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Year 2 Conditions > Urinary > Flashcards

Urinary Flashcards

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1
Q

What is AKI?

A

Abrupt drop in renal function causing a reversible build up of nitrogen waste products
Occurs over days to weeks

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2
Q

What are some pre-renal causes of AKI?

A

Decreased blood flow

Hypovolaemia - dehydration, haemorrhage, D&V, burns
Decreased CO - heart failure, MI
Decreased peripheral resistance - anaphylaxis, septic shock

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3
Q

What are some intra-renal causes of AKI?

A

Nephrotoxic injury - drugs (NSAIDs), rhabdomyolysis
Interstitial nephritis
Acute glomerulonephritis

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4
Q

What are some post-renal causes of AKI?

A

Obstruction to renal outflow

BPH
Bladder ca
Renal calculi

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5
Q

What is rhabdomyolysis?

A

Release of myoglobin due to muscle necrosis
Treated w/ IV fluids
Occurs in IVDU, elderly ppl or post earthquakes

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6
Q

What is acute tubular injury?

A

Cell damage due to ischaemia, nephrotoxins & sepsis
Generally not necrosis, but cells are damaged so it cannot be reversed
More likely if there is reduced perfusion AND a nephrotoxin

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7
Q

What is the management of AKI?

A

Volume overload - restrict Na & water intake
Hyperkalaemia - calcium gluconate, dextrose & insulin, restrict dietary intake
Sepsis - abx

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8
Q

What is CKD?

A

Gradual, irreversible drop in renal function

Takes months - years

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9
Q

What are the signs & Sx of CKD?

A

Uraemia
Proteinuria
Haematuria

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10
Q

What is the aetiology of CKD?

A 
Diabetes - most commonly 
Hypertension 
Immunological - glomerulonephritis 
Genetic - APCKD, Alport’s 
Obstruction 
Acute tubular necrosis
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11
Q

What is the management of CKD?

A

Modifiable risk factors - smoking, exercise, diet
Control diabetes
Control HTN - anti-hypertensives, diuretics, fluid restriction
Control proteinuria
Control lipids - statins

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12
Q

What are some complications of CKD?

A

Acidosis
Anaemia
Mineral bone disease
Altered drug metabolism

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13
Q

Why do pts get anaemia after CKD?

A 
Decreased EPO
Absolute iron deficiency 
Blood loss 
Short RBC life span 
Bone marrow suppression from uraemia 
B12 & folate deficiency
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14
Q

Why do pts get mineral bone disease after CKD?

A

Reduced activation of vitamin D => decreased Ca2+ absorption from gut => decreased serum Ca2+ => stimulation of PTH => increased osteoclast activity => break down of bone

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15
Q

What is end stage renal failure?

A

When death is likely without renal replacement therapy

eGFR <15ml/min

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16
Q

What are some Sx of end stage renal failure?

A 
Overwhelming fatigue 
Difficulty sleeping
Sx of volume overload; SoB, oedema 
Nausea &amp; vomiting 
Pruritis
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17
Q

What are some examples of renal replacement therapy?

A

Haemodialysis
Peritoneal dialysis
Transplant

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18
Q

What are the advantages & disadvantages of haemodialysis?

A

Advantages:
Less responsibility for pt
Can I have “days off”

Disadvantages
Travel & waiting time => massive restrictions
Big restriction on food & fluid intake

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19
Q

What are some advantages & disadvantages of peritoneal dialysis?

A

Advantages:
Allows independence
Generally less food & fluid restriction
Can travel more easily

Disadvantages:
Frequent daily changes
Responsibility is on pt

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20
Q

What is diabetes insipidus?

A

Inadequate reabsorption of water => diuresis

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21
Q

What are the two types of diabetes insipidus?

A

Central and nephrogenic

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22
Q

What is central diabetes insipidus?

A

Low plasma ADH

Due to damage to hypothalamus & posterior pituitary eg brain injury, tumour

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23
Q

What is nephrogenic diabetes insipidus?

A

Acquired insensitivity to ADH

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24
Q

What is the treatment for diabetes insipidus?

