Disease Table Notes: Flashcards
Aetiology prostate cancer
commonest male cancer older African Caribbean Western countries FH
Pathology prostate cancer
Mostly adenocarcinomas
Affecting peripheral zone
Signs prostate cancer
PSA
Mass on PR
Symptoms prostate cancer
Often asymptomatic
Prostatic symptoms
Weight loss
Lethargy
Prostatic symptoms
Hesitancy
Poor stream
Termina dribbling
Symptoms locally invasive prostate cancer
Haematuria Suprapubic pain Anuria Weight loss Lethargy Incontinence Impotence
Symptoms distant mets prostate cancer
Bone pain
Sciatica
Paraplegia
LN enlargement
Investigations prostate cancer
PSA PR Transrectal US + biopsy CT MRI
Rx for prostate cancer
Watchful waiting
Radical prostatectomy
Hormone therapy
Active surveillance
What is PSA
Protease produced by semen
Many leaked into serum
when do you not measure PSA?
after PR
ejaculation
What can causes elevations in PSA?
UTI
Chronic prostatitis
BPH
Prostate cancer
Risk factors testicular cancer
Young males Infertility Atrophic testis Previous cancer in contralateral testis FH
2 types of testicular cancer
Seminoma
Non-seminomatous:
Commonest type of testicular cancer
Germ cell tumour
Testicular cancer tumour markers
Alpha fetoprotein
Beta HCG
LDH/lactase dehydrogenase
Symptoms testicular cancer
Painless lump
Trauma often brings people to notice lumps
Pain
Symptoms lung mets in testicular cancer
Dyspnoea
Investigations testicular cancer
MSSU
Testicular USS
Mets:
CXR
CT chest/abdo/pelvis
Rx testicular cancer
Orchidectomy
Radiotherapy
Rx testicular cancer metastases
Chemotherapy
Common mets site testicular cancer
Para-aortic LN
Chest
Bone
Risk factors renal cancer
M FH Smoking Anti-hypertensives OBesity End-stage renal disease
Subtypes renal cancer
Clear cell
Papillary
Chromophobe
Classic triad renal cancer
Flank pain
Haematuria
Mass
Symptoms renal cancer
Haematuria
Loin pain
Weight loss
Anorexia
Investigations for renal cancer
U&E's FBC US CT MRI
RX renal cancer
radical nephrectomy
How does RCC respond to chemo and radio?
Resistant to both
2 benign lesions of kidneys
Oncocytoma
Angiomyolipoma
Risk factors TCC bladder cancer
Smoking
Aromatic amines
Risk factors squamous cell carcinoma
Schistosomiasis
Chronic cystitis
Recurrent UTI
Pelvis radiotherapy
What do most RCC arise from
TCC
Symptoms of bladder cancer
Frank haematuria
Recurrent UTI
Dysuria
Investigations for bladder cancer
Cystoscopy + biopsy
CT urogram
USS
Investigations for bladder cancer staging
CT
MRI
Bone scan if suspected mets
RX for grade non-muscle invasive bladder cancer
TURBT
Followed by chemo
Rx for High grade non-invasive bladder cancer
BCG therapy
Radical surgery
RX muscle invasive bladder cancer
Radical cystectomy
Radiotherapy
Follow up bladder cancer
Regular cystoscopy
Common mets bladder cancer
Iliac LN
Para-aortic LN
Liver
Lungs
Risk factors UTI
F (short urethra) Sexual activity DM Pregnancy Renal cysts Renal stones Catheterisation Instrumentation (cystoscopy) BPH Loss of bladder sensation (stasis of urine) Congenital
Common UTI organisms
E.coli
Proteus sp.
Staph saprophyticus
Symptoms UTI
Dysuria Frequency Urgency Polyuria Haematuria Suprapubic pain
Investigations for UTI
MSSU:
>105
Catheter:
Collected from catheter sampling port
Uncomplicated UTI treatment
3d course:
Trimethoprim
Nitrofurantoin
eGFR >30
RX Men UTI
7d course
Trimethoprim
Nitrofurantoin
eGFR>30
RX UTI in pregnancy
Nitrofurantoin
NOT trimethoprim
Who should be screened for UTI
Pregnant W
What might recurrent UTI in young males be a sign of?
