Renal + Urology Flashcards

Question

What are the Rxs for acute ep/orchitis?

Answer 1

Pain - ibuprofen/naproxen/paracetamol STD related - ceftriaxome IM 250mg + doxycycline BD 100mg Enteric - ofloxacin / levofloxacin 300/500mg OD Amiodarone - stop amiodarone TB - refer to specialist

Answer 2

Twisting of the testicle on the spermatic cord which leads to constriction of the vascular supply -> ensuing ischaemia and necrosis

Answer 3

Bellclapper deformity, age <25, neonate, trauma, exercise, cold weather

Answer 4

ACUTE onset severe pain, N+V, scrotal oedema and erythema, reactive hydrocele, high riding testicle ABSENT CREMASTERIC REFLEX sign No relief on elevation, abdo pain Fever = possible, dysuria = possible

Answer 5

EMERGENCY - "time is testicle" Colour flow doppler USS - absent supply Greyscale USS - see whirlpool sign Urinary WCC - N , FBC - N

Answer 6

5-20mg morphine + 4mg ondansetron Urgent scrotal exploration and detorsion +/- clips which can prevent recurrence If loss of testicle then offer prosthesis

Answer 7

Heterogenous group of diseases character by renal cysts and systemic and extrarenal manifestations.

Answer 8

PKD1 85%, PKD2 15%

Answer 9

Gradual growth of cysts until compression of ordinary renal vasculature and architecture Increases kidney size, interstitial fibrosis and atrophy. Results in progressive renal impairment until CKD

Answer 10

Cysts on imaging -> HHHH - HTN, haematuria, headaches, hepatomegaly. Abdo/flank pain Dysuria/fever/urgency/suprapubic pain if UTI concom Palpable cysts on kidneys Abdo hernias Chest pain - uncommon

Answer 11

Renal USS - <30 - 2 cysts total, 30-59 - two bilaterally, >60 - 4 bilaterally If inconclusive - CT abdo Urinalysis - haematuria/proteinuria/albumin Genetic testing - PKD1/2 Lipids - low HDL, H LDL associated to poorer prognosis U+Es - N / H Other tests - CT for risk of CVA, KUB if suspect stones as alternate diagnosis, echo if comorbid valvular disease.

Answer 12

Narrowing of the lumen of the renal arteries. Angiographically significant if >50% decrease

Answer 13

DM, HTN, smoking

Answer 14

Smoking, medial fibroplasia/adventital

Answer 15

``` RF presence Onset HTN in >55yo /// Accelerated HTN Abdominal bruit Hx CAD, PVD, unexplained dec in renal function Refractory angina, hx hypokalaemia ```

Answer 16

Estimated GFR - N/H K+ - N/L Urinalysis - No protein/haematuria/WBCs/Sediment Renal angiography (CT/MRI) - Dec in lumen size >50% Aldosterone:renin ratio - < 20 = confirms RAS rather than CONNS (in which aldosterone is significantly higher)

Answer 17

When stenosis reaches >50%, compensatory mechanisms begin to fail. There is a decrease in endothelin secretion, and relative increases in renin and ang II due to underperfusion of the kidneys. Results in increased Na+ absorption and dec K+ -> hypokalaemia and an increase in BP

Answer 18

Infection of the urinary tract and subsequent inflammation of the epithelium.

Answer 19

E. coli - most common G -ve - klebsiella, proteus G+ve - Enterococcus/staphylococcus (Less common that g-ve) If catheter - candida/staph A - biofilm formation

Answer 20

BPH, stones, recent surgery, recent hospitalisation, age >50, Hx UTI, catheterisation Unprotected sex

Answer 21

Frequency, dysuria, urgency, nocturia, terminal dribbling, large prostate, suprapubic pain, discharge Fever Rectal pain/ perianal pain / tender bladder/prostate

Answer 22

``` Urine DIP - +ve for WCC/nitrites Urine microscopy - WC/bacteria Urine culture - culture of organism Culture discharge CT/KUB/USS - if suspect concomitant blockage ```

