GU Flashcards
1
Q
Describe the pathophysiology of nephrotic syndrome
A
Podocyte injury/scarring
2
Q
What is the main difference between nephrotic and nephritic syndrome?
A
Nephrotic: proteinuria >3.5g/day
Nephritic: haematuria
3
Q
Describe the symptoms of nephrotic syndrome
A
Proteinuria: >3.5g/day
Hypoalbuminaemia->oedema
Hyperlipidaemia
Hypogammaglobuniaemia
Hypercoagulability
4
Q
How does nephrotic syndrome result in hyperlipidemia?
A
Liver increases synthesis of lipids in response to low albumin
5
Q
How does nephrotic syndrome result in hypogammaglobulinemia?
A
Loss of Ig’s in urine
6
Q
How does nephrotic syndrome result in hypercoagulability?
A
Loss of antithrombin 3 and proteins C and S in urine
7
Q
How is nephrotic syndrome diagnosed?
A
Biopsy
Light/electron microscopy
8
Q
What are the 3 main conditions that result in nephrotic syndrome?
A
Minimal change disease
Focal segmental glomerulosclerosis
Membranous nephropathy
9
Q
What is the most common cause of nephrotic syndrome in children?
A
Minimal change disease
10
Q
What is the most common cause of nephrotic syndrome in adults?
A
Focal segmental glomerulosclerosis
11
Q
What is the most common cause of nephrotic syndrome in the elderly?
A
Membranous nephropathy
12
Q
What would you see in light microscopy in a patient with minimal change disease?
A
Nothing
13
Q
What would you see in electron microscopy in a patient with minimal change disease?
A
Podocyte effacement and fusion
14
Q
What would you see in light microscopy in a patient with focal segmental glomerulosclerosis?
A
Segmental sclerosis
15
Q
What would you see in electron microscopy in a patient with focal segmental glomerulosclerosis?
A
Podocyte effacement
16
Q
What would you see with light microscopy in a patient with membranous nephropathy?
A
Thickened glomerular basement membrane
17
Q
What would you see in electron microscopy in a patient with membranous nephropathy?
A
Subpodocyte immune complex deposition
Spike and dome appearance
18
Q
Describe the pathophysiology of nephritic syndromes
A
T3 hypersensitivity reactions
Apart from Goopasture’s-Type 3
GBM breaks: inflammation and Bowman crescents
19
Q
Describe the symptoms of nephritic syndrome
A
Haematuria
Hypertension
Oedema
Oliguria
20
Q
Name the conditions that commonly cause nephritic syndrome
A
IgA nephropathy
Post-strep glomerulonephritis
Goodpasture’s syndrome
SLE nephropathy
(Haemolytic uremic syndrome)
21
Q
What is IgA nephropathy also called?
A
Berger’s syndrome
22
Q
Name 2 conditions that can present as both nephrotic and nephritic
A
Diffuse proliferative glomerulonephritis
Membrano-proliferative glomerulonephritis
23
Q
Name 2 risk factors for developing IgA nephropathy
A
Asian(greater incidence in Asian populations)
HIV
24
Q
How do patients with IgA nephropathy usually present?
A
Visible haematuria(Ribena/coke) 1-2 days post viral infection (URTI-pharyngitis/tonsilitis/gastroenteritis)
25
How is IgA nephropathy diagnosed?
Biopsy:
Immunofluorescence microscopy shows IgA complex deposition in mesangium(supportive cells of Bowman's capsule)
26
Describe the treatment for IgA nephropathy
Non-curative: 30% progress to ESRF
BP control: ACE-i 1st line control
27
Name a differential diagnosis for a patient presenting with IgA complex deposition in the kidneys
Could be :
IgA nephropathy
Henoch Schonlein purpura
28
What is Henoch Schonleun purpura?
AKA IgA vasculitis
Alos shows IgA complex deposition in kidneys
29
How can you distinguish between Henoch Schonlein purpura and IgA nephropathy?
