Genitourinary Flashcards
What are the CKD stages?
1 2 3a 3b 4 5
What is CKD stage 1?
GFR > 90ml/min
What is CKD stage 2?
GFR = 60-90ml/min with some sign of kidney damage
What is CKD stage 3a?
GFR = 45-59ml/min, a moderate reduction in kidney function
What is CKD stage 3b?
GFR = 30-44ml/min, a moderate reduction in kidney function
What is CKD stage 4?
GFR = 15-29ml/min, severe reduction in kidney function
What is CKD stage 5?
GFR < 15ml/min, established kidney failure (dialysis or transplant may be needed)
What are the NICE criteria for AKI diagnosis (creatinine)?
Rise in creatinine of > 26µmol/L in 48 hours
or
> 50% rise in creatinine over 7 days
What is AKI stage 1?
Increase in creatinine 1.5-1.9 times baseline
or
Reduction in urine output to <0.5ml/kg/hour for ≥ 6 hours
What is AKI stage 2?
Increase in creatinine to 2.0 to 2.9 times baseline
or
Reduction in urine output to <0.5ml/kg/hour for ≥ 12 hours
What is AKI stage 3?
Increase in creatinine to ≥ 3.0 times baseline
or
Increase in creatinine to ≥ 353.6µmol/L
or
Reduction in urine output to <0.3ml/kg/hour for ≥24 hours
What are CKD and AKI?
Reduced kidney function (acute or chronic)
What is the function of the kidneys?
Water/hormone homeostasis
Removal of waste/toxins
RBC production
Activate vitamin D
What are the risk factors for CKD and AKI?
Emergency surgery i.e. risk of sepsis or hypovolaemia CVD risk CKD - eGFR < 60 DM HF Age >65 Liver disease Use of nephrotoxic drugs
How does intrinsic AKI present?
T2DM and HTN, low urine osmolality, high urine Na+, high blood K+
How does pre-renal AKI present?
Normal Na+, raised urea and creatinine. Responds well to fluid therapy
How does post-renal AKI present?
Loin > groin acute colicky pain, microscopic haematuria
What are the pre-renal causes of AKI?
Hypovolaemia secondary to diarrhoea/vomiting
Renal artery stenosis
What are the intrinsic causes of AKI?
Glomerulonephritis Acute tubular necrosis (ATN) Acute interstitial nephritis (AIN) Rhabdomyolysis Tumour lysis syndrome
What are the post-renal causes of AKI?
Kidney stone in ureter or bladder
BPH
External compression of the ureter
How is AKI managed?
Fluid balance Stop nephrotoxic drugs Treat hyperkalaemia (risk of arrhythmia) Treat underlying cause RRT if not responding to medical treatment
What drugs are nephrotoxic?
NSAIDs Aminoglycosides ACEi ARB Loop diuretics Metformin Digoxin Lithium
How is CKD managed?
Slow the progression of disease
20mg atorvastatin (reduce risk of CVD)
Manage complications
What complications of CKD need to be managed?
Mineral bone disease - low vitamin D HTN Proteinuria Anaemia > ESA RRT - haemodialysis, peritoneal dialysis, transplant
What does the prostate do?
Produces testosterone and dihydrotestosterone
Produces PSA - liquefies semen
What is BPH?
Benign enlargement of prostate
How does BPH present?
LUTS - storage and voiding
How do you investigate BPH?
DRE and PSA
How is BPH managed?
Tamulosin (or finasteride)
What is prostate cancer?
Adenocarcinoma
How does prostate cancer present?
LUTS symptoms
Metastasis - haematuria, back pain
How is localised prostate cancer treated?
Radical prostatectomy
How is advanced prostate cancer treated?
Zoladex (GnRH agonist)
What is varicocele?
Abnormal enlargement of testicular veins - ‘bag of worms’
How is varicocele investigated?
US and doppler
How is varicocele treated?
Conservative
What is hydrocele?
Fluid in tunica vaginalis in scrotum
How does hydrocele present?
Soft, non-tender transluminous swelling
How is hydrocele treated?
Conservative
What is testicular torsion?
Twisting of spermatic cord
How does testicular torsion present?
Acute, severe pain
Unilateral, swollen, tender, retracted upwards
How is testicular torsion investigated?
Prehn’s sign negative
pain not relieved by lifting scrotum
How is testicular torsion treated?
De-torsion
How does epididymitis present?
Acute pain
Unilateral
How is epididymitis investigated?
Prehn’s sign positive
How is epididymitis treated?
Stat IM ceftriaxone if organism unknown plus doxycycline
What is the most common cause of scrotal swelling?
Epididymal cyst
How does epididymal cyst present?
Lump found in posterior aspect of testicle
How is epididymal cyst investigated?
US
How is epididymal cyst treated?
Dissolve in 10 days
How does testicular cancer present?
Painless lump
Hydrocele
Gynaecomastia
How is testicular cancer investigated?
US
How is testicular cancer treated?
Chemo/radio
Orchidectomy
What is nephritic syndrome?
Inflammation within kidney
What are the features of nephritic syndrome?
Haematuria - reflects inflammation of kidney
Oliguria - reduced GFR
Proteinuria - <3g/24 hours
HTN - fluid overload
What causes nephritic syndrome?
Inflammatory disease affecting kidney - can arise from both systemic disease and renal limited disease
What are the systemic causes of nephritic syndrome?
SLE
Post strep GN
Small vessel vasculitis
Goodpasture’s/anti-GMB disease
What are the renal causes of nephritic syndrome?
IgA nephropathy
How is nephritic syndrome investigated?
Diagnostic = kidney biopsy
Urinalysis
Bloods
How is nephritic syndrome managed?
Treat underlying cause
ACEi/ARB
Corticosteroids
What are the NICE guidelines for diagnosing AKI (urine output)?
Fall in urine output <0.5ml/kg/hour >6 hours in adults (8 in children)
What does urinalysis of nephritic syndrome show?
Haematuria
What do bloods for nephritic syndrome show?
Raised ESR and CRP
May be anaemia