GP- renal and urology

Question 1

BPH cause

Answer 1

common condition affecting men in older age (usually over 50 years). It is caused by hyperplasia of the stromal and epithelial cells of the prostate

Question 2

BPH symptoms

Answer 2

Question 3

scoring system that can be used to assess the severity of lower urinary tract symptoms.

Answer 3

International Prostate Symptom Score (IPSS)
tool for classifying the severity of lower urinary tract symptoms (LUTS) and assessing the impact of LUTS on quality of life
* Score 20–35: severely symptomatic
* Score 8–19: moderately symptomatic
* Score 0–7: mildly symptomatic

Question 4

The initial assessment of men presenting with LUTS involves:

Answer 4

Question 5

Common causes of raised PSA

Answer 5

Question 6

Examination signs Differences between a benign prostate and a cancerous prostate

Answer 6

Question 7

Management of BPH

Answer 7

Question 8

ED definition

Answer 8

Erectile dysfunction (ED) is the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance. It is a symptom and not a disease and the causes can broadly be split into organic, psychogenic and mixed.

Question 9

Factors favouring an organic cause of ED and factors favouring a psychogenic cause of ED

Answer 9

Question 10

Risk factors for ED

Answer 10

• cardiovascular disease risk factors: obesity, diabetes mellitus, dyslipidaemia, metabolic syndrome, hypertension, smoking
• alcohol use
• drugs: SSRIs, beta-blockers

Question 11

investigations for ED

Answer 11

Question 12

Management of ED

Answer 12

Question 13

CKD definition

Answer 13

Chronic kidney disease (CKD) describes a chronic reduction in kidney function sustained over three months. It tends to be permanent and progressive.

Question 14

CKD causes

Answer 14

Kidney function naturally declines with age. Factors that can speed up the decline and cause CKD include:

Diabetes
Hypertension
Medications (e.g., NSAIDs or lithium)
Glomerulonephritis
Polycystic kidney disease

Question 15

CKD symptoms

Answer 15

Most patients with CKD are asymptomatic. Signs and symptoms as the renal function worsens may be non-specific:

Fatigue
Pallor (due to anaemia)
Foamy urine (proteinuria)
Nausea
Loss of appetite
Pruritus (itching)
Oedema
Hypertension
Peripheral neuropathy

Question 16

CKD investigations

Answer 16

Question 17

CKD diagnosis and classification

Answer 17

Question 18

CKD complications

Answer 18

Anaemia
Renal bone disease
Cardiovascular disease
Peripheral neuropathy
End-stage kidney disease
Dialysis-related complications

Question 19

Management of CKD

Answer 19

Question 20

The NICE clinical knowledge summaries (May 2023) suggest referral to a renal specialist when:

Answer 20

• eGFR less than 30 mL/min/1.73 m2
• Urine ACR more than 70 mg/mmol
• Accelerated progression (a decrease in eGFR of 25% or 15 mL/min/1.73 m2 within 12 months)
• 5-year risk of requiring dialysis over 5%
• Uncontrolled hypertension despite four or more antihypertensives

Question 21

The…can be used to estimate the 5-year risk of kidney failure requiring dialysis.

Answer 21

The Kidney Failure Risk Equation can be used to estimate the 5-year risk of kidney failure requiring dialysis.

Question 22

Treating the underlying cause of CKD involves:

Answer 22

Optimising diabetic control
Optimising hypertension control
Reducing or avoiding nephrotoxic drugs (where appropriate)
Treating glomerulonephritis (where this is the cause)

Question 23

The blood pressure target is less than… in patients under 80 with CKD and an ACR above… mg/mmol.

Answer 23

The blood pressure target is less than 130/80 in patients under 80 with CKD and an ACR above 70 mg/mmol.

Question 24

Medications that help slow the disease progression in CKD are:

Answer 24

ACE inhibitors (or angiotensin II receptor blockers)
SGLT-2 inhibitors (specifically dapagliflozin)

Question 25

Reducing the risk of complications in CKD involves:

Answer 25

Exercise, maintain a healthy weight and avoid smoking

Atorvastatin 20mg for primary prevention of cardiovascular disease (in all patients with CKD)

Question 26

Management of complications in CKD involves:

Answer 26

• Oral sodium bicarbonate to treat metabolic acidosis
• Iron and erythropoietin to treat anaemia
• Vitamin D, low phosphate diet and phosphate binders to treat renal bone disease

Question 27

Management of end-stage renal disease involves:

Answer 27

Special dietary advice
Dialysis
Renal transplant

Question 28

in CKD ACE inhibitors are offered to all patients with:

Answer 28

ACE inhibitors are offered to all patients with:

• Diabetes plus a urine ACR above 3 mg/mmol
• Hypertension plus a urine ACR above 30 mg/mmol
• All patients with a urine ACR above 70 mg/mmol

The serum potassium needs close monitoring, as both CKD and ACE inhibitors can cause hyperkalaemia.

Question 29

which SGLT-2 inhibitor is licenced for CKD and what is the criteria for patients to receive it

Answer 29

Dapagliflozin is the SGLT-2 inhibitor licensed for CKD. It is offered to patients with:

• Diabetes plus a urine ACR above 30 mg/mmol

Dapagliflozin is considered for patients with:

• Diabetes plus a urine ACR or 3-30 mg/mmol
• Non-diabetics with an ACR of 22.6 mg/mmol or above

Question 30

what type of anaemia does CKD cause and how is it treated?

Answer 30

Question 31

Pathophysiology of renal bone disease, signs, investigation findings, complications and management

Answer 31

Question 32

Key examination findings to look for in back pain

Answer 32