IgA nephropathy: IgA deposition only in kidneys
Henoch Schonlein: systemic deposition-kidneys, skin ,liver
30
Describe how patients with post-strep glomerulonephritis commonly present
Visible haematuria (ribena/coke)
2 weeks after pharyngitis from group A,Beta haemolytic strep (S pyogenes)
31
Which bacteria is responsible for post-strep glomerulonephritis?
S pyogenes
32
How is post-strep glomerulonephritis diagnosed?
Biopsy then light/electron/immunofluorescence microscopy
33
What would you find in a patient with post strep glomerulonephritis with light microscopy?
Hypercellular glomeruli
34
What would you find in a patient with post-strep glomerulonephritis with electron microscopy?
Subendothelial immune complex deposition
35
What would you find in a patient with post strep glomerulonephritis with immunofluorescence microscopy?
Starry sky appearance
IgG, IgM and C3 deposition along GBM and mesangium
36
Describe the treatment for post strep glomerulonephritis
Usually self limiting
Can progress to RPGN(rapidly progressing glomerulonephritis)
37
Describe the cause of SLE nephropathy
ANA desposition in endothelium
38
How is SLE nephropathy diagnosed?
ANA positive
anti dsDNA positive
39
Describe the treatment for SLE nephropathy
Steroids
Hydroxychloroquine
Immunosuppressants: cyclophosphamide
40
Describe the pathophysiology of Goodpasture's
Autoantibodies: anti-GBM that cause pulmonary+alveolar haemorrhage and glomerulonephritis
41
How is Goodpasture's syndrome diagnosed?
Immunofluorescence: Linear deposition of IgG along glomerular capillaries
42
Describe the treatment for Goodpasture's syndrome
Steroids and plasma exchange
43
Which nephritic syndrome can lead to rapidly progressing glomerulonephritis?
Post strep glomerulonephritis
44
How do patients with haemolytic uremic syndrome commonly present?
5 days post infection with shiga toxin
E coli, shigella
45
Name 2 micro bacteria that can cause haemolytic uremic syndrome
E coli, shigella
46
Name the consequences of haemolytic uremic syndrome
Haemolytic anaemia
AKI(glomerulonephritis) and uremia
Thrombocytopenia
47
How is haemolytic anaemia treated?
Mostly self-limiting
Present as a medical emergency-supportive fluids and antibiotics
48
What is rapidly progressing glomerulonephritis
Subtype of glomerulonephritis that progresses to ESRF very quickly-weeks to months
49
How is rapidly progressing glomerulonephritis diagnosed?
Inflammatory crescents in Bowman's space
50
Name the causes of rapidly progressing glomerulonephritis
Wegener's granulomatosis
MPA
Good pastures
51
Name 2 conditions that can present as both nephritic and nephrotic?
Diffuse proliferative glomerulonephritis
Membranoproliferative glomerulonephritis
52
What is polycystic kidney disease?
Cyst formation throughout renal parenchyma leading to bilateral enlargement and damage
53
How is polycystic kidney disease inherited?
Familial
Can be autosomal dominant-most common
Or autosomal recessive
54
Which gene mutations are involved in autosomal dominant PCKD?
85%: PKD1
15%: PKD2
55
What groups of people do autosomal dominant PCKD tend to affect?
Males
Present at 20-30 years
56
Is autosomal recessive or dominant PCKD more common?
Autosomal dominant more common
57
When do patients with autosomal recessive PCKD commonly present?
Disease of infancy or prebirth
High mortality
58
Name some congenital abnormalities associated with autosomal recessive PCKD?
Potter's sequence: flattened nose, clubbed feet
59
Which kind of PCKD inheritance is associated with congenital abnormalities?
