Renal quick Flashcards by benno Brennan

Nephrotic

HSP, minimal change, FSGS

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Renal cell carcinoma

Clear cell
Smoking risk factor
Haematuria, loin pain, pyrexia of an unknown location

ADENOCARCINOMA
Left sided varicocele
Cholestasis/ hepatosplenomegaly

USS CT kidneys and CT TAP- cannonball

Total nephrectomy
If <7cm –> partial nephrectomy

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Bladder cancer

TCC-smoking, aromatic amines
SCC- schistomatosis

Most likely TCC

TURBT if no muscle invasion
Radial cystocetomy if invasive

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Testicular cancers

Infertility is risk factor

teratomas is 25 years and seminomas is 35 years

Painless lump, hydrocele, non tender, hard irregular
Gynaecomastia - germ cell and leydig cell

SCtoral USS, HCG high in seminaomas
LDH high in germ cell

Orchidectomy

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Prostate cancer

Risk factors - age, obesity, anabolic steroids, tall

LUTS, haematuria, ED
PSA, PR exam, multi parametric MRI

Prastectomy, radiotherapy.
Metastatic - hormonal e..g goserelin, cover with anti androgen

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PSA rules

Wait 6 weeks post treatment of prostatitis/ UTI

Ejection and exercise - not for 48 hours

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Side effects of radical prostatectomy and radiotherapy

Radiotherapy - proctitis , bladder colon rectal cancer

Radical prosatectomy - erectile dysfunction

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Epididmyorchitis

Painful, discharge, unilateral

E coli or chlymadia/ gonorrhoea or mumps

USS check for torsion
NAAT for young, MC+S for old

IV ABX if acutely unwell

Quinolone for UTIs and ofloxacin for e coli

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Epididymal cysts

Simple cysts separate to the body of the testicle
Non painful, above and below
USS
PCKD, CF

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Varicocele

Asymptomatic, may be associated with infertility
L>R, bag of worms
USS

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Hydrocele

Non painful, fluctuant, transilluminates, soft
Must do an USS
Could be testicular cancer

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Inguinal hernia

Cant get above it
High chance of strangulation

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Testicular torsion

Severe and sudden
Cremasteric reflex lost
Prehn’s sign ( elevation doesn’t ease the pain)

urgent surgical exploration- fix both

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Paraphimosis

Not replacing a retracted foreskin
Commonly seen post catheterisation
Apply pressure
Dorsal slit if the last resort

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Phimosis

Foreskin tight and can’t be retracted
Normal in babys
Adults - STIs, eczema, lichen sclerosis, balantitis

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Membranous glomerulonephritis

Malignancy
Nephrotic or haematuria
Cycloglobinurea, hep B or C

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Good pasture

Anti GBM antibodies
Haemopytsis
Haematuria
Pulmonary haemorrhage

High transfer factor, IgG deposits

Plasmapheresis, cyclosphosamide, steroids

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Alports

Children, microscopic haematuria bilateral sensineural deafness, sight reduced

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Granulomatosis with polyangitis (Wegner’s)

Renal failure
Epistaxis/ haemopysis
cANCA
Sinusitis, vasculitis, dyspnoea

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Eosinophilic granulomatosis with polyangitis (Churg- Strauss)

Asthma
pANCA
eosinophilia
Sinusitis, vasculitis , dyspnoea

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IgA

1-2 days post URTI

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Nephrotic syndrome

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Steroids
Increased risk of VTE due to loss of antithrombin III –> VTE prophylaxis

post strep

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1-2 weeks post URTI

Aspirin overdose

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IV sodium bicarbonate
Raised anion gap metabolic acidosis, nauseam vomiting, tinnitus

PCKD

Autosomal dominant Frank pain and haematuria - cyst rupture Flank pain Liver cysts and hepatomegaly, mitral valve prolapse USS and USS the relatives ---> Tolvaptan slows disease progression

Acute interstitial nephritis

Drugs are most common cause penicillin, rifampicin, NSAIds, allopurinol, furosemide, SLE, sarcoid, infection Fever, rash, arthralgia, esophilia, HTN, renal impairment STERILE pyuria, white cell casts

Acute tubular necrosis

Most common cause of AKI Cell regerate after 7-21 days Muddy brown casts Hypoperfusion or tons, necrosis Poor response to fluids

Calcium based stones

Oxalate Hypercalaemia Take potassium citrate or thiazide diuretics to reduce

Struvite

Stag horn

Uric acid

Not visible on XRAY

Kidney stones imaging

Non contrast CTKUB USS for pregnant

Management of kidney stones

<5mm -- pass spontaneously >5mm - lithotripsy, CI in pregnant - uteroscopy >2cm - percutaenoys nephrolitotomy Uteric - shockwave lithotripsy +/- alpha blockers 10-20mm utereoscopy EMERGENCY = DECOMPRESSION remember no diclofenac if they have an ulcer -give IV paracetamol instead

HSP

IgA mediated small cell vasculitis Palpable purpuric rash on the bottom and extensor of legs, abdo pain, polyarthritis Monitor BP and urinalysis

HUS

AKI, MAHA, thrombocytopenia Classically shiga toxin - ecoli Blood diarrhoea, abdo pain, vomiting, petechiae SCHISTOCYTES stool culture Anaemia and thrombocytopenia

Renal artery stenosis

HTN, CKD, pulmonary oedema USS - small kidneys REnal angiography ---> angioplasty and stenting

Urge incontinence

Bladder retraining Oxybutnin

Stress

Pelvic floor muscle training ---> surgery and duloxetine

CHildren <3 months uti

refer

men and pregnant UTI

Nitro for 7 days ( avoid near term) Men can have tried meth too make sure to send culture do another urien test for cure in pregnant

Pyelonephritis

Cephalosporin or quinolone IV abx for 7-10 days

Organic vs psychogenic ED

ORganic - gradual onset of symptoms, normal libido Psychogenic - low libido, sudden onset

BPH

Alpha 1 antagonist - alpha blockers, tamsulosin Can get dizzy, hypotension, dry mouth 5 alpha reductase inhibitors e..g finasteride Block conversion of testosterone to DHT Can get ED, LIBIDO reduced and gynaecomastia

Cranial - desmopressin Nephrogenic - thiazide/ low salt and low protein diet

Diabetic nephropathy

DO ACR- annually early morning >2.5 = microalbuminaemia Proteinurea ---> give them an ACEI or ARB!!!!

CKD proteinurea

ACEI, dapagliflozin and atorvastatin Oral sodium bicarbonate Anaemia ---> iron ten EPO Osteomalacia, sclerosis of vertebra, rugger jersey spine ---> low phosphate diet, phosphate binders, active vitamin D

Stop in AKI

NSAIDs Not aspirin 75mg diuretics Ang II ACEI Aminoglycerides

Egfr variables

CAGE Pregnant, red meat and muscle mass can effect it

Hydronephrosis

Acute - nephrostomy Chronic - steric stent

Fibromuscular displasia

Young women who get AKI after ACEi

TURP complications

Irrigation with glycine ---> can get TURP syndrome T- Turp syndrome - hyponatraemia, fluid overload, glycerine toxicity U- urethral stricture/ UTI R- retrograde ejaculations P - perforation of the prostate

Prostatitis

E coli most common 14 day course of quinolone e.g. cirpo Boggy tender prostate

ACute graft failure

Happens within months, asymptomatic, high creatinine, pyuria adn proteinuria

Dialysis indications

Acidosis Electrolyte imbalance Intoxication Overload e..g pulmonary oedema Uraemia - encephalopathy or pericarditis

Renal quick Flashcards

(54 cards)