Urology 2

oelomar's version from 2016-02-27 14:50


Question Answer
What are the potential side effects of trimethoprim?Thrombocytopenia, megaloblastic anaemia.
What are aminoglycosides?Aminoglycoside is a medicinal and bacteriologic category of traditional Gram-negative antibacterial therapeutic agents that inhibit protein synthesis.
Give examples of aminoglycosidesStreptomycin, gentamycin.
Streptomycin was the first effective treatment for what disease?Tuberculosis.
What are the potential side effects of aminoglycosides?Nephrotoxicity, ototoxicity, teratogenic.
What is xanthogranulomatous pyelonephritis?This is an uncommon chronic interstitial infection of the kidney, most often due to Proteus, in which there is fever, weight loss, loin pain and a palpable enlarged kidney. It is usually unilateral. It is an unusual form of chronic pyelonephritis characterised by granulomatous abscess formation, severe kidney destruction, and a clinical picture that may resemble renal cell carcinoma.
What is the treatment of choice for xanthogranulomatous pyelonephritis?Nephrectomy.
Pathogens of the Proteus genus are known to cause what type of infection?Urinary tract infections.
What is acute tubulointerstitial nephritis and what causes it?This is acute interstitial renal inflammation. In 71-92% of cases acute TIN is due to a hypersensitivity reaction to drugs, usually a penicillin or NSAIDs.
What does drug-induced acute tubulointerstitial nephritis present with?Patients present with fever, arthralgia, skin rashes and acute oliguric or non-oliguric renal failure. Many have eosinophilia and eosinophiluria.
What is the recommended treatment for acute pyelonephritis?Broad-spectrum cephalosporin or quinolone.
What is the recommended treatment for acute prostatitis?Quinolone or trimethoprim.


Question Answer
What is hyperuricemia and what is the most important factor contributing towards it?Hyperuricemia is an abnormally high level of uric acid in the blood. The most important factor contributing towards it is alcohol consumption.
What does hyperuricemia predispose to?Gout, and if very high, renal failure.
What drug is given for the treatment of hyperuricemia?Allopurinol.
What is the main cause of renal artery stenosis in older patients?Atherosclerosis.
What is the main cause of renal artery stenosis in younger patients?Fibromuscular dysplasia.
What is fibromuscular dysplasia and what does it primarily affect?A condition that causes narrowing (stenosis) and enlargement (aneurysm) of the medium-sized arteries in your body. The areas of narrowing and bulging occur next to each other and can cause the artery to narrow so much that organs that receive blood from the artery are damaged. It most commonly affects the renal and carotid arteries.
What does renal artery stenosis present with?Most cases are asymptomatic. Otherwise, patients present with hypertension that is resistant to treatment, and episodes of flash pulmonary oedema.


Question Answer
What is the male:female ratio renal calculi?2:1.
What is the most common type of renal calculus?Calcium oxalate usually with calcium phosphate.
What are the risk factors for developing renal calculi?Family history, low fluid intake (dehydration), gout, RTA, diet, hyperparathyroidism (leading to hypercalcaemia).
What are the clinical features of renal calculi?Acute onset of severe flank pain that may radiate to the testes or vulva and is associated with nausea and vomiting. Patients are unable to get comfortable and shift position frequently.
What is ureteric colic? Is it painful?Ureteric colic occurs when a urinary tract canaliculus enters the ureter and either obstructs it or causes spasm during its passage. This is one of the most severe pains known.
What normally happens when a ureteric colic is left untreated?The pain typically subsides after a few hours.
Urinary calculi of less than 0.5cm in diameter usually pass spontaneously. True or false?True.
How are urinary calculi managed?Stones greater than 1cm diameter normally require intervention. Extracorporeal shock wave lithotripsy (ESWL) will fragment most stones, which then pass spontaneously. Ureteroscopy with a Yag laser can be used for larger stones.
What is extracorporeal shock wave lithotripsy?Extracorporeal shock wave lithotripsy (ESWL) is a non-invasive treatment of kidney stones and biliary calculi using an acoustic pulse.
What is nephrocalcinosis?A term used to describe diffuse renal parenchymal calcification that is detectable radiologically. The condition is typically painless. Hypertension and renal impairment commonly occur.
What are the causes of nephrocalcinosis?Hypercalcaemia (hyperparathyroidism), RTA, medullary sponge kidney.
What is medullary sponge kidney?A congenital disorder of the kidneys characterised by cystic dilatation of the collecting tubules in one or both kidneys. Individuals with medullary sponge kidney are at increased risk for kidney stones and urinary tract infections.
What does medullary sponge kidney usually present with?Renal colic or haematuria.


