condition part 2 Flashcards
definition of urinary tract calculi
renal stones consisting of crystal aggregates form in collecting ducts and maybe deposited anywhere from the renal pelvis to the urethra although classically at pelvoureteric junction, pelvic brim, vesicoureteric junction
what are the different types of urinary tract calculi
calcium oxalate - 75% magnesium ammonium phosphate/struvite -15% urate -5% hydroxyapatite -5% brushite/cystine - 1%
how common is urinary tract calculi
common, lifetime incidence up to 15%
who is affected the most by urinary tract calculi
peak age - 20-40 yrs
males 3 times more than female
causes of urinary tract calculi
supersaturation of urine
- necessary but not sufficient condition for development of any urinary calculus
- factors influence this - Ph (better dissolve in alkaline rather than acidic soultions), fluid volume (dec volume - greater conc)
what can inhibit renal stone
citrate and magnesium (together can work synergistically to inhibit the renal stones
RF for renal stones
life style - dehydration, salt, oxalate in tea bitter leaf vegetables, nuts, berries, chocolate, calcium supplements, animal protein
biological
recurrent UTIs
metabolic abnor - hypercalciuria, hypercalcaemia, hyperparathyroidism, hyperuricosuria, hyperoxaluria, cystinuria, renal tubular acidosis
urinary tract abnor - PVJ obstruction, hydronephrosis, vesicoureteric reflux, ureteral stricture
foreign bodies -stents, catheters
Crohn’s disease - associated with hyperoxaluria and dec absorption of magnesium
symptoms of UT stones
can be asymptomatic
renal colic - excruciating ureteric spasm loin to goin, radiate to genitals, inner, thighs, constant pain
haematuria
anuria
N+v
sign of TU calculi
loin tendernes
suprapubic pain
prostatic enlargement
differential for UT calculi
Biliary colic/acute cholecystitis/gallstones aortic dissection pyelonephritis acute pancreatitis acute appendicitis peritonitis perforated peptic ulcer MSK back pain ectopic pregnancy epididymitis/testicular torsion
investigation for UT calculi
urine dipstick
bloods - FBC, U+Es, CRP, calcium, phosphate, urate, renal function
MSU MS+C
imaging - CT KUB, X-ray KUB, IV pyelogram, USS
24 hrs for calcium, oxalates, urate, citrate, sodium, creatinine
stone biochemistry
treatment for UT Calculi
analgesia, ABx if infection
medical expulsion therapy
- alpha blocker
- calcium channel blocker - nifedipine
extracorporeal shockwave lithotripsy (ESWL) - USS waves to shatter stone
surgical
- percutaneous nephrolithotomy - laparo surgery
- ureteroscopy - insertion of stent or ureteroscopic lithotripsy
definition for UTI
the presence of a pure growth of >10(5) organisms/mL of fresh MSU. Bacteria might be present in MSU but pt might be asymptomatic. It can affect other organs such as bladder (cystitis), urethra (urethritis), prostate (prostatitis), lower UTI or renal pelvis (pyelonephritis) - upper UTI
how common is UTI
50,000/1mn/year, 1-2% presentation to GP, recurretn infection can cause considerable morbidity and renal failure
up to a 1/3 of women with symptoms have -ve MSU (abectrial cystitis or urethral syndrome)
Who is affected the most by UTI
newborn male - due to higher GU abnor
Teenage women - due to beginning of sexual activity
men when older - mostly due to prostate problems
women post-menopause - low oestrogen makes it easier for bacteria to adhere
women more so than men - due to shorter and straight urethra if men or children have UTI then investigate further for abnor –> complicated cystitis
causes of UTI
bacteria from person’s own bowel flora (gut) transfer via ascending transurethral route but maybe via blood stream, lymphatic or direct extension eg vesicocolic fistula
relapse - when bacteruria within 7 days of the same organisms
reinfection - when bacteriuria is absent after treatment for at least 14 days followed by recurrence of infection with the same or different organisms
RF of UTI
female
sexual intercourse
exposure of spermicide in females (by diaphragms or condoms)
pregnancy - not usually picked up unless severe pyelonephritis develop
menopause
immunosuppression
urinary tract obstruction/stones/malformation
long term catheter
symptoms of UTI
Symptomatic infection related to bacteria virulence but inflammation and injury determined by host response not bacteria.
