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Renal/urology Flashcards

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1
Q

What is the definition of AKI?

A

Rise in creatinine of >25 micromol/l in 48 hours

Rise in creatinine of more than 50% in 7 days

Urine output of <0.5ml/kg/hour

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2
Q

Name some risk factors for AKI

A

Older age, sepsis, CKD, heart failure, diabetes, liver disease, medications

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3
Q

Name some common medications that can increase the risk of AKI

A

NSAIDs, gentamicin, diuretics, ACE inhibitors, contrast agents

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4
Q

Name some pre-renal causes of AKI

A

Dehydration, shock, heart failure, sepsis

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5
Q

Name some renal causes of AKI

A

Acute tubular necrosis, glomerulonephritis, acute interstitial nephritis, haemolytic uraemic syndrome, rhabdomyolysis

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6
Q

Name some post renal causes of AKI

A

Kidney stones, tumours, BPH, neurogenic bladder, strictures in urethra etc.

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7
Q

What is acute tubular necrosis?

A

Damage and death of the epithelial cells in the renal tubules due to ischaemia/hypoperfusion/nephrotoxins

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8
Q

What is seen in urinalysis of someone with acute tubular necrosis?

A

Muddy brown casts on urinalysis

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9
Q

How can you prevent AKI?

A

Avoid nephrotoxic drugs where appropriate, ensure adequate fluid intake, additional fluids before contrast

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10
Q

How do you manage AKI?

A

Reverse the underlying cause, IV fluids, withhold medication that may worsen condition, dialysis may be required in severe cases

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11
Q

What is CKD?

A

Progressive and permanent decrease in kidney function

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12
Q

What are the causes of CKD?

A

Diabetes, hypertension, age related decline, glomerulonephritis, polycystic kidneys, medications, renal artery stenosis

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13
Q

What are the symptoms associated with high urea/poor kidney function

A

Itching, loss of appetite, nausea, oedema, muscle cramps, peripheral neuropathy, pallor, hypertension

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14
Q

How do you confirm the diagnosis of CKD?

A

eGFR - two tests are required 3 months apart to confirm diagnosis

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15
Q

What are the stages and associated eGFRs?

A

Stage 1 = eGFR >90
Stage 2 = eGFR 60-89
Stage 3a = eGFR 45-59
Stage 3b = eGFR 30-44
Stage 4 = eGFR 15-29
Stage 5 = eGFR <15 (end stage)

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16
Q

How do you treat hypertension in those with CKD?

A

ACE inhibitors are 1st line

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17
Q

What is a significant result in urine albumin:creatinine?

A

> 3mg/mmol

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18
Q

What supportive management can be offered to those with CKD?

A

Optimise hypertensive/diabetic control, dietary advice regarding water and electrolyte intake, iron supplementation and EPO to treat anaemia

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19
Q

Why is CKD associated with anaemia?

A

Healthy kidneys produce EPO which stimulate production of RBC, in CKD this process does not occur as well –> anaemia

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20
Q

Why with CKD associated with bone disease?

A

High serum phosphate occurs due to reduced phosphate excretion

There is low vitamin D as the kidneys are essential in metabolising vitamin D

Active vitamin D is essential in calcium absorption from intestines and kidneys

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21
Q

How do you treat renal related bone disease?

A

Active vitamin D
Low phosphate diet
Bisphosphonates for osteoporosis

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22
Q

What is the preferred method for delivering long term dialysis?

A

Haemodialysis via AV fistula

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23
Q

What are the symptoms of nephritic syndrome?

A

Haematuria, oliguria, proteinuria (<3g), fluid retention

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24
Q

Why does nephrotic syndrome occur?

A

The basement membrane in the glomerulus becomes highly permeable resulting in significant proteinuria

