GU Flashcards
What is the most common cause of hypercalcaemia leading to renal stone formation?
Hyperparathyroidism
What 3 main places do renal stones get stuck?
Pelviureteric junction, Pelvic brim and Vesicoureteric junction
Pre-renal causes of AKI?
FRIST F- failure --> heart/liver/skin I- infection/sepsis, intrarenal haemodynamics R- red cell haemorrhage S- sick --> gi losses, stenosis T- thrombosis
Define AKI
= abrupt DETERIORATION in parenchymal renal function which is usually but not invariably REVERSIBLE over a period of days or weeks
Define CKD
= LONG STANDING and usually PROGRESSIVE DECLINE in renal fucntion
3 main causes of rapidly progressive GN?
- background of acute nephritic syndrome
- antiglomerular BM disease (Goodpastures if w. lung involvement)
- ANCA-assoc. vasculitis
Triad of features seen in nephrotic syndrome?
proteinuria, hypoalbuminaemia and oedema
may also get hyperlipidaemia
why do pts get recurrent infections in nephrotic syndrome?
Due to decreased IgG levels as they are lost in urine/deposited in glomerular BM
why do pts get hyper-coagulability symptoms in nephrotic syndrome and give an example
–> venous/arterial thrombosis due to loss of proteins and clotting factors in the urine
most common causes of chronic kidney disease
DM
HTN
Atherosclerotic renal vascular disease
(=most common causes in european countries)
RF for CKD
CVD, proteinuria, HTN, DM, AKI, recurrent UTIs
How do you distinguish between AKI and CKD?
normochromic anaemia, small kidneys on US and presence of renal osteodystrophy favour chronic process
What GFR level is considered as established renal failure?
3 possible causes of severe fluid losses
burns
diarrhoea/vomiting
virus/fever
Advantages of renal transplant rather than dialysis (4)
- survival advantage
- QoL advantage
- economic advantage
- enable successful pregnancy
Why are women with CKD less likely to conceive
women normally stage 4/5 CKD when they reach CBA and often develop anaemia –> decrease likelihood of conception
Complications of kidney transplant
- malig and inf much more common due to immunosuppressant therapy
Others: CVD, cerebrovascular disease and tx withdrawal
indications for dialysis in AKI
hyperK metabolic acidosis (DKA) pulm. oedema uraemic pericarditis severe uraemia (can --> neurological complications
Wha are the criteria for absolute exclusion of transplant (renal)
malig HIV active infection not fit for general anaesthesia life expectancy
inhibitors of creatinine secretion?
trimethoprin, cimetidine, ritonavir
Albumin levels in urine & their interpretation:
300mg = macro-(proper)-albuminuria >1g = heavy, golemrular pathology likely >3g = nephrotic range (--> hypoalbuminaemia --> periph. oedema)
where do thiazide diuretics work?
distal tubule
medication causing hypokalaemia
loop diuretics (furosemide, bumetanide) thiazide diuretics (bendoflumethiazide)
medication causing hyperkalaemia
spironolactone (= aldosterone antag)
amiloride (= potassium sparing diuretic)
ACEIs (ramipril, lisinopril, perindopril)
ARBs (trimethroprin and calcineurin inhibitors) - eg losartan, irbesartan
calcitriol actions
- increases calcium and phosphate absorption from the gut
- suppressed PTH
EPO=?
= eryhtropoietin, a hormone secreted by the kidney that stimulates RBC production by bone marrow
What do polycystins do and what is their relation to PKD?
PKD1 & 2 cause mutations in polycystins 1 and 2
polycystins regulate tubular and vascular development in kindneys
also in other organs, incl. liver, brain, arterial blood vessels and pancreas –> casuing extra-renal manifestations of PKD
what is a varicocoele?
= abnormal dilation of the testicular veins in the pampiniform plexus, caused by venous reflux
2 complications of varicocoeles
- reduced testicular function
- male infertility
when is surgery indicated in varicocoele
pain
infertility possibility
possible testicular atrophy
typical presentation of testicular torsion
sudden, severe pain in one testes, makes walking uncomfortable
may spread to lower abdo
comes on during sport or exercise
How do you differentiate between testicular torsion and epididymo-orchitis?
torsion = sudden onset pain, younger pt
EO = slower onest of symps in an older pt (often assoc with STD)
both have inflamed and painful testis
histological appearance of benign prostatic hyperplasia
cell hyperplasia and reduced apoptosis
What would DRE find in benign prostatic hyperplasia
smooth enlargement of prostate, often asymmetrical across lateral lobes
4 factors involved in UT obstruction in prostatic hyperplasia
- hyperplastic nodules compress and stretch prostatic urethra
- involvement of periurethral zone interferes with sphincter mechanism
- contraction of hyperplastic SM in stroma
- inflam cell infiltration
role of dihydrotestosterone
enlargement of the prostate gland and seminal vesicles (in puberty)
Where in prostate does benign hyperplasia occur
Transitional zone (lateral lobes)
Where in prostate does prostate cancer occur?