cystitis - frequency, urgency, nocturia, dysuria, haematuria, suprapubic pain
acute pyelonephritis - fever, rigors, vomiting, loin pain and tenderness, oliguria
prostatitis - flu-like symptoms, low backache, swollen/tender prostate on PR, few urinary symptoms
in older pts, UTI can cause confusion too
sign of UTI on exam
pyerxial, abdo pain/loin tenderness foul-smelling urine distended bladder enlarged prostate
differential diagnosis for UTI
urethral syndrome - similar presentation to UTI but not related to infection
interstitial cystitis/bladder pain syndrome - chronic inflammatory condition of bladder
chronic nonbacterial prostatitis/chronic pelvic pain syndrome - non-infective and similar presentation for UTI
vaginitis/vulvovaginal infections - itching, irritation, discharge, pain on intercourse
STI
investigation for UTI
urine dipstick - MSU, urine inspection (cloudy, red), if infection present - inc leucocytes inc nitrites, haematuria (might be microscopic)
urine MS+C - white bottle, red bottle - contains bolic acid which stops contaminate overgrowth that could affect results. only do if pt symptomatic, dipstick +ve, male, child, pregnant, immunosuppressed
bloods - FBC, U+E, CRP, culture - if systemically unwell
imaging - USS - pyelonephritis, kidney stones etc
CT KUB, cystoscopy, MRI
management of UTI
- prevent - drink plenty of water, cranberry/lingo juice, antibiotic prophylaxis
- treatment (only treat >10(5) organism/mL or <10(5) and pyuric and symptomatic)
what are the causes of sterile UTI
previous treated UTI (<2 weeks prior) inaduqately treated UTI appendicitis calculi prostatitis bladder tumour UTI with fastidious organism (organisms only grow in special environment eg Neisseria gonnorhoeae) tubulointersitital nephritis papillary necrosis polycystic kidney chemical cystitis
treatment for UTI
empirical
- trimethorim or nitrofuranotoin
- cefalexin for pregnant women
if pyelonephritis
- ciprofloxacin for 7 days or co-amoxiclav for 14 days
- cefalexin for 10-14 days if pregnant
how common is renal cell carcinoma
1-2% of all tumours, most common renal tumour in adults
who is affected the most by renal cell carcinoma
M:F 2:1, rarely present <40yrs, average age of presentation is 55
core symptoms of RCC
Often asymptomatic; though possible haematuria, loin pain and mass in the flank
Malaise, anorexia and weight loss (30%)
signs on exam for RCC
common - polycythaemia (5% - genetic condition when bone marrow produce too much RBC) but in this cause due to secreation fo renin by the tumour, anaemia due to depression of EPO production, maybe pyrexial
rare - lef-sided varicocele due to invasion of renal vein and obstruction of left testicular vein into renal vein
causes f RCC
arise from proximal tubular epithelium
RF for RCC
Von Hippel-Linau disease - AD disorder, bilateral RCC, haemangioblastomas, phaeochromocytomas, renal cysts common
investigation for RCC
USS, MRI
mangement for RCC
nephrectomy (partial of whole)- unless bilateral RCC or contralateral kidney function poor. Should still go ahead even if mets are present asa they might dec after.
medroxyprogesterone acetate - help with mets
IL-2 therapy
temsirolimus - new, inhibits rapamycin kinase improve overall survival rates in those with mets RCC
definition of bladder/urothelial tumours
cancer of the bladder, ureters and/or urethra
90% are transitional cell carcinomas (TCC) also known as urothelial cell carcinoma (UCC)
how common is bladder cancer
1/6000 people per year in the UK
3% of deaths from all cancers
Bladder tumours are 50x more common than those of ureter or renal pelvis
who is affected the most by bladder cancer
m:f 5:2
ncommon in <50s
RFF for bladder cancer
smoking (biggest risk factor), exposure to industrial carcinogens, exposure to some drugs (phenacetin, cyclophosphamide - lupus etc), chronic inflammation
symptoms of bladder cancer
painless haematuria recurrent UTI dysuria urgency frequency metastatic symptoms
differentials for bladder cancer
UTI, renal/urinary stones, BPH, prostatitis
investigation for bladder cancer
cystoscopy, urine cytology/microscopy, CT urogram, MRI/lymphangiography
treatment for bladder cancer
TURBT
radical cystectomy
palliative chemo/radiotherapy
