Genitourinary Flashcards
What is the definition of acute kidney injury?
Significant deterioration in renal function occurring over hours or days
What is the aetiology of acute kidney injury?
Pre-renal (decreased perfusion), renal (acute tubular necrosis, glomerulonephritis, post-renal (benign prostatic hyperplasia, kidney stones, tumour)
What is the clinical presentation of acute kidney injury?
Oliguria, fatigue, or tiredness, shortness of breath (severe cases: pulmonary oedema, encephalopathy, pericarditis)
What are the investigations of acute kidney injury?
o Creatinine: elevated
o Urine output: <0.5 ml/kg for > 6 consecutive hours
o Urea: elevated
What is the treatment of acute kidney injury?
Treat underlying cause, dialysis, manage complications (hyperkalaemia, pulmonary oedema, uraemia, acidaemia), fluid management
What is the definition of chronic renal failure?
Abnormalities of kidney structure or function present for > 3 months
What is the aetiology of chronic renal failure?
Acute renal failure, hypertension, diabetes, kidney disease
What is the clinical presentation of chronic renal failure?
Asymptomatic, tired, bone pain, fluid overload, anorexia
What are the investigations of chronic renal failure?
o Blood: low calcium, high phosphate, high PTH
o Kidney biopsy
What is the treatment of chronic renal failure?
BP control, ACE inhibitors, treat complications, dialysis, transplant
What is the classification of chronic renal failure?
o G1: GFR ≥ 90 (normal or high)
o G2: GFR 60-80 (mildly decreased)
o G3a: GFR 45-59 (mildly to moderately decreased)
o G3b: GFR 30-44 (moderately to severely decreased)
o G4: GFR 15-29 (severely decreased)
o G5: GFR <15 (kidney failure)
What is the definition of acute nephritic syndrome?
Inflammation and damage to the glomeruli due to an immune response triggered by an infection
What is the aetiology of acute nephritic syndrome?
IgA nephropathy, streptococcal infection, SLE, Goodpasture’s, ANCA
What is the pathophysiology of acute nephritic syndrome?
IgA immune complex deposition
What is the clinical presentation of acute nephritic syndrome?
Asymptomatic, visible haematuria, hypertension, oedema
What are the investigations of acute nephritic syndrome?
o Renal biopsy: IgA deposition
o Urinalysis: haematuria and red cell casts, proteinuria
o Urine output: low
What is the treatment of acute nephritic syndrome?
ACE inhibitors (reduce BP and proteinuria)
What is the definition of nephrotic syndrome?
Proteinuria due to podocyte pathology
What is the aetiology of nephrotic syndrome?
Minimal change disease (podocyte fusion), diabetes, amyloid, SLE, focal segmental glomerulosclerosis
What is the clinical presentation of nephrotic syndrome?
Pitting oedema, frothy urine
What are the investigations of nephrotic syndrome?
o Urinalysis: proteinuria
o Serum albumin: hypalbuminaemia
What is the treatment of nephrotic syndrome?
Fluid and salt restriction, and diuretics (oedema), treat underlying cause (steroids in minimal change disease), ACE inhibitor (reduce proteinuria)
What is the definition of polycystic kidney disease?
Inherited disorder in which clusters of cysts develop within the kidney causing them to enlarge and lose function
What is the aetiology of polycystic kidney disease?
ADPKD (PKD1/2), ARPKD (PKHD1)
What is the clinical presentation of polycystic kidney disease?
Hypertension, flank pain and mass, haematuria, polycystic liver disease, intracranial aneurysms (subarachnoid haemorrhage)
What are the investigations of polycystic kidney disease?
Ultrasound scan
What is the treatment of polycystic kidney disease?
High water intake (suppress cyst growth), BP control, cyst decompression
What is the definition of nephrolithiasis?
Stones in the urinary tract, usually consisting of calcium oxalate
What is the clinical presentation of nephrolithiasis?
Renal colic, loin pain which radiates to the groin, dysuria, urgency, frequency, recurrent UTI’s, haematuria, vomiting
What are the investigations of nephrolithiasis?
o Bloods (calcium, phosphate, and urate)
o Urinalysis
o Ultrasound: hydronephrosis (swelling of the kidney)
o NCCT-KUB
What is the treatment of nephrolithiasis?
Conservative (<5mm, IV fluids, analgesia, anti-emetics), medical (nifedipine), Lithotripsy (fragment stones), surgical (PCNL for larger stag horn stones)
What is an epididymal cyst?
Benign cyst of the epididymis which presents with small paratesticular swelling which may be tender and can be removed if symptomatic
What is hydrocele?
Accumulation of fluid in between the tunica vaginalis layers due to trauma. It presents with scrotal swelling and can spontaneously resolve, or require aspiration or surgery
What is varicocele?
Persistent abnormal dilation of the pampiniform venous plexus which presents with nodularity, dull ache, distended scrotal blood vessels. Surgery can be performed if symptomatic
What is the clinical presentation of a testicular torsion?
Sudden onset of pain in testes, abdominal pain, nausea and vomiting
What are the investigations of a testicular torsion?
o Doppler ultrasound: lack of blood flow
o Surgical exploration
What is the treatment of a testicular torsion?
Surgical untwisting
What is the definition of benign prostatic hyperplasia?
Enlargement of the prostate gland due to an increase in cell number
What is the clinical presentation of benign prostatic hyperplasia?
Frequency, nocturia, hesitancy, post void dribbling
What is the treatment of benign prostatic hyperplasia?
Alpha-blockers (tamsulosin), 5-alpha-reducatse inhibitors, transurethral resection of prostate
What is the aetiology of urinary treat infections?
E. coli, coagulase negative staphylococcus, proteus mirabililis, enterococci, klebsiella pneumonia
What is the clinical presentation of urinary treat infections?
Frequency, urgency, dysuria, haematuria, suprapubic pain, (fever, rigors, vomiting, pyuria, loin pain if pyelonephritis)
What are the investigations of urinary treat infections?
o Urinalysis: leucocytes or nitrates
o Microscopy: WBCs, RBCs, casts, bacteria
o MCS MSU: >105 organisms/ml
What is the treatment of urinary treat infections?
Antibiotics (trimethoprim (avoid in pregnancy), nitrofurantoin)
What is the clinical presentation of Chlamydia Trachomatis?
o Male: asymptomatic, urethritis, testicular pain
o Female: asymptomatic, vaginal discharge, bleeding, lower abdominal/pelvic pain
How is Chlamydia Trachomatis diagnosed?
Nucleic acid amplification test
What is the treatment of Chlamydia Trachomatis?
Avoid sexual intercourse, doxycycline (CI pregnancy) or azithromycin, contact tracing
What is the clinical presentation of Neisseria Gonorrhoea?
o Male: asymptomatic, urethritis, purulent discharge, dysuria
o Female: endocervicitis (pelvic pain), vaginal discharge, itch, dysuria
How is Neisseria Gonorrhoea diagnosed?
o Nucleic acid amplification test
o Microscopy: gram-negative diplococci with polymorphonuclear cells
What is the treatment of Neisseria Gonorrhoea?
Ceftriaxone