Chlamydia
What is acute polynephritis
Acute kidney infection
Symptoms of acute polynephritis
Fever
Rigors
Loin pain
Urinary symptoms
Rx for acute polynephritis
Ciproflaxin
Commonest kidney stone type
Calcium oxalate
Are more M or F affected with urothliasis
M
Symptoms of kidney stone?
Loin tenderness
Dysuria
Haematuria
UTI
Commonest presentation of kidney stones
Loin pain
Imaging for kidney stones
CT KUB
KUB x-ray
USS
Investigations for kidney stones
FBC U&E's Creatinine Albumin Calcium Phosphate
Rx for kidney stones
Analgesics: NSAIDS
ESWL
PCNL
Ureteroscopy
When is ESWL not effective for renal stones?
> 2cm
Cystine stones
In pregnancy
Indications for PCNL
Large stones
PUJ stenosis
What is AKI
Sudden episode of kidney failure or kidney damage that occurs within hrs/days
Increase in Serum Creatinine by ≥26.5 umol/l
Or
≥1.5x baseline
Urine output <0.5ml/kg/hr for 6 hrs
Who is AKI common in
Hospitalised patients
Risk factors for AKI
Age>75 Previous AKI HF Liver disease CKD DM Vascular disease Common hospitalised patients
Pre-renal causes AKI
Hypovolaemia Arterial occlusion ACE inhibitors Haemmorhage Hypotension (shock)
Renal causes AKI
Toxin related (NSAIDS, aminoglycosides) Acute interstitial nephritis Acute tubular necrosis Acute GN Vasculitis
Which drugs are notoriously renal toxic?
Gentamicin
NSAIDs
Aminoglycosides
Post renal causes AKi
Obstruction Stones Malignancy Stricture Fibrosis
Investigations AKI
Serum creatinine Urine output Potassium ECG USS Renal biopsy Proteinuria? Haematuria?
ECG signs hyperkalaemia
Tall tented T waves
Increased PR interval
Rx fluid balance AKI
Volume resuscitation
Optimised BP
Stop ACE inhibitors
Rx toxicity AKI
Stop nephrotoxic drug
RX for hyperkalaemis
Calcium gluconate
IV insulin + glc
Salbutamol
Consequences AKI
Acidosis Electrolyte imbalance Intoxication Fluid overload Uraemia symptoms: gout
Definition of CKD
Defined by either the presence of kidney damage
Or
eGFR <60ml/min that is present 3 months
Causes of CKD
Hypertension DM GN Renovascular disease Polycystic kidney disease Chronic exposure to toxins
Define stage 1 CKD
GFR>90
Define stage 2 CKD
GFR 60-89
Define stage 3 CKD
GFR 30-59
Define stage 4 CKD
15-29
Define stage 5 CKD
<15
Blood investigations CKD
U&E’s K+ Urea Creatinine Bicarb Albumin Calcium LFT’s
Urine investigations CKD
Blood
Protein
PCR
24hr collection
Histology investigations CKD
Biopsy
Clotting factors
Radiology investigations CKD
USS
Plain radiograph
CT
MRI
Rx hypertension CKD
Look diuretics
RX CKD
Manage the underlying cause Establish good DM control Treat hypertension Erythropoietin Sodium bicarbonate Restrict fluid and salt intake Loop diuretics Activated vitamin D analogues RRT Kidney Tx
When is RRT required for CKD
Stage 5
<15 GFR
Long term complications of CKD
Acidosis Renal bone disease Death and dialysis Uraemic complications Hypertension
Examples of uraemic complications in AKI and CKD
Pericarditis
Encephalopathy
Gout
How does CKD lead to anaemia
Kidneys are responsible for erythropoietin production
Which stimulate production of RBC from bone marrow
So in CKD:
Reduced erythropoietin production
Lower production of RBC
Anaemia
Treatment for anaemia in CKD
Rx give erythropoietin
Describe bone disease in CKD
Loss or renal tissue leads to lack of activated Vit D3
Indirect reduction in calcium absorption from gut
Leads to hypocalcaemia
PTH is released causing the bones to lose calcium
Over time this resorption of calcium from the bones leads to brittle bones
Describe serum calcium and phosphate levels in CKD
High serum phosphate
Low serum calcium
Describe acidosis in CKD
Worsen hyperkalaemia
Describe hyperkalaemia in CKD
K+ normally secreted with exchange for Na+ absorption in distal tubule
Reduced deliver of Na+ to distal tubule as GFR falls
Therefore, retain potassium
Leading to hyperkalaemia
What can K+ >7mmol/L cause
Fatal cardiac arrhythmia
Which zone does BPH typically affect?
