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Renal Year 2 > AKI > Flashcards

AKI Flashcards

1
Q

What is the NICE criteria for diagnosing AKI?

A

Rise in creatinine of ≥ 25 micromol/L in 48 hours
Rise in creatinine of ≥ 50% in 7 days
Urine output of < 0.5ml/kg/hour for > 6 hours

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2
Q

Risk factors for AKI

A 
Chronic kidney disease
Heart failure
Diabetes
Liver disease
Older age (above 65 years)
Cognitive impairment
Nephrotoxic medications such as NSAIDS and ACE inhibitors
Use of a contrast medium such as during CT scans
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3
Q

What medications can cause AKI?

A

Nephrotoxic medications such as NSAIDS and ACE inhibitors

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4
Q

AKI can be classified into three groups of causes; what are they?

A

Pre-renal, intra-renal and post-renal causes

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5
Q

Pre-renal causes of AKI

A

It is due to inadequate blood supply to kidneys reducing the filtration of blood.
> Dehydration
> Hypotension (shock)
> Heart failure

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6
Q

Intra-renal causes of AKI

A

This is where intrinsic disease in the kidney is leading to reduced filtration of blood. It may be due to:

> Glomerulonephritis
Interstitial nephritis
Acute tubular necrosis

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7
Q

Post-renal causes if AKI

A

Caused by obstruction to the outflow of urine from the kidney, causing back-pressure into the kidney and reduced kidney function.

> Kidney stones
Masses such as cancer in the abdomen or pelvis
Ureter or uretral strictures
Enlarged prostate or prostate cancer

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8
Q

Symptoms of AKI

A
  1. Nausea/vomiting
  2. Reduced appetite
  3. Weight loss
  4. Pruritis
  5. Fatigue
  6. Confusion
  7. Uraemic tinge to skin
  8. Raised respiratory rate
  9. metabolic acidosis with respiratory compensation)
  10. Pulmonary oedema
  11. Hypovolaemia
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9
Q

Investigations for AKI

A
  1. Pre-renal – MR angiography
  2. Renal – history
  3. Post-renal – USS
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10
Q

Management of AKI

A

Pre-renal
> Fluid challenge test – 0.9% saline repeatedly intil 1L has been given. If no improvement, seek help
> Dialysis if anuric/uraemia

Renal
> Target the cause (eg. Immunosuppressives for vasculitis)

Post-renal
> Relieve the obstruction (eg. By catheter)

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11
Q

What are the complications of AKI?

A

Hyperkalaemia
Fluid overload, heart failure and pulmonary oedema
Metabolic acidosis
Uraemia (high urea) can lead to encephalopathy or pericarditis

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12
Q

What are the 5 stages of chronic kidney disease?

A

o 1: GFR >90ml/min with evidence of kidney damage
o 2: 60-89 with evidence of kidney damage
o 3a: 45-59
o 3b: 30-44
o 4: 15-30
o 5: <15 or renal replacement therapy

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13
Q

Causes of CKD

A 
o	Diabetes Mellitus
o	Hypertension
o	Ageing kidneys 
o	Chronic glomerulonephritis
o	Polycystic kidneys 
o	NSAIDs
o	Ciclosporin
o	Lithium
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14
Q

What drugs causes CKD?

A
  1. NSAIDs
  2. Ciclosporin
  3. Lithium
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15
Q

Symptoms of CKD

A 
o	Tiredness
o	Anorexia
o	Itch
o	Sleep disturbance
o	Nocturia-early symptom 
o	Oedema

Bone disease symptoms due to loss of vitamin D and secondary hyperparathyroidism
> Osteopenia
> Osteoporosis
> Calcified vessels

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16
Q

What is the A score diagnosis in CKD?

A

The A score is based on the albumin:creatinine ratio:

A1 = < 3mg/mmol
A2 = 3 – 30mg/mmol
A3 = > 30mg/mmol

The patient does not have CKD if they have a score of A1 combined with G1 or G2. They need at least an eGFR of < 60 or proteinuria for a diagnosis of CKD.

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17
Q

What is the treatment of CKD?

