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Phase 2a diseases > Genitourinary > Flashcards

Genitourinary Flashcards

1
Q

What is nephrolithiasis?

A

Presence of calculi within the urinary tract.

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2
Q

What are the clinical presentations of kidney stones?

A
  • Many will be asymptomatic.

If they obstruct the collecting ducts in the kidneys:

  • Renal colic pain (loin to groin).
  • Commonly associated with nausea and vomiting.
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3
Q

What are the risk factors for kidney stones?

A
  • Dehydration.
  • Obesity.
  • Male.
  • Previous kidney stones.
  • Older age.
  • High salt intake.
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4
Q

What is the pathophysiology of renal colic pain?

A
  • Kidney stone blocks the collecting ducts of the kidney.
  • The stone increases the intraluminal pressure which stretches the nerve ends.
  • This is felt as renal colic pain.
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5
Q

What are the main types of kidney stone?

A

Calcium stones (80% of all kidney stones):

  • Calcium oxalate. 80% of all calcium stones, so the most common type of kidney stone overall.
  • Calcium phosphate. The other 20% of calcium stones.

Uric acid stones. Approx. 10%

Stones can also be cystine or struvite.

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6
Q

What are the investigations used for kidney stones?

A
  • Non-contrast CT of KUB (kidney, ureter and bladder) is the gold standard.
    NOTE: Use USS rather than CT in people under 16.
  • Urinalysis. There is often microhaematuria.
  • FBC. Raised WCC can be indicative of infective differential such as UTI or pyelonephritis.
  • Serum electrolytes. Low calcium suggestive of hyperthyroidism being the cause.
  • Pregnancy test (ectopic pregnancy?).
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7
Q

What is the treatment for kidney stones?

A
  • If asymptomatic, watch and wait.

If smaller but symptomatic:

  • Analgesia (ibuprofen 1st line, paracetamol 2nd line).
  • Keep hydrated, and try to pass normally.

If larger:

  • Surgical intervention (Shock wave lithotripsy SWL).
  • Potentially other more invasive surgical intervention.

If there is a blockage:
- Fit a ureteric stent and achieve decompression before removing the stone surgically.

If there is an infection:
- Antibiotic treatment.

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8
Q

What are the differentials for kidney stones?

A
  • Pyelonephritis.
  • Ectopic pregnancy.
  • Appendicitis.
  • Bowel obstruction

The differentials can be differentiated through use of a KUB NCCT.

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9
Q

Which kidney stones are radiolucent? What does this mean?

A
  • Pure uric acid stones are radiolucent.

- This means that they do not show up on XR.

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10
Q

What is acute kidney injury?

A

Rapid deterioration of renal function, which causes:
- Decreased urinary output.
AND/OR
- A rise in creatinine levels.

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11
Q
  • What are the four types of AKI?
A
  • Pre-renal AKI. Due to reduced kidney perfusion.
  • Intrinsic AKI. Due to direct injury to the kidney parenchyma.
  • Post-renal AKI. Due to obstruction in urinary outflow.
  • Drug-induced AKI. Due to nephrotoxic drugs.
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12
Q

What are some examples of causes of pre-renal AKI?

A

PRE-RENAL: Overdiuresis, hypotension, haemorrhage

RENAL: Glomerulonephritis, interstitial nephritis. kidney insult (either surgery or septic).

POST-RENAL: BPH, cancer, UTI, renal stones.

Drug-induced AKI: “DAMN” drugs (diuretics, ACEI, ARB’s, Metformin, NSAIDs).

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13
Q

What is the pathophysiology of pre-renal AKI?

A
  • Decreased kidney perfusion, resulting in reduced GFR. To try and compensate/maintain GFR, the body:
  • More ADH is secreted from the pituitary, this increases water/sodium reabsorption.
  • Baroreceptors in the carotid artery and aortic arch sense low BP and increase sympathetic activity.
  • Afferent arterioles (towards the glomerulus) in kidney dilate, efferent arterioles (away from glomerulus) in kidney constrict.
    NOTE: It would be the opposite to decrease the GFR.
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14
Q

What are the key nephrotoxic medications?

What common drug is not nephrotoxic?

A

“DAMN” drugs:

  • Diuretics.
  • ACEI, ARBs
  • Metformin.
  • NSAIDs.
  • Gentamycin is also nephrotoxic.
  • Paracetamol IS NOT NEPHROTOXIC.
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15
Q

What is the treatment for AKI?

