Renal/Urology Flashcards by Liam Lennox

Prerenal AKI causes

Hypovlaemia

Renal artery stenosis

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Renal AKI causes

Glomerulonephritis
Acute tubular necorosis
Acute interstitial nephritis
Rhabdomylosis
Tumour lysis syndrome

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Post renal AKI causes

Kidney stones

BPH

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Diagnosis AKI

Renal US if no identifiable cause

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AKI treatment

Assess drugs
Loop diuretics for oedema
Treat hyperkalaemia

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Renal replacement therapy indications

Hyperkalaemia
Pulmonary oedema
Uraemia

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Drugs to stop in AKI

NSAID except aspirin
ACEI
ARB
Diuretic
Aminoglycoside
Metformin
Digoxin
Lithium

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AKI diagnostic criteria

Increase creatinine 26 in 48h
or increase >50% in 7d
or oligurea

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Staging criteria AKI

1) Creatinine 1.5-1.9x or oliguria >6h
2) Creatinine 2-2.9x or oliguria >12h
3) Creatinine 3x or oliguria >24h

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CKD classification

1) GFR > 90 and abnormal U and E/proteinuria
2) 60-90
3) 30-59
4) 15-29
5) <15

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Treatment anaemia in CKD

Optimise iron then erythropoitin stimulating agents

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Kind of anaemia in CKD

Normochromatic normocytic anaemia

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Bone profile in CKD

Decreased calcium
Increased PTH
Increased phosphate
Decreased vit D

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Treatment bone disease in CKD

1) Decrease dietary phosphate
2) Phosphate binders and vit D
3) Parathyroidectomy

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Treatment CKD hypertension

1) ACEI - rise in creatinine 25% acceptable

2) Furesemide

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Treatment proteinuria CKD

1) ACEI if ACR>30

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Identify nephrotic syndrome

Triad:

proteinuria
hypoalbuminaemia
oedema

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Diseases causing nephrotic syndrome

Minimal change disease
Membranous glomerulonephritis
Focal segmental glomerulonephritis

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Diseases cause nephritic syndrome

Rapidly progressive glomerulonephritis
IgA nephropathy
Alport syndrome

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Diseases causing mix of nephrotic and nephritic syndrome

Diffuse proliferative glomerulonephritis
Membranoproliferative glomerulonephritis
Post-strep glomerulonephritis

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Most common nephrotic syndrome

Children - minimal change

Adults - focal segmental glomerulosclerosis

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Identify hyperacute rejection

Minutes to hours

Needs removed

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Identify acute failure

<6m
Asymptomatic worsening renal function
Maybe reversible with steroids

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Identify chronic graft failure

> 6m

Recurrence original disease

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Identify acute interstitial nephritis

Caused by drugs - antibiotics, NSAID Allergic type picture Sterile pyuria and white cell casts on urinalysis

Identify ADPKD

``` Hypertension Stones CKD Liver cyst Berry aneurysm ```

Diagnosis ADPKD

Abdominal US

Treatment ADPKD

Tolvaptin

Identify alport syndrome

X linked, childhood presentation Renal failure Microscopic haematuria Bilateral sensorineural deafness

Identify anti-glomerular basement membrane disease (goodpasture)

Pulmonary haemorrhage | Rapidly progressive glomerulonephritis - proteinuria and haematuria

Diagnosis goodpasture

Renal biopsy

Treatment goodpasture

Steroids

Identify focal segmental glomerlunephritis

Linked HIV | Young males

Identify haemolytic uraemic syndrome

Young children classic triad: - AKI - haemolytic anaemia - thrombocytopenia

Treatment haemolytic uraemic syndrome

Suportive, no role antibiotics

Identify henoch schlein purpula

``` Children Rash on buttocks and extensors Arthritis Abdominal pain Maybe IgA nephropathy ```

Treatment henoch schlein purpula

Supportive

Identify IgA nephropathy

Within days of infection | Blood in urine

Identify post-strep glomurulonephritis

1 to 2 weeks after infection | Blood in urine

Identify membranous glomerulonephritis

Most common Associated malignancy Nephrotic syndrome Biopsy - thickened basement membrane and dense deposites

