GP- renal and urology Flashcards
BPH cause
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
BPH symptoms
scoring system that can be used to assess the severity of lower urinary tract symptoms.
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
The initial assessment of men presenting with LUTS involves:
Common causes of raised PSA
Examination signs Differences between a benign prostate and a cancerous prostate
Management of BPH
ED definition
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.
Factors favouring an organic cause of ED and factors favouring a psychogenic cause of ED
Risk factors for ED
- cardiovascular disease risk factors: obesity, diabetes mellitus, dyslipidaemia, metabolic syndrome, hypertension, smoking
- alcohol use
- drugs: SSRIs, beta-blockers
investigations for ED
Management of ED
CKD definition
Chronic kidney disease (CKD) describes a chronic reduction in kidney function sustained over three months. It tends to be permanent and progressive.
CKD causes
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
CKD symptoms
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
CKD investigations
CKD diagnosis and classification
CKD complications
Anaemia
Renal bone disease
Cardiovascular disease
Peripheral neuropathy
End-stage kidney disease
Dialysis-related complications
Management of CKD
The NICE clinical knowledge summaries (May 2023) suggest referral to a renal specialist when:
- 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
The…can be used to estimate the 5-year risk of kidney failure requiring dialysis.
The Kidney Failure Risk Equation can be used to estimate the 5-year risk of kidney failure requiring dialysis.
Treating the underlying cause of CKD involves:
Optimising diabetic control
Optimising hypertension control
Reducing or avoiding nephrotoxic drugs (where appropriate)
Treating glomerulonephritis (where this is the cause)
The blood pressure target is less than… in patients under 80 with CKD and an ACR above… mg/mmol.
The blood pressure target is less than 130/80 in patients under 80 with CKD and an ACR above 70 mg/mmol.
Medications that help slow the disease progression in CKD are:
ACE inhibitors (or angiotensin II receptor blockers)
SGLT-2 inhibitors (specifically dapagliflozin)
Reducing the risk of complications in CKD involves:
Exercise, maintain a healthy weight and avoid smoking
Atorvastatin 20mg for primary prevention of cardiovascular disease (in all patients with CKD)
Management of complications in CKD involves:
- 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
Management of end-stage renal disease involves:
Special dietary advice
Dialysis
Renal transplant
in CKD ACE inhibitors are offered to all patients with:
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.
which SGLT-2 inhibitor is licenced for CKD and what is the criteria for patients to receive it
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
what type of anaemia does CKD cause and how is it treated?
Pathophysiology of renal bone disease, signs, investigation findings, complications and management
Key examination findings to look for in back pain