A

ADH injection or nasal spray

Low sodium diet

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25
What is adult polycystic kidney disease?
An autosomal dominant condition resulting in growth of cysts on kidneys
26
What is the clinical presentation of APCKD?
``` Pain Bleeding into cyst Infection Renal stones Hypertension Intra-cranial aneurysms Heart valve abnormalities ```
27
How is APCKD managed?
Treat HTN by blocking RAAS Diet changes - low salt, don’t eat excessive protein Tolvaptan - blocks ADH, affects how cysts grow
28
What is hyponatraemia?
When serum conc of Na is 135mmol Most commonly caused by too much fluid - relative hyponatraemia
29
What causes hyponatraemia?
True Na loss: D&V, diuretics, renal failure, peritonitis Changes to ADH secretion: heart failure, kidney disease, liver disease, tumours (small cell carcinoma)
30
What is the treatment for hyponatraemia?
Fluid restriction Symptomatic pts can be treated w/ hypertonic saline & furosemide
31
What causes hyperkalaemia?
Decreased renal excretion; AKI, CKD, drugs blocking K+ secretion, low aldosterone state DKA Metabolic acidosis Exercise
32
What is the emergency treatment for hyperkalaemia?
Reduce effect on heart; IV calcium gluconate Shift K+ to ICF; glucose & IV insulin Removal of excess K+ ; dialysis
33
What is the long term treatment of hyperkalaemia?
Treat cause eg managing diabetes to prevent DKA Reduce intake Removal of excess; dialysis
34
What are the clinical features of hyperkalaemia?
Altered excitability of the heart => arrhythmias & heart block Neuromuscular dysfunction in the GI tract => paralytic ileus Acidosis
35
What causes hypokalaemia?
Excessive loss of K+ ; D&V, renal loss (diuretics) | Metabolic alkalosis
36
What is the treatment of hypokalaemia?
Treat underlying causes K+ replacement - IV or oral If due to increased aldosterone => potassium sparing diuretics or block action of aldosterone
37
What are the clinical features of hypokalaemia?
Heart; arrhythmias GI; neuromuscular dysfunction, paralytic ileus Skeletal muscle; muscle weakness Renal; nephrogenic DI
38
What is urinary incontinence?
A condition in which a pt loses the ability to control micturition Occurs when the bladder pressure is greater than the urethral sphincter pressure
39
What is stress incontinence?
Involuntary leakage on increased intra-abdominal pressure eg coughing, sneezing
40
What is urge incontinence?
Involuntary leakage preceded by urgency
41
What is mixed incontinence?
A mix of stress and urge incontinence
42
What investigations are done for incontinence?
``` Urine dipstick Non-invasive urodynamics; frequency volume chart, bladder diary Invasive urodynamics Pad tests Cystoscopies ```
43
What is nephrotic syndrome?
Injury to podocytes or basement membrane resulting in proteinuria, hypoalbuminaemia & oedema
44
What causes nephrotic syndrome?
Primary renal disease: Minimal change disease, membranous nephropathy, focal segmental glomerulosclerosis Secondary renal disease: DM, SLE, amyloidosis
45
How is nephrotic syndrome managed?
Oedema; Diuretics, salt & fluid restriction Increased cholesterol; Statins Proteinuria; ACE-I
46
What is nephritic syndrome?
Damage to endothelium or vessel resulting in haematuria (can get some proteinuria) and hypertension
47
What causes nephritic syndrome?
Inflammation of glomerular basement membrane Anti-GBM, vasculitis Post infection
48
How is nephritic syndrome managed?
HTN/proteinuria/oedema; ACE-i, salt & fluid restriction, diuretics Treat underlying cause; generally immunosuppression
49
What is glomerulonephritis?
Inflammation of glomeruli | Can cause damage to capillary endothelium, basement membrane, mesangial cells or podocytes
50
What is the clinical presentation of glomerulonephritis?
Asymptomatic proteinuria or haematuria | Nephrotic syndrome
51
What is systemic lupus erythmatosus?
A type of vasculitis Autoimmune condition which can affect multiple systems Can cause either nephrotic or nephritic syndrome
52
What is diabetic nephropathy?
A glomerulonephropathy | Most common cause of end stage renal disease
53
What changes occur in diabetic nephropathy?
``` Hyperfiltration Glomerular basement thickening Mesangial expansion Podocyte injury Glomerular sclerosis ```
54
What occurs in hyperfiltration in diabetic nephropathy?
More NaCl & glucose is filtered out => increased reabsorption in PCT Less salt is delivered to the macula densa Makes macula densa thinks there is low perfusion => release of renin
55
What are signs and symptoms of diabetic nephropathy?
Hyperfiltration & hypertrophy => increased GFR Microalbuminuria (earliest stage, not picked up on dipstick) Overt proteinuria develops over many years => progressive drop in GFR => ESRD
56
What is the primary prevention of diabetic nephropathy?
Tight blood glucose control | Tight blood pressure control
57
How are microalbuminuria and proteinuria in diabetic nephropathy managed?
