Genitourinary Flashcards
Kidney function
→ Water / Hormone homeostasis
→ Removal of waste
→ RBC production
→ Activate vit. D
AKI & CKD & Risk Factors
AKI = Sudden loss of kidney function. CKD = Gradual loss of Kidney function. Risks: → Age > 65 → Diabetes → High BP
AKI Diagnostic Criteria
- Rise in creatinine of >= 26umol /L in 48 hrs
- > = 50% rise in creatinine over 7 days
- Fall in urine output to less than 0.5ml/kg/hr for more than 6hrs in adults (8 in kids)
Aetiology & characteristic for Pre-renal
- Hypovolaemia Secondary to diarrhoea & vomiting (Dehydration)
- Sepsis
- NSAIDs / Diuretics
→ Normal Na+, Raised urea & creatinine. Responds well to Fluid therapy.
Aetiology & Characteristic for Intrinsic / Intra-renal
- Post - strep. infection
- Acute Tubular Necrosis
- Rhabdomyolysis
→ T2DM & HTN, low urine osmolality, High urine Na+, High blood k+.
Aetiology & Characteristic for Post - renal
- kidney stone in ureter / bladder
- Benign Prostatic Hyperplasia
- bladder cancer
→ Loin → Groin acute colicky pain, Microscopic haematuria.
AKI Management
- Fluid balance
- Stop Nephrotoxic Drugs
- Treat hyperkalaemia → risk of arrythmias
- Renal Replacement Therapy
Nephrotoxic drugs
- NSAIDs
- ACE-I & ARBs
- Aminoglyclides e.g. Gentamicin
- Loop diuretics
CKD management
ACE-I / ARB
→ Ramipril / Candesartan
Reduce risk of CVD
→ Atorvastatin
Anaemia
→ Erythropoietin
Reduce swelling
→ Chlorothiazide
CKD complications
- Mineral bone diseases - low vit. D
- HTN
- Proteinuria
- Anaemia
Benign Prostatic Hyperplasia (BPH)
Hyperplasia of stromal & epithelial cells of the Prostate. Presents in men > 50 yrs
BPH symptoms
Mainly LUTs Symptoms
- Hesitancy - weak urine flow
- Urgency
- Frequency
- Intermittency
- Straining
- Nocturia
BPH Investigations
- Digital Rectal Examination
- Prostate - Specific antigen
- Prostate examination (abnormal transitional zone)
BPH management
- Alpha-blockers [ Tamsulosin ]
- 5 - alpha reductase inhibitors [ Finasteride ]
- Transurethral Resection of Prostate (TURP)
Lower Urinary Tract Infections (LUTS]
Infection (mainly E.coli) in the bladder causing cystitis.
They can spread to kidneys & cause pyelonephritis
LUTS Symptoms
- fever & Dysuria
- Discomfort & Suprapubic pain
- Frequency
- Urgency
- Incontinence
- Cloudy & Smelly urine
LUTS investigations
- Urinanalysis
- Urine dipstick - Nitrites → Gram -ve bacteria break down nitrates into nitrites.
Most common cause of UTI
- E. Coli
- Klebsiella
- Enterococcus
- Candida
- Staphylococcus
UTI Management
- Nitrofurantoin
- Cefalexin
- Trimethoprim or Amoxicillin if sensitive
Hydrocele
Fluid in tunica vaginalis - secondary to trauma/ infection
Hydrocele examinations & cause
- testicle is Palpable
- Transilluminated
→ Idiopathic
Hydrocele management
- Watch & wait
- Surgery (if inguinal hernia is seen)
- Aspiration
- Sclerotherapy
Varicocele
Veins in the Pampiniform Plexus which drains into the testicular Vein become Swollen.
Due to increased resistance in the testicular vein.
Testicular vein drainage
Right Testicular vein = drains into infcrior vena cava
Left Testicular vein = drains into the left renal vein
Most varicocele occurs in Left due to increased resistance
Varicocele Symptoms
- Throbbing / dull pain or discomfort, worse on Standing
- dragging sensation
- ‘Bag of worms’
Varicocele investigations
- Ultrasound with Doppler imaging
- Semen analysis
- Hormonal test ( FSH & testosterone)
varicocele Management
- Surgery
- Endovascular embolisation - for testicular atrophy / infertility
Testicular torsion
Sx:
Ix:
Mx:
= twisting of cord that supply testicle
Sx: - severe pain, hot, red & swollen
- Unilateral, Swollen, Tender, Retracted upwards
Ix: Imaging - Prehn’s sign -ve
Mx: De - torsion
Epididymitis
Sx:
Ix:
Mx;
- Inflammation in tube that’s at back of testicle carrying sperm
- Gradual unilateral pain
- Prehn’s sign + ve
- start IM Ceftriaxone + Doxycycline
Epididymal Cyst
Ix:
Mx:
- Common cause of Scrotal swelling
- painless lump found in Posterior aspect of testicle (epididymus)
- Clear/ milky fluid
- Transillumination & Ultrasound
- Analgesia
Cystitis
Infection of the urinary bladder due to E. coli
- common in young sexually active women
Cystitis Risks
- History of UTI
- Diabetic
- Frequent sex
- Pregnancy
Cystitis Symptoms
- Dysuria - discomfort, pain, burning on urination
- Frequency
- Urgency
- cloudy smelly urine
- Suprapubic tenderness
Cystitis Investigations
- Urine dipstick - if + ve then UTI
Gold - Urine culture & sensitivity
Cystitis management
- Antibiotic = Trimethoprim / NitrofurantoinI avoid in 3rd trimester)
Prostate cancer
Sx:
Ix:
Tx:
- Adenocarcinoma in peripheral zone
- LUTS symptoms
- Metastasis - haematuria, back pain
- MRI
- Give Goserelin (GnRH agonist), Radiotherapy
Nephritic Syndrome
Inflammation within the kidney.