A

Proteinuria linked with progression so reduce and slow it by controlling blood pressure.

o	Lifestyle (limit alcohol consumption/stop smoking)
o	ACEI (regardless of BP)
o	Angiotensin receptor block (losartan)
o	Statins (reduce CV risk)
o	Glucose control in diabetes
o	Spironolactone
o	Furosemide 
o	Iron injections
o	Phosphate binders 
o	Vitamin D supplements
o	Haemodialysis 
o	Peritoneal dialysis
o	Transplantation
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18
Q

Complications of CKD

A 
Anaemia
Renal bone disease
Cardiovascular disease
Peripheral neuropathy
Dialysis related problems
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19
Q

Why does anaemia occur with CKD?

A

Erythropoietin is produced by kidneys, loss of which causes anaemia, check bloods, b12 and folate levels

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20
Q

Why does renal bone disease occur in CKD?

A

Vitamin d is hydroxylated in the liver and kidney, which is impaired in CKD. Functional loss of kidneys lead to vitamin d loss which leads to reduced calcium absorption from gut(secondary hyperparathyroidism)

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21
Q

Pyelonephritis

A

Infection of the kidney. Can be in the pelvis, calyces, tubules and/or the interstitium
• Can be chronic or acute
• Tends to be patchy

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22
Q

Most common causes of pyelonephritis

A

o E. coli, pseudomonas, strep. Faecalis

o Tends to be post-operative or by ascending infection

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23
Q

Risk factors for pyelonephritis

A 
Female
Pregnancy (ureteric dilatation)
Urinary tract obstruction
Vesico-ureteric reflux 
Diabetes
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24
Q

Symptoms of pyelonephritis

A
  1. Flank pain
  2. Lower back pain
  3. Fever
  4. Rigors
  5. Symptoms of cystitis
  6. Vomiting and diarrhoea
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25
Q

Diagnosis of pyelonephritis

A

o Urinalysis

o Coarse cortical scarring on imaging

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26
Q

Treatment of pyelonephritis

A
  1. IV amoxicillin and gentamicin

2. If penicillin allergic, IV co-trimoxazole and Gentamicin

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27
Q

Complications in pyelonephritis

A

Kidney abscess
Sepsis
Kidney failure

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28
Q

What are the 2 sub-types of pyelonephritis?

A
  1. Chronic pyelonephritis

2. Tuberculosis pyelonephritis

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29
Q

Chronic pyelonephritis

A
  1. Previous/recurring UTI beginning since toddler years
  2. Scarring or distension of calyces on imaging
  3. Hypertension
  4. Uraemia
  5. Lots of urine produced
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30
Q

Tuberculosis pyelonephritis

A
  1. Spreads from lungs
  2. Weight loss
  3. Fever
  4. Loin pain
  5. Caseous foci which can cause destruction
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31
Q

Glomerulonephritis

A

Glomerulonephritis is an umbrella term applied to conditions that cause inflammation of or around the glomerulus and nephron. There are many conditions that can be described as glomerulonephritis.

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32
Q

What is Nephritic syndrome

A

Nephritic syndrome or acute nephritic syndrome refers to a group of symptoms, not a diagnosis.

When we say a patient has “nephritic syndrome” it simply means they fit a clinical picture of having inflammation of their kidney and it does not represent a specific diagnosis or give the underlying cause.

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33
Q

Nephrotic syndrome

A

Nephrotic syndrome refers to a group of symptoms without specifying the underlying cause. Disorder that causes your body to pass too much protein in your urine.

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34
Q

Features of nephritic syndrome

A
  1. Haematuria
  2. Oliguria means there is a significantly reduced urine output.
  3. Proteinuria is protein in the urine. In nephritic syndrome, there is less than 3g / 24 hours.
  4. Fluid retention
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35
Q

Oliguria

A

Means there is a significantly reduced urine output.

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36
Q

Haematuria

A

Haematuria means blood in the urine. This can be microscopic (not visible) or macroscopic (visible).

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37
Q

Features of nephrotic syndrome

A
  1. Peripheral oedema
  2. Proteinuria more than 3g / 24 hours
  3. Serum albumin less than 25g / L
  4. Hypercholesterolaemia
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38
Q

What are the different types of glomerulonephritis?

