Renal + urology Flashcards

Question

Calcium homeostasis

Answer 1

Absorption - GIT - Renal reabsorption Storage: - 99% calcium hydroxyapatite in the bones - Remainin 1% in cells + serum - Protein-bound - Chelated - for transport - Ionised - used in cellular signalling PTH: - Secreted in response to hypocalcaemia, from parathyroid glands (x 4) - Stimulates bone resorption - Increases renal calcium reasbsorption - Increases renal vitamin D activation Vitamin D - Increases in response to hypocalcaemia - Metabolised in two steps into 1,25-dihydroxyvitamin D - Increased expression of GIT calcium-binding proteins -> increased absorption - Stimulates bone resorption Calcitonin - Secreted from parafollicular C cells (thyroid) in response to hypercalcaemia - Inhibits bone resorption - Inhibits renal reabsorption of calcium

Answer 2

Levels are usually inverse to calcium High: - Aetiology - CKD, acidosis, tissue lysis, tertiary hyperparathyroidism Low: - Aetiology - primary hyperparathyroidism, refeeding syndrome, ETOH, Cushing's, alkalosis - Features - muscle weakness, tremor, infection, confusion, respiratory depression - Management - PO or IV replacement

Answer 3

Aetiology: - Malnutrition - Medications - diuretics, PPIs, ciclosporin, cisplatin - Osmotic loss - diabetes - Malabsorption - Prolonged GI suction, stoma, fistula etc. Features: - Fatigue - Weakness - Muscle cramps - Spasticity - Seizures Investigations: - U&Es + bone profile - Leads to hypokalaemia - ECG - prolonged QTc, tachy

Answer 4

Adrenal insufficiency - Hyponatraemia - Hyperkalaemia - Normal anion gap acidosis - Hypoglycaemia - Hypercalcaemia Hyperaldosteronism - Hypernatraemia - Hypokalaemia - Metabolic alkalosis Phaochromocytoma - beta-2 blockade - Hypokalaemia Sarcoidosis - ACE activity - Hypercalcaemia - Hypercalciuria Carcinoid syndrome - secretory diarrhoea - Hypokalaemia - Hypomagnesaemia - Normal anion gap acidosis Refeeding sybdrome - Hypophosphataemia - Hypokalaemia - Hypomagnesaemia - Hyperglycaemia Parenteral nutrition - Hyperglycaemia - Hyperlipidaemia - Normal anion gap acidosis Rhabdomyolysis - Hyperkalaemia - Hyperphosphataemia - Myoglobinuria - Raised CK, LDH Tumour lysis syndrome - Hyperkalaemia - Hyperphosphataemia - Hypocalcaemia - Hyperuricaemia - Raised anion gap acidosis - Raised LDH Toxic alcohols (e.g. ethylene glycol) - Hypocalcaemia - Raised anion gap acidosis - Raised serum osmolar gap Lithium toxicity - Hypernatraemia - Low anion gap acidosis Salicylate toxicity - High anion gap acidosis - Hypokalaemia - Hyperkaluria

Answer 5

Membraneous GN - Pencillamine - Gold - Captopril (Acute) interstitial nephritis - Penicillins - Cephalosporins - NSAIDs - Allopurinol - Phenytoin - PPIs Renal tubular damage: - Amphotericin - Heavy metals - incl. mercury, lithium - Cisplatin - Aminoglycosides - Vancomycin - NSAIDs - Aciclovir

Answer 6

Renal tubular cell damage (+/- death) which initially causes AKI but can lead to strictural injury Aetiology: - Reduce renal perfusion e.g. hypovolaemia, sepsis - Nephrotoxic medications Pathology: - Loss of brush border - Tubular cell vacuolation and sloughing - Typically Na+ wasting Features - three phases: - Initiation - Oliguria - Uraemia - Maintenance - Worsening oliguria and uraemia - Hyperkalaemia - Acidosis - Fluid overload - Recovery - Polyuria - massive loss of Na+ and K+ - Hypokalaemia Investigations: - Urine analysis - Urine Na+ > 40 - Urine osmolality < 350 - Microscopy - brown epithelial casts + free epithelial cells - Fluid balance - Bloods - Renal US normal

