Prerenal AKI causes
Hypovlaemia
Renal artery stenosis
Renal AKI causes
Glomerulonephritis Acute tubular necorosis Acute interstitial nephritis Rhabdomylosis Tumour lysis syndrome
Post renal AKI causes
Kidney stones
BPH
Diagnosis AKI
Renal US if no identifiable cause
AKI treatment
Assess drugs
Loop diuretics for oedema
Treat hyperkalaemia
Renal replacement therapy indications
Hyperkalaemia
Pulmonary oedema
Uraemia
Drugs to stop in AKI
NSAID except aspirin ACEI ARB Diuretic Aminoglycoside Metformin Digoxin Lithium
AKI diagnostic criteria
Increase creatinine 26 in 48h
or increase >50% in 7d
or oligurea
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
CKD classification
1) GFR > 90 and abnormal U and E/proteinuria
2) 60-90
3) 30-59
4) 15-29
5) <15
Treatment anaemia in CKD
Optimise iron then erythropoitin stimulating agents
Kind of anaemia in CKD
Normochromatic normocytic anaemia
Bone profile in CKD
Decreased calcium
Increased PTH
Increased phosphate
Decreased vit D
Treatment bone disease in CKD
1) Decrease dietary phosphate
2) Phosphate binders and vit D
3) Parathyroidectomy
Treatment CKD hypertension
1) ACEI - rise in creatinine 25% acceptable
2) Furesemide
Treatment proteinuria CKD
1) ACEI if ACR>30
Identify nephrotic syndrome
Triad:
- proteinuria
- hypoalbuminaemia
- oedema
Diseases causing nephrotic syndrome
Minimal change disease
Membranous glomerulonephritis
Focal segmental glomerulonephritis
Diseases cause nephritic syndrome
Rapidly progressive glomerulonephritis
IgA nephropathy
Alport syndrome
Diseases causing mix of nephrotic and nephritic syndrome
Diffuse proliferative glomerulonephritis
Membranoproliferative glomerulonephritis
Post-strep glomerulonephritis
Most common nephrotic syndrome
Children - minimal change
Adults - focal segmental glomerulosclerosis
Identify hyperacute rejection
Minutes to hours
Needs removed
Identify acute failure
<6m
Asymptomatic worsening renal function
Maybe reversible with steroids
Identify chronic graft failure
> 6m
Recurrence original disease
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
US
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
US
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
CT
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
