GU Flashcards
Define Acute Kidney Injury?
An abrupt and sustained rise in serum urea and creatinine levels due to a rapid decline in eGFR. This leads to failure to maintain fluid, electrolyte and acid base balance
What is the criteria for AKI?
Rise in creatinine level > 26umol/l in 48hours
Rise in creatinine level > 1.5x the baseline
Urine output <0.5ml/Kg/hr for >6 consecutive hours
Give some causes of AKI?
Pre-renal = NSAIDs/ACEis (= hypoperfusion), dehydration, haemorrhage, shock, cardiac failure and cirrhosis Intra-renal = acute tubular necrosis due to toxins, thrombosis/embolism, glomerular damage Post-renal = urinary tract obstruction e.g. malignancy, stones or compression
S&S of AKI
Palpable kidneys/bladder, oliguria, oedema, hypertension, dehydration, fatigue, dysponea, weakness, nausea/vominting, confustion, seizures etc.
S&S depend greatly on cause!
Describe the basic treatment for the 3 types of AKI?
Pre-renal = correct volume depletion with fluids and give antibiotics if septic Intra-renal = refer to nephrology Post-renal = catheterise and consider CT-KUB. Stent if obstruction
How do you treat hyperkalaemia?
Insulin and dextrose
What are the three types of Renal Replacement Therapy?
Heamofiltration - most commonly used (exchange via convection)
Haemodialysis - exchange via diffusion
Peritoneal dialysis - used commonly in CKD (uses the peritoneum as an exchange surface adn can be done from home)
Complications of Renal Replacement Therapy?
Increased risk of cardiovascular disease, infection, malignancy adn amyloidosis
Define chronic kidney disease?
A eGFR <60ml/min/1.73m2 for >3months with or without evidence of kidney damage
Causes of CKD?
T2DM, hypertension, PCKD, amyloidosis, priamry glomerulonephritis, SLE and vasculitis
S&S of CKD ?
Weight loss, anorexia, oliguria, haematuria, nausea/vomiting, insomnia, itching, oedema, anaemia, fatigue, amenorrhoea and erectile dysfunction.
Symptoms occur late in disease
Treatment of CKD?
Reduce BP to <130/80 - ACEis, diuretics and CCBs
Reduce PTH if raised to protect bones - give phosphate binders and calcium supplements
Renal replacement therapy and kidney transplant.
How do you differentiate CKD from AKI?
Normochromic anaemia, small kidneys and osteodystrophy indicate CKD
Complications of CKD?
Anaemia (due to low EPO), bone disease/pain, autonomic dyfunction (e.g. postural hypotension and disturbed GI motility), cardiovascular disease and skin disease.
Decreased cerebral function and seizures in severe disease
ADPKD vs ARPKD
ADPKD = Autosomal dominant mutation in the PKD1/PKD2 genes. It leads to cyst formation and kidney function decline throught life. ARPKD = Autosomal recessive mutation in teh PKHD1 gene. It leads to cyst formation and kidney function decline in infancy.
S&S of ADPKD?
Bilateral kidney enlargement with cysts, hypertension, uric acid renal stone formation, haematuria, nocturia, abdominal pain and reduced kidney function
Diagnostic criteria for ADPKD?
Diagnose if: 15-39 = 3 or more cysts (uni/bilateral) 40-59 = 2 or more cysts on each kidney 60+ = 4 or more cysts on each kidney Diagnosis can not be excluded in under 30s
S&S of ARPKD?
Enlarged polyscystic kindeys, renal cysts/hepatic fibrosis in infancy and reduced renal function
Treatment for PKDs?
No direct treatment, remove cysts/kidneys, ACEis for blood pressure control and analgesics.
SCREEN CLOSE RELATIVES
Causes of Nephritic syndrome?
IgA nephropathy due to streptococcal infection (often of the throat), SLE, ANCA vasculitits, Hep B/C infection, systemic sclerosis and malaria
S&S of nephritic syndrome?