Autosomal recessive
60
Describe the normal physiology of PKD1+2 genes
Code for polycystin (Ca2+ channel)
When filtrate passes cilia of nephron, they move and polycystin(Ca2+ channels)open
Ca2+ influx->inhibits excessive growth of cilia
61
Describe the pathophysiology of PCKD
PKD mutations lead to decreased Ca2+ influx so excessive growth of cilia->cysts
Many cysts-polycystic
62
Describe the common presentation of a patient with polycystic kidney disease
Bilateral flank/back/ abdo pain
Can have hypertension and haematuria
Can also cause extra-renal cysts which can rupture and cause haemorrhage
63
Name a common location of extra renal cysts
Circle of Willis: Berry aneurysm
64
Name a complication that can arise from a ruptured berry aneurysm
Subarachnoid haemorrhage
65
How is PCKD diagnosed?
Kidney US
Genetic testing and fHx of PCKD
66
What findings would you expect on the ultrasound of someone with PCKD?
Enlarged bilateral kidneys with multiple cysts
67
Describe the treatment of PCKD
Non curative
Manage symptoms:
Acei-hypertension
RRT/transplant for ESRF
68
What MUST you rule out when investigating a scrotal mass?
Cancer until proven otherwise
69
What is an epididymal cyst?
Extra testicular cyst(above and behind testes) that will transilluminate
70
How is an epididymal cyst diagnosed?
US scrotum
71
What is a hydrocele?
Fluid collection in tunica vaginalis
Cyst
Will transilluminate
72
How can you diagnose a hydrocele?
US scrotum
73
What is a varicocele?
Distended pampiniform plexus due to increased left renal vein pressure causing reflux
74
Describe the common presentation of a patient with a varicocele
Bag of worms on exam
Usually LHS
Typically painless but can be painful when larger and more severe
75
Name a complication of a varicocele
Infertility
76
What is testicular torsion?
Spermatic cord twists it on itself causing occlusion of testicular artery->ischaemia->can lead to gangrene of testes if untreated
77
Name a risk factor for developing testicular torsion
Bell clapper deformity
Testes lie horizontally instead of vertical
78
How do patients with testicular torsion commonly present?
Severe uni testicular pain (hurts to walk)
Abdominal pain
Nausea and vomiting
Cremasteric reflex lost
No pain relief when elevating testes.
79
What is the cremasteric reflex?
Stroke inner thigh: ipsilateral testicle should elevate(retract upwards)
80
How is testicular torsion diagnosed?
US to check testicular blood flow
1ST: Surgical exploration if high risk
81
Describe the treatment of testicular torsion
Urgent surgery within 6 hours
All cases require bilateral orchiopexy
If testes viable: orchipexy
If testes not viable: Orchidectomy
82
What is orchiopexy surgery?
Fixing of testes to scrotal sac to overcome Bell clapper deformity
83
What are the 2 categories LUTS can be characterised as?
Storage symptoms
Voiding symptoms
84
Are storage or voiding symptoms more common in men or women?
Storage: more common in women
Voiding: more common in men
85
When do storage symptoms occur?
Occurs when the bladder should be storing urine (need to pee)
86
When do voiding symptoms occur?
Occur when bladder outlet is obstructed (hard to pee)
87
Name the LUTS storage symptoms
FUNI
Frequency
Urgency
Nocturia
Incontinene
88
Name the LUTS voiding symptoms
SHID
poor Stream
Hesitancy
Incomplete emptying
Dribbling
89
Name the GU related red flag symptoms
Haematuria
Dysuria
90
Is incontinence commonly seen in males or females?
Females
91
What are the 3 types of incontinence?
Stress
Urge
Spastic paralysis
92
What is stress incontinence?
Pee leaks out due to increase in intra abdominal pressure->causes sphincter weakness
Post pregnancy trauma
93
What causes urge incontinence?
Detrusor muscle overactivity
94
What causes spastic paralysis incontinence?
Neuro urological UMN lesion
Overactive reflexes and hypertonia of detrusor
95
What is the treatment for incontinence?
Surgery
Anticholinergic drugs
96
Is retention commonly seen in males or females?
Males
'Overflow incontinence'
97
What is urinary retention?
