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2a stuff > Genitourinary > Flashcards

Genitourinary Flashcards

1
Q

CKD stages

A

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

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2
Q

AKI diagnostic criteria

A
  • 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
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3
Q

AKI management

A
  • 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
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4
Q

CKD management

A
  • 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
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5
Q

Benign prostatic hyperplasia (BPH) investigation/treatment

A
  • DIGITAL RECTAL EXAM AND PSA TEST
  • TAMSULOSIN
  • Finasteride
  • Surgery - transurethral resection of prostate
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6
Q

Prostate cancer treatment

A
  • Localised - radical prostatectomy

- Advanced - ZOLADEX (GnRH agonist)

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7
Q

Varicocele

A
  • Abnormal enlargement of testicular veins
  • Bag of worms
  • US and doppler for diagnosis
  • Should go normally
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8
Q

Hydrocele

A
  • Fluid in tunica vaginalis
  • Soft, non-tender, trans luminous swelling
  • Should go normally
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9
Q

Testicular torsion investigation/treatment

A
  • Prehn’s sign NEGATIVE

- De-torsion/surgery

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10
Q

Epididymitis investigation/treatment

A
  • Prehn’s sign POSITIVE

- Stat (immediate) IM CEFTRIAXONE + doxycycline

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11
Q

Nephritic syndrome def/investigations/treatment

A
  • 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
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12
Q

Glomerulonephritis (nephritic syndrome) causes

A

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
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13
Q

Nephrotic syndrome def/presentation/investigations/management

A
  • 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
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14
Q

Nephrotic syndrome causes

A

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
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15
Q

Nephritic vs nephrotic differences

A

Nephritic

  • Hypertension
  • Haematuria

Nephrotic

  • Hypoalbuminaemia
  • Oedema
  • Hyperlipidaemia
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16
Q

Bladder cancer pres/investigation/management

A
  • 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
17
Q

Renal cancer pres/investigations

A
  • Triad of HAEMATURIA, FLANK PAIN, PALPABLE ABDO MASS
  • Bloods - polycythaemia from erythropoietin secretion
  • CXR shows CANNON BALL METASTASES
18
Q

Pyelonephritis info (UTI)

A
  • 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
19
Q

Cystitis info (UTI)

A
  • 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
20
Q

Prostatitis info (UTI)

A
  • Inflammation and swelling of prostate, commonly by E.coli
  • VERY TENDER PROSTATE on digital rectal exam
  • Antibiotics - CIPROFLOXACIN or levofloxacin for 14 days
21
Q

Chlamydia diagnosis/treatment

A
  • Nucleic acid amplification testing (NAAT)

- Single 1g dose of AZITHROMYCIN and 7 days DOXYCYCLINE

22
Q

Gonorrhoea diagnosis and treatment

A
  • Nucleic acid amplification testing (NAAT)

- Single CEFTRIAXONE IM dose

23
Q

Urolithiasis (renal colic) pres/diagnosis/treatment

A
  • 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

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