Genitourinary COPY Flashcards
Membranous glomerulonephritis
more common in adults
causes
- antibodies again PLA2R
- SLE
- NSAIDs
- HBV/HCV
diagnosis = renal biopsy EM → thickened glomerular basement membrane
Focal segmental glomerulosclerosis
adults
causes
- idiopathic
- HIV
- sickle cell
- heroin
diagnosis = presence of scarring on glomeruli
Risk factors of testicular cancer
- 20-45
- male
- caucasian
- cryptorchidism
- previous testicular cancer
- HIV
- family history
Presentation of testicular cancer
- palpable lump within the testis
- non-transilluminable
- haematospermia
- often found on self-examination
Investigations for testicular cancer
- urgent US of testes
- chest xay for pulmonary mets
- tumour markers → not always raised
Management of testicular cancer
- urgen radical inguinal orchidectomy +/- testicular prosthesis
- semen cryopreservation
- treat metastatic disease → chemo, radiotherapy, lymph node dissection
What is pyelonephritis?
- infection of kidneys/upper ureter
- most commonly acquired by ascending transurethral spread
- can be via blood or lympatics
- majority caused by uropathic e.coli
Presentation of pyelonephritis
- triad of loin pain, fever, pyuria
- costovertebral joint pain
- severe headache
- N&V
- septic shock if advanced
Investigations of pyelonephritis
- urine dipstick → WBC, microscopic haematuria
- bloods → inflammatory markers
- urgent US → stones, obstruction
GOLD STANDARD = mid-stream MC&S → diagnosis of causative agent
Treatment of pyelonephritis
Abs
- cefalexin 7-10 days
- trimethoprim/amoxicillin if sensitive
analgesia → PCM
What is prostatitis?
- inflammation and swelling of prostate gland
- most common cause = e.coli
Presentation of prostatitis
- very tender prostate → seen on DRE
- systemic symptoms → fever, chills, malaise
- voiding symptoms
Investigations for prostatitis
- U&C → blood and WBCs, bacteria
- bloods cultures if patients febrile
Management of prostatitis
Abs
- ciprofloxacin/levofloxacin 14 days
Which Abs should you avoid in pregnancy?
- trimethoprim = teratogenic
- nitrofurantoin → avoid at full term
What is an epididymal cyst?
- smooth extra testicular spherical cyst at the epididymis
- contains clear and milky fluid
- may be multiple and bilateral
- painful if large
- most common cause of scrotal swelling
Investigation for epididymal cyst
- lump found in posterior aspect of testicle
- can palpate cyst and testis separately
- US
no treatment needed → dissolve in 10 days
Epididymitis
- acute pain, unilateral
- could be due to previous infection
- Prehn’s sign +ve
- treatment = IM ceftriaxone (organism unknown) and doxycycline
What is hydrocele?
- abnormal collection of fluid in tunica vaginalis
What are the two types of hydrocele?
- simple = overproduction of fluid
- communicating = peritoneal fluid and scrotum are connected
Presentation of hydrocele
- non tender smooth cystic swelling
- painless unless infected
- transluminates
Treatment of hydrocele
- most resolve spontaneously
- similar to testicular cancer → rule out
What is nephritic syndrome?
syndrome presenting as inflammation within the kidney
Key features of nephritic syndrome
- haematuria → kidney inflammation
- oliguria → decreased GFR
- proteinuria
- HTN → fluid overload
Causes of nephritic syndrome
- SLE
- post strep glomerulonephritis
- small vessel vasculitis
- Goodpasture’s
- IgA nephropathy
Investigations for nephritic syndrome
DIAGNOSTIC = kidney biopsy → cause
- urinalysis → haematuria
- bloods → high ESR, CRP
Management of nephritic syndrome
- treat underlying cause
- ACEi/ARB → reduced proteinuria, preserves renal function
- corticosteroids → reduce inflammation
What is IgA nephropathy
- AKA Berger disease
- deposition of IgA into mesangium of kidney → inflammation and damage
Presentation of IgA nephropathy
- asymptomatic
- microscopic haematuria
Diagnosis of IgA nephropathy
- biopsy
- same management as nephritic syndrome
What is post strep GN?
- nephritic syndrome following infection 3-6 weeks before
- deopsition of atrep antigen in glomeruli → inflammation and damage
Presentation of post strep GN
- haematuria
- acute nephritis
diagnosed by evidence of strep infection
Treatment of post strep GN
- Abs to clear strep
- supportive care
What is PKD
- clusters of cysts develop within kidneys
- autosomal dominant
- PKD1 and PKD2 genes on Cr16
Pathophysiology of PKD
- cysts develop and grow over time in tubular part of nephron
- compression of renal architecture and vasculature
3 progressive impairment
Risk factors of PKD
- family history of PKD/CVS events
- male
- caucasian
Presentation of PKD
- HTN
- abdominal/flank pain
- headaches
- LUTS
- palpable cysts
Investigations for PKD
renal US then biopsy
- <30 → 2 cysts
- 30-59 → 2 cysts in each kidney
- >60 → 4 cysts in each kidney
Management of PKD
- treat HTN
- infected - Abs, drain
- surgical removal → nephrectomy
- chronic → dialysis/transplant
Complications of PKD
- berry aneurysms → rupture causes sub-arachnoid haemorrhage
- cysts on other organs
- ventricular hypertrophy