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25
What are the symptoms of nephrotic syndrome?
Proteinuria, low serum albumin, peripheral oedema, high cholesterol, frothy urine
26
What is the most common cause of nephrotic syndrome in children and adults?
Children = minimal change disease Adults = membranous nephropathy
27
What is IgA nephropathy?
Nephritic syndrome that can occur 1-2 days after URTI
28
What is post-strep glomerulonephritis?
Nephritic syndrome that occurs 1-3 weeks following a strep infection
29
What is the pathology of anti-GBM?
Anti-GBM antibodies attack the glomerulus and pulmonary basement membranes causing pulmonary haemorrhage and glomerulonephritis
30
What systemic disease can cause glomerulonephritis?
HSP, vasculitis, lupus nephritis
31
What is renal tubular acidosis?
Metabolic acidosis due to imbalance of the hydrogen and bicarbonate ions
32
What is the pathology of type 4 renal tubular acidosis (most common)?
Caused by reduced aldosterone which leads to insufficient potassium and hydrogen ion excretion in the distal tubules (diabetes is most common cause)
33
What is the pathology of HUS?
Thrombosis in small vessels throughout the body triggered by shiga toxins for shigella or E.coli 0157
34
What is the triad of findings in HUS? | And what symptoms does that cause?
Haemolytic anaemia, AKI, thrombocytopenia --> Fever, abdo pain, lethargy, pallor, reduced urine output, haematuria, hypertension, bruising, jaundice, confusion
35
What is the management for HUS?
Supportive care - IV fluids, treat hypertension, blood transfusions, haemodialysis
36
What is released in rhabdomyolysis?
Myoglobin, potassium, phosphate and CK CK >10000
37
What are the causes of rhabdomyolysis?
Prolonged immobility, extremely vigorous exercise, crush injuries, seizures, statins
38
What are the symptoms associated with rhabdomyolysis?
Muscle pain, muscle weakness, reduced urine output, red brown urine, fatigue, confusion
39
What is the management of rhabdomyolysis?
IV fluids, treat any hyperkalaemia
40
What extra-renal manifestations are associated with PKD?
Cerebral aneurysms, cysts on liver/spleen/pancreas/ovaries, mitral regurg, colonic diverticula
41
Which type of PKD is worse?
Autosomal recessive is more severe and often leads to renal failure before adulthood
42
What treatment is done for people with PKD?
Antihypertensives, analgesia, antibiotics, drainage of cysts, dialysis, renal transplant, screen for complications
43
What symptoms are associated with BPH?
Hesitancy, weak flow, urgency, frequency, intermittency, straining, terminal dribbling, incomplete emptying, nocturia
44
What is done to assess someone with/for BPH?
International prostate scoring system, DRE (large but smooth with intact central sulcus), urinary frequency volume chart, urine dip, bloods including PSA
45
What lifestyle advice can be given to someone with BPH?
Reduce caffeine/alcohol, avoid large fluid intakes in evening, avoid constipation, bladder retraining
46
What medications can be given to men with BPH?
Alpha blockers - tamsulosin (fast acting) 5-alpha reductase inhibitors - finasteride (can take up to 6 months)
47
What surgical options are available for men with BPH?
TURP is main one and most common
48
Which zone of the prostate are the majority of prostate cancers found?
Peripheral zone
49
What would a prostate feel like in someone with prostate cancer?
May feel firm, hard, asymmetrical, craggy, loss of central sulcus
50
What are the 1st line and definitive investigations for prostate cancer?
1st line = mutliparametric MRI Definitive = prostate biopsy
51
Where does prostate cancer spread to?
Lymph nodes, bones, lungs, liver
52
What options are there for managing prostate cancer?
Active surveillance, watchful waiting, radiotherapy, brachytherapy, hormone therapy (used in non-local disease), surgery
53
What are the two types of testicular cancer?
Seminomas Non-seminomas (usually teratomas)
54
What are the risk factors for testicular cancer?
Undescended testes Male infertility Family history Low birth weight Infantile hernia Kleinfelter's syndrome
55
What are the features of testicular cancer lumps?
Painless, arising from testicle, hard, irregular, no transillumination
56
What tumour markers are used for testicular cancer?
Alpha fetoprotein Beta-hCG LDH - non-specific
57
What is the management for testicular cancer?
Surgery to remove testicle, chemotherapy (if advanced or adjuvant to prevent recurrence), radiotherapy
58
What is the most common type of bladder cancer in the UK?
Transitional cell carcinomas (95%) SCC (5%)
59
What are the main risk factors for bladder cancer?
Smoking and increased age, aromatic amines found in dye and cigarette smoke
60
What symptoms are associated with bladder cancer?
Painless haematuria >45 with visible haematuria =2ww >60 with microscopic haematuria plus dysuria or raised WCC =2ww
61
What investigations are used in bladder cancer?
Flexible cystoscopy + biopsy and CT urogram
62
What is the management for bladder cancer?
TURB, intravesical chemotherapy/BCG, radical cystectomy Chemo + radiotherapy may be used
63
What is the triad of symptoms associated with RCC?