A
  1. Minimal change disease
  2. Focal segmental glomerulosclerosis
  3. Membranous glomerulonephritis
  4. IgA nephropathy
  5. Post streptococcal glomerulonephritis
  6. Mesangiocapillary glomerulonephritis
  7. Rapidly progressive glomerulonephritis
  8. Goodpasture Syndrome
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39
Q

IgA nephropathy

A

Macroscopic haematuria after a respiratory or GI infection
Associated with Henoch-Schönlein purpura (arthritis, colitis, rash)
Biopsy shows mesangial cell proliferation and expansion on light with IgA deposits on immunofluorescence
> 25% progress to renal failure
> Usually self-resolving

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40
Q

What condition is IgA nephropathy associated with?

A

Associated with Henoch-Schönlein purpura (arthritis, colitis, rash)

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41
Q

What does the biopsy of IgA nephropathy show?

A

Mesangial cell proliferation and expansion on light with IgA deposits on immunofluorescence

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42
Q

What is the most common cause of nephrotic syndrome in children?

A

Minimal change nephritis/disease

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43
Q

What is the most common cause of nephrotic syndrome in adults?

A

Focal segmental glomerulosclerosis

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44
Q

Membranous glomerulonephritis

A

Most common type of glomerulonephritis overall
There is a bimodal peak in age in the 20s and 60s
Histology shows “IgG and complement deposits on the basement membrane”
The majority (~70%) are idiopathic
Can be secondary to malignancy, rheumatoid disorders and drugs (e.g. NSAIDS)

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45
Q

What does the histology of Membranous glomerulonephritis show?

A

IgG and complement deposits on the basement membrane

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46
Q

Post streptococcal glomerulonephritis (AKA diffuse proliferative glomerulonephritis)

A

Patients are typically under 30 years. It presents as:

1-3 weeks after a streptococcal infection (e.g. tonsillitis or impetigo)
They develop a nephritic syndrome
There is usually a full recovery

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47
Q

Goodpasture syndrome

A

Anti-GBM (glomerular basement membrane) antibodies attack glomerulus and pulmonary basement membranes. This causes glomerulonephritis and pulmonary haemorrhage.

In your exam, there may be a patient that presents with acute kidney failure and haemoptysis (coughing up blood).

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48
Q

What antibodies are present in Goodpasture syndrome?

A

Anti-GBM (glomerular basement membrane) antibodies attack glomerulus and pulmonary basement membranes. This causes glomerulonephritis and pulmonary haemorrhage.

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49
Q

What glumerulonephritis is associated with acute kidney failure and coughing up blood?

A

Goodpasture syndrome

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50
Q

What antibodies are present in Wegener’s granulomatosis?

A

Anti-neutrophil cytoplasmic antibodies (ANCA)

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51
Q

Rapidly progressive glomerulonephritis

A

Histology shows “crescentic glomerulonephritis”
It presents with a very acute illness with sick patients but it responds well to treatment
Often secondary to Goodpasture syndrome

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52
Q

What glomerulonephritis shows crescentic glomerulonephritis?

A

Rapidly progressive glomerulonephritis

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53
Q

What does the histology of IgA nephropathy show?

A

IgA deposits and glomerular mesangial proliferation”.

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54
Q

Focal segmental glomerulosclerosis

A
  • Massive proteinuria
  • Haematuria
  • Hypertension
  • Renal impairment

A disease in which scar tissue develops on the parts of the kidneys that filter waste from the blood (glomeruli). FSGS can be caused by a variety of conditions

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55
Q

Focal segmental glomerulosclerosis

A
  • Massive proteinuria
  • Haematuria
  • Hypertension
  • Renal impairment

A disease in which scar tissue develops on the parts of the kidneys that filter waste from the blood (glomeruli). FSGS can be caused by a variety of conditions.

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56
Q

What are Kimmelstiel-wilson lesions associated with?

A

Are present in diabetic nephropathy

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57
Q

What is the most common tumor in children?

A

Wilm’s tumour - aka nephroblastoma

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58
Q

Risks of clear cell renal cancer

A 
o	Male
o	Age 55-60
o	Smoking
o	Obesity
o	Hypertension
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59
Q

Renal cancer

A
  • Clear cell is the most common form
  • Wilm’s tumour is the most common in children
  • Can be multifocal or bilateral
  • Arises from the proximal convoluted tubulue
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60
Q

What part of the kidney does renal cancer arise from?

