Genitourinary 2 Flashcards
What causes glomerulonephritis?
IgA nephropathy
Goodpasture’s disease
Post strep glomerulonephritis
Henoch Schoenlein purpura
What is IgA nephropathy?
Deposition of IgA into the mesangium of the kidney - results in inflammation and damage
How does IgA nephropathy present?
Asymptomatically with microscopic haematuria
How is IgA nephropathy treated?
Same as nephritic syndrome
Fish oil and steroids if persistent proteinuria after 3-6 months
How is IgA nephropathy diagnosed?
Biopsy
What is the most common cause of nephritic syndrome in high income countries?
IgA nephropathy
What causes Goodpasture’s disease?
Autoantibodies to type IV collagen in glomerular and alveolar membrane
How does Goodpasture’s disease present?
SOB and oliguria due to respiratory and renal damage
How is Goodpasture’s disease diagnosed?
Anti-GBM antibodies in bloods and biopsy
How is Goodpasture’s disease managed?
Plasma exchange, steroids and cyclophosphamide for immune suppression
What is Goodpasture’s disease a cause of?
Rapidly progressing glomerulonephritis leading to renal failure in days/weeks
What is post streptococcal glomerulonephritis?
Nephritic syndrome following infection 3-6 weeks prior
What causes post streptococcal glomerulonephritis?
Deposition of strep antigens in the glomeruli leading to inflammation and damage
How does post streptococcal glomerulonephritis present?
Haematuria - can present with acute nephritis
How is post strep glomerulonephritis diagnosed?
Evidence of strep infection
How is post strep glomerulonephritis treated?
Antibiotics to clear strep and supportive care
What is Henoch Schoenlein purpura?
Small vessel vasculitis that affects the kidney and joints due to IgA deposition
How does Henoch Schoenlein purpura present?
Purpuric rash on legs, nephritic symptoms and joint pain due to IgA deposition
How is Henoch Schoenlein purpura diagnosed?
Clinically, confimed with renal biopsy
How is Henoch Schoenlein purpura managed?
Corticosteroids and ACEi/ARB
What is nephrotic syndrome?
Issue with filtration barrier
Podocytes being implicated
Results in leaking of protein into urine
How does nephrotic syndrome present?
Proteinuria
Hypalbuminaemia
Oedema
Frothy urine
What causes nephrotic syndrome?
Minimal change disease
Focal segmental glomerulosclerosis
Membranous nephropathy
What are the secondary causes of nephrotic syndrome?
DDANI
Diabetes, drugs, autoimmune, neoplasia
How is nephrotic syndrome investigated?
Urinalysis
Urine protein:creatinine ratio
Blood tests
Renal biopsy
How is nephrotic syndrome managed?
Fluid and salt restriction Loop diuretics - furosemide to manage oedema Treat cause ACEi/ARB to reduce protein loss Manage complications
What are the complications of nephrotic syndrome?
Hyperlipidaemia - loss of albumin increases cholesterol formation (manage with statins)
VTE due to increased clotting factors - give heparin
How is minimal change disease diagnosed?
Biopsy
How does minimal change disease present?
Nephrotic presentation
How is minimal change disease treated?
High dose steroids - prednisolone
What is the most common cause of nephrotic syndrome on renal biopsy?
Focal segmental glomerulosclerosis
What causes focal segmental glomerulosclerosis?
Idiopathic
How is focal segmental glomerulosclerosis diagnosed?
Presence of scarring of glomeruli i.e. focal sclerosis
How is focal segmental glomerulosclerosis managed?
Steroids for idiopathic disease
All patients should receive ACEi/ARB for BP control
How is membranous nephropathy diagnosed?
Renal biopsy = thickened glomerular basement membrane
Anti-phospholipase A2 receptor antibody 70-80% of patients
How is membranous nephropathy managed?
ACEi/ARB in all
High risk of progression = prednisolone and cyclophosphamide
What are the key clinical features of nephritic syndrome?
