Genitourinary Flashcards
What is renal colic (nephrolithiasis)?
unilateral loin to groin pain that can be excruciating and fluctuates in severity (colicky) as the stone moves and settles - the presenting compliant in symptomatic kidney stones (nephrolithiasis)
What is the epidemiology of renal colic?
5-15% of people experience renal colic
What are the risk factors for renal colic/kidney stones?
Dehydration
Excess calcium in urine
Diet high in protein, sodium and sugar
Obesity
Certain medications/supplements
GI conditions such as ulcerative colitis or Crohn’s disease
Hyperparathyroidism
What is the most common type of kidney stone?
75% calcium oxalate stones (enveloped shaped)
What are the clinical manifestations of renal colic?
painful urination
haematuria
cloudy urine
changes in urine (e.g. strong-smelling, increased urgency, reduced/increased frequency)
crystals in urine
fever
What are the investigations for renal colic?
computer tomography scan
urine dipstick, kidney USS, abdo XR, renal scan
Where are the most common sites of kidney stones?
pelvi-ureteric junction
pelvic brim
vesico-ureteric junction
What is the management for renal colic?
Analgesia e.g. paracetamol, NSAIDs
↑ fluid intake
watchful waiting for stones less than 5mm
larger stones (10mm+) require surgical intervention
What are the surgical options for large kidney stones?
Extracorporeal shock wave lithotripsy (ESWL) - shock waves break stones into smaller parts so they can be passed
Ureteroscopy and laser lithotripsy - camera inserted via the urethra to identify stone and then targeted lasers used to break it up
Percutaneous nephrolithotomy (PCNL) - nephroscope is inserted via incision through back into kidney to assess ureter - can break up stones
Open surgery - last resort to remove stones
What is acute kidney injury?
An acute drop in kidney function characterised by a:
Rise in creatinine of ≥25umol/L in 48hrs
Rise in creatinine of ≥50% in 7 days
Urine output of <0.5ml/kg/hr for >6 hours
What are the pre-renal causes of AKI?
[cause inadequate blood supply to kidneys reducing the filtration of blood]
- dehydration
- hypotension
- heart failure
What are the renal causes of AKI?
[intrinsic disease in the kidney leading to reduced filtration of blood]
- glomerulonephritis
- interstitial nephritis
- acute tubular necrosis
What are the post-renal causes of AKI?
[caused by obstruction to flow of urine out of the kidney]
- kidney stones
- masses such as cancer in the abdomen or pelvis
- ureteral strictures
- enlarged prostate or prostate
What are the risk factors for AKI?
Chronic kidney disease
Heart failure
Diabetes
Liver disease
Older age (65+)
Cognitive impairment
Nephrotoxic medications e.g. NSAIDS, ACE-is
use of contrast medium during CT scans
What are the clinical manifestations of AKI?
Commonly asymptomatic
Hypotension
Kidney insults
Reduced urine production
Changes in urinary urgency, frequency or hesitancy
What are the investigations for AKI?
Urinalysis for protein, blood, (acute nephritis) leukocytes, nitrites (infection) and glucose (diabetes)
USS (look for obstruction)
What is the management for AKI?
Stop nephrotoxic medications
Fluid rehydration ( IV fluids in pre-renal AKI)
Relieve obstruction
Severe AKI may require dialysis
What are the potential complications of AKI?
hyperkalaemia
fluid overload
heart failure
pulmonary oedema
metabolic acidosis
uraemia (high urea) –> encephalopathy or pericarditis
What is chronic kidney disease?
Chronic (>3months) reduction in kidney function with implications for health which tends to be permanent and progressive
Diagnostic characteristics: eGFR <60 or albuminuria
What is the normal urine output?
0.5ml/kg/hr
What is the aetiology of CKD?
Diabetes
Hypertension
Age-related decline
Glomerulonephritis
Polycystic kidney disease
Medications such as NSAIDS, PPIs + lithium
What are the risk factors for CKD?
Older age
Hypertension
Diabetes
Smoking
Use of medications that affect the kidneys
What are the key presentations for CKD?
Majority asymptomatic at presentation
Pruritus
Loss of appetite
Nausea
Oedema
Muscle cramps
Peripheral neuropathy
Pallor
Hypertension
What factors affect the progression of CKD?
non-modifiable: underlying cause of renal disease, race
modifiable: BP, level of proteinuria, exposure to nephrotoxics, underlying disease activity, further renal insults, dyslipidaemia, ↑phophate, acidosis, anaemia, smoking, glycaemic control if diabetic