Transitional zone
What is BPH common with?
Increasing age
Which score is used for prostate symptoms?
International prostate symptoms score
What are the voiding symptoms of BPH
Hesitancy
Poor stream
Terminal dribbling
Incomplete emptying
What are storage symptoms of BPH
Frequency
Nocturia
Urgency
Urge incontinence
Investigations for BPH
PSA MSSU Flow rate study Urea Creatinine Flexible cystoscopy Renal USS Prostate biopsy
Medical therapy for BPH
Alpha blocker
5 alpha reductase inhibitors
Surgical treatment for BPH
Transurethral resection of prostate
TURP
Potential side effect of TURP
Impotence
Complications of BPO
Progression of LUTS Acute or chronic urinary retention Urinary incontinence UTI Bladder stone Renal failure due to hydronephrosis
Characteristics of nephritis syndrome
Haematuria
Hypertension
Little proteinuria
Low urine vol.
Pathology of IgA nephropathy
IgA deposits in the mesangium
Causing increased proliferation in mesangial cells
Irritates mesangial cells and causes them to proliferate and produce more matrix
IgA becomes stuck in mesangium and becomes clogged with antibody
Symptoms of IgA nephropathy
Haematuria
Proteinuria <1g
Hypertension
Investigations for IgA nephropathy
Renal biopsy
Rx IgA nephropathy
ACEi/ARB
Corticosteroids
What does post infective nephritis commonly follow?
Pharyngitis
Impetigo
Streptococcal infection
How long after infection does post infective nephritis occur?
10-21 days
Rx for post-infective nephritis
Antibiotics for infection
Pathology of post infective nephritis
Streptococcal antigen deposits in the glomerulus leading to immune complex formation and inflammation
Triad of nephrotic syndrome
Heavy proteinuria
Oedema
Hypoalbuminaemia
Treatment for oedema
Furosemide
3 main nephrotic syndromes
Minimal change disease
Membranous Nephropathy
Focal Segmental Glomerulonephritis
3 main Nephritic Syndormes
IgA Nephropathy
Post infective Nephritis
Cresentic Glomerulonephritis
Who is minimal change disease most commonly seen in?
Children
Symptoms minimal change disease
Sudden onset oedema
Proteinuria
Hyperlipidaemia
Treatment for minimal change disease
Corticosteroids:
Prednisolone
Does minimal change disease cause renal failure?
No
Investigations for minimal change disease
Urinanalysis
24hr protein urine
Serum albumin levels
Urine protein/creatinine reation
Pathology membranous glomerulonephritis
Thickened glomerular basement membrane
Diffusely thickened due to sub epithelial deposits of IgG
Activates compliment C3 which punches holes in the membrane
Glomerular membrane thickened by leaky
Allowing albumin to be filtered (oedema)
Signs of membranous glomerulonephritis
Oedema
Hypoalbuminaemia
Heavy proteinuria
Which antibody is seen in membranous glomerulonephritis
PLA2R
Which three areas does glomerulonephritis with polyangitis commonly affect
Kidney
Lungs
Nose
What can membranous glomerulonephritis be secondary to?
Malignancy
Infection
Rheumatoid Arthritis
Drugs
Pathology of focal and segmental glomerulosclerosis
Scar tissue formation in segments of some glomeruli
Segmental sclerosis and hyalinosis
Symptoms/signs of focal and segmental glomerulosclerosis
Proteinuria
Hypoalbuminaemia
Hyperlipidaemia
Oedema
Does focal and segmental glomerulosclerosis pose a risk of CKD?
yes
Rx for focal and segmental glomerulosclerosis
ACEi/ARB
Furosemide
Rutiximab