Flashcards in Week 3 Deck (59):
What do diuretics enhance the excretion of?
Salt and water
What causes oedema
Imbalance between the rate of formation and apportion of interstitial fluid
What is nephrotic syndrome?
Involves the disorder of glomerular filtration allowing protein the the filtrate
How do diuretics reduce oedema?
Cause excretion of water so blood is more concentrated, so oncotic pressure increase meaning more fluid travels into the capillaries in the peripheries so reducing the oedema
Where do loop diuretics act and what do they block?
The Na/K/2Cl co transporter in the thick ascending loop of henle
Where do thiazide diuretics act and what do they block?
Act in distal convoluted tubule and block the Na/Cl co transporter
Where do potassium sparing diuretics act and what do they block?
Act in collecting tubule and block Na/K exchange
Where do carbonic anhydrase inhibitors work?
Proximal and distal convoluted tubule
Which produces a milder diuresis, loop or thiazide?
Why do thiazide diuretics predispose you to gout?
Because they compete for transport with uric acid at OAT
Name two loop diuretics?
Furosemide and bumetanide
How do loop diuretics work?
Inhibit Na/K/Cl carrier by binding to the Cl site
5 clinical indications of loop diuretics?
Pulmonary oedema, chronic kidney failure, hepatic cirrhosis, chronic heart failure, nephrotic syndrome
5 Adverse effect of loop diuretics?
Hypokalaemia, shift in acid base balance towards alkaline, hypovolaemia, hypotension, depletion of calcium and magnesium, hyperuricaemia
Name 2 thiazide diuretics?
How do thiazide diuretics work?
Inhibit Na/Cl carrier by binding to Cl site
5 indications of thiazide diuretics?
Mild heart failure, hypertension, severe oedema, renal stones, nephrogenic diabetes insipidus
5 adverse effect of thiazides?
Hypokalaemia, metabolic alkalosis, hypovolaemia, hypotension, depletion of Mg, hyperuricaemia, male sexual dysfunction, impaired glucose tolerance
How does spironolactone work?
Competes with aldosterone for binding to intracellular receptors
Name 2 potassium sparing diuretics?
4 clinical indications of potassium sparing diuretics?
Heart failure, conns, resistant essential hypertension, secondary hyperaldosteronism
What % of benign renal cysts are asymptomatic?
What is an oncocytoma, what is the risk of metastases and what is the treatment?
Benign renal mass
Will not metastasise
Usually a nephrectomy because some RCC look like oncoytoma on imaging - and also to reduce mass effect
Why is there an area of central necrosis in an oncocytoma?
Because it does not recruit a new blood supply unlike RCC
What is renal cell carcinoma?
Adenocarcinoma of proximal tubule
What is the triad of symptoms in RCC and what % of patients have this?
Loin pain, renal mass, haematuria
Only in 15% of patients
Where is the most common spread of RCC?
Where is the most common site of metastases of RCC?
Surgery of choice in RCC?>
What is 5 year survival rate of T1N0M0 RCC?
How might balantis xerotica obliterans present?
White patches, fissuring, bleeding, scarring
How might SSC of the penis present?
Red velvety patches
What increases the risk of testicular tumours?
Undescended testes, by 3x
Is more RCC radiosenstive or not?
What is alpha calcidol?
Hydroxylated form of vitamin D given in renal failure because kidneys can't hydroxylate it
What ages do dominant and recessive polycystic kidney disease present in?
Dominant - adult
Recessive - childhood
What GFR would require dialysis?
Give on example of an osmotic diuretic?
What are 2 indications for osmotic diuretics?
Prevention of acute hypovolaemic renal failure, raised intracranial or intraocular pressure
Carbonic anhydrase inhibitors are no longer used for diuresis, what are they used for?
Galucoma and following eye surgery
Prophylaxis of altitude sickness
What are the symptoms of diabetes insipidus?
Thirst, polyuria, polydipsia, copious dilute urine
What are the two types of diabetes insipidus and describe them?
Nephrogenic - inability of the nephron to respond to vasopressin
Neurogenic - lack of vasopressin secretion from the posterior pituitary
How is neurogenic diabetes insipidus treated?
How do vaptans work?
Competitive antagonists of vasopressin receptors
Cause excretion of water without the accompanying Na
Where is glucose reabsorbed?
In the proximal tubule
How do prostaglandins effect GFR?
Vasodilator effect on afferent arteriole
Release renin - increases filtration pressure
Treatment for acute urinary retention?
Catheter, uroselective alpha blocker
What are the indications to treat a renal calculi?
Pain unrelieved, pyrexia, persistent nausea vomiting
6 causes of frank haematuria?
Infection, stones, tumours, BPH, polycystic kidneys, trauma
What is the most likely cause of a swollen, painful testes in a young boy?
Torsion of the testes - until proven otherwise
What does the blue dot sign on the testes suggest?
Torsion of appendix testes
Treatment of epididymitis?
What is common cause of paraphimosis?
Foreskin retracted and not replaced after catheter insertion
What may happen to bowel sounds in a bladder injury?
Symptoms of prostatism?
Difficulty starting micturition, poor stream, and overflow incontinence
Which part of prostate is more commonly associated with prostate carcinoma?
How many patients have advanced disease at presentation of prostate carcinoma?
What is the difference between teratoma in a man and woman?
Always malignant in a man, not always in women - tissue is mature