A

Arises from the proximal convoluted tubules

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61
Q

Presentation of Renal cancer/carcinoma

A 
>	Polycythaemia 
>	Weight loss
>	Anaemia
>	Hypertension
>	Hypercalcaemia
1.    Loin pain
2.    Haematuria 
3.	Lumpy feeling in hypochondrium
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62
Q

Polycythaemia

A

Overproduction of RBCs

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63
Q

Classic triad of symptoms in renal carcinoma

A
  1. Loin pain
    2, Haematuria
  2. Lumpy feeling in hypochondrium
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64
Q

Investigations of renal carcinoma

A
  1. Tests to exclude UTI
  2. Renal function tests
  3. CT before and after IV contrast
  4. XR may show “cannon balls” from renal mets
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65
Q

Treatment for renal carcinoma

A

o Surgery (radical or partial)
o Radiotherapy
o Chemotherapy

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66
Q

What does the Xray show in renal carcinoma?

A

“Cannon balls” from renal metastasis

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67
Q

What is the most common cancer of the bladder?

A

Transitional cell cancer - 90% of bladder tumours

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68
Q

What are the recognized causes of Transitional cell cancer?

A

o Working with dyes, rubber, plastics, aluminium and pesticides
o Medications – cyclophosphamide

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69
Q

Symptoms of Transitional cell cancer

A

o Haematuria
o Loin pain
o Frequency
o Dysuria

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70
Q

What is the 1st line diagnosis of Transitional cell cancer?

A

Cytsoscopy - *sea anemone” appearance

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71
Q

What is another name for renal calculi?

A

Nephrolithiasis.

If the stones cause severe pain, this is known as colic.

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72
Q

What are renal calculi?

A

Renal/kidney stones

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73
Q

What medications cause renal calculi?

A
  1. Aspirin
  2. Antacids
  3. Calcium and vitamin D supplements
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74
Q

What kind of climates cause renal calculi?

A

Living in a hot climate

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75
Q

Symptoms of renal calculi

A
  1. Can be asymptomatic
  2. Loin to groin pain
  3. Microscopic haematuria on dipstick testing
  4. Restlessness
  5. Nausea
  6. Increased frequency of urine
  7. Dysuria
  8. Pain can mimic pyelonephritis or hynaecological pain
76
Q

What are the classic symptoms of renal calculi?

A

Loin to groin pain
Microscopic haematuria on dipstick testing

77
Q

Investigations for renal calculi

A
  1. KUB xray
  2. CT – the definitive way to search for a stone
  3. Intravenous urogram
78
Q

Treatment for renal calculi

A

o NSAIDs
o Opiates
o Alpha blocker

If the stone does not pass within 1 month, intervention

  1. Ureteric stent
  2. Stone fragmentation
79
Q

Complications of renal calculi

A
  1. Infection

2. Obstruction - Treat immediately by percutaneous nephrostomy

80
Q

What is an percutaneous nephrostomy?

A

A percutaneous nephrostomy is the placement of a small, flexible rubber tube (catheter) through your skin into your kidney to drain your urine. It is inserted through your back or flank

81
Q

Autosomal Dominant Polycystic Kidney Disease (ADPKD)

A

A genetic disorder characterized by the growth of numerous cysts in the kidneys. Symptoms vary in severity and age of onset, but usually develop between the ages of 30 and 40.

ADPKD is a progressive disease and symptoms tend to get worse over time.

82
Q

Autosomal Dominant Polycystic Kidney Disease (ADPKD)

A

A genetic disorder characterized by the growth of numerous cysts in the kidneys. Symptoms vary in severity and age of onset, but usually develop between the ages of 30 and 40.

83
Q

Symptoms of Autosomal Dominant Polycystic Kidney Disease (ADPKD)

A 
o	Abdominal mass
o	Haematuria
o	Hypertension
o	Chronic kidney failure
o	Pain
o	Spread of cysts to liver, pancreas and lungs
o	Renal stones
o	Renal and transitional cell carcinoma are both seen in affected kidneys 
o	Polycythaemia
84
Q

Investigations in Autosomal Dominant Polycystic Kidney Disease (ADPKD)

A

o Urinalysis (shows microalbuminuria)
o FBC (excess erythropoietin)
o USS
o CT/MRI can detect smaller cysts

85
Q

Treatment for Autosomal Dominant Polycystic Kidney Disease (ADPKD)

A
  1. ACEI
  2. Paracetamol
  3. Break down large stones using extracorporeal shock wave lithotripsy
  4. Dialysis
  5. Kidney transplant
86
Q