``` Inhibition of RAAS; Reduces glomerular hyperfiltration, slows progression Blood pressure kept below 130/80 Statins Moderate protein intake Tight blood glucose control ```
58
What host factors increase risk of a UTI?
Shorter urethra in women Obstruction from large prostate, pregnancy, stones or tumour Neurological problems eg incomplete bladder emptying and residual volume Ureteric reflex
59
What features of bacteria contribute to a UTI?
Fimbriae allow attachment Haemolysis damages host membrane Urease breaks down urea => favourable environment K antigens provide protection against host defences w/ polysaccharide capsule
60
What are some clinical syndromes associated with a UTI, and what are their features?
Cystitis; Lower UTI Presents with frequency, urgency and dysuria Acute pyelonephritis; Upper UTI Systemic therefore pt has a fever Presents w/ renal angle tenderness Chronic pyelonephritis Asymptomatic bacteriuria; Usually doesn’t need treatment However needs to be treated in pregnant women
61
What is an uncomplicated UTI?
An infection by a usual organism in a pt with a normal urinary tract (no catheter) and normal urinary function Can occur in males and females of any age
62
What is a complicated UTI?
When the pt has one or more predisposing factors to persistent infection, recurrent infection or failure of treatment Abnormal urinary tract; vesicoureteric reflux, indwelling catheter Virulent organism; S. aureus Impaired host defences; poorly controlled diabetes, immunosuppression Impaired renal function Typically affects men, children and pregnant women
63
What investigations are done for a UTI?
Dipstick tests;
64
What is the treatment for UTIs?
Uncomplicated; 3 day course of trimethoprim Complicated; 5-7 day course of trimethoprim, nitrofurantoin or cephalexin Pyelonephritis; 14 day course of abx IV initially unless pt is well enough for PO
65
What are the different types of ureteric obstruction?
Intraluminal; Stones, sloughed papilla, clots Intramural; Pelvic-ureteric junction obstruction, congenital Upper TCC Benign strictures, TB, surgical injury Extraluminal; Retroperitoneal malignancy, metastases to lymph nodes Retroperitoneal fibrosis Tumour => direct obstruction (bladder or prostate ca)
66
What is acute renal colic?
Flank pain radiating to groin which comes and goes Usually unilateral Generally caused by a stone, but can be caused by clots or sloughed papilla Can present w/ infection - pyonephrosis
67
What is pyonephrosis?
Infection of the collecting system in kidneys Pus collects in renal pelvis and causes distension of the kidney Can cause kidney failure
68
How does chronic ureteric obstruction typically present?
Generally painless, typically an incidental finding Can present with: Renal failure, pyonephrosis
69
What is obstructive uropathy?
Renal impairment due to uni- or bilateral ureteric obstruction Results in high pressure chronic retention Can result in hyperkalaemia
70
How are upper urinary tract obstructions diagnosed?
USS confirms hydronephrosis CT can show cause of obstruction Functional tests; Diuretic renography,
71
How can the upper urinary tract be drained in when there is obstruction?
JJ stent; Facilitates drainage to bladder Good for pts w/ clotting disorder Internal Nephrostomy; Direct tube from kidney to bag Good for pts who can’t have GA
72
What happens in a pelviureteric junction obstruction?
Dilation of the renal pelvis and calyces Congenital condition, can present w/ hydronephrosis on antenatal USS However can present whenever
73
What are symptoms in pelviureteric junction obstruction?
Can be asymptomatic Loin pain caused by intermittent blockage eg alcohol consumption => swelling of renal pelvis
74
What is treatment for pelviureteric junction obstruction?
Pyeloplasty
75
What are causes of retroperitoneal fibrosis, and how does it affect the urinary tract?
Causes: Idiopathic, malignancy, AAA, autoimmune conditions, drugs Scar tissue interferes with peristalsis of ureters
76
What is the treatment for retroperitoneal fibrosis?
Stents to decompress Need to exclude malignancy Steroids/immunosuppression
77
What are some causes of intravesical obstruction?
``` BPH (most common) UTI Neurological dysfunction Surgery Drugs Urethral strictures Pelvic masses (fibroids, tumours) ```
78
How does acute urinary retention present, and what is the treatment?
Painful inability to void ``` Treatment: Catheterise and record residual volume Treat obvious cause α-blocker in men relaxes prostate TURP ```
79
How does chronic urinary retention present?
High pressure: Abnormal U&E Hydronephrosis Low pressure; Normal urinary function No hydronephrosis
80
How is chronic urinary retention treated?
Catheterise and record residual volume Monitor for post-obstructive diuresis; Salt and water overload Causes diuresis Can lead to salt and water imbalance => fluid replacement

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