Answer 7

Aetiology: - Infection - Medications e.g. NSAIDs, PPIs, antibiotics Features: - AKI - HTN - Rash - Eosinophilia - Fever - Flank pain - from swelling and stretch of the renal capsule

Answer 8

Fibrosis and dysfunction secondary to chronic or repeated insults Aetiology: - Heavy metals - Nephrocalcinosis - Chronic hyperkalaemia - Medication e.g. analgesics

Answer 9

Both freely filtered by the tubules but urea should be reabsorbed in a regulated fashion whereas creatinine is not Normal ratio 40-110:1 Used to define types of AKI: - > 110:1 = prerenal - 40-110:1 = post-renal - < 40:1 = intrinsic

Answer 10

Azotaemia = increased non-nitrogenous waste products in the blood (usually proteinaceous) Uraemia = increased urea in the blood Azotaemia will precede uraemia Features: - Azotaemia - Fatigue - Muscle weakness - Nausea/vomiting - Uraemia - Itching - Pericardial effusion - Encephalopathy - Stomatitis or parotitis - Tremors - Peripheral neuropathy

Answer 11

Aetiology: - Diabetic nephropathy (44%) - HTN (27%) - Glomerulonephritis (8%) - Other - Cystic disease - Urological - Infection - malaria, schistosomiasis Classification - eGFR + ACR: G stage: - Stage 1 - Preserved eGFR + abnormal ACR - Stage 2 - eGFR 60-89 + abnormal ACR - Stage 3 - A = eGFR 45-50 - B = eGFR 30-44 - Stage 4 - eGFR 15-29 - Stage 5 - eGFR < 15 or requiring RRT A stage - A1 - ACR < 3 - A2 - ACR 3-30 - A3 - ACR > 30

Answer 12

Pathophysiology: - Reduced vitamin D activation + reduced secretion of phosphate leads to hyperphosphataemia - High phosphate leaches calcium out of bones causing osteomalacia - Compensatory response includes PTH secretion Aim of treatment is to treat high PTH and high phosphate - Reduced dietary phosphate - Phosphate binders - Activated vitamin D supplements e.g. alfacalcidol

Answer 13

Usually 4hr sessions, 3x a week Access: - AV fistula in the non-dominant hand - 6-8 weeks to mature - Ideally formed several (6) months prior to need - Tunneled dialysis line - Only if fistula fails or severe vascular disease Complications - Fistula stenosis or thrombosis - Line infection - Steal syndrome - Redirection of blood leading to hand ischaemia - Hypotension - Arrhythmias - Dialysis disequilibrium syndrome - Cerebral oedema secondary to rapid fall in urea - Headache, confusion, focal neurology - Anaphylaxis - Usually to dialysis membrane - Accelerated cardiovascular disease

Answer 14

Utilisation of the peritoneum as a semipermeable membrane to dialyse the blood Performed daily but can be done at home - Requires generally good health (no cardiac comorbities) - Preferred if have a residual renal function Complications: - Exit site infection - Peritonitis - Fatigue, headache, cramps, etc.

Answer 15

A slower type of dialysis which reduces the haemodynamic shifts associated Allows removal of both fluid and solutes Continuous venovenous haemofiltration or haemodialysis - Dialysis = gradients alone, filtration = pressure Indications: - Pulmonary oedema or pericardial effusion resistant to diuresis - pH < 7.2 - Persistent K+ > 6.5 or other severe eletrolyte abnormalities - Symptomatic uraemia

Answer 16

- Gout - Lesch-Nyhan syndrome - Congenital disorder of purine metabolism - Tumour lysis syndrome - High purine diet - Hyperparathyroidism - Lead posioning - Downs syndrome - Exercise - Starvation - Medications e.g. thiazides, salicylates, ETOH

Answer 17

Includes both AKI and CKD developed on a background of liver cirrhosis with no other cause for renal impairment Aetiology: - Acute - SBP, GI bleed, ETOH, acute liver failure, large volume ascites paracentesis - Chronic - liver decompensation Pathophysiology: - Hypoalbuminaemia + splanchnic vasodilation -> fall in systemic BP -> renal hypoperfusion - RAAS activates and cannot deactivate leading to worsening renal perfusion and impairment Management: - Aim to restore euvolaemia + splachnic vasoconstriction - HAS + terlipressin - TIPS - Liver transplant