Answer 23

1. Levi/ciprofloxacin 500mg OD/BD 7-14 2. Trimethoprim 500mg BD 7-14 3. Amoxicillin / clavulanate 500mg BD 7-14

Answer 24

Presence of proteinuria >3.5g/24hrs Hypoalbuminaemia Peripheral oedema

Answer 25

Diabetic nephropathy, Focal Segmetal GlomeruloSclerosis FSGS

Answer 26

Peripheral oedema AKI If progresses haematuria Muerkes lines xanthalesmata (from hyperlipid) Facial oedema

Answer 27

Proteinuria >3.5g day Low serum albumin Cellular casts in urine microscopy SUGGEST ALTERNATE DIAGNOSIS BIOPSY = definitive diagnosis - not performed with cysts/hydronephrosis, infection

Answer 28

Presence of crystalline stones in the urinary system

Answer 29

Oxalate, calcium, sodium and urticaria acid | Low ph and urine volume contribute as well as decreased magnesium and citrate -> inhibit stone formation

Answer 30

Male Dec water, High salt, High protein, obesity, warm climate

Answer 31

Non contrast CT - shows all stones aside from rare indinavir stones Urinalysis - N unless infection. May be small haematuria Preg test - rule out ectopic

Answer 32

Acute severe flank pain May radiate to groin N+V Haematuria, inc urinary free, testicular pain, UNCOM - Tachycardia, fever, groin pain, hypotension, costovertabral angle tenderness

Answer 33

Tamsulosin0.4/alfulosin10mg - a adrenergic blockers - dec sm tone If fails / dependent on size: cystoscopy + laser therapy/shock wave lithotripsy

Answer 34

hyper URIC/calcuria/citrauria/cysteinuria = alkalinisation of urine with potassium citrate Hyper OXalauria = calcium citrate (ox chelator) + 2l urine output Dec dietary protein, salt and oxalate Inc citrus fruits

Answer 35

An amyloid tissue deposition disease that may have a primary cause or be secondary to other diseases. Usually presents with unexplained weight loss, fatigue, and oedema resistant to diuretic therapy. Immunofixation of the serum and urine confirms the presence of monoclonal light chains in primary systemic amyloidosis. Biopsy verification of amyloid deposits is essential. Treatment includes appropriate management of resulting clinical syndromes, such as nephrotic syndrome, neuropathy, cardiomyopathy, and conduction disorders. Definitive treatment of primary systemic amyloidosis (AL amyloidosis) includes myeloablative high-dose chemotherapy, with stem cell reconstitution in selected patients, or chemotherapy. Any histological tissue specimen that binds the cotton wool dye, Congo red, and demonstrates green birefringence when viewed under polarised light is, by definition, an amyloid deposit. The patient with this deposit has amyloidosis. Deposits of amyloid may be localised in tissue or part of a systemic process. Progressive deposition of amyloid is disruptive to tissue and organ function and manifests its clinical sequelae by the dysfunction of those organs in which it deposits.

Answer 36

In the UK, the age-adjusted incidence is between 5.1 and 12.8 per 1 million per year There are no ethnicity studies specifically for amyloidosis MM + MGUS = B>W>A

Answer 37

Primary amyloidosis (also known as immunoglobulin light chain amyloidosis, or AL): All are associated with clonal plasma cell dyscrasia, although in most instances this is of insufficient degree to qualify as multiple myeloma. Non-familial secondary amyloidosis (AA): Inflammatory polyarthropathies account for 60% of cases. Conditions include rheumatoid arthritis, juvenile arthritis, psoriatic arthritis, and ankylosing spondylitis. Chronic infections, such as bronchiectasis, subcutaneous injection of illicit drugs, decubitus ulcers, chronic UTIs, and osteomyelitis can result in secondary amyloidosis Inflammatory bowel disease, specifically Crohn's disease, can result in secondary amyloidosis Castleman's disease is a lymphoproliferative disorder where the plasma cell variant can cause secondary amyloidosis. Also inherited forms