A

“STOP AKI”

  • Sepsis? SEPSIS-6
  • Toxins. Stop any nephrotoxic drugs.
  • Optimise bp/blood volume. Use fluids as appropriate but manage electrolyte levels. Consider use of desmopressin if fluids are not enough.
  • Prevent harm. If the patient has: Hyperkalaemia, metabolic acidosis, hyperphosphataemia, volume overload (excess fluids), severe AKI ADMIT FOR EMERGENCY RRT (Renal replacement therapy).
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16
Q

What are some of the main potential complications of AKI?

A
  • Hyperphosphataemia.
  • Hyperkalaemia.
  • Metabolic acidosis (inadequate nephritic removal of acid from the blood).
  • Fluid overload (due to excess IV fluid administration).
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17
Q

What is chronic kidney disease (CKD)?

What are the risk factors for CKD?

A

Also known as chronic renal failure, CKD is:
- Abnormalities in kidney function/structure present for over 3 months.

Risk factors:

  • Diabetes mellitus (most common cause DKD which is a type of CKD).
  • Hypertension.
  • Age > 50.
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18
Q

How is chronic kidney disease classified?

A

Stage 1 - GFR = >90mL/min BUT THERE IS EVIDENCE OF KIDNEY DISEASE.

Stage 2 - GFR = 60-89mL/min

Stage 3a - GFR = 45-59mL/min

Stage 3b - GFR = 30-44mL/min

Stage 4 - GFR = 15-29mL/min

Stage 5 (End stage/kidney failure) - GFR = <15mL/min

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19
Q

What is the clinical presentation of CKD?

A

Significant number of people will be asymptomatic. Can also present with:

  • Fatigue
  • Oedema (due to volemic overload).
  • Nausea with/without vomiting.
  • Pruritus due to hyperphosphataemia.
  • Restless leg syndrome (due to hypercalcaemia, anaemia, iron deficiency.
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20
Q

What is the pathophysiology of CKD?

A

Renal damage causes:

  • Increased renal pressure to try and restore the GFR.
  • This results in glomerular scarring/fibrosis and inflammation.
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21
Q

What are the investigations used in CKD?

A
  • Creatinine. Raised.
  • GFR estimate: Will be reduced.
  • Urinalysis: Proteinuria (hyperalbuminaemia) and haematuria.
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22
Q

What are the common complications of CKD?

A
  • Anaemia (due to reduced production of erythropoietin).
  • CV disease (poor glycemic control, hypertension etc.)
  • Metabolic acidosis (impaired ability to excrete acid from the blood).
  • Hyperkalaemia (reduced K excretion due to sodium/water retention).
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23
Q

What is the treatment for CKD?

A

Mainstay is to try and treat cardiovascular disease, as this is what causes most of the mortality in CKD:

Hypertension: treat with ACEI (ramipril) or ARB (losartan).

Dyslipidaemia: Give statin (atorvastatin) to reduce risk.

Poor glycemic control: 1st line is ACEI or ARB. If needed introduce a SGLT2 inhibitor (canagliflozin).

Next steps:

  • If severe (stage 5), consider RRT (renal replacement therapy) or ideally a kidney transplant.
24
Q

What is BPH?

A
  • Benign prostatic hyperplasia.

- Increase in the size of the prostate gland without malignancy.

25
Q

What is the clinical presentation of BPH?

A
  • Frequent urination
  • Incomplete emptying
  • Intermittent/weak stream
  • Urgency
  • Nocturia
  • Straining to urinate (later in disease).
26
Q

What is the pathophysiology of BPH?

A
  • Hyperplasia of the epithelial and stromal cells if the prostate.
  • Usually, the median lobe is affected.
27
Q

What is the aetiology of BPH?

A
  • Androgens promote cell proliferation in the prostate.
28
Q

How is BPH diagnosed?

A
  • History taking (assess for symptoms).
  • Ultrasound (assess size and shape of prostate).
  • DRE (enlarged, craggy mass).
29
Q

How is BPH treated?

A

NO SYMPTOMS:
- Watch and wait

FOR THOSE WITH SYMPTOMS NOT SUITABLE FOR SURGERY:

  • Doxazosin (alpha blocker)
  • Finasteride (5-a-reductase inhibitor)

IF SUITABLE FOR SURGERY:

  • Transurethral resection of prostate (GS)
  • Open prostatectomy if transurethral surgery not an option.
30
Q

What are the potential complications of BPH?

A
  • Recurrent UTI

- Bladder calculi.

31
Q

What is pyelonephritis?

