency nocturia terminal dribbling haematuria dysuria/pain ```
36
presentation of prostate cancer?
``` urine retention lower abdo pain LUTs eg frequency, dribbling asymetrical hard, lumpy prostate with loss of median sulcus weight loss, etc ```
37
investigations for prostate cancer?
PSA - non specific multiparametric MRI biopsy transrectal USS
38
how is prostate cancer graded & staged?
Gleasson score to grade (higher is worse) | TMN to stage
39
treatment options for prostate cancer?
prostatectomy radiotherapy brachytherapy - radioactive beads into prostate flutamide - anti testosterone
40
3 times when PSA may be high?
``` cancer BPH exercise post ejaculation infection ```
41
5 risk factors for CKD?
``` smoking hypertension SLE infection eg HIV ACEi nephrotic/nephritic syndromes polycystic kidney vesicourethral reflux ```
42
4 pathophysiological effects of declining kidney function?
fluid balance/BP regulation disrupted -- hypervolaemia/hypertension vit D metabolism poor -- bone resorbed hyperkalaemia, uraemia decreased EPO = normocytic anaemia metabolic acidosis - as less H+ excretion and less bicarb production
43
5 clinical presentations of CKD?
``` HTN oedema uraemia = sallow/frost anaemia -- lethargy, pallor frothy urine muscle cramps (hyperK) nausea anorexia ```
44
what is ACR and what does it show/mean?
albumin/creatinine ratio | more than 3 means proteinuria
45
how is GFR calculated?
eGFR - creatinine | gold standard - inulin - but v invasive
46
end stage renal failure is what GFR?
15 or less
47
what does FBC show in CKD?
normocytic anaemia
48
2 types of dialysis?
haemodialysis - more effective | peritoneal dialysis - easier for pt
49
why is BPH more common with age?
5a reductase converts testosterone to dihydrotestosterone 5a reductase increases with age dihydrotestosterone is more active
50
presentation of BPH?
LUTS eg frequency, straining, hesitancy, weak stream, urgency, incontinence, nocturia enlarged but smooth prostate
51
tests for BPH?
PSA slightly raised urinalysis to exclude infection transurethral biopsy to exclude cancer urodynamics/flow studies
52
what scoring system is used for BPH?
IPSS
53
2 drugs for BPH?
a1 antagonists eg tamsulosin - relax smooth muscle - 1st line 5a reductase inhibitors eg finasteride - shrink prostate - 2nd line/for severe
54
2 lifestyle changes/conservative management in BPH?
reduce fluid intake/caffeine urethral milking incontinence pads bladder training
55
3 Complications of BPH?
UTI urine retention stones nephropathy
56
5 risk factors for UTI?
``` sexually active catheterised enlarged prostate renal tract tumour renal stones urinary retention woman incontinence poor hygeine dehydration ```
57
what does pyuria mean?
neutrophils in the urine
58
what is cystitis?
inflammation of the bladder | associated with UTI
59
uncomplicated vs complicated UTI?
uncomplicated - healthy non pregnant women | everyone else - complicated
60
4 bacteria that commonly cause UTI? Which is most common?
``` e.coli most common staph saphrophyticus klebsiella pneumoniae pseuddomonas aeruginosa proteus - stones as they increase the pH of urine ```
61
what is pyelonephritis?
infection in the kidney inflammation of upper urinary tract, renal pelvis, parenchyma, upper ureter
62
5 clinical presentations of UTI?
``` frequency dysuria urgency incontinence confusion suprapubic pain ```
63
3 features that suggest pyelonephritis over UTI?
loin pain fever haematuria
64
what do nitrates suggest?
gram neg bacteria eg e coli
65
what do urine casts suggest?
damage to epithelium/tubular necrosis/glomerulus
66
what does epithelium in MSU suggest?
poorly taken sample, may be contaminated
67
what number of bacteria in an MSU is significant?
10^5 | 10^4 may be contamination
68
what samples do you need, to test for TB in urine?
3 early morning samples
69
how to treat uncomplicated UTIs in young women?
3 days abx | eg nitrofurantoin or trimethoprim
70
how to manage 'complicated' UTI?
MSU for culture | 7 days abx
71
what about abx for UTI in pregnancy?
nitrofurantoin = 1st line 2nd line = cefalexin or amoxicillin (not trimethoprim)
72
3 things about UTI in pregnancy?
urinalysis is an unreliable test, always send for culture asymptomatic bacteriuria is common always treat, they are at much higher risk of pyelonephritis
73
when would/wouldn't you treat or test a ?UTI?