Moderate-large eGFR decrease, haematuria, <2g/24hrs proteinuria, hypertension, oliguria, nausea and anorexia
Causes of Nephrotic syndrome?
Podocyte abnormalities.
Primary = Minimal Change Disease, Membranous Nephropathy, Focal Segmental Glomerulosclerosis
Secondary = DM, amyloid build-up, infections, RA and SLE
S&S of nephrotic syndrome?
Normal - mild decrease in eGFR (does NOT develop into AKI), hypoalbuminaemia, pitting oedema and proteinuria > 3g/24hrs
What is minimal change disease?
Seen commonly in children, kidneys appear normal under light microscope but under electron microscope fusion of foot processes can be seen
What is membranous nephropathy?
IgG deposits in teh basement membrane lead to damage - occurs due to autoimmune disease, infection and drugs
What is focal segmental glomerulosclerosis?
segmental scarring of the glomeruli
What are the main complications of nephrotic syndrome?
Increased susceptibility to infection (Igs lost in urine), increased risk of thromboembolism and hyperlipidaemia (liver goes into overdrive due to low albumin)
Where do renal stones classicly lodge?
Pelviureteric junction, pelivic brim and vesicoureteric junction
What are the 4 types of renal stones?
Calcium stones, uric acid stones, infection induced stones and cystine stones
S&S of renal colic?
Rapid onset severe spasamodic loin to groin pain relieved by leaning forward, pain worse on drinking, dysuria, haematuria, reccurent UTIs
Treatment for renal colic?
Strong analgesics e.g. diclofenac, antiemetics, nifedipine/tamulosin to promote expulsion.
Sodium bicarbonate = uric acid stones
Cystine binders = cystine stones
Bendroflumethiazide = hypercalcuria
What is hydronephrosis?
dilation of the renal pelvis (usually due to obstruction) leading to lasting kidney damage
What is the difference between a complicated and an uncomplicated UTI?
Uncomplicated = in a healthy non-pregant female with normally functioning urinary tract Complicated = in a male, pregnant female or any patient with an abnormal urinary tract/systemic disease involving the kidney
Common causes of UTIs?
KEEPS = Klebsiella spp., E.coli, Enterococci, Proteus spp. and Staphylococcus spp.
S&S of pyelonephritis?
UPPER UTI
Loin pain, fever, pyuria - classic triad
Nausea, vomiting, severe headache, rigours and oliguria
S&S of cystitis?
LOWER UTI
Smelly/cloudy urine, loin tenderness, dysuria, frequency, urgency and haematuria
Causes of prostatits?
Strep. faecalis, E.coli and chlamydia
S&S of prostatitis?
Fever, rigours, pain on ejaculation, pelvic pain, tender prostate, hesitancy/incomplete emptying/straining/dysuria etc.
Reccurent UTIs if chronic
Causes of urthethritis?
Nisseri gonorrhoea, Chlamydia trachomatis, Mycoplasm genitalium, trauma, urethral stricture and urinary caliculi
S&S of urethritis?
Skin lesions, dysuria, discharge (pus/blood), urethral pain, fever, nausea/vomiting, penile dyscomfort etc.
OFTEN ASYMPTOMATIC
Treatment of gonorrhoea and chlamydia?
Chlamydia = oral azithromycin stat or 1 week doxycycline Gonorrhoea = IM ceftriaxone with oral azithromycin
Where does the enlargement occur from in BPH?
The inner transitional zone of the prostate
S&S of BPH?
Enlarged bladder, nocturia, frequency, urgency, poor stream/flow, hesitancy, haematuria, incomplete bladder emptying.
DOES NOT affect fertility/cause erectile problems
DRE of PBH vs prostatitis vs cancer?
BPH = enlarged but smooth prostate Prostatits = tender, hot and hard prostate Cancer = enlarged, hard and irregular prostate
Treatment for BPH?
