GU Flashcards
What does haematuria in the urine at different parts of the stream indicate? Start/end/throughout?
start = urethral disease end = prostate/bladder base bleeding throughout = source above bladder
What is macroscopic and microscopic haematuria?
Blood in urine
Macroscopic = visible
Microscopic = dipstic +ve
Transient causes of haematuria?
UTI, menstruation, vigorous exercise, sex
Causes of haematuria?
cancer of urinary tract, stones, BPH, prostatitis, urethritis, IGA nephropathy, nephritic syndrome
Ix of haematuria?
exclude transient causes, urine microscopy
Plasma Cr (calculate eGFR), protein/creatinine ratio
renal tract imaging, cystoscopy
What is the triad of nephrotic syndrome?
proteinuria, hypoalbuminaemia, oedema
name 2 causes of nephrotic syndrome?
minimal changes disease, membranous nephropathy
What are some causes of membranous nephropathy?
Drugs - penicillame, gold, NSAIDS
Autoimmune - SLE
Neoplastic - lung, colon, breast
Infection - hep B & C
How do you diagnose minimal changes disease?
electron microscopy of kidney biopsy - shows fusion of podocytes
How do you manage nephrotic syndrome?
Oedema - salt restriction and a thiazide diuretic
Proteinuria - ACEi
DVT prophylaxis
Ix of Nephrotic/Nephritic synd?
eGFR, urinary protein, serum UEs, serum albumin, urine microscopy (red casts?), strep throat swab, BG, CXR, US kidneys, renal biopsy
Abs - ANA, DNA, ANCA, GMM, Hep B and C, HIV
Complications of nephrotic syndrome?
Thrombosis - loss of clotting factors in urine Sepsis - loss of Igs AKI hyperlipidaemia CKD
Triad of nephritic syndrome?
Haematuria, Proteinuria, Hypertension
+/- oliguria, uraemia
causes of nephritic syndrome?
post-strep glomerulonephritis, infective endocarditis, SLE, HSP
how do you manage nephritic syndrome?
HTN - loop diuretic, Na restriction
Monitor fluid balance
Commonest cause of a UTI?
E.Coli
What increases the risk of a UTI?
female, urinary obstruction and stasis, previous bladder damage, bladder stones, reduced bladder emptying
UTI symptoms?
frequency, dysuria, suprapubic pain, tenderness, haematuria, smelly urine
Pyelonephritis symptoms?
loin pain, tenderness, N&V, fever
What makes a UTI complicated?
abnormal tract (stone/obstruction), systemic disease invovling kidney (DM/sickle cell), men, pregnancy
Ix for UTI?
urine dipstick (leucocytes and nitrates)
urine microscopy and culture
renal tract imaging
Management of a UTI?
Nitrofuratoin, Trimethoprim = first line
high fluid intake, search cause if it is an underlying infection
What is renal HTN?
Narrowing of the renal arteries due to atheroma. This causes reduced renal perfusion and renal ischaemia. The reduced pressure in afferent glomerular arterioles causes activation of RAAS.
How do you investigate renal HTN?
renal arteriography, doppler US, CT + IV contrast
Management for renal HTN?
treat atherosclerosis - exercise, stop smoking, statins, antiplatelets, control `bp
Stent if necessary
Comonest type of renal calculi?
Calcium oxalate
Causes of hypercalcaemia?
hyperparathyroidism, increased dietary intake, increased bone resporption (cancer/immobilisation)
Causes of hyperoxaluria?
high oxalate diet (spinach/rhubarb)
enzyme deficiencies
What condition is associated with hyperuricaemia?
gout
what GI condition is associated with uric acid stones?
ileostomy, due to loss of carbonate
which UTI organisms are associated with infection - induced calculi? Why do they increase the risk?
proteus, klebsiella. The bacteria produces urea which converts to ammonia and increases the pH of the urine which favours stone formation.
Renal calculi symptoms?
colicky pain (loin to groin) N&V, sweating, UTI, pyelonephritis, bladder outflow obstruction, haematuria
Ix for renal calculi?
urine dipstick and culture, serum UE, Cr, Ca, urate
FBC, CRP, non contrast CT KUB
management of renal calculi?
