Renal + urology Flashcards
(50 cards)
What are the causes of CKD?
Diabetic nephropathy
Hypertension
Chronic glomerulonephritis
Chronic pyelonephritis
Adult PCKD
What constitutes stages 1-5 of CKD?
1: >90ml/min + evidence of renal damage
2: 60-90ml/min + evidence of renal damage
3a: 45-59
3b: 30-44
4: 15-29
5: <15
Outline the diagnosis process of CKD
eGFR < 60ml/min, repeat in 2 weeks to exclude AKI
if eGFR <60ml/min OR ACR >=3mg, repeat in 3 months
if 3 month repeats as above, diagnose CKD
When should referral to nephrology be made for
Symptoms
eGFR
Proteinuria
Clinical:
- Persistent haematuria + cancer symptoms
- Uncontrolled HTN on 4 drugs
- Features of PCKD, RAS
eGFR:
- >25%/15 point decrease in 12 months
>25% decrease in 3 months of starting RAAS
- Increased CKD category
ACR
- >70 alone OR >30 with persistent haematuria
How do you manage anaemia in CKD?
Check iron status
Correct iron levels first
Then Erythropoetin if benefit likely
What is an important side effect of erythropoetin therapy
Accelerated Hypertension
Can lead to encephalopathy and seizures
How do you manage proteinuria in CKD?
Offer ARB/ACEI if ACR
Non-diabetic:
>70mg/mmol
30-70 with hypertension
Diabetic:
3mg/mmol
+ SGLT2i if ACR 3-30mg/mmol
How to protect bones in CKD
Reduce phosphate intake (phsophate pulls Ca2+ from bones)
If CKD 4-5 Give phosphate binders: calcium acetate, sevelamer
When is sevelamer favoured over calcium acetate?
Hypercalcaemia and vascular calcification
When should a CKD patient be dialysed?
eGFR < 15 (stage 5)
Renal transplant
What are the two main forms of dialysis?
Peritoneal
Haemodialysis
Patient reports pain distal to AV fistula, what could be occuring
STEAL syndrome
Fistula removes arterial blood, causing ischaemia of distal limb
What are the two commonest causes of peritonitis in dialysis?
How does NICE recommend you treat it?
Coag -ve staph eg Staph epidermidis
Staph aureus another cause
Vanc + ceftazidime added to fluid
OR
Vanc orally + Ceftazidime in fluid
How do you manage hyperkalaemia on bloods?
ECG
Stop drugs eg ACEIs
IV calcium gluconate for cardiac protection
Insulin/dextrose or neb salbutamol to shift K+ into cells
Calcium resonium to remove K+ from body
What are the causes for non visible haematuria that is
Spurious
Persistent
Spurious:
UTI, Menstruation, vigorous exercise, sexual intercourse
Persistent
Urogen cancer, stones, BPH, inflammation, nephritic syndromes
What infection can cause haematuria?
TB
Who gets referred for haematuria
Urgently
Non-urgently
Urgent
>=45 years + visible haematuria that is unexplained/persistent after UTI
>=60 years + unexplained NON-visible haematuria + dysuria/raised WCC
Non-urgent
>=60yrs + recurrent/persistent unexplained urinary tract infection
What features would make you suspect prostate cancer
LUTS, bloody/painful urination in an older man, especially if black
Who gets referred for prostate cancer?
2 week referral for
Malignant features on PR exam
Raised PSA
What is the first line and GS investigation for prostate cancer?
1st: Multiparametric MRI
GS: TRUS biopsy if Likert scale >3/5
What scoring system aids diagnosis of prostate cancer?
Gleason scoring
>=6 indicates cancer
What are the treatment options for bladder cancer?
Localised (T1/2): Radical prostatectomy + radiotherapy
Localised advanced (T3/4): Above + hormonal therapy
Metastatic
Anti-androgen therapy: Gosrelin to downregulate/bicalutamide to block
Bilateral orchidectomy
Docetaxel chemotherapy
What features raise suspicion of bladder cancer?
Older men who smoke and worked in textiles
Reporting recurrent urinary symptoms or painless haematuria
What is the first-line and definitive investigation for bladder cancer?
1st: CT-KUB
GS: TURBT