Answer 18

High anion gap (CAT MUDPILES) - > 12 - C - CO, CN - A - alcoholic and starvation ketoacidosis - T - toluene - M - metformin, methanol - U - uraemia - D - diabetic ketoacidosis - P - paracetamol, propylene glycol - I - iron, isoniazid, IEM - L - lactic acidosis - E - ethylene glycol - S - salicylates Normal anion gap (CAGE) - NB hypercholraemic acidosis (Cl - replacing HCO3 - ) or HCO3 loss - C- chloride excess - A - acelazolamide, adrenal insufficiency - G - GI e.g. diarrhoea, vomiting, fistulae - E - extras e.g. RTA

Answer 19

A rare cause of raised anion gap acidosis Aetiology: - Short bowel syndrome - SIBO - Jejuno-ileal bypass Pathophysiology: - Malabsorptive state - carbohydrate is taken up and metabolised by abnormal colonic flora, producing D-lactate - D-lactate competes with pyruvate in the heart and brain (although can be used and metabolised in the liver) Features: - Reduced GCS / confusion - Ataxia - Coma - Heart arrhythmias or block Investigations: - Serum D-lactate levels - not seen on standard assays

Answer 20

Aetiology: - Membraneous glomerulonephritis - Minimal change disease - SLE - FSGS - Mesangiocapillary glomerulonephritis - Amyloidosis - IgA glomerulonephritis Features: - Hypoalbuminaemia (< 35) - Proteinuria (> 3.5g/day) - Oedema - Hypercoagulability - Hyperlipidaemia - High cholesterole + LDL, normal HDL - Immunodeficiency - esp. pneumococcal infections, loss of IgG - Hypothyroidism - loss of thyroid-binding protein - Vitamin D deficiency - loss of vitamin D binding protein - Abdominal pain - from splanchnic ischaemia Investigations: - Urine - Dipstick - Protein-creatinine ratio - 24h protein collection - Bloods: - Routine - Lipid profile - Serology - syphilis, HIV, hepatitis, autoimmune - Myeloma screening - Increased alpha- and beta-globulin fractions - Renal biopsy Management: - Treat underlying cause - Fluid + salt restriction - Diuresis - furosemide, ACEi (anti-proteinuric) - Anticoagulation

Answer 21

Aetiology: - Idiopathic (up to 85%) - SLE - Infection - malaria, HBV/HCV - Drugs - pencillamine, NSAIDs, gold - Malignancy (10%) Pathology: - Generalised thickening of the glomerular basement membrane - Subepithelial deposition of IgG and C3 Management: - Diuretics + fluid restriction - Anticoagulation + aspirin - ACEi/ARBs - Immunosuppression if no improvement after 6 months - cyclophosphamide, tacrolimus, biologics Prognosis: - 25% spontaneous remission - 25% partial remission - 50% progressive renal impairment

Answer 22

Aetiology: - Severe dehydration - e.g. neonate in NICU with insufficient feed - Hypercoagulability - Cancer, nephrotic syndrome, polycythaemia, protein C deficiency Features: - Flank pain - Renal enlargement - Haematuria - Worsening renal function Investigations: - Renal USS - CT angio Management: - Hydration - Anticoagulation

Answer 23

A syndrome of worsening renal failure associated with haematuria, non-nephrotic proteinuria, and hypertension Aetiology: - Paeds: - IgA nephropathy - PSGN - HSP - HUS - Adults - Above causes - Autoimmune e.g. SLE, Goodpasture's, vasculitis - RPGN - MPGN - Infective endocarditis - Cryoglobulinaemia Features: - Hypertension - Renal impairment - Haematuria - Flank pain Investigations - Urinalysis - Bloods - Renal biopsy - Commonly crescenteric appearance - Immunofixation

Answer 24

The most common type of glomerulonephritis in adults - 20-40% progress to CKD Aetiology: - 1-2 days following URTI, pneumonia, tonsillitis or gastroenteritis - Post-immunisation - Some association with coeliac disease and cirrhosis Pathology: - Hypercellular mesangium + crescenteric appearance - Granular IgA + C3 deposition Features: - HTN - Visible haematuria - May worsen with exercise - AKI or CKD - High serum IgA (in 50%) Management: - Immunosuppression - steroids - Consider tonsillectomy if tonsillitis is a trigger