PAIN RELIEF - Diclofenac
- <5mm stones usually pass spontaneously
REMOVAL - shock wave lithotripsy, ureteroscopy, open surgery
how to prevent recurrence of renal calculi?
normal Ca diet, high fluid intake
Allopurinol for uric stones
cystine stones - need to drink 5L water a day
Common causes of an urinary tract obstruction?
LUMEN - calculi, tumour, blood clot
WALL - congenital abnormality, stricture, neuropathic bladder
OUTSIDE PRESSURE - BPH, prostate or pelvic tumour, phimosis
Symptoms of a upper urinary tract obstruction?
dull ache in flank, anuria
Symptoms of a bladder outlet obstruction?
hesitancy, poor stream, terminal dribbling, felling of incomplete emptying
What is an AKI?
sustained rise in urea and creatinine due to a rapid decline in GFR leading to loss of normal water and solute homeostasis
Causes of AKI?
PRE-RENAL - hypovolaemia, reduced BP, reduced cardiac pump efficiency, renal stenosis
RENAL - NSAIDS, ACEi, acute tubular necrosis
POST RENAL - enlarged prostate or pelvic masses
Ix for AKI?
Bloods - FBC, ESR, cultures, Ca, Ph, uric acid
Urine dipstick - MS&C, culture, urinary electrolytes
renal US/CT
ANCA Ab/complement levels
Hep/HIV Abs
What is CKD?
progressive renal impairment over >3 months
Causes of CKD?
diabetic nephropathy Chronic glomerulonephritis (SLE) chronic pyelonephritis HTN Schistomiasis
Features of CKD and why?
ANAEMIA - reduced EPO production by diseased kidney and haematuria means more losses
BONE DIS - due to tertiary hyperparathyroidism. renal Ph retention means reduced Ca and increased PTH
NEURO - polyneuropathy
CVD - increased risk of MI/HF/CVA due to HTN and dyslipidaemia
How do you manage CKD?
Renoprotect (optimise BP) - usual pathway
Reduce CVS RF - optimise BP, statins, smoking, diabetes, normal protein diet.
Treat complications;
1. HYPERKALAEMIA - dietary restriction, stop spironolactone
2. dietary phosphate restriction, synthetic Vit D
3. Recombinant EPO for anaemia
4. Sodium bicarbonate for acidosis
5. Infections - influenza and pneumococcal vaccine
What is dialysis and how does it work?
uraemic toxins are removed from blood by diffusion across semipermeable membrane towards low concentrations in dialysis fluid. Gradient maintained by replacing dialysis fluid.
What is autosomal dominant PKD?
multiple cysts throughout kidneys, the cysts increase with age causing destruction of kidney tissue and reduced renal function.
mutations in which gene cause ADPKD?
PKD1/PKD2
Features of ADPKD?
acute loin pain if haemorrhage abdo discomfort HTN progressive renal impairment REMEMBER: liver cysts, SAH, MV prolapse
Ix for ADPKD?
Exam - large irregular kidneys, HTN, hepatomegaly
US kidneys
family history
mangement of ADPKD?
monitor BP, control
Measure creatinine regularly
dialysis
offer US to family members
Where does renal cell carcinoma normally arise?
proximal tubular epithelium?
Features of RCC?
haematuria, loin pain, mass in flank
+/- malaise, fever, weight loss
Ix for renal tract cancers
US, CT KUB, bloods, PET scan, prostate exam
Where do urothelial tumours usually arise?
transitional cell epithelium
What is BPH?
hyperplasia of the glandular and connective tissue of the prostate
Features of BPH
frequency, nocturia, delayed initiation, post void dribble, acute retention
Ix for BPH
US, examination, serum UE, PSA
Name 2 medications and their classes used to treat BPH? name some adverse effects for each
A1 antagonist - Tamsulosin
A/E - dizzy, postural hypotension, dry mouth
5a reductase inhibitors - Finasteride
A/E = ED, reduced libido, ejaculation problems
Features of Prostate cancer?
the same as BPH, bone pain, weight loss, malaise, bladder outflow obstruction
Ix for bladder cancer?
transrectal US of prostate, PSA levels, MRI to stage tumour
Mx of prostate cancer? Name 2 drugs and their action
radical prostatectomy
LH analogues e.g. goserelin
antiandrogens - Cyproterone acetate