3 UTI symptoms -- empirical abx 2 UTI symptoms + nitrates -- empirical abx 2 UTI symptoms + leucocytes -- send MSU symptoms but no leuco/nitr in dipstick or it looks clear - unlikely to be a UTI
74
2 bacteria that are yellow on a CLED?
yellow on CLED = lactose fermenting e.coli staph saprophyticus
75
2 organisms that are blue on a CLED?
blue on cled = non lactose fermenting salmonella shigella pseudomonas
76
pink colonies on a MacConkey plate are_____
lactose fermenting e coli staph saprophyticus
77
pyelonephritis is most common in ___
females under 35 | esp pregnant
78
3 ways infection can spread to the upper urinary tract and cause pyelonephritis?
ascending from urethra, common in intercourse haematogenous, in sepsis lymphatic
79
presentation of pyelonephritis?
``` fever rigors unilateral loin (-- groin) pain pyuria nausea haematuria dysuria/frequency ```
80
investigations for pyelonephritis?
``` urine dip -- leuco and nitrates MSU shows white cell casts CRP USS DMSA scan if recurrent ```
81
treatment for pyelonephritis?
``` broad spec abx - coamoxiclav, gentamycin analgaesia antipyretics fluid drain kidney ```
82
5 bacteria that can cause prostatitis, which is most common?
``` e coli - most common pseudomonas klebsiella proteus mirabilis chlamydia gonorrhoea staph aureus (disseminated from somewhere else) ```
83
5 clinical signs/symptoms of prostatitis?
``` pain - perineal/rectal/pelvic/back hesitance, straining, dribbling dysuria, frequency, urgency tachycardia, pyrexia malaise, myalgia palpable bladder prostate feels hot/swolen/tender ```
84
investigations for prostatitis?
``` urinalysis/MSU Blood/semen culture trans urethral ultrasound - TRUSS MRI of prostate DRE CRP ```
85
management for prostatitis?
ciprofloxacin 14 days if abscess - TRUSS guided drainage
86
treatment for chronic prostatitis?
analgaesia tamsulosin stool softener - docusate
87
most common cause of urethritis?
STI | eg chlamydia
88
presentation of urethritis? - 5
``` dysuria haematuria/pus in urine discharge urethral pain / itching inflammation skin lesion reactive arthritis conjunctivitis epididymitis ```
89
management of chlamydia?
doxycycline | azithromycin - if preg
90
management for gonorrhoea?
ceftriaxone + azithromycin
91
does chlamydia infect the vagina?
no, chlamydia and gonorrhoea cannot infect squamous epithelium
92
what is the incubation period for chlamydia and gonorrhoea?
chlamydia = 1-3 weeks | gon: 10 days for women, 1-5 days in men
93
presentation of gonorrhoea & chlamydia in women?
asymptomatic change in vaginal discharge menstrual irregularity dysuria
94
3 complications of GC/ chlamydia in women?
PID neonatal transmission fitz-hugh-curtis: diagnose at nephrostomy, similar to gallbladder dis
95
what does gonorrhoea look like on a gram stain?
gram neg diplococci in the cytoplasm of polymorphs
96
what organism causes syphilis?
treponema pallidum
97
what are the features of primary syphilis?
chancre | macule - papule - non tender solitary ulcer
98
5 features of secondary syphilis?
``` may or may not follow chancre rash mucous membrane lesions generalised lymphadenopathy alopecia bone pain hepatitis nephrotic syndrome deafness iritis meningitis CN palsy ```
99
treatment for syphilis?
penicillin
100
how is CKD defined?
GFR less than 60 GFR less than 90 with renal damage albuminuria - more than 30mg/24hr or ACR more than 3
101
what is the most common cause of CKD?
diabetes | -damage to efferent arteriole
102
what is nephritis? what are the two types?
nephritis = general inflammation of the kidney glomerulonephritis interstitial nephritis
103
3 conditions that cause glomerulonephritis and lead to a nephritic syndrome?
goodpastures rapidly progressive glomerulonephritis (can come from goodpastures) IgA nephropathy Henloch-schonlein purpura - essentially this is like a sstemic version of IgA nephropathy post streptococcal glomerulonephritis membranoproliferative glomerulonephritis SLE
104
post streptococcal glomerulonephritis develops in who following what kind of conditions?
tonsilitis impetigo under 30s immune complexes are deposited in glomerulus, causing inflammatory damage to podocytes
105
goodpastures syndrome is caused by
antibodies to glomerular basement membrane
106
3 conditions that cause glomerulonephritis leading to nephrotic syndrome?