Extracorporeal shock wave lithotripsy

A

Uses shock waves to break a kidney stone into small pieces that can more easily travel through the urinary system

87
Q

Complications of Autosomal Dominant Polycystic Kidney Disease (ADPKD)

A
  1. Stones
  2. Polycystic liver disease
  3. Secondary hypertension
  4. Berry aneurysm –> subarachnoid haemorrhage
88
Q

Autosomal recessive polycystic kidney disease (ARPKD)

A
  • Also known as infantile type
  • Very rare, only occurs in perinatal group (causes terminal renal failure)
  • Uniform bilateral renal enlargement
  • No gross distortion of kidney

Mutation of gene on chromosome 6

89
Q

What gene is responsible for Autosomal recessive polycystic kidney disease (ARPKD) ?

A

Caused by a gene on chromosome 6.

90
Q

What are the genes responsible for Autosomal Dominant Polycystic Kidney Disease (ADPKD)?

A

PKD-1: chromosome 16 (85% of cases)

PKD-2: chromosome 4 (15% of cases)

91
Q

Symptoms of Autosomal recessive polycystic kidney disease (ARPKD)?

A 
o	Hypertension
o	CKD
o	Pulmonary hypoplasia
o	Signs of potter’s syndrome
>	Widely separated eyes
>	Broad nasal bridge
>	Low set ears
92
Q

Diagnosis of Autosomal recessive polycystic kidney disease (ARPKD)

A

o Pregnancy using USS at week 20
o USS after birth
o GFR

93
Q

What is a hydronephrosis?

A

Swelling of one or both kidneys

Dilatation of the renal pelvis as a result of an obstruction

94
Q

Causes of hydronephrosis

A
  1. Urethral obstruction
  2. Calculi
  3. Neoplasms
  4. Pelvi-ureteric obstruction
  5. Strictures
  6. Surgery in the retroperitoneal space (can result in fibrosis and block the ureters – leading to hydronephrosis)
95
Q

What kind of pain is present in hydronephrosis?

A

Loin pain that is provoked by increasing fluid intake or diuretics (including alcohol)

96
Q

Treatment for hydronephrosis?

A

Drain urine from the kidneys and remove blockage

97
Q

What is Renovascular disease?

A

Impairment of renal perfusion due to arterial disease affecting the blood supply to the kidneys. Activates RAAS, resulting in hypertension.

98
Q

What is the main cause of renovascular disease?

A

Atherosclerosis

99
Q

Symptoms of renovascular disease

A

o Usually asymptomatic
o Abrupt onset of hypertension in middle-aged or older patients
o “Difficult to control hypertension”
o Impairment during treatment with ACEI or ARBs
o “Flash” pulmonary oedema due to decompensation of CCF in hypertensive patient
o Haematuria
o Abdominal bruit

100
Q

Diagnosis of renovascular disease

A 
o	eGFR
o	Blood glucose
o	Microalbuminuria
o	Urinalysis to exclude glomerulonephritis
o	USS (renal and duplex)
o	Angiography
101
Q

Main diagnostic tool for reno vascular disease

A

Angiography

102
Q

Management for renovascular disease

A
  1. Do not use ACEI or ARBs
  2. Avoid NSAIDs
  3. Angioplasty
103
Q

What is Cystitis?

A

Inflammation of the bladder, normally due to infection

104
Q

Causes of Cystitis

A 
o	E. coli
o	Klebsiella
o	Proteus 
o	Enterococci
o	Staph. Saphrophytics
o	Pseudomonas auruginosa
105
Q

Risks for cystitis

A 
o	Female
o	Sexual intercourse
o	Pregnancy
o	Enlarged prostate
o	Menopause
o	Prostatitis 
o	Diabetes
o	Catheter trauma
106
Q

Symptoms of cystitis

A
  1. Dysuria
  2. Polyuria
  3. Urgency
  4. Frequency
  5. Haematuria
  6. Suprapubic pain
107
Q

Management of cystitis

A

Trimethoprim/nitrofurantoin
> 3 days for females, 7 days for males

Complicated/pyelonephritis presenting to GP
> Co-amoxiclav or co-trimoxazole for 14 days

Complicated/pyelonephritis presenting to hospital
> IV amoxicillin and gentamicin for 3 days

108
Q

What is the treatment of cystitis caused by Pseudomonas auruginosa?