Answer 25

Aetiology: - Most commonly post-streptococcal - Typically children, 1-2 weeks after infection - Can be viral, fungal, etc. Pathology: - Type III hypersensitivity reaction - Hypercellular mesangium - IgG + C3 deposition Features: - Haematuria - AKI - HTN - Can also present with proteinuria + oedema Investigations: - Urine MCS - Haematuria with RBC casts - Streptolysin-O titre - Complement levels - low C3 Management: - Usually self-limiting with only supportive care required

Answer 26

Epidemiology: - 8-30 yrs - M > F Aetiology: - Idiopathic - Infection - Viral - HIV, HBV/HCV - Bacterial - TB, infective endocarditis - Autoimmune - any immune complex deposition disease - Cryoglobulinaemia, SLE, scleroderma - Malignancy - Leukaemia and lymphoma Pathology: - BM splitting allows mesangial cell cytoplasm to spread between the endothelium and basement membrane - Appears as mesangial cell proliferation + subendothelial thickening Features: - Can present as nephrotic syndrome, nephritic syndrome, or more subtle progressive renal failure Investigations: - Low complement levels Prognosis - 50% progress to ESRF at 10 yrs - Fluctuant disease severity

Answer 27

Aetiology: - Associated with atopy, infection, malignancy, and drugs (NSAIDs) Pathology: - No obvious change on standard microscopy - Effacement of the podocyte foot processes Features: - Massive oedema - Foamy urine - Nephrotic syndrome Management: - Steroids should induce rapid remission

Answer 28

Aetiology: - Idiopathic - M > F, African ethinicity - Drugs - Heroin - Lithium, steroids, doxorubicin - Infection - HepB/C, HIV, CMV - Other - Obesity, diabetes Pathology: - Focal and segmental sclerosis - IgM + C3 positive - Foot process effacement Features: - Paeds - nephrotic syndrome - Adults - spectrum of nephrotic and pre-nephrotic syndromes Investigations: - Urine MCS - Casts + protein - Renal biospy Management: - 1st line - steroids - 2nd line - calcineurin, mycophenolate, rituximab Prognosis: - Usually leads to progressive renal dysfunction - Prognosis worse in idiopathic cases

Answer 29

Epidemiology: - Peaks at 4-6yr - 90% of cases are in under-10s - Rare in both adults and infants Pathophysiology - IgA vasculitis, usually triggered by preceding illness or vaccination Features: - Low-grade fever - Lower limb purpura - Abdominal pain - Arthralgia - Bloody diarrhoea - Renal dysfunction (IgA nephropathy, nephrotic picture) Management: - Usually self-limiting, within 4 weeks - Supportive Prognosis: - Rarely leads to permanent kidney damage (<1%)

Answer 30

Secondary to shiga toxin or shiga-like toxin, predominantly produced by gastrointestinal pathogens - Usually 5 days after onset of diarrhoea Features: - Preceding profuse diarrhoea, turning bloody after 1-3 days - Haemolytic anaemia - Thrombocytopenia - AKI with uraemia - (Also abdo pain, confusion, lethargy) Investigations: - Blood film - Schistocytes, thrombocytopenia - DAT+ Management: - Supportive care +/- dialysis - Avoid antibiotics where possible Complications: - Abdominal pain - Perforation or strictures - Pancreatitis - Myocarditis or cardiomyopathy - Retinal haemorrhage - Kidney failure

Answer 31

Anti-GBM disease affecting both kidneys and lungs - antibodies against type IV collagen Risk factors: - HLA-DR15 - Cocaine use - Smoking - Infection (esp. influenza) Pathology: - Crescenteric glomerulonephritis - Linear IgG deposition along basement membrane Features: - Renal disease - Nephritic syndrome with acute renal failure - Pulmonary disease - Haemoptysis + alveolar haemorrhage Management: - Many (esp. younger patients) may present in acute respiratory failure + AKI - Induction = Prednisolone + cyclophosphamide + plasmapheresis