``` minimal change focal segmental glomerular sclerosis diabetes membranous glomerulonephritis amyloidosis ```
107
membranous glomerulonephritis is caused by
igG deposition in the glomerular membrane
108
minimal change disease is commonest in
children
109
nephritic & nephrotic syndrome?
nephritic: haematuria (cola), mild proteinuria,, HTN, peripheral oedema nephrotic: severe/frothy proteinuria, central oedema, hypoalbuminuria, lipid/clot
110
epidemiology, aetiology and investigations for IgA nephropathy?
in the 20s following GI or URT infection dipstick mesangial proliferation ang IgA at biopsy
111
aetiology, epidemiology of membranoproliferative glomerulonephritis?
20s and 60s igG and c3 deposition in basement membrane idiopathic secondary - NSAIDs, malignancy, rheumatoid is the most common primary cause of nephrotic syndrome in adults (diabetes is most common secondary cause)
112
management of nephritic syndrome?
steroids | BP control
113
gold standard investigation for nephritic/nephrotic syndromes?
nephritic = biopsy - crescent shaped glomeruli | nephrotic - needle biopsy and microscopy - light, electron, fluroescence
114
pathophysiology in nephrotic syndrome?
damage to glomerulus = protein esp albumin leak into urine instead of being filtered and retained loss of albumin = oedema
115
what happens in minimal change disease?
T cells release cytokines which damage podocytes | 'minimal change' seen at microscopy, may see loss of podocytes
116
management for nephrotic syndrome?
``` steroids - mainstay ciclosporin diuretics ACEi albumin anticoagulant - apixaban, lmw heparin, warfarin (warfarin has a delayed effect) ```
117
the two forms of polycystic kidney disease?
autosomal dominant - develops in adulthood PKD1 on chr 16 / PKD on chr 4 autosomal recessive - rarer but worse develops in childhood chr 6 PKDH1
118
what protein is mutated in polycystic disease, what is its normal function and what happens when its mutated?
polycystin protein allows calcium influx to inhibit cell proliferation mutation = cell overproliferation and overexpression of water channels = fluid formed cysts
119
what are 3 pathophysiological effects of the cysts in polycystic kidney disease?
compress blood flow -- hypoperfusion -- RAAS activation -- hypertension block the collecting ducts -- stasis of urine -- kidney stones renal failure
120
5 renal signs/symptoms of polycystic kidney disease?
``` pain palpable enlarged kidneys haematuria nocturia polyuria, polydipsia, hypertension ```
121
5 extra-renal complications of polycystic disease? caused by cysts forming elsewhere
``` hepatomegaly splenomegaly pancreatic dysfunction infertility mitral/aortic regurg berry anneurysm aortic root dilatation diverticulae ```
122
3 presentations of autosomal recessive polycystic kidney disease?
``` at birth: - olighydramosis (lack of amniotic fluid) underdeveloped lungs -- resp failure low ears, flat nasal bridge congenital liver fibrosis ```
123
investigations to diagnose PKD?
U & E USS genetic testing
124
management of polycystic kidney disease?
tolvaptan / v2 antagonist cyst drainage dialysis avoid contact sports, nsaids, anticoagulants
125
where is an epidydimal cyst/ what does it feel like?
smooth in the epidydimus, above the testicle feels clearly separate from testicle
126
investigations for epidydimal cyst?
uss | transluminates on exam, as is fluid filled
127
a lump that's separate from the testicle could be:
epidydimitis / varicocele if solid | epidydimal cyst if fluid filled
128
what is a hydrocele?
a collection of fluid within the tunica vaginalis - between the parietal and visceral layers
129
aetiology of hydrocele?
idiopathic most common esp in younger men | secondary - tumour, trauma, tb, torsion
130
what is a communicating hydrocele caused by?
failure of the tunica vaginalis to close at birth
131
what is a simple hydrocele caused by?
overproduction of serous fluid by the mesothelium
132
what does a hydrocele look/feel like?
painless soft swelling in the scrotum, above and below testicle not reducible transluminates
133
3 management options for a large problematic hydrocele?
aspiration remove it sclerotherapy
134
what is a varicocele?
swelling of the veins in the pampiniform plexus
135
which side is it more common to have a varicocele, why?
left as the left testicular vein flows into renal vein before vena cava the right testicular vein flows straight into vena cava
136
left sided varicocele can be caused by
renal cell carcinoma
137
classically a varicocele feels like
a bag of worms
138
how does a varicocele change when lying down?
it should disappear | if it doesnt there could be a retroperitoneal tumour
139
if the left scrotum is smaller where is the varicocele?
left
140
what are the 5 gleasson stages?