A

Needs treatment with ciprofloxacin, associated with urethral instrumentation

109
Q

Symptoms of Overflow incontinence

A 
o	Abdominal distention
o	Dribbling
o	Wet at night 
o	Feeling as through the bladder is never empty
o	Urinary flow <15ml/second
o	Post-void residue volume >100ml
110
Q

Diagnosis of Overflow incontinence

A
  1. Digital rectal examination
  2. Residual urine test
  3. USS
111
Q

Treatment for Overflow incontinence

A
  1. Remove renal obstruction
  2. Catheterisation
  3. Rehabilitate bladder
112
Q

What medications cause overflow incontinence?

A
  1. ACEI
  2. Diuretics
  3. Sedatives
113
Q

What is overflow incontinence?

A

Is the involuntary release of urine—due to a weak bladder muscle or to blockage—when the bladder becomes overly full, even though the person feels no urge to urinate.

114
Q

What is urge incontinence?

A

When you have a sudden urge to urinate. In urge incontinence, the urinary bladder contracts when it shouldn’t, causing some urine to leak through the sphincter muscles holding the bladder closed.

115
Q

Causes of urge incontinence

A

Detrusor overactivity
Idiopathic
Post-menopausal vaginal atrophy
Damage to CNS

116
Q

Management for urge incontinence

A
  1. Avoid caffeine
  2. Weight loss
  3. Bladder retraining
  4. Oxybutynin
117
Q

What is stress incontinence?

A

Happens when physical movement or activity — such as coughing, laughing, sneezing, running or heavy lifting — puts pressure (stress) on your bladder, causing you to leak urine. Stress incontinence is not related to psychological stress.

118
Q

What are the causes of stress incontinence?

A
  1. Weakened pelvic floor muscles, typically due to childbirth
  2. Post-menopausal
  3. Obesity
119
Q

Management of stress incontinence

A

Weight loss
Smoking cessation
Pelvic floor exercises
Duloxetine

120
Q

Oxybutinin

A

Works by relaxing the muscles around your bladder. This means your bladder can hold more liquid and you do not need to pee as often or as urgently. Used in urge incontinence

121
Q

Wegener’s granulomatosis

A

Also known as granulomatosis with polyangitis.

Rare form of vasculitis thought to be an autoimmune inflammatory process affecting endothelial cells

Almost all patients have ENT and lung involvement and around 75% have renal involvement

122
Q

Symptoms of Wegener’s granulomatosis

A 
o	Fatigue, malaise, fever and night sweats
o	Weight loss
o	Rhinorrhoea
o	Sinusitis
o	“Saddle nose”
123
Q

Diagnosis of Wegener’s granulomatosis

A
  1. C-ANCA and P-ANCA
  2. Urinalysis for protein, blood and casts
  3. Nasal endoscopy
  4. CXR
124
Q

What antibodies are present in Wegener’s granulomatosis

A

C-ANCA and P-ANCA

125
Q

Amyloidosis

A

Clinical disorder caused by deposition of insoluble abnormal amyloid fibrils. Overproduction can cause fibrils to be deposited in organs and cause progressive organ destruction

Can be primary or secondary to chronic infection

126
Q

Symptoms of Amyloidosis

A 
o	Fatigue
o	Weight loss 
o	Easy bruising 
o	Peripheral oedema
o	RHF
o	Spontanous periorbital purpura – racoon eye signs 
o	Congo red staining – apple green bifringence
o	Produces large kidneys
127
Q

Diagnosis of Amyloidosis

A
  1. Urinalysis – protein/light chain on electrophoresis
  2. Howell-jolly antibodies
  3. Clotting abnormality
  4. USS shows large kidneys
128
Q

What antibodies are present in Amyloidosis?

A

Howell-jolly antibodies

129
Q

Benign Prostatic Hyperplasia

A

An enlarged prostate - Very common condition affecting older men that is not usually a serious health threat (it is not pre-malignant)

130
Q

What is the cause of Benign Prostatic Hyperplasia?