Peripheral zone
5 cancers that metastasise to bone
breast lung kidney thyroid prostate
What is PSA
= prostate specific antigen, an protease responsible for the liquefaction of semen
will be raised in any prostatic disease
Pros of screening for prostate cancer
- saves lives (decreases mortality 30%)
- earlier detection = better prognosis
- commonest cancer of men
- 4th most common cause of cancer death
Cons of screening for prostate cancer
- goes against ‘do more good than harm’ –> detect cancer where tx won’t help –> pt anxiety
- overdx of insignificant disease
- negative implications fo dx/tx
- uncertain natural history
presentation of renal cell carcinoma
classic triad:
haematuria, loin pain, loin mass (in flank)
What is Wilms tumour
= undifferentiated mesodermal tumour of the intermediate cell mass
Most common intra-abdo tumour of CHILDHOOD (20% of all childhood malig)
What cell line do most testicular tumours arise from?
> 96% from germ cells
3 physiological examples of dipstick +ve haematuria
menstruation sport (muscle breakdown) sexual intercourse
why is Von Hippel Lindau premalignant
pts are predisposed to forming cysts, an then lose their normal gene to inhibit this, leading to multiple cysts forming which can develop into cancerous lesions
indicators of psychological aetiology of ED?
sudden onset
good nocturnal/early morning erections
situational ED
young patient
examples of drugs with negative effect on ED
ACEI
B-blockers
diuretics
(ang. II receptor blockers may have positive effect)
why are UTIs more common in women
short urethra & its proximity to anus facilitates transfer of bowel organisms to bladder
what is the most common cause of UTI and where does it arise from?
E. coli, usually arises from pt’s own bowel flora (bacteria colonise urethral orifice and ascend urinary tract
5 main bacterial causes of UTI
E.COLI (70%), Proteus Mirabilis, Staph saprophyticus/epidermis, Klebsiella, Enterococcus faecalis
Definition of UTI
> 10^5 organisms per ml (or for dx 10^2 with pyruia)
RF for UTI
Female, sex/new sexual partner, immunosuppression/DM, pregnancy and catheter, any abnormality in urinary tract or internal/external obstruction, age
Normal host defences preventing bacterial colonisation of UT (preventing UTI)
pH of urine flow of urine washes out bacteria commensals tamm-harsfall protein (from kidney) GAG layer
definition of recurrent UTI
> 2 episodes in 6m OR
>3 episodes in 12m
definition of complicated UTI
= UTI in the presence of:
- structurally/functionally abnormal UT (w. or w/o host compromise
- poor renal function
- outflow obstruction
- virulent organisms
indications for ix of UTIs
recurrent episodes
signif LUTS
haematuria
men/children
abnormalities that encourage cystitis
UT obstruction/stasis
previous damage to bladder epi
bladder stones
poor emptying
symptoms of UTI (lower)
frequency, dysuria, strangury, haematuria, suprapubic pain
signs of UTI
fever
abdo/loin tenderness
foul smelling urine
Tx of UTI
trimethoprim (empirical)
nitrofurantoin
ADVICE: increase fluids, urinate often (& void pre and post intercourse)
S&S of acute pyelonephritis (=inflam of kidneys)
rigors, pyrexia, N&V, loin pain & tenderness
uncomplicated UTI = ?
UTI in otherwise healthy, non-pregnant woman with functionally normal UT
pyelonephritis = ?
neutrophil infiltration of parenchyma, (small cortical abscesses and streaks of pus in renal medulla often present)
vesicoureteric reflux = ?
incompetent valve between bladder and ureter, allowing reflux of urine up ureters during bladder contraction and voiding
(usually ceases by ~ puberty but normally damage is already done by then)
epididymo-orchitis = ?
syndrome consisting of pain swelling and inflam of epididymus ± inflam of testes
Most common aetiology in epididymo-orchitis
35yrs = mostly G -ve enteric organisms, eg E. coli, pseudomonas
RF for epididymo-orchitis
previous infection
indwelling catheters
anal intercourse
structural/functional abnormalities of UT
typical presentation fo epididymo-orchitis
UNILATERAL scrotal pain and swelling of ACUTE ONSET, with UTI symps
presentation of prostatitis
fever, malaise, myalgia, rigors
(plus UTI symptoms)
pain in low back/abdomen
pain on ejaculation
tx of prostatitis
analgesia, suprapubic catheter (if retention), parenteral ABX, flouroquinolones - eg ciprofloxacin - 4 wks 2nd line - trimethoprim/macrolides
presentation of urethritis
urethral pain, dysuria ± discharge
NB primarily sexually acquired
presentation of pyelonephritis
Classic triad: loin pain, fever and pyuria
why does dairy consumption reduce chance of UT stone formation?
it doesnt impact calcium in urine, BUT it binds to oxalate removing it from gut and urine, hence decreasing stone formation
give 4 preventative measures for reducing stone formation
decrease salt in diet overhydration normal dietary intake/healthy protein intake physical activity/regular exercise reduce BMI
what condition is classically described by pain thats 12/10 or ‘worse than labour’
Renal colic
what is gold standard for dx of renal stone?
NCCT KUB - v. rapid, 99% sens for stones
mx of ureteric colic
analgesia - NSAID suppository, opiates
antiemetics
± admit and IV fluids
observe for sepsis
whats the most common cause of stress incontinence (in women)
childbirth –> denervation of pelvic floor and urethral sphincter
what medication do you give in renal colic and when
if stone is >5mm give tamsulosin (=a blocker) - relaxes smooth muscle allowing the stone to pass OR nifedipine (CCB)
RF for AKI
PMH - DM, CKD, prostate cancer
elderly