1 - well formed uniformly distributed 2 - mostly well formed with minor poorly formed 3 - mostly poorly formed with minor well formed 4 - poorly formed glands 5 - necrosis, cords, nests, sheets
141
risk factors for testicular torsion?
``` young trauma bell clapper deformity bicycle riding cryptorchidism large testicles ```
142
presentation of anti-glomerular basement membrane disease / goodpastures ?
``` oliguria nephritic haemoptysis SOB cough ```
143
what is Alports syndrome?
genetic problem with type 4 collagen = renal failure, hearing loss, problems with eyesight - lenticonus x linked recessive or autosomal recessive
144
what are the stages of CKD?
``` 1 - kidney damage but GFR over 90 2. kidney damage GFR 60-90 3A - 45-60 3b - 30-45 4 - 15-30 5 - less than 15 ```
145
what is first line for urgency incontinence?
oxybutynin - antimuscarinic | prevent parasympathetic contraction of detrusor
146
what is the treatment for stress incontinence?
1 - bladder training | 2 - duloxetine (SNRI)
147
what are struvite stones made from?
magnesium ammonium phosphate
148
what is prehns sign for? what is a positive prehns sign?
to identify testicular torsion pos when lifting the testicle = relief of pain pos sign = epidydimitis NOT testicular torsion
149
what are kimmelstiel-wilson lesions?
when the mesangeal matrix invades glomerular capillaries | eg in diabetic hypertensive nephropathy
150
what diet is best for kidney disease?
low potassium, phosphate, sodium, protein
151
2 markers for testicular cancer?
alpha fetoprotein | beta hCG
152
tumour marker for bladder cancer?
fibrin
153
what are the stages of AKI?
1 - 150-200% increase in creatinine. less than 0.5ml/kg/hr for 6 hrs 2 - 200-300% increase in creatinine, less than 0.5mg/kg/hr for 12 hours 3 - less than 0.3ml/kg/hr
154
what are first medications for vasculitis?
steroids | rituximab
155
what investigation would you use to stage renal cancer?
CT or MRI
156
what is the surgery for testicular torsion?
manual detorsion (it is an emergency)
157
3 investigations for post streptococcal glomerulonephritis?
U&E urinalysis biopsy - dead bacterial cells and antibodies causing inflammation
158
3 common places for renal stones to get lodged?
ureteropelvic junction pelvic brim vesicoureteral junction ureteral crossing of iliac vessels
159
presentation of CKD?
``` fatigue uraemic frost bone pain anorexia pruritis arrythmia ```
160
presentation of AKI?
``` encephalopathy due to uraemia arrythmia/muscle weakness oliguria creatinine if post renal cause - luts signs of cause eg infection, vasculitis, etc metabolic acidosis itchiness ```
161
in nephrotic syndrome, what happens to cholesterol and coagulability?
albumin is lost so liver increases production of albumin along with this the liver increases production of cholesterol (xanthelasma) and coagulation factors (coagulopathy)
162
what is focal segmental glomerulosclerosis? & what is it caused by?
focal segments of plaques | hiv, sickle cell, interferon drugs
163
what is von hippel lindau syndrome?
mutation in VHL which regulates HIF -- mutation = cancer cysts form all over - kidney, pancreas, adrenals, phaeochromocytoma, liver dominant or de novo
164
what drugs should be stopped in AKI?
NSAIDS | ACEi
165
what stones can/can't be seen on x ray?
uric acid and cysteine stones are radiolUCent (can't see) | calcium and struvite stones can be seen
166
how is phosphate affected in CKD?
hyperphosphataemia | the kidnneys normally excrete phosphate, they can't do that as well in CKD
167
what things might suggest acute tubulointerstitial nephritis?
``` rash recently started a drug pyuria eosinophils fever ```
168
yolk sac tumour?
most common testicular cancer in boys schiller duval bodies high ALP
169
what is the most common cause of epidydimitis?
gonorrhoea in young | e coli over 35
170
NSAIDs cause what kind of AKI?
intrarenal
171
what happens to calcium in CKD?
hypocalcaemia
172
what antibiotics commonly cause AKI?
macrolides eg gentamycin -- causes tubular necrosis
173
IgA nephropathy and post strep glomerulonephritis are both nephritic conditions that develop after tonsilitis etc but what is the difference?
IgA - within a few days | post strep - within a few weeks
174
which part of the prostate is cancer usually in?
peripheral | transitional in BPH
175
what nerves innervate the bladder?
sympathetic - relax detrusor - inferior hypogastric parasymp - contracts detrusor - pelvic somatic - sphincter - pudendal

phase 2a (10 decks)

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