Answer 32

Wilson's disease - Fanconi syndrome -> type II RTA - Basal ganglia dysfunction - Peripheral neuropathy Hypertension - CKD - Hypertensive encephalopathy Haemolytic uraemic syndrome - AKI - Uraemic encephalopathy SLE - Lupus nephritis - typically diffuse sclerosis + crescenteric glomerulonephritis - Encephalitis, neuropathies, seizures Alport syndrome - FSGS with micro- and macroscopic haematuria - Sensorineural deafness APCKD - Renal cysts + CKD - Berry aneurysms, SAH Sickle cell anaemia - Nephropathy with varying appearances - renal papillary necrosis, FSGS - Renal medullary carcinoma - Stroke Lead poisoning - Fanconi syndrome -> type II RTA - Raised ICP Tuberous sclerosis - Renal cysts - Angiomyolipoma can cause HTN and AKI - Seizures - Intellectual impairment Neurofibromatosis - Renal artery stenosis - Learning difficulties Posterior reversible encephalopathy syndrome (PRES) - HTN with AKI/CKD - Seizures, delirium, visual changes

Answer 33

Aetiology: - Kidney - e.g. cancer, stone, infarction, cysts, GN - Bladder - e.g. cancer, cystitis, stones, tear - often terminal +/- pain - Prostate - e.g. BPH, varices, post-RT - painless, can be initial or terminal - Urethra - dribbling Also several transient causes - UTI, period, beetroot, exercise, rifampicin, anticoagulants Investigations: - Urine dip +/- MCS - Bloods incl. clotting - Renal USS or CT renal w/ contrast - Flexi-cystoscopy Management: - Exclude transient causes - 2ww - if > 45 with VH or > 60 with non-VH

Answer 34

Risk factors: - Male - testosterone increases liver oxalate production - women have higher urinary citrate - Family history - Dehydration - esp. urate and cysteine stones - High oxalate diet - meat, spinach - Hypercalciuria - RTA, hyperparathyroidism Types: - 80-85% calcium oxalate - 10% mixed calcium oxalate/phosphate - 5-10% urate - 2-20% struvite - 1% cysteine Investigations: - Urine dip - Microscopic haematuria - r/o possible UTI -> struvite stones - CT KUB - Radio-opaque: Ca phos > ca oxalate > cysteine > struvite > uric acid Management: - Analgesia - PR diclofenac, tamsulosin - < 5mm - Watch and wait - < 2cm - Lithotripsy, or ureteroscopy if pregnant - > 2cm, obstructive, staghorn - Percutaneous nephrolithotomy +/- nephrostomy

Answer 35

Autosomal recessive disorder - Impaired renal and GI transport of dibasic amino acids (cysteine, ornithine, arginine, lysine) Features: - Up to 3% will produce cysteine renal stones (radio-translucent) - Yellow/brown hexagonal crystals on MCS - Postive urinary cyanide nitroprusside test Management: - High fluid intake - Urinary alkalisation - bicarbonate/citrate

Answer 36

Epidemiology: - Autosomal dominant mutations in PKD 1/2 - Presents between 30-50 yr Pathophysiology: - Polycystin-1/2 mutations lead to dysfunction of cilia and cell junctions - Form large fluid-filled cysts which cause ischaemic atrophy of surrounding parenchyma as well as obstruction of tubules Features: - Polycystic kidneys - Prone to infection, haemorrhage, etc - Progressive renal dysfunction - HTN, oedema, stones - Liver cysts (33%) - Berry aneurysms (30%) - Aortic root dilatation - With associated MR, TR, etc. - Increased risk of renal adenomas Investigations: - Urinalysis + bloods - Imaging - Renal US, CT, MRI - Genetic testing Management: - Early - Monitoring - Antihypertensives - Hydration - Late - Requires RRT - dialysis or transplant

Answer 37

Infectious: - Renal TB - Perinephric abscesses - Chronic prostatitis - Fungal UTIs Non-infectious: - Drugs - lithium, heavy metal toxicity - Renal stones - Sarcoidosis - Interstitial cystitis - Polycystic kidney disease - Urinary tract malignancies - Renal transplant rejection

Answer 38

Hyaline - Not pathological if occurring in isolation Red cell casts - Always pathological, usually an underlying glomerulonephritis White cell casts - Acute pyelonephritis or interstitial nephritis Granular casts - Tubular or interstitial disease, although finely granular casts can be normal in paeds