Haematuria, flank/loin pain, palpable mass
64
What risk factors are there for RCC?
Smoking, obesity, hypertension, end-stage renal failure, male
65
What is the classical metastasis for RCC?
Cannonball mets in the lung (spreads via inferior vena cava)
66
What paraneoplastic features are associated with RCC?
Polycythaemia = due to secretion of unregulated EPO Hypercalcaemia - due to secretion of a hormone that mimics action of PTH Hypertension - due to increased renin Stauffer's syndrome - abnormal LFTs without liver mets
67
What investigations are done in RCC?
USS - can differentiate cyst from tumour CT scan - senstitive for small tumours Excretion uropathy
68
What is the management of someone with RCC?
Surgery - partial or total nephrectomy Arterial embolisation, ablation, percutaneous cryotherapy
69
Where do renal stones most commonly get stuck?
Vesico-ureteric junction
70
What is the most common type of renal stone and what are the other types?
Calcium stones (80%) Uric acid Struvite (associated with staghorn calculus) Cystine (associated wtih geentic condition that leads to high cystine levels in urine --> recurrent renal stones)
71
What are the symptoms of renal stones?
Renal colic - unilateral loin to groin pain, fluctuates in severity as the stone moves and settles May also have haematuria, N+V, sepsis
72
What is the first line investigation in someone with renal colic?
Non-contrast CT KUB (within 24 hours)
73
What type of analgesia is given in renal colic?
IM/PR diclofenac (if renal function allows) IV paracetamol if not suitable for NSAIDs
74
When are surgical interventions required for renal stones?
10mm or larger or do not pass spontaneously or where there is complete obstruction or infection
75
What findings would you see on a urine dipstick that indicate UTI?
Nitrites (best indicator), leukocytes, microscopic haematuria
76
What bacteria cause UTIs?
E.coli, klebsiella, enterococcus, pseudomonas aeruginosa, staph aureus, candida albicans
77
What antibiotics are used for UTIs? | And what length course is used for different types of people
1st line = trimethoprim/nitrofurantoin 2nd line = fosfomycin Pregnancy = amoxicillin, cefalexin 3 days in simple lower UTIs 5-10 days for immunosuppressed, abnormal anatomy or impaired renal function 7 days for men, pregnant women or catheter related UTI
78
What are the risk factors for pyelonephritis?
Female, structural urological abnormalities, vesico-ureteric reflux, diabetes
79
What symptoms are associated with pyelonephritis?
Fever, loin/back pain, N+V, haematuria, dysuria, renal angle tenderness
80
What antibiotics are used in pyelonephritis?
Cefalexin, co-amox, trimethoprim, ciprofloxacin
81
What are the typical findings on testicular examination in someone with hydrocele?
Testicle is palpable within hydrocele Soft, fluctuant, transilluminated Irreducible and has no bowel sounds
82
When do hydroceles require surgery/aspiration?
If large or symptomatic In babies need surgery if not corrected by 1-2years of age
83
What are the symptoms and examination findings of someone with varicocele?
Symptoms = throbbing/dull pain or discomfort worse on standing, dragging sensation, infertility Examination = bag of worms, disappears when lying down, asymmetry in testicle size
84
What examination findings are present in those with epididymal cyst?
Soft round lump typically at top of testicle, separate from testicle, may transilluminate if large
85
Do epididymal cysts need removing?
Usually harmless so no but can be removed if causing pain
86
What are the causes of epididymo-orchitis?
E.coli, chlamydia trachomatis, neisseria gonorrhoea, mumps
87
What are the symptoms of epidiymo-orchitis?
Gradual onset (hours) of unilateral testicular pain, heavy dragging sensation, swelling of testicle and epididymis, tenderness on palpation
88
What antibiotics are typically used for epidydmo-orchitis?
If enteric cause - ofloxacin, levofloxacin, co-amoxiclav If STI - IM ceftriaxone, doxycyline
89
What are the causes of ED?
Spinal cord disease, diabetes, vascular disease, trauma, hypertension, drugs, psychological causes
90
What medications can be used to treat ED?
Phosphodiesterase-5-inhibitors = sildenafil Intracavernosal injections of alprostadil
91
What are the causes of acute urinary retention?
BPH, urethral obstruction, medications, UTI, postoperatively
92
What symptoms are common in acute urinary retention?
Inability to pass urine, lower abdominal pain, considerable pain or distress, acute confusional state
93
What investigations and management are done in acute urinary retention?
Bladder USS Bloods - U+Es, creatinine, FBC, CRP Catheterisation
94
What is a complication of treating acute urinary retention?
Post-obstructive diuresis - requires IV fluids
95
When is the PSA blood test very useful?
In monitoring response to treatment in those with prostate cancer
96
What investigation is required in a child/adult with nephrotic syndrome?
Child - none as likely minimal change disease Adult - renal biopsy to determine cause
97
What is required before contrast in someone with CKD?
IV fluids

Finals (21 decks)

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