Genitourinary Flashcards
CKD stages
1 - GFR >90ml/min
2 - GFR 60-90ml/min with some kidney damage
3a - GFR 45-59ml/min with moderate reduction in kidney function
3b - GFR 30-44ml/min with moderate reduction in kidney function
4 - GFR 15-29ml/min with severe reduction in kidney function
5 - GFR <15ml/min established kidney failure
AKI diagnostic criteria
- Rise in creatinine of >26micromol/L in 48 hours
- > 50% rise in creatinine over 7 days
- Fall in urine output to <0.5 ml/kg/hr for more than 6 hours
AKI management
- Fluid balance often for hypovolaemia
- STOP nephrotoxic drugs - NSAIDs, ACE-i, ARB, loop diuretics
- Treat hyperkalaemia - risk of arrhythmia by giving insulin
- Renal replacement therapy
CKD management
- If slow progression - diabetes treatment, HTN treatment or glomerulonephritis treatment
- Reduce risk of CVD - ATORVASTATIN (20mg) statin to reduce cholesterol levels
- Mineral bone disease to low vit D - vit D supplements
- Anaemia - erythrocyte stimulating agent (ESA) and iron supplements
- Renal replacement therapy
Benign prostatic hyperplasia (BPH) investigation/treatment
- DIGITAL RECTAL EXAM AND PSA TEST
- TAMSULOSIN
- Finasteride
- Surgery - transurethral resection of prostate
Prostate cancer treatment
- Localised - radical prostatectomy
- Advanced - ZOLADEX (GnRH agonist)
Varicocele
- Abnormal enlargement of testicular veins
- Bag of worms
- US and doppler for diagnosis
- Should go normally
Hydrocele
- Fluid in tunica vaginalis
- Soft, non-tender, trans luminous swelling
- Should go normally
Testicular torsion investigation/treatment
- Prehn’s sign NEGATIVE
- De-torsion/surgery
Epididymitis investigation/treatment
- Prehn’s sign POSITIVE
- Stat (immediate) IM CEFTRIAXONE + doxycycline
Nephritic syndrome def/investigations/treatment
- INFLAMMATION within kidney aka glomerulonephritis
- Proteinuria <3g/24 hours
- Haematuria
- Kidney biopsy
- Urinalysis shows haematuria in nephritic syndrome
- Treat underlying cause, BP control - ACE-i/ARB, or CORTICOSTEROIDS to reduce inflammation
Glomerulonephritis (nephritic syndrome) causes
IgA nephropathy (BERGER’s DISEASE)
- Most common cause of nephritic syndrome in HIGH INCOME countries
- Presents ASYMPTOMATICALLY with microscopic haematuria
- Diagnose with biopsy
Goodpasture’s disease
- Presents with dyspnoea and oliguria due to resp/renal damage
- Diagnose with ANTI-GBM ANTIBODIES in bloods and biopsy
- Manage with plasma exchange, steroids and cyclophosphamide
Post strep GN
- Following infection 3-6 weeks prior due to deposition of strep antigens in glomeruli
- Presents with HAEMATURIA and acute nephritis
- Diagnosed by evidence of STEP INFECTION
- Treat with antibiotics to clear strep
Henoch Schoenlein Purpura
- Small vessel vasculitis affecting kidney and joints
- Presents with PURPURIC RASH on legs, and JOINT PAIN
- Diagnosed clinically, confirmed with renal biopsy
- Manage with corticosteroids and ACE-i/ARB
Nephrotic syndrome def/presentation/investigations/management
- O for oedema, issue with filtration barrier
- Results in triad characterising nephrotic syndrome:
- PROTEINURIA >3g/24 hours
- HYPOALBUMINAEMIA due to loss of albumin in urine
- OEDEMA
- Presents with oedema and frothy urine reflecting proteinuria
- Urinalysis
- URINE PROTEIN: CREATININE RATIO to quantify degree of proteinuria
- Blood tests - renal function, elevated lipids
- Renal biopsy to find cause
- Fluid/salt restriction
- Loop diuretics to manage oedema
- Treat cause
Nephrotic syndrome causes
Minimal change disease
- Normal appearance upon microscopy but abnormal function
- Diagnose with biopsy, presentation is nephrotic
- Treat with prednisolone
Focal segmental glomerulosclerosis
- Most common cause on renal biopsy
- Diagnosed by scarring of glomeruli - FOCAL SCLEROSIS
- All patients should receive ACE-i/ARB for bp control
Membranous nephropathy
- Diagnosed by renal biopsy showing THICKENED GLOMERULAR BASEMENT MEMBRANE
- ANTI-PHOSPHOLIPASE A2 RECEPTOR antibody found in 70-80% patients
- Managed with ACE-i/ARB
- If high risk of progression - prednisolone and cyclophosphamide
Nephritic vs nephrotic differences
Nephritic
- Hypertension
- Haematuria
Nephrotic
- Hypoalbuminaemia
- Oedema
- Hyperlipidaemia
Bladder cancer pres/investigation/management
- PAINLESS HAEMATURIA - most common for bladder cancer
- Urinalysis - sterile pyuria (WBC in urine)
- Cystoscopy and biopsy - diagnostic
- T1 - transurethral resection
- T2-3 - radical cystectomy
- T4- palliative chemo/radio
Renal cancer pres/investigations
- Triad of HAEMATURIA, FLANK PAIN, PALPABLE ABDO MASS
- Bloods - polycythaemia from erythropoietin secretion
- CXR shows CANNON BALL METASTASES
Pyelonephritis info (UTI)
- Infection and inflammation of kidney, most often due to ascending UTI
- Midstream urine and culture gold standard for diagnosis of causative agent
- Antibiotics - CEFALEXIN
- Analgesia - paracetamol
Cystitis info (UTI)
- Infection of bladder - most common in young sexually active women
- Gold standard- urine culture and sensitivity
- Urine dipstick - if positive for nitrites, WBC and RBC then UTI likely
- Antibiotics - TRIMETHOPRIM or NITROFURANTOIN
- Avoid trimethoprim in pregnancy completely
- Avoid nitrofurantoin at term in pregnancy
Prostatitis info (UTI)
- Inflammation and swelling of prostate, commonly by E.coli
- VERY TENDER PROSTATE on digital rectal exam
- Antibiotics - CIPROFLOXACIN or levofloxacin for 14 days
Chlamydia diagnosis/treatment
- Nucleic acid amplification testing (NAAT)
- Single 1g dose of AZITHROMYCIN and 7 days DOXYCYCLINE
Gonorrhoea diagnosis and treatment
- Nucleic acid amplification testing (NAAT)
- Single CEFTRIAXONE IM dose
Urolithiasis (renal colic) pres/diagnosis/treatment
- Colicky unilateral pain from loin to groin
- Haematuria 85% of cases
- KUBXR - 1st line and diagnostic
- Non contrast CTKUB - gold standard
- TAMSULOSIN/NIFEDIPINE - relaxes smooth muscle and helps expulsion