Answer 39

Benign: - Adenoma - symptomless Malignant: - Renal cell carcinoma (80% of adult) - M > F - Asytmpomatic, haematuria (50%), loin ache (40%), loin mass (25%), unilateral varicocele (1%) - Paraneoplastic manifestations possible - HTN (renin), hypercalcaemia (PTH), polycythaemia (EPO) - Nephroblastoma - Most common paediatric renal cancer Metastases: - Generally rare but can be from breast, lung, or haematological malignancies

Answer 40

Epidemiology: - 90% urothelial carcinoma - Middle-aged - Risks - smoking, long-term catheterisation, beta-naphthylamine exposure - Squamous cell carcinoma - Associated with schistosomiasis Features: - Painless haematuria - LUTS - frequency, urgency, dysuria - Possible spread to other pelvic viscera Investigations: - Urine dip - Bloods - Flexi-cystoscopy +/- CT KUB for staging Management: - Superficial = resection + BCG + mitomycin C - Muscle-invasive = platinum chemotherapy + cystectomy -

Answer 41

Similar types and causes as renal stones, many will be formed in kidney and pass into bladder Bladder-unique causes include foreign body (catheter) or stasis (stricture, BPH, atony) Features: - Pain - Suprapubic, perineal, or tip of penis - Worse at end of micturition (bladder contracted) - Urinary frequency - Worse during the day as upright position allows stone to irritate the trigone - Terminal haematuria

Answer 42

Air or bubbles in the urine, or a history of sputturing passage of urine Aetiology: - Colovesical fistula - Diverticular disease (80%), IBD, colorectal or bladder cancer - Often also have faecuria - Air-forming UTIs Investigations: - Urine dip + culture - Renal US - CT +/- PR contrast - Colonoscopy

Answer 43

Epidemiology: - Mostly boys aged 10-15 yr - Uncommon in over-30s Features: - Sudden unilateral testicular pain - Although may have non-specific abdo pain - Nausea and vomiting - Tender swollen testis - High in scrotum - Oedematous + erythema Management: - Urgent surgical exploration +/- fixation or orchidectomy - Must happen within 1hr - Ischaemia occurs within 4hr but testis can be salveagable up to 8hr after pain Differentials: - Torted hydatid cyst or epididymal appendix

Answer 44

Aetiology: - Bacterial infection: - Younger men = chlamydia, Older men = E. coli - Viral infection incl. mumps Features: - Gradual onset unilateral pain and swelling - Initially epididymis thickened + tender, then hemiscrotum becomes oedematous and erythematous - Fever - Dysuria - Lymphadenopathy Management: - IV fluids - Antibiotics - 2-6 weeks - May form abscesses requiring IV gentamicin + surgical drainage

Answer 45

Necrotising fasciitis of the scrotum, perineum, and/or perianal region - Often spread from a urinary or anorectal infection Management: - Urgent surgical debirdement - Catheterisation if penile involvement - IV antibiotics

Answer 46

Seen in patients with spinal cord injury above the level of T6 Symptoms most commonly triggered by bladder problems e.g. calculi, UTI, instrumentation Symptoms: - Hypertension - Bradycardia - Flushing + diaphoresis - Palpitations - Blurred vision

Answer 47

Aetiology: - Infection - Bacterial - STIs - Fungal - candida - Increased risk with diabetes or HIV Features: - Penile soreness + itch - Bleeding + odour from foreskin - Dysuria + dyspareunia - Redness, swelling, and exudate over glans - Tightening or phimosis of the foreskin Investigations: - Urine dip - Foreskin swab - for candida and STIs Management: - Avoid triggers - Clean daily with water - Topical hydrocortisone + imidazole cream - Flucloxacillin if confirmed bacterial infection

Answer 48

Epidemiology: - Over-50s - Most common cancer in men Investigations: - DRE - hard, craggy surface - PSA - >20 ng/ml suggestive of disseminated disease - Imaging: - Multiparametric MRI - Transrectal USS for biopsy - Bone scan if PSA > 20 or bony pain Gleeson scoring: - Based on the tissue architecture - Scores <= 6 suggest low risk, 7 is intermediate, >= 8 is high risk Management: - Watch and wait - If low risk, well-differentiated, no mets, life- expectancy < 10yr - Radial prostatectomy and/or radiotherapy - removal of prostate, seminal vesicles, pelvic lymph nodes - GnRH antagonists - symptom relief in metastatic disease