Question Answer
What does cloudy urine indicate?Infection.
What is the first line investigation for a urinary tract obstruction?Ultrasound.
What is diuresis?Diuresis is the physiological process by which urine production in the kidneys is increased as part of the body's homeostatic maintenance of fluid balance.
What is obstructive megaureter and what is it a result of?This is a medical anomaly whereby the ureter is abnormally dilated. It results from the presence of a region of defective peristalsis at the lower end of the ureter. Megaureter can be congenital.
What is Ormond’s disease?Also known as retroperitoneal fibrosis, this is a disease featuring proliferation of fibrous tissue in the retroperitoneum.
What may Ormond’s disease present with?Malaise, lower back pain, kidney failure, hypertension, DVT.
What causes Ormond’s disease?The causes are many but 2/3 are idiopathic.
What does “renal failure” actually mean?Failure of adequate renal excretory function due to depression of GFR.
What is azotaemia?A medical condition characterised by abnormally high levels of nitrogen-containing compounds in the blood, such as urea and creatinine.


Question Answer
What are the different classifications of acute kidney injury?Pre-renal, renal, post-renal.
What is pre-renal acute kidney injury?Decrease in blood flow to the kidney e.g. hypovolaemia, hypotension, heart failure, liver cirrhosis.
What is renal/intrinsic acute kidney injury?Sources of damage to the kidney itself e.g. glomerulonephritis, acute tubular necrosis.
What is post-renal acute kidney injury?Post-renal acute kidney injury is a consequence of urinary tract obstruction. This may be related to BPH, kidney stones, bladder stones, etc.
With a pre-renal acute kidney injury, what would be the findings for urinary osmolality, urine Na, and FENA (fractional sodium excretion)?UOSM: >500. UNA: <10 FENA: <1%.
With a renal/intrinsic acute kidney injury, what would be the findings for urinary osmolality, urine Na, and FENA (fractional sodium excretion)?UOSM: <350 UNA: >20 FENA: >2%.
With a post-renal acute kidney injury, what would be the findings for urinary osmolality, urine Na, and FENA (fractional sodium excretion)?UOSM: <350 UNA: >40 FENA: >4%.
What can cause acute tubular necrosis?It results most often from renal ischaemia but can also be caused by direct renal toxins including drugs.
Describe the clinical course of acute tubular necrosis.-Oliguria is common in the early stages. -Recovery of renal function typically occurs after 7–21 days, although recovery is delayed by continuing sepsis. There is a risk of hyperkalaemia. -In the recovery phase, GFR may remain low while urine output increases. There is a risk of hypokalaemia. -Eventually renal function usually returns to almost normal or to normal.
Treatment can speed up the duration during which acute tubular necrosis has occurred. True or false?False. No treatment will reduce the duration of ATN once it has occurred.
How is acute tubular necrosis managed?The aim of management of ATN is to keep the patient alive until spontaneous recovery of renal function occurs. Managements include identifying and correcting pre-renal and post-renal factors, finding and treating exacerbating factors, and stopping nephrotoxic drugs.