Features that define Nephritic Syndrome
→ Haematuria - reflects inflammation of kidney
→ Dysuria - due to less GFR
→ Proteinuria - less than 3g/ 24 hrs
→ Hypertension - due to fluid overload
Systemic Causes of Nephritic Syndrome
- SLE
- Post strep GN
- Small vessel vasculitis
- Goodpasture’s /anti-GMB disease
Renal cause of Nephritic Syndrome
lgA nephropathy
Nephritic Syndrome investigations
- Kidney biopsy
- Urinalysis - blood & Protein
- Bloods - high ESR & CRP & eGFR
Nephritic Syndrome Management
- Blood pressure control - ACE-I / ARB
- Corticosteroids
IgA Nephropathy
Deposition of lgA into the Mesangium of the kidney. This results in inflammation & damage.
It presents asymptomatically with microscopic haematuria.
IgA Nephropathy Investigations
Biopsy
lgA Nephropathy Management
- Corticosteroids
- Rituximab
- Give fish oil
Goodpasture’s Disease
Caused by autoantibodies to Type lV collagen in glomerular & alveolar membrane.
Goodpasture ‘s Disease Symptoms
- Dyspnoea
- Oliguria
→ due to resp & renal damage
Goodpasture’ s disease Investigations
- Anti-GBM antibodies in bloods & biopsy
Goodpasture’s Disease Management
- Plasma exchange
- steroids
- Cyclophosphamide (for immune suppression)
Nephrotic Syndrome
Issue with the filtration barrier, with podocytes being primarily implicated, which results in leaking of Protein into the urine.
Features of Nephrotic Syndrome
- Proteinuria - >3g/24 hr
- Hypalbuminaemia - due to Ioss of albumin in urine
- Oedema - loss of of oncotic pressure, this can be rapid & severe
Symptoms of Nephrotic Syndrome
- Oedema
- Frothy Urine - Shows Proteinuria
Nephrotic Syndrome Investigations
- Urinalysis
- Urine protein: Creatinine ratio
- Blood tests - renal function, elevated lipids
- Renal biopsy
Nephrotic Syndrome Management
- Corticosteroids (prednisolone)
- Low salt diet
- Diuretics
- Antibiotic Prophylaxis
Nephrotic Syndrome Complications
Hyperlipidaemia - loss of albumin increases cholesterol formation.
- Manage with Statins
VTE - due to increased clotting factors.
- Give heparin
Causes of Nephritic Syndrome
→ lgA nephropathy
→ Goodpasture’s disease
→ Post Streptococcal glomerulonephritis
Causes of Nephrotic Syndrome
→ Minimal change disease
→ Focal segmental glomerulosclerosis
→ Membranous Nephropathy
Minimal Change Disease
Diagnosis
Treatment
Normal appearance upon microscopy but there’s abnormal Function. Most common in children
- Biopsy = Presentation is nephrotic (Periorbital oedema, ankle oedema, frothy urine)
- Treatment = High dose steroids → Prednisolone
Focal Segmental Glomerulosclerosis
Diagnosis
Treatment
Can be idiopathic or Secondary to HIV, Heroin & Lithium.
- Diagnosed by presence of scarring of glomeruli i.e. Focal sclerosis
- Give steroids idiopathic disease
- Give ACE-I / ARB ) → Blood pressure control
Membranous Nephropathy
Diagnosis
Treatment
- Immunologically mediated - small vessels in glomeruli get inflammed.
- Diagnosed by renal biopsy → Shows thickened glomerular basement membrane.
- Anti Phospholipase A2 receptor antibody
→ Give ACE-I / ARB for all.
→ Prednisolone + Cyclophosphamide
Renal colic (Nephrolithiasis/ Urolithiasis)
- Renal stones that form in the renal pelvis, where urine collects before travelling to ureters.