Alpha-1-antagonists (e.g. tamulosin), 5-alpha-reductase-inhibitors (e.g. finasteride).
Transurethral recection/incision of the prostate if urinary retention or severe haematuria
What is an epididymal cyst?
A smooth extra-testicular spherical cyst which develops at the head of the epidiymis. It lies above and behind the testes and contains a clear/milky fluid
S&S of an epididymal cyst?
Testicular lump which will transluminate.
Pain if large. The tetis is palpable seperatley from the cyst
What is a hydrocele?
An abnormal fluid collection within the tunica vaginalis
How can hydroceles be classified?
Primary = patent processus vaginalis Secondary = tumour, trauma, infection or oedema Simple = overproduction of fluid in the tunica vaginalis Communicating = processus vaginalis fails to close so peritoneal fluid can communicate with the scrotum
S&S of a hydrocele?
Scrotal englargement with non-tender (unless infected), smooth and cystic swelling. It will transluminate and is found anterior to and below the testis
What is a varicocele?
An abnormal dilation of the testicular veins in the panpiniform venous plexus due to venous reflux
S&S of a varicocele?
Disteneded scrotal blood vessels, dull ache, scrotal heaviness meaning the affected scrotum hangs lower.
Mainly affects teh left testicle
S&S of testicular torsion?
Sudden onset of pain in one of the testis which makes walking uncomfortable, hot/red/swollen/inflammed testis which lies higher and more transversley, nausea and vomiting
Name all the UTIs
Upper: Pyelonephritis = infection of the renal parenchyma and soft tissues of the renal pelvis/upper ureter
Lower: Cystitis = infection of the bladder, Urethritits = urethral inflammation, Prostatitis = prostate inflammation
Risk factors for bladder cancer?
Smoking, drugs e.g. cyclophosphamide, chronic urinary retention, being male, indwelling catheterisation and occupational risk e.g. rubber workers
S&S of bladder cancer?
painless haematuria, reccurrent UTIs, voididing irritability
Treatment for bladder cancer?
No muscle invasion = surgical resection and MDC chemotherapy
Local muscle invasion = radical cystectomy and M-VAC chemotherapy
Metastasized = palliative chemotherapy
Where to prostate cancers arise from and where do they commonly metastasise?
Peripheral zone of the prostate gland
Bone lymph node, brain liver and lung metastasis (they’re slow growing)
S&S of prostate cancer?
Nocturia, hesitancy, poor stream, terminal dribble, obstruction of the urethra, weight loss, bone pain and anaemia
What are marker of prostate cancer?
Blood = PSA increased Urine = PCA3
Treatment of prostate cancer?
Confined to prostate = radical prostectomy/active surveillence, radiotherapy and hormone therapy
Metastatic disease = androgen receptor blockers or endocrine therapy (e.g. orchidectomy/LHRH agonists)
What age is the cut off for radical prostectomy (above this age use active surveillence)
70 years
Give some examples of testicular tumours?
Germ cell origin = seminous and teratomas
Non-germ cell origin = leydig/sertoli cell tumours and sarcomas
S&S of testicular cancer?
Hydrocele, abdominal mass, painless testicular lump, testicular or abdominal pain
What are markers of testicular cancer?
Serum alpha-fetoprotein or Beta-hCG
Treatment of testicular cancer?
Radical orchidectomy, radiotherapy, chemotherapy if metastasized.
Offer sperm storage!
Risk factors for renal cancer?
Smoking, obesity, hypertension, renal failure, RRT, PKD, VHL syndrom and being male
S&S of renal cancer?
Adbominal mass, varicocele, hypertension, polycythemia, anaemia, painful haematuria and loin pain
Treatment of renal cancer?
Local disease = nephrectomy, cyoablation or chemotherapy
Metastatic/locally advanced disease = Interleukin-2 and Interferon-alpha treatment, biological therapies or temsirolimus
