7. Urology

Question 1

Renal disease signs and symptoms (5)

Renal function investigations

Definition of renal failure (4)

Types of renal failure (3)

Features of acute renal failure (5)
Usual cause
Signs and symptoms of volume overload (4)
Treatment

Features of primary chronic renal failure (2)
Features of secondary chronic renal failure (2)
Signs and symptoms (7)
Management (2)

Answer 1

Polyuria, dysuria, haematuria, proteinuria, uraemia

Creatinine clearance best measure - 24hr urine collection

Loss of excretory function, loss of water/electrolyte balance, loss of acid/base secretion, loss of renal endocrine function

Pre-renal (kidney hyperperfusion), intra-renal (chronic disease), post-renal (outflow obstruction)

Rapid loss of function, creatinine >200umol/l. Anuric with volume overload, increased potassium

Raised JVP, SoB, oedema, weight gain

Pre-renal cause

Dialysis until recovery - supportive treatment

PKD, glomerulonephritis –> nephrotic syndrome

Diabetes, hypertension

Anaemia, hypertension, polyuria, nocturne, tired, weak, nausea

Correct fluid balance, correct deficiencies, remove outflow obstruction

Question 2

Features of renal vascular disease (2)

Cause of PKD (2)

eGFR, creatinine and ESRD relationship (2)

Types of renal malignancy (2)

Dental renal relevance (2)

Answer 2

Reduced blood flow to kidneys, microangiopathy

Due to gene mutation (PKD 1, 2, 3), multiple cysts in renal parenchyma

ESRD when eGFR <15ml/min and creatinine 800-1000umol/l

Transitional cell carcinoma, renal cell carcinoma

Avoid NSAIDs, slower growth/eruption in kids

Question 3

Dialysis

Definition
Types (2)

Renal endocrine replacement treatment (3)

ESRD treatment

Transplantation restores (3)
Transplantation issues (2)

Answer 3

Intermittent correction of changes in plasma concentration of small molecules

Haemodialysis, peritoneal dialysis

EPO, vitamin D supplement, ACE inhibitors

Transplant

Restores renal function, restores normal energy, restores fertility

Immunosuppression, rejection

Question 4

Microscopic blood in urine suggests

UTI
Causes of infected urine (3)
Population affected
Associated bacteria
Causes (2)
Signs and symptoms (2)
Investigations
Treatment (2)

Answer 4

Infection

Cystitis, urinary reflux, prostatitis

Females > males due to urethra length

E. coli

Poor bladder emptying, low urinary flow rate

Dysuria, suprapubic pain

MSSU

Increase fluids, antibiotics (trimethoprim)

Question 5

UTO

Types (4)
Signs and symptoms (4)

Types of prostate disease (2)

Features of BPH
Treatment

Features of renal malignancy
Role of PSA (2)
Treatment (3)

Metastatic sites of prostatic malignancy

Renal calculi definition
Renal calculi treatment

Answer 5

Renal calculi, prostate disease, UT strictures, external compression

Slow stream, hesitancy, nocturne, incomplete voiding

Prostatitis, benign prostate hyperplasia

Almost normal - 80% of men 80+ have it
A-adrengeric blockers, surgery (TURP/open prostatectomy)

90% of men 90+ have it, often not cause of death. Good survival
PSA useful in monitoring disease activity in those known to have disease - problems with specificity/sensitivity excludes PSA for screening
Surgery, radiotherapy, hormone treatment

Bone metastasis - osteosclerosis

Stones in kidney/bladder - 5% affected
Lithotripsy - ultrasonic sound energy