A

Hormonal imbalance between oestrogens and androgens

131
Q

Risk factor for Benign Prostatic Hyperplasia

A

Hypertension and diabetes

132
Q

Symptoms of Benign Prostatic Hyperplasia

A 
o	Incomplete emptying
o	Hesitancy
o	Terminal dribbling 
o	Frequency
o	Intermittency
o	Urgency
o	Weak stream
o	Straining
o	Nocturia
o	Haematuria  
o	Overflow incontinence
133
Q

Diagnosis of Benign Prostatic Hyperplasia

A
  1. Urine tests to exclude infection
  2. Rectal examination - central boggy prostate
  3. PSA (prostate specific antigen)
  4. Transrectal ultrasound
  5. Intravenous urography
134
Q

Treatment for Benign Prostatic Hyperplasia

A

1st line: alpha blockers
> Tamsulosin
> Alfuzosin

2nd line: 5-alpha reductase inhibitors
> Finasteride
> Dutasteride

TURP (trans-urethral resection of the prostate

135
Q

What is the 1st line treatment for BPH?

A

1st line: alpha blockers
> Tamsulosin
> Alfuzosin

136
Q

What is the 2nd line treatment for BPH?

A

2nd line: 5-alpha reductase inhibitors
> Finasteride
> Dutasteride

137
Q

Give example of alpha blockers used in BPH

A

Tamsulosin

Alfuzosin

138
Q

Give examples of 5-alpha reductase inhibitors used in BPH

A

Finasteride

Dutasteride

139
Q

What are the complications of BPH?

A
  1. UTI
  2. Acute urinary retention
  3. Bladder hypertrophy
  4. Hydronephrosis
140
Q

Prostate cancer

A

Most common cancer in men in the UK. Typically due to adenocarcinoma that spreads locally (to urethra, bladder, seminal vesicles or rectum) or to local lymph nodes.

Spreads haematogenously to lung/liver metastases

141
Q

What is the most common cancer in men in the UK?

A

Prostate cancer

142
Q

What are the risk factors for prostate cancer?

A

o Age 50+
o African descent
o Family history
o Obesity

143
Q

Symptoms of Prostate cancer

A 
o	Frequent urination
o	Urgency
o	Hesitancy
o	Straining
o	Weak flow
o	Incomplete voiding
o	Bone pain
o	Weight loss
144
Q

Diagnosis of prostate cancer

A
  1. PSA
  2. Digital rectal exam
  3. Transrectal ultrasound biopsy
  4. MRI
  5. CT
145
Q

Testicular torsion

A

When a testicle rotates, twisting the spermatic cord that brings blood to the scrotum. The reduced blood flow causes sudden and often severe pain and swelling.

Testicular torsion is most common between ages 12 and 18, but it can occur at any age, even before birth

146
Q

What is one cause of testicular torsion?

A

Bell-clapper deformity (congenital malformation)

147
Q

Symptoms of testicular torsion

A
  1. Extreme pain that radiate to the lower abdomen
  2. Nausea and vomiting
  3. Erythema over scrotum
  4. Swollen, tender testis retraced upwards and laying transverse
  5. Hydrocele/oedema
  6. “Difficult to sit on a chair”
148
Q

Investigation for testicular torsion

A

Doppler USS

149
Q

Management of testicular torsion

A

> 

Manually reduce the torsion

> If testis are necrotic, remove

150
Q

What is paraphimosis?

A
  • Swelling of the foreskin distal to the phimotic ring

* Urological emergency

151
Q

Give one cause of paraphimosis

A

Post catherisation

152
Q

Symptoms of paraphimosis

A

Swollen glans

153
Q

Management of paraphimosis

A
  1. Gentle compression with an iced glove
  2. Granulated sugar for 1-2h
  3. Punctures in oedematous skin
154
Q

What is a priapism?

A

Painful erection lasting more than 4 hours

155
Q

What are the causes of priapism?

A
  1. Intracorporeal injection
  2. Trauma
  3. Neurological
  4. Idiopathic
156
Q

Treatment of priapism

A 
Ischaemic
>	Aspiration
>	Surgical shunt
>	Penile prosthesis
>	Alpha agonist

Non-ischaemic
> Observe
> Arterial embolization

157
Q

How common is penile cancer?

A

Very uncommon cancer. Typically occurs around 80 years of age and on the glans and prepuce (foreskin)

158
Q

Causes of penile cancer

A

> 

Smoking
Genital warts
Poor hygiene
159
Q

What are the premalignant lesions present in penile cancer?