A
  • Infection within the renal pelvis.

- Can be acute or chronic.

32
Q

What are the symptoms of pyelonnephritis?

A
  • Rapid onset loin, suprapubic or back pain.
  • Fever, malaise, nausea, anorexia.
  • Possible lower UTI with frequent dysuria, haematuria or hesitancy.
33
Q

What is the pathophysiology of pyelonephritis?

A
  • Infection of the renal pelvis by UTI organisms (Escheria coli for 70% of cases, Klebsiella, Proteus, Enterococcus).
34
Q

What are the risk factors for pyelonephritis?

A
  • Can occur at any age.

- Generally more frequent in females.

35
Q

What are the investigations used to diagnose pyelonephritis?

A
  • Urine will look cloudy and smell bad.
  • Urine dipstick (confirms diagnosis).
  • Midstream urine culture (assesses antibiotic susceptibility of the causative organism).
36
Q

What is the treatment for pyelonephritis (acute)?

A
  • Antibiotics (ciprofloxacin or co-amoxiclav).
  • When urine culture comes back, change antibiotics if necessary.
  • Consider paracetamol for analgesia (not NSAIDs as these can cause AKI).
37
Q

What is the treatment for pyelonephritis (chronic)?

A
  • Aim to treat underlying cause (GS)

- Antibiotics (e.g. ciprofloxacin).

38
Q
  • What is cystitis?
A
  • Infection causing inflammation in the bladder.
39
Q

What are the symptoms of cystitis?

A
  • Frequent urination (polyuria).
  • Urgency.
  • Pain on urination (dysuria)
  • Abdominal tenderness
  • Swollen bladder
40
Q

What is the pathophysiology of cystitis?

A
  • Infection of the urine stored in the bladder. Can be washed out with frequent fluids.
41
Q

What is the aetiology of cystitis?

A
  • Can be caused from incomplete emptying.
42
Q

How is cystitis diagnosed?

A
  • History taking

- Midstream urine sample

43
Q

What is the treatment for cystitis?

A
  • 3 Days of trimethoprim OR 5 days of nitrofurantoin.

- Phenazopyridine to relieve dysuria.

44
Q

What is prostatitis?

A

Inflammation of the prostate gland usually due to bacterial infection

45
Q

What is the clinical presentation of prostatitis?

A
  • Macroscopic haematuria.
  • Fever
  • Dysuria
  • Pyrexia
  • Sharp pelvic/penile/anal pain.
46
Q

What is the aetiology of prostatitis?

A

Normally caused by gram -ve organisms:

  • E. coli
  • Enterobacter
  • Serratia

Will sometimes be caused by STIs:

  • Neisseria gonorrhoeae.
  • Chlamydia trachomatis.
47
Q

What is the investigation used to diagnose prostatitis?

A

DRE:

- Prostate will feel nodular, tender and hot.

48
Q

What is the treatment for prostatitis?

A
  • Quinolone antibiotics (Ciprofloxacin) 1st line.

- Ibuprofen (NSAID) for analgesia.

49
Q

What are the potential complications of prostatitis?

A
  • Can cause sepsis.
50
Q

What is urethritis?

A
  • Urethral inflammation.
51
Q

What are the two different types of urethritis?

A
  • Gonococcal. Caused by Neisseria gonorrhoea as a result of an STI.
  • Non-gonococcal. Caused by something else.
52
Q

What are the symptoms of urethritis?

A
  • Maybe asymptomatic (especially in women).
  • May create urethral discharge, especially after holding urine overnight.
  • Dysuria.
  • If the urethritis is non-gonococcal, it will not produce discharge. There may still be dysuria.
53
Q

What is the epidemiology of non-gonococcal urethritis?

A
  • Most common GU condition diagnosed and treated in men.
54
Q

What are the diagnostic investigations used for urethritis?

A
  • Nucleic acid amplification tests (NAATs). Can confirm presence of urethritis, and diagnose the causative pathogen. NOW 1st LINE.
  • Gram stain of urethral discharge. Can confirm the presence of a gonococcal infection. (1st line).
  • HIV screen.
55
Q

What is the treatment for urethritis?

A
  • For gonococcal urethritis, ceftriaxone (cephalosporin).

- For non-gonococcal uteritis, doxycycline or azithromycin.

56
Q

What are the potential complications of uteritis?

A
  • Epididymitis.

- Prostatitis.

57
Q

Which kidney stones are radiolucent?

A
  • Uric acid stones.

Phase 2a diseases (18 decks)

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