Question Answer
How does one determine if uraemia is acute or chronic?A rapid rate of change of serum urea and creatinine with time suggests an acute process. A normochromic, normocytic anaemia suggests chronic disease, but anaemia may complicate many of the diseases that cause acute renal failure. Ultrasound assessment of renal echogenicity and size is helpful. Small kidneys of increased echogenicity are diagnostic of a chronic process. Evidence of renal osteodystrophy is indicative of chronic disease.
With regards to regenerative capabilities, how does medullary ischaemic damage compare to cortical ischaemic damage in the kidney?Medullary ischaemic damage is largely reversible owing to the capacity of the tubular cells for regeneration. In contrast, glomerular ischaemic injury does not heal with regeneration but with scarring – glomerulosclerosis. Prolonged cortical ischaemia may lead to irreversible loss of renal function termed “cortical necrosis”.
Contrast media may be nephrotoxic in patients with impaired renal function. True or false?True.
In what way are NSAIDs nephrotoxic agents?They constrict the afferent arteriole.
In what way are ACE inhibitors nephrotoxic agents?They dilate the efferent arteriole. (Note, ACE inhibitors are beneficial in diabetic nephropathy, but are nephrotoxic in renal artery stenosis).
What are the main causes of CKD?Diabetes, hypertension, and atherosclerosis.
What physical findings can be found in someone with CKD?Short stature (in patients who have had chronic kidney disease in childhood), pallor (due to anaemia), brown discoloration of the nails, scratch marks due to uraemic pruritus, pericardial friction rub.
What is renal osteodystrophy?The term “renal osteodystrophy” embraces the various forms of bone disease that are a direct result of the electrolyte and endocrine derangements that accompany chronic kidney disease.
What is “pepperpot skull”?Pepperpot skull refers to a typical radiographic appearance of multiple radiolucent punched out lesion to skull vault. It usually signifies multiple myeloma (cancer of plasma cells). It can be seen in renal osteodystrophy.


Question Answer
Guidelines suggest starting renal replacement therapy when GFR < what?15.
What type of catheter is used for peritoneal dialysis?Tenchkoff catheter.
What are the pros of haemodialysis?Very thorough cleansing, constantly monitored.
What are the cons of haemodialysis?Hypotension, dialysis disequilibrium syndrome, can be exhausting and painful, strict water intake limitations, strict diet, (maintaining low phosphorus and potassium intakes), the fistula can cause long-term CVS problems, limited freedom.
What is dialysis disequilibrium syndrome?Dialysis disequilibrium syndrome, is the occurrence of neurologic signs and symptoms, attributed to cerebral oedema, during or following shortly after intermittent haemodialysis.
What are the pros of peritoneal dialysis?More freedom, no vascular access, less problems with blood pressure.
What are the cons of peritoneal dialysis?Potential peritonitis, chronic back pain, catheter malfunction.
What is the difference between haemofiltration and haemodialysis?Haemofiltration is a renal replacement therapy which is used in the intensive care setting. As in dialysis, in haemofiltration one achieves movement of solutes across a semi-permeable membrane. However, solute movement with haemofiltration is governed by convection rather than by diffusion. With haemofiltration, dialysate is not used. Instead, a positive hydrostatic pressure drives water and solutes across the filter membrane from the blood compartment to the filtrate compartment, from which it is drained. Solutes, both small and large, get dragged through the membrane at a similar rate by the flow of water that has been caused by the hydrostatic pressure. Haemofiltration is more expensive and takes longer, but there is less haemodynamic instability and so is used for critically ill patients.
What are the leading causes of death in patients on long-term dialysis?Cardiovascular disease and sepsis.
_____ is the cause of death post-kidney transplantation in 50% of patientsCardiovascular disease.


Question Answer
What is Autosomal-dominant polycystic kidney disease (ADPKD)?ADPKD is an inherited disorder usually presenting in adult life. It is characterised by the development of multiple renal cysts, variably associated with extra-renal (mainly hepatic and cardiovascular) abnormalities. ADPKD is the most common inherited nephropathy. It accounts for 10% of all patients commencing regular dialysis in the West.
What does Autosomal-dominant polycystic kidney disease present with?ADPKD presents with flank pain, haematuria, hypertension, urinary infection and progressive renal failure.
What complications can there be in Autosomal dominant polycystic kidney disease?Progressive renal failure (most eventually need dialysis), hepatic cysts (in 30%), mitral valve prolapse (in 20%), intracranial aneurysm formation.
How is Autosomal-dominant polycystic kidney disease diagnosed?Ultrasound.
What antibiotics are used to treat the cysts in Autosomal-dominant polycystic kidney disease?Lipophilic antibiotics active against Gram negative bacteria, such as co-trimoxazole and fluoroquinolones are used. They penetrate into the cysts better than conventional antibiotics which are poor penetrators of the cyst wall.
What is juvenile nephronophthisis?Nephronophthisis is a genetic disorder of the kidneys which affects children. It is classified as a medullary cystic kidney disease. The dominant features are polyuria, polydipsia and growth retardation. Diagnosis is based on the family history and renal biopsy, the cysts rarely being visualised by imaging techniques. Progressive renal failure is inevitable.