Inability to pass urine even when bladder full (>500mL)
98
Name some causes of urinary retention
Obstruction: stones, BPH, neurological flaccid paralysis
99
What is the treatment for urinary retention?
Catheterisation
100
What is benign prostate hyperplasia?
Non malignant prostate hyperplasia-normal with ageing
101
Name some risk factors for developing BPH
Increasing age
Ethnicity(Afrocaribbeans have higher testosterone)
102
Name something that is protective against BPH
Castration
103
Describe the pathophysiology of BPH
Proliferation of inner transitional zone of prostate->narrows urethra
104
How do patients with BPH typically present?
LUTS (mostly voiding)
Poor stream dribbling, incomplete emptying, straining, dysuria, nocturia, urgency
Anuria if totally occluded urethra->hydronephrosis, UTI, stones
105
What is the difference between BPH and prostate cancer?
BPH: proliferation of inner transitional zone
Prostate cancer: Outer zone proliferation
106
Name some consequences of a totally occluded urethra from BPH
Retention->
Hydronephrosis!!!!
UTI
Stones
107
How is BPH diagnosed?
DRE-rectal exam: smooth and enlarged
PSA: rule out prostate cancer but unreliable
Bladder diary, rule out other causes
108
What differences would you expect in the rectal exam of a patient with BPH vs prostate cancer?
PBH: smooth enlarged
Prostate cancer: Hard and irregular
109
How is PSA useful?
Very unreliable-can be raised in both BPH and prostate cancer but can be used to rule out prostate cancer
110
Describe the treatment for BPH
Lifestyle changes: decrease caffeine-may eventually need catheter
Medications: tamsulosin, finasteride
Surgery as last resort: TURP
111
Describe the medications used to treat BPH
1st line: alpha blocker-tamsulosin
2nd line: 5 alpha reductase inhibitor-finasteride
112
How are alpha blockers useful in treating BPH?
Relax baldder neck
113
How are 5 alpha-reductase inhibitors useful in treating BPH?
Decrease testosterone production so decrease prostate size
114
Name a surgery used for BPH treatment
TURP-trans urethral prostate resection-remove prostate tissue to reduce size
115
Name a complication from a TURP procedure
Retrograde ejaculation
116
What is obstructive uropathy and what complication can it lead to?
Blockage of urine flow, can affect one or both kidneys depending on the level of obstruction->obstructive nephropathy
117
Name some causes of obstructive uropathy
BPH
Stones
(Things that cause obstructions)
118
Describe the pathophysiology of obstructive uropathy
Obstruction-> increased retention and increased KUB pressure->reflexing/backlogged urine in renal pelvis (hydronephrosis)->dilated renal pelvis which is more infection prone
119
Describe the typical presentation of a patient with obstructive uropathy
Signs of an obstruction
Might be asymptomatic if only 1 kidney is affected
120
How is obstructive uropathy treated?
1)Relieve kidney pressure->catheteris urethra, ureteral stent
2)Treat BPH or stones (underlying cause)
121
What are the components of the upper urinary tract
Kidneys and ureters
122
What are the components of the lower urinary tract
Bladder and urethra
123
What is a UTI in the upper urinary tract called?
Pyelonephritis-kidney infection
124
Which UTIs occur in the lower urinary tract?
Cystitis-UPEC infection of bladder
Prostatitis-inflammation of prostate
Urethritis
Epididymo orchiditis
125
Which organisms commonly cause UTIs?
KEEPS
Kliebsiella
Enterobaccter
E.Coli
Proteus
S.saprophyticus
126
Which organism is responsible for 80% of UTIs?
Uropathogenic E.Coli
127
What is the difference between a complicated and non-complicated UTI?
Uncomplicated-non pregnant women
COmplicated-anything else
128
Why are females more affected by UTIs than men?
Females have shorter urethras so closer to anus and easier for bacteria to colonise
129
What is the first line test for diagnosing UTIs?
Urine dipstick!