Answer 38

``` STRONG MGUS Inflammatory polyarthropathy Chronic infections IBD Familial periodic syndromes ``` WEAK Castleman's disease

Answer 39

COMMON RFs JVP Lower extremity oedema UNCOMMON Periorbital purpura Macroglossia OTHER COMMON Fatigue WL Dyspneoa ``` OTHER UNCOMMON Parasthesia Claudication Nausea Cramps Alternating bowel habit Orthostatic hypotension Submandibular salivary gland enlargement Hepatomegaly Should pad sign Weakness Sensory neuropathy Tinels Sx Phalens manoeuvre ```

Answer 40

1) Stem cell transplantation = myoablative chemo -> SC reconstitution OR if not SCT candidate = Chemotherapy -> = Bortezomib

Answer 41

The prognosis for patients with primary (i.e., immunoglobulin light chain) amyloidosis following treatment is dependent on the impact of the therapy in suppressing light chain synthesis. In patients who achieve a complete response to therapy, the 7-year survival approaches 80%. For patients who achieve a 50% reduction in therapy at 7 years, survival is 57%. Outcome is also determined by the severity of cardiac involvement. ``` COMPLICATIONS Rx related Chronic RF Progressive cardiomyopathy Conduction abnormalities Painful peripheral neuropathy Obstruction (macroglossia) Factor X deficiency Splenic rupture ```

Answer 42

Detection of monoclonal protein in: Serum/urine Immunoglobulin free light chain assay - abnormal kappa to lambda ratio BM biopsy - clonal plasma cells Immunohistological studies of amyloid deposits - These can be attempted to distinguish the various forms of systemic amyloidosis. Beta-2-microglobulin - Predictive of survival in patients with amyloidosis.

Answer 43

STAGES 1-2 NO URAEMIA ACE or ARB + Statin + HTN Rx STAGES 3-4 NO URAEMIA SAME BUT Education re Renal replacement therapy IF NEEDED: Erythropoeitin stimulating agents - epoetin alfa / darbepoetin alfa Iron Vit D (ergocalciferol) Na Bicarbonate Stage 5 OR WITH URAEMIA DIALYSIS Continuous cycling peritoneal dialysis is done with a machine at night on a daily basis. Continuous ambulatory peritoneal dialysis is done on a daily basis. Patients manually exchange the peritoneal fluid. Haemodialysis is prescribed 3 times a week for approximately 4 hours each session. Transplant For patients with stage 5 CKD on dialysis, calcium, phosphorus, and intact PTH levels should be managed with phosphate binding agents, calcimimetics, active vitamin D analogues, or a combination of these based on serial laboratory assessments.

Answer 44

Chronic kidney disease (CKD) is progressive and will eventually lead to end-stage renal disease (ESRD) and the need for renal replacement therapy (i.e., dialysis, transplant). CKD is a strong cardiovascular risk factor, and the majority of patients with CKD will die prior to reaching ESRD. As kidney function declines, complications such as anaemia and hyperparathyroidism develop that may contribute to worsening cardiovascular disease and renal osteodystrophy, respectively. There is no cure for CKD.

Answer 45

``` Anaemia Renal osteodystrophy CV disease Protein malnutrition Metabolic acidosis Hyperkalaemia Pulmonary oedema ```

Answer 46

Obstructive uropathy is blockage of urinary flow, which can affect one or both kidneys depending on the level of obstruction. If only one kidney is affected, urinary output may be unchanged and serum creatinine can be normal. When kidney function is affected, this is termed obstructive nephropathy. Hydronephrosis refers to dilation of the renal pelvis and can be present with or without obstruction. A variety of conditions may cause obstructive uropathy. _______________ Blockage of urinary flow, which can occur at any level in the urinary tract. May affect one or both kidneys, depending on the level of obstruction. A number of underlying conditions can result in obstructive uropathy, most commonly urolithiasis and benign prostatic hyperplasia. Initial treatment is directed at relieving pressure on the kidneys to prevent obstructive nephropathy and irreversible renal damage. Prompt relief of obstruction usually leads to preservation of kidney function. This may involve a urethral catheter, ureteric stent, or nephrostomy tube, depending on the level and cause of obstruction. Subsequent treatment is targeted towards the underlying cause. Infection within an obstructed system must be treated promptly.