Answer 49

Germ cell tumours - Risk factors - undescended testis, dysgenesis, genetics - Seminoma (50%) - Less aggressive, usually curable with orchidectomy - NSGCT - Teratoma - Yolk sac - Most common testicular cancer in children - Testicular much less aggressive than ovarian - AFP secretion - Choriocarcinoma - Highly aggressive - bHCG secretion - Embryonal Non-germ cell tumours - Lymphoma

Answer 50

A vascular compression disorder - compression of the L renal vein - Usually between SMA and aorta Can be anatomical but can also be secondary to retroperitoneal or pancreatic cancers or AAA Features: - Renal venous hypertension - Flank pain - Haematuria - Increased risk of renal vein thrombosis Investigations: - Urine dip - CT abdomen

Answer 51

Aetiology - Idiopathic (70%) - Drugs - methylsergide, etanercept - Malignancy - AAA Features: - Malaise - Back pain - Normocytic anaemia - Uraemia - Raised ESR Investigations: - Bloods - Anaemia, uraemia, raised ESR - CT/MRI - Bilateral ureteric obstruction at level of pelvic brim +/- periaortic mass Management: - Surgery with biopsy + ureteric stenting - Trial of long-term steroids or steroid-sparing agents

Answer 52

Features: - Recurrent UTIs - HTN - Premature renal impairment - Renal atrophy Investigations: - Urinalysis - proteinuria - Imaging - VCUG Management: - Intermittent antibiotic therapy - Surgical correction of any anatomical abnormalities

Answer 53

Aetiology: - Enteric - short bowel syndrome - Dietary - meat, spinach - Male sex - testosterone Features: - Recurrent oxalate stones Management: - Hydration - Calcium supplementation (binds excess free oxalate to enhance excretion) - Low oxalate diet

Answer 54

Hyperacute - Presence of recipient antibodies against the donor kidney - Features: - Within minutes of revascularisation - Kidney swelling + discolouration - RBC clumping + haemorrhage, fibrin deposition - Management: - Transplant nephrectomy Acute - Within 4 weeks of transplant - Either cell-mediated or antibody-mediated - Management: - Increased immunosuppressive therapy Chronic - > 3 months after transplant - Gradual worsening of kidney function - HTN, proteinuria are key markers - Usually due to transplant vasculopathy

Answer 55

A rare and aggressive form of chronic pyelonephritis Histology: - Enlarged kidney - Destruction and replacement of renal and peri-renal tissue with granulomas and lipid-rich macrophages Features: - Weight loss - Flank pain and mass - Fevers - Anorexia Investigations: - CT abdomen - Replacement of renal parenchyma with rounded, low-density areas surrounded by a ring of enhancement Management: - Antibiotics in acute phase, nephrectomy in chronic phase

Answer 56

The spectrum of SLE-associated renal disease characterised by diffuse immune complex deposition - Immune deposits along tubular and glomerular basement membranes - Subendothelial, subepithelial, and mesangial deposits - Tubular reticular structures on EM - Systemic depletion of complement Class I - Minimal mesangial lupus nephritis Class II - Mesangial proliferative lupus nephritis Class III - Focal lupus nephritis Class IV - Diffuse lupus nephritis Class V - Membraneous lupus nephritis Class VI - Advanced sclerotic lupus nephritis

Answer 57

A cause of renovascular HTN - 5% of all HTN Features: - Occult HTN with hypertensive eye disease - Periodic pulmonary oedema - Mild hypokalaemia - Worsening renal function post-ACEi - RAAS overactivation Investigations: - Urine - Bloods - Renal US - normal - Renal angiography - arterial stenosis, often in a rosary bead appearance Management - HTN control - ACEi / ARBs - Angioplasty Prognosis: - Variable course and may not progress (vs atherosclerotic disease)

Answer 58

Initial formation of glomerular granulomas which eventually rupture and lead to medullary disease Features: - Sterile pyuria - Haematuria - Dysuria - Refractory HTN - Renal calcification Management: - Anti-mycobacterial agents

Answer 59

aka benign urinary frequency Aetiology: - Idiopathic - esp paeds - Drugs - risperidone Features: - Increased daytime urinary frequency - Enuresis - Urinary incontinence

Renal + urology Flashcards

(83 cards)