A
  1. Balanitis xerotica oblierans

2. Leukoplakia (white patches)

160
Q

Diagnosis for penile cancer

A
  1. USS

2. Sentinel lymph node biopsy

161
Q

Management of penile cancer

A 
o	Penectomy
o	Reconstruction
o	Inguinal node lymphadenectomy
o	Radiotherapy
o	Chemotherapy
162
Q

Testicular cancer

A

Commonest in 20-35 years

Causes
• Undescended testes
• Being Caucasian
• Pesticides, infertility and smoking

163
Q

Causes of testicular cancer

A
  • Undescended testes
  • Being Caucasian
  • Pesticides, infertility and smoking
164
Q

What are the symptoms of testicular cancer?

A 
o	Swelling or lump in testis
o	Dull ache or sharp pain
o	Heaviness in the scrotum
o	Dull ache in abdomen
o	Hydrocele
o	Gynaecomastia
o	Fatigue
165
Q

Diagnosis of testicular cancer

A

Scrotal ultrasound

Blood tests

  1. AFP – never raised in seminoma
  2. HCG – always raised in teratoma
166
Q

Treatment of testicular cancer

A
  1. Orchiectomy (surgical removal of one or both testicles)
  2. Chemotherapy (teratoma)
  3. Radiotherapy (seminoma)
167
Q

What are the different types of testicular cancer?

A 
50% are non-seminomas (mainly 20-30years)
>	teratoma 
>	embryonal carcinoma
>	choriocarcinoma 
>	yolk sac tumour

45% are seminomas (potato tumours, mainly 30-50years)

168
Q

Hyperkalaemia treatment

A 
Mild cases (K+ >5.5-6.0 mmol/l)
•	Calcium resonium (orally or rectally)

Moderate cases (K+ > 6.5 mmol/l)
• Calcium resonium
• Dextrose + insulin

Severe cases (K+ > 7.0 mmol/l)
•	IV calcium chloride or gluconate 
•	Bollus of 50ml 50% dextrose and 10-15 units soluble insulin
•	Salbutamol nebulisers
•	Possibly sodium bicarbonate
169
Q

What is the role of IV calcium chloride or gluconate?

A

IV calcium chloride or gluconate (to stabilise the myocardium) in hyperkelemia

170
Q

What is the role of calcium resonium?

A

Removal of potassium ions out of body

171
Q

What is the adverse effects of thiazide diuretics?

A

 Potassium loss (hypokalaemia)
 Metabolic alkalosis
 Hypotension/hypovolaemia
 Hyperuricaemia (leading to gout)

172
Q

What is the adverse effects of Loop diuretics?

A

 Potassium loss (hypokalaemia)
 Metabolic alkalosis
 Hypotension/hypovolaemia
 Hyperuricaemia (leading to gout)

173
Q

“Cannon balls”

A

renal mets on CXR

174
Q

Sea anemone

A

transitional cell carcinoma on cystoscopy

175
Q

UTI + Travel to india

A

Carbapenemase-producing klebsiella (resistant to all abx)

176
Q

“Muddy brown casts” of epithelial cells

A

acute tubular necrosis

177
Q

Potato appearance

A

Testicular seminoma

178
Q

What do nitrites in urine suggest?

A

Infection

179
Q

How are recurrent UTI’s investigated?

A

Excretion urography - x-ray of urinary tract

180
Q

“Can of worms” prostate feeling

A

varicocele

181
Q

What are the 2 scrotal swellings?

A

If you can’t get above it - inguinal hernia

If you can get above it - hydrocele

182
Q

Anti-rejection therapy

A 
Calcineurin inhibitors (cyclosporin)
Azathioprine & mycophenolate
183
Q

Investigations for patients with haematuria

A

Over 50 (because of increased risk of transitional cell carcinoma): CT

Under 50: USS of kidneys, cystoscopy then CT

184
Q

Anderson-fabrys disease

A

o X-linked disease
o Renal failure
o Cardiomyopathy
o Angiokeratoma (tiny painless, dark-red papules that typically occur on the thighs, around the belly-button, lower abdomen, groin and buttocks)

185
Q

Medullary cystic kidney

A

Autosomal dominant
Morphologically abnormal renal tubules leading to fibrosis
Treat with renal transplant

186
Q

Indications for emergency dialysis

A
  1. Persistent hyperkalaemia
  2. Fluid overload
  3. Acidosis
  4. Pericarditis
187
Q

What antibiotic can cause proteinuria?

A

Gentamicin treatment

Renal Year 2 (3 decks)

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