Answer 47

Unilateral obstructive uropathy is most commonly due to ureteral stones. Stones are more common in hot and dry climates and obesity appears to increase the incidence. The highest incidence is seen in adults aged 30 to 50. Prevalence of ureteric stones is estimated to be 10% to 15% Benign prostatic hyperplasia (BPH) is a common cause of acute and chronic bilateral obstruction. No men under 30 years have pathological evidence of hyperplasia of the prostate but nearly 100% of men in their 80s show evidence of the disease. Women with bilateral obstruction will most commonly be diagnosed with an anatomical problem such as a cystocele or a physiological problem such as neurogenic bladder. Cancer involving the pelvic organs or retroperitoneal space may cause unilateral or bilateral obstruction.

Answer 48

Common causes include renal stones, benign prostatic hyperplasia, prostate cancer, and bladder tumours. Other less common causes include ureteropelvic junction obstruction, cystocele, herniation of the bladder into the inguinal canal, iatrogenic injury during gynaecological surgery, and pelvic malignancy.

Answer 49

``` STRONG BPH Constipation Medication - anticholinergic agents, narcotic analgesia, alpha receptor agonists Stones SC injury MS Malignancy Posterior urethral valves Mental stenosis ``` ``` WEAK Pregnancy Haematuria Bladder hernia Cystocele Iatrogenic Urethral instumentation Retroperitoneal fibrosis ```

Answer 50

``` COMMON Flank pain Fever LUTS Distended abdo Palpable bladder Inability to urinate Enlarged / nodular prostate Costovertebral angle tenderness ``` UNCOMMON Neurological disease OTHER COMMON Haematuria Increasing age Meatal narrowing ``` OTHER UNCOMMON Pelvic/abdominal malignancy Previous urethral instrumentation UTI as child Pelvic mass WL / LNs Recurrent UTIs Urinary incontinence ```

Answer 51

``` 1st: Urine dipstick Renal US RFTs FBC CT pyelogram (non-contrast CT) ``` ``` CONSIDER PSA CT abdo pelvis CEA/CA125 Voiding cysturthrogram Bladder US MRI ```

Answer 52

Anaglesia + rehydration Nephrostomy or ureteric stent ABx if septic IF STONES Alpha blockers - tamsulosin / alfuzosin IF BPH ALSO: 5a reductase inhibitors: Finasteride 5mg

Answer 53

Obstructive uropathy can result in permanent renal damage, but the majority of patients recover completely if the obstruction is relieved promptly. Although benign prostatic hyperplasia (BPH) is a common cause of obstructive uropathy, most patients with BPH do not go on to develop obstruction. COMPLICATIONS ``` Urethral trauma Ureteric stent displacement / occlusion Post-obstructive diuresis Severe sepsis/shock Renal failure - Unless obstruction is relieved, back pressure on the kidney can result in tubulo-interstitial fibrosis, tubular atrophy, and interstitial inflammation resulting in renal failure. ```

Answer 54

Glomerulonephritis (GN) denotes glomerular injury and applies to a group of diseases that are generally, but not always, characterised by inflammatory changes in the glomerular capillaries and the glomerular basement membrane (GBM). The injury can involve a part or all of the glomeruli or the glomerular tuft. The inflammatory changes are mostly immune mediated. Diseases include membranous GN, minimal change disease, focal and segmental glomerulosclerosis, immunoglobulin A nephropathy, forms of rapidly progressive GN (vasculitis and anti-GBM disease), and systemic lupus erythematosus nephritis as the more common forms; and glomerular damage in other systemic diseases such as diabetes, amyloidosis, myeloma, and a variety of infections.

Renal + Urology Flashcards

(80 cards)