Proteinuria ++ HTN Haematuria visible/non-visible Oedema + GFR ↓↓ Rash? N+V? Abdo pain?
What is the most common GU tract malignancy?
Bladder cancer - M>F
What is the epidemiology of bladder cancer?
3% of all cancer deaths and 10th most common cancer
What makes up the majority of bladder cancers?
90% are urothelial carcinoma and spreads to iliac and para-aortic nodes, liver and lungs
What causes bladder cancer?
Smoking - 2-4x risk, accounts for half of male cases of bladder cancer >55 Pelvic radiation Exposure to occupational carcinogens Bladder stones - chronic inflammation
How does bladder cancer present?
Painless haematuria
UTI symptoms without bacteriuria
How is bladder cancer investigated?
Urinalysis - sterile pyuria
Cytoscopy and biopsy - diagnostic
CT urogram - allows staging
How is bladder cancer managed?
T1: transurethral resection or local diathermy
T2-3: radical cystectomy
T4: palliative chemo and radio
What are the majority of renal cancers found to be?
90% of cancers are found to be arising from the proximal tubular epithelium and are classes of carcinomas
What is the epidemiology of renal cancer?
Mean age of diagnosis is 55 with M:F = 2:1
How is renal cancer picked up?
50% are picked up incidentally with 30% having mets on diagnosis
Where can renal cancer spread to?
Bone, liver and lungs
What are the risk factors for renal cancer?
Haemodialysis
Smoking
HTN
How does renal cancer present?
Haematuria
Flank pain
Palpable abdominal mass
How is renal cancer investigated?
Bloods - polycythaemia from EPO secretion Raised BP - renin secretion US CT/MRI CXR - shows cannon ball mets
What score is used to predict survival from renal cancer?
Mayo prognostic risk score
How is renal cancer treated?
Stage 1: partial or radical nephrectomy
Stage 2: radical nephrectomy
Stage 3: radical nephrectomy and adrenalectomy
Stage 4: systemic treatment
What is a UTI?
Presence of microorganisms in the urinary tract and produces clinical features
What do UTIs affect?
Lower tract causing cystitis (bladder), urethritis and prostatitis, and upper causing pyelonephritis
What can untreated urolithiasis lead to?
UTI
What causes a UTI?
KEEPS
Klebsiella E. Coli - most common causing 50% of cases Enterococci Proteus Staphylococcus coagulase -ve
How does a UTI present?
Voiding symptoms - FUNDS
Frequency
Urgency
Nocturia
Dysuria
What is pyelonephritis?
Infection and inflammation of kidney, most often due to ascending UTI
How does pyelonephritis present?
Loin pain, fever and pyuria
Costovertebral joint pain and tenderness
Septic shock in advanced disease
How is pyelonephritis investigated?
Urinalysis
Midstream urine and culture - gold standard
Bloods
Renal US
How is pyelonephritis treated?
Antibiotics - cefalexin for 7-10 days
Trimethoprim or amoxicillin if sensitive
Paracetamol for analgesia
What is cystitis?
Infection of the urinary bladder and is most common in young sexually active women
What are the risk factors of cystitis?
History of UTI
Diabetes
Frequent sexual intercourse
Pregnancy
How does cystitis present?
Dysuria - discomfort pain, burning on urination Frequency Urgency Cloudy smell urine Suprapubic tenderness/discomfort
How is cystitis investigated?
Urine dipstick - if positive for nitrites or WBCs and RBCs then UTI likely (unreliable in women over 65 so don’t bother)
Urine culture and sensitivity - gold standard
How is cystitis managed?
3 days of trimethoprim (avoid if pregnant) or nitrofurantoin (avoid at term pregnancy)
What are the secondary causes of focal segmental glomerulosclerosis?
HIV, heroin or lithium
How does minimal change disease present on microscopy?
Normal appearance upon microscopy but there is abnormal function