Sites:
→ Pelviureteric junction
→ Pelvic brim
→ Vesicoureteric junction
Renal colic Complications
→ Obstruction = leading to A.K.I
→ Infection = with Obstructive Pyelonephritis
Types of renal colic
- Calcium - based stones:
→ Calcium Oxalate
→ Calcium Phosphate - Having a raised Serum calcium (hypercalcium) and a low urine output.
Other types:
- Uric acid
- Struvite
- Cystine
Renal Colic Symptoms
- Unilateral loin to groin pain
- Colicky
- Haematuria
- Nausea & vomiting
- Reduced urine output
Renal colic Investigations
- Kidney, Ureter, Bladder (KUB) X-Ray =1st line
- NCCT - KUB = Gold Standard
- Ultrasound
Cause of renal Stones/ colic
- Hypercalcaemia
Renal colic Management
- NSAIDs (analgesics) - e.g. IM diclofenac, IV Paracetamol
- Anti-emetics - e.g. Metoclopramide (for nausea & vomiting)
- Tamsulosin ( alpha-blocker - aid Passage of Stones)
- Antibiotics - for infections
Management to reduce risk of renal stone reoccurrence
→ Potassium Citrate
→ Thiazide diuretics (eg. Indapamide)
Polycystic Kidney Disease
Genetic Condition where kidneys develop multiple fluid filled cysts.
- There is Autosomal dominant (more common) & Autosomal recessive type
Types of PKD
- Autosomal Dominant:
PKD-1
PKD- 2 - Autosomal Recessive:
Gene on Chromosome 6
Autosomal Dominant Manifestations
- Cerebral aneurysms
- Hepatic, Splenic, Pancreatic, Ovarian & Prostatic cysts
- Cardiac valve disease (mitral regurgitation)
- Colonic diverticula
Autosomal Dominant PKD Complications
- Chronic loin pain
- Hypertension
- Cardiovascular disease
- Renal stones
- Haematuria
Autosomal Recessive PKD
- Oligohydramnios in Pregnancy → low amniotic fluid
- which leads to underdevelopment of the lungs → results in resp. failure
- underdeveloped ear cartilage, flat nasal bridge, end- stage renal failure
PKD management
Tolvaptan (vasopressin receptor antagonist) - Slow renal failure in autosomal dominant PKD.
- Antihypertensives
- Analgesia for renal colic
- Antibiotics for infection
- Dialysis
- Renal transplant
Bladder Cancer
Ix
Tx
Ix = Flexible Cystoscopy
Tx =
Transurethral Resection of the Bladder Tumour
Mitocycin C → given with TURBT
BCG → For higher risk, non- muscle invasive cancers
Methotrexate, Vinblastine, Cisplatin → Muscle- Invasive Cancers
?Post Streptococcal Glomerulonephritis Diagnosis
Urinalysis - has protein & blood (infection)
Kidney Biopsy
Bladder cancer
Symptom
Type of cancer
Haematuria
Lethargy
Usually present with history of schistosomiasis
→ Squamous cell carcinoma
Gonorrhoea
Symptoms
Diagnosis
Treatment
Neisseria gonorrhoea
Gram - ve diplococci bacteria
Man= Urethral discharge, dysuria, Epididymo-orchitis Women= Abnormal vaginal discharge, Painful sex
Nucleic acid amplification test = swab
TX= Ceftriaxone & Azithromycin
Pyelonephritis
Symptoms
Diagnosis
Tx
Inflam. of kidney due to bacteria. Usually E. Coli. & Klebsiella
Fever, Loin pain, Polyuria
Ix: Midstream Urine sample
Tx = Cefalexin, Co-amoxiclav, Trimethoprim, Ciprofloxacin
Bladder nerve supply
Sympathetic = Hypogastric nerves (T12-L2)
Parasympathetic = Pelvic nerve (S2-S4) - Contraction of detrusor muscle (when urinating)
Somatic = Pudenal nerve (S2-4) - Innervates external urethral sphincter
Testicular Cancer
Symptoms = Gynaecomastia, Testicular discomfort, feeling of mass in testis.
Dx = Raised Serum alpha-fetoprotein
Renal cancer (Renal cell carcinoma)
Sx:
Ix:
Tx:
SX: Weight loss, loin pain, Painless haematuria, Loin mass
Ix: CT /MRI
Tx: Chemo., Transplant
Why does Person have hypertension with renal cancer?
Renin secretion → Increase in BP due to Raas system
Diuretics & their mechanism
→ Thiazide = Inhibit of Na+ & CI-
→ Loop diuretic = Inhibit Na+ / k+ / CI
→ K+ Sparing diuretic = Inhibits Na+ reabsorption & k+ secretion
Hypercalcaemia Presentations
- Stones
- Groans
- Bones
- Moans
Erectile Dysfunction
- Associated conditions
- Management
- Diabetes, MI, Renal failure, Liver disease
- > Phosphodiesterase e.g. Sildenafil