Positive leukocytes
Positive nitrites
Might or might not have haematuria
130
What is the gold standard test for diagnosing UTIs?
Midstream urine sample-confirm UTI and ID pathogen
131
What is pyelonephritis?
Infection of renal parenchyma and upper ureter
Ascending transurethral spread
Usually UPES but can be other KEEPS
132
Which groups tend to be affected by pyelonephritis?
Females
<35
133
Name some risk factors for developing pyelonephritis
Urine stasis(stones)
Renal structure abnormalities
Catheters
134
How do patients with pyelonephritis typically present?
Triad of:
Loin pain
Fever
Pyuria
135
What is pyuria?
Pus and WBC's in urine
136
How is pyelonephritis diagnosed?
1st line: urine dipstick
Gold standard: microscopy culture and sensitivities
Also investigate for stones if suspected
137
Describe the treatment for pyelonephritis?
Analgesia, paracetemol
Antibiotics: ciprofloxacin or co-amoxiclav
Cefalexin if pregnant
138
Which antibiotic should be used for pyelonephritis in pregnant patients?
Cefalexin
139
What is the official triad of pyelonephritis symptoms?
Nausea and vomiting
Fever
Loin pain
(No pyuria as would need to be investigated to show it)
140
What is cystitis?
UPEC infection of bladder
141
Name some risk factors for developing cystitis
Urine stasis
Bladder lining damage
Catheters
142
Is cystitis predominantly seen in males or females?
Females
143
Describe the presentation of a patient with cystitis
Suprapubic tenderness and discomfort
Increased frequency and urgency
Visible haematuria
Confusion in elderly
144
How is cystitis diagnosed?
1st line: urine dipstick
GS: microscopy cultures and sensitivity
145
How is cystitis treated?
Abx: trimethoprim or nitrfurantoin
Amoxicillin if pregnant
146
What antibiotic should be used to treat cystitis in pregnant patients?
Amoxicillin
147
What is urethritis?
Inflammation with/without infection of urethra
Most commonly a sexually acquired condition
148
Name the infective causes of urethritis
Gonococcal(Neisseria gonorrhoea)
Non-gonococcal (Chlamydia trachomatus)
149
What is the most common cause of urethritis?
Neisseria gonorrhoea
150
Name a non infective cause of urethritis
Trauma
151
Name some risk factors for urethritis
MSM
Unprotected sex
152
Describe how patients with urethritis commonly present
Dysuria with/without urethral discharge (blood/pus)
Urethral pain
153
How is urethritis diagnosed?
NAAT(nucleic acid amplification test)->detect gonorrhoea or chlamydia)
Urine dip(positive if infective, UTI indicated)
MC+s-detect and ID pathogen if UTI
154
Name a gram-negative diplococcus bacteria that could cause urethritis
Gonorrhoea
155
How is urethritis treated?
Neisseria gonorrhoea: IM ceftriaxone + azithromycin
Chlamydia trachomatis: azithromycin (or doxycycline)
156
Name the triad of reactive arthritis
'Can't see, can't pee, can't climb a tree'
Conjunctivitis, urethritis, arthritis
157
What kind of bacteria is chlamydia
Obligate intracellular gram-negative aerobe (bacillus)
158
What is epididymo-orchitis?
Inflammation of epididymis, extending to testes
159
What are the 2 main causes of epididymo-orchitis?
Urethritis (STI) <35yrs
Cystitis(KEEPS in bladder)
160
How do patients with epididymo-orchitis
Unilateral scrotal pain and swelling
Pain relieved with elevating testes(Prehn's sign)
Intact cremaster reflex
161
Name a differential diagnosis for epididymo-orchitis
Testicular torsion
More acute, nausea and vomiting, cyptochordism(BellClapper)1
162
How is epididymo-orchitis diagnosed?
NAAT-STI
Urine dip
MC+S
163
Describe the treatment for epididymo-orchitis
Dependent on STI/UTI
NG: ceftriaxone + azathioprine
CT: azithromycin
