GU Flashcards
What is nephrolithiasis?
Kidney stones (renal calculi or urolithiasis)
What are the 5 types of kidney stone?
Most common
* Calcium oxalate
* Calcium phosphate
Less common below
* Uric acid
* Struvite
* Cystine
Which kidney stone is not visible on X-ray?
Uric acid stones
What causes struvite stones to form?
Produced by bacteria (so during a renal infection)
What causes cystine stones?
Autosomal recessive condition causes amino acids to join together
What is it called when a calculus form in the shape of a renal pelvis?
Staghorn calculus
When do staghorn calculus often form?
Recurrent UTIs causes bacteria to hydrolyse urea to ammonia forming a struvite stone to form
What are some risk factors for kidney stones (5)?
- Chronic dehydration
- Kidney diseases (e.g. PKD)
- Hyperparathyroidism
- UTIs
- History of stones
What are the signs/ symptoms of renal stones (4)?
- Renal colic
- Haematuria
- N+V
- Low urine output
What is renal colic?
Pain felt with renal stones that is unilateral colicky (due to stones moving and settling) loin to groin pain
How are kidney stones investigated (4)?
- Urine dipstick
- Abdominal X-ray = first line
- CT KUB (kidney, ureter, bladder) = gold
- Ultrasound (if pregnant)
How are kidney stones treated (4)?
- Hydration
- NSAIDs
- Abx for UTIs
- Surgery
What is the name of a strong NSAID used for kidney stones?
Diclofenac (IM)
What procedures are done for kidney stones (3)?
- Extracorporeal shock wave lithotripsy (ESWL)
- Percutaneous nephrolithotomy (keyhole retrieval)
- Ureteroscopy (catheter with a LAZER on it basically)
How can recurrent stone be prevented (2)?
- Hydration
- Avoid carbonated drinks
What size kidney stones usually pass on their own?
< 5mm
What is an example of an antiemetic?
Cyclizine
What is acute kidney injury (AKI)?
An acute drop in renal function
What are NICE criteria for AKI (3)?
- Rise in creatinine of >26 micromol/ L within 48 hours
- Rise in creatinine of >50% in 7 days
- Urine output of < 0.5 ml/kg/hour for 6 hours
What is normal urine output?
0.5-1.5 ml/kg/hour
What are the 3 types of AKI?
- Pre-renal
- Renal
- Post-renal
What causes pre renal AKI (5)?
- Dehydration
- Hypotension
- Heart failure
- NSAIDS
- Renal artery stenosis/ blockage
What causes renal AKI (4)?
- Glomerulonephritis
- Interstitial nephritis
- Acute tubular necrosis
- Sepsis (toxins)
Intrinsic kidney disease –> reduced filtration of blood
What causes post renal AKI (4)?
- Stones
- Cancer
- Large prostate
- Unsafe bladder
Blocked urine outflow
What important substances does AKI lead to the build up of (4)?
- K+
- Urea
- Fluid
- H+
AKI signs/ symptoms (4)?
- N+V
- Reduced urine output
- Abdo pain
- Confusion
How is AKI investigated (4)?
Establish cause:
* Urinalysis
* Bloods
* Kidney biopsy (for intra renal)
* Ultrasound (for post renal)
How is AKI managed (3)?
- Correct complications (electrolytes)
- Treat underlying cause
- Dialysis/ transplant if severe
What are some complications of AKI (4)?
- Fluid overload (heart failure)
- Hyperkalaemia
- Metabolic acidosis
- Uraemia (high urea)
What can uraemia cause (2)?
- Encephalitis
- Pericarditis
What is chronic kidney disease?
A chronic reduction in kidney function (usually permanent and progressive)
What are the two main causes of CKD?
- Hypertension
- Diabetes
What other things can cause CKD (3)?
Any kidney disease:
* PKD
* Glomerulonephritis
* Nephrotoxic drugs (e.g. NSAIDs)
How do NSAIDs damage the kidneys?
Inhibit the production of prostaglandins, which regulate vasodilation in the kidneys
How does the kidney compensate for CKD?
Release renin –> higher BP –> higher GFR
What effect does a compensatory release of renin have on the kidneys?
Increase BP –> increase transglomerular pressure –> high shearing force –> loss of BM selective permeability
How does diabetes damage the kidneys?