Treatment membranous glomerulonephritis

ACEI | Immunosuppresion

Identify minimal change disease

Nephrotic syndrome in children

Treatment minimal change disease

1) Steroids | 2) Cychlophosphamide

Identify rapidly progressive glomerulonephritis

Associated goodpasture and wegeners Nephritic syndrome Biopsy - epithelial cresents

Identify rhabdomyolysis

Often eldery fall | Huge rise CK

Treatment rhabdomyolysis

IV fluids maintain urinary output

Identify pre-renal uraemia instead of acute tubular necrosis

Prerenal - urine Na <20, urine osmolaty > 500 and response to fluid challenge is good, Urea to creatine serum is raised Acute tubular necrosis - urine Na >40, urine osmolarity <350, response to fluid challenge poor

Anion gap calculate

(Na + k) - (bicarbonate + Cl)

Normal anion gap

8-14

Daily fluid needs

25-30ml/kg/day water 1mmol/kg/day K, Na, Cl 50-100g/day glucose

Identify renal artery stenosis

Hypertension CKD Flash pulmonary oedema Increased renin

Calculate paeds fluid needs

100ml/24h first 10kg 50ml/24h next 10kg 20ml/24h/kg after

"Brown granular casts"

Acute tubular necrosis

"Red cell casts"

Nephritic syndrome

"Hyaline casts"

Normal, after exercise, fever

Acute urinary retention diagnosis

Prostate cancer histology

Adenocarcinoma

Prostate cancer diagnosis

Multiparametric MRI

Grading system for prostate cancer

Gleason

Treatment prostate cancer

Radical prosectomy and radiotherapy | Androgen receptor blockers and GnRH agonists

Complications prosectomy

Erectile dysfunction | Urinary incontinence

Most common renal stone

Calcium oxalate

Radio lucent renal stone

Urate

"ground glass" appearance renal stone

Cystine

Stag horn renal stone

Struvite

Renal stones diagnosis

CT KUB

Pain treatment in renal stones

IM diclofenac

Treatment renal stones

<5mm - expectant <2cm - shockwave lithotripsy <2cm and pregnant - ureteroscopy complex and staghorn - percutaneous nephrolithiostomy

"Whirlpool sign"

Testicular torsion

Diagnosis testicular torsion

Treatment BPH

1) Watchful waiting 2) Alpha1-antagonist - eg tamsulosin 3) 5a-reductase inhibitors - eg finasteride 4) Surgery

Mechanism tamsulosin

Decreases smooth muscle tone

Mechanism finasteride

Blocks conversion testosterone to dihydrotestosterone

Bladder cancer histology

Transitional cell carcinoma most common | Squamous cell carcinoma in schistosomiasis

Identify bladder cancer

Painless macroscopic haematuria

Diagnosis bladder cancer

Cystoscopy to visualise | MRI and CT to stage

Treatment bladder cancer

Low stage - TURP T2 - surgery High grade - chemo and radiotherapy

Renal carcinoma histology

Adenocarcinoma

Pareaneoplastic features of renal cancer

Polycythaemia Hypercalcaemia Hypertension Stauffers syndrome (abnormal LFTs without mets)

Diagnose renal cancer

Treatment renal cancer

T1 - partial nephrectomy T2 - radical nephrectomy Chemo and radiotherapy sometimes

Treatment bacterial prostatitis

Quinolone - ciprofloxacin

Most common cause prostatitis

E coli

Identify chronic urinary retention

High pressure - impaired renal function and bilateral hydronephrosis Low pressure - normal renal function and no hydronephrosis

Treatment epidymo-orchitis

Ceftriaxone IM followed by deoxycycline oral 14d

Diagnose erectile dysfunction

Testosterone 9-11am

Treatment erectile dysfunction

Sildenofil (viagra)

Treatment hydrocele

Refer for US to exclude tumour

Investigating hydronephrosis

US first | CT if suspect cancer

Treatment hydronephrosis

Acute - nephrostomy | Chronic - stent

Investigating genitourinary trauma

Urogram/cystogram

Testicular cancer most common

Germ cell tumours: - seminomas - non seminomas - yolk sac, teratoma, chariocarcinoma

What kind of testicualar cancer causes gynaemocastia

Germ cell - secretion hCG and AFP

AFP tumour marker for

Non seminomas testicular cancer

Renal/Urology Flashcards

(94 cards)