Glucose sticks to proteins in the walls of the efferent vessels (stiffening them), and making it hard for blood to leave the glomerular
What are the signs/ symptoms of CKD (6)?
Early stages = asymptomatic
* Oedema
* N+V
* Hypertension
* Loss if appetite
* Muscle cramps
* Pruritus (itching)
What are some complications of CKD?
- Anaemia (low EPO)
- Renal bone disease (low activated vit D)
- Neuropathy + encephalopathy (uraemia)
- CVD
How is CKD investigated (3)?
- FBC = anaemia
- Urine dip
- U+Es
What does a urine dipstick look for in CKD (2)?
- Proteinuria
- Haematuria
How is proteinuria quantified and what value is significant?
UACR (Urine albumin:creatinine ratio) > 3 mg/ mmol
What is eGFR?
Estimated glomerular filtration rate?
What information does eGFR use to calculate?
- Creatinine
- Age
- Gender
- Ethnicity
What is a normal eGFR?
> 90 ml/min/1.73m^2
What are the stages of CKD?
What are renal signs in stage 1 and 2 CKD?
Significant proteinuria
How is CKD treated?
Treat underlying cause and manage complications
How are the complications managed of CKD?
- Anaemia = EPO + Fe
- Renal bone disease = active vit D
- Oedema = diuretics
What is classed as end stage renal failure?
CKD stage 5 (eGFR <15)
How is end stage renal failure treated?
Dialysis / transplant
What is benign prostatic hyperplasia?
Increase in the number of cells (hyperplasia) and enlargement of the prostate
What are 2 risk factors for BPH?
- Older age
- Afro-carribean (higher testosterone)
Which part of the prostate proliferates and narrows urethra ?
Transitional zone (inner part)
What are the three types of LUTSs?
- Storage
- Voiding
- Post micturition
What are some examples of storage LUTSs (4)?
- Increased frequency
- Nocturia
- Increased urgency
- Incontinence
What are some examples of voiding LUTSs (4)?
- Poor stream
- Terminal dribbling
- Incomplete emptying
- Straining/ hesitancy
What are some examples of post micturition LUTSs?
- Post micturition dribbling
- Incomplete emptying - usually considered voiding symptom
Which type of LUTSs do patients with BPH usually present with?
Voiding (as urethra obstructed)
How is BPH diagnosed?
Rectal exam = smooth + enlarged prostate
What other test may be carried out for patients with enlarged prostates (depending on their wishes)?
PSA test (more commonly raised in those with prostate cancer)
What does a cancerous prostate feel like?
Irregular, central sulcus disrupted
How is BPH treated (4)?
- Lifestyle (decrease caffeine)
- Medications
- Self catheterisation
- Surgery
What medications are used to treat BPH (2)?
- Alpha blockers (tamsulosin)
- 5 alpha reductase inhibitors (finasteride)
What is a side effect of tamsulosin?
Postural hypotension (as alpha 1 receptors relax BV walls)
How do 5 alpha reductase inhibitors reduce prostate size?
Prevent conversion of testosterone to dihydrotestosterone (more potent androgen)
What surgery is offered for BPH (2)?
- Transurethral resection of the prostate (TURP)
- Prostatectomy
What is a complication of TURP?
Retrograde ejaculation (into bladder)
What is a complication of BPH?
Anuria –> hydronephritis
What is the most common renal cancer?
Renal cell carcinoma
What is the most common type of renal cancer?
Renal cell carcinoma
What are some risk factors for RCC (3)?
- Smoking
- Haemodialysis (due to the kidney disease)
- Family history
What is a auto dom hereditary condition that increases risk of RCC?
Von Hippel-Lindau syndrome
What are the symptoms of an RCC?
- Flank pain
- Haematuria
- Abdo mass
- Swollen left testicle
How is RCC investigated?
- Ultra-sound = 1st line
- CT = gold
What is Wilms tumour?
Renal tumour (starts in mesenchymal cells)
What is Wilm tumour also known as?
Nephroblastoma
What is a blastoma?
Cancer of developing cells
What is the most common type of bladder cancer?
Transitional cell carcinoma (TCC)
What are some risk factors for bladder cancer (3)?
- Exposure to dyes/ paints/ rubber
- Smoking
- Age (old)
What is the main symptoms of bladder cancer?
Haematuria
How is bladder cancer diagnosed?
Cystoscopy + biopsy