GU Flashcards
What is CKD?
Abnormal kidney structure or function for greater than 3 months.
What is the GFR in diagnosis of CKD>
<60ml/min
What are risk factors for CKD>
Diabetes, hypertension, male, age, smoking
How does diabetes cause CKD?
Glucose is deposited on proteins in the efferent arteriole. this causes fibrosis and diabetic nephropathy
What are other causes of CKD?
Diabetes, hypertension, glomerulonephritis, congenital causes, persistent pyelonephritis, obstruction, nephrotoxic drugs.
How do patients present with CKD?
Often asymptomatic until end stage renal failure
What might signs and symptoms of CKD be due to?
Raised levels of urea in the blood.
How does hypertension lead to CKD>
Thickening of the afferent arteriole leadign to a reduced blood supply to the kidney and therefore reduced GFR.
Why is hypertension a vicious circle for CKD?
Decreased blood flow in the nephron leads to the RAAS system being activated and renin being released. This further increases the blood pressure in the rest of the system.
What does the loss of nephrons cause in the early stages of CKD?
Glomerular hyperfiltration
What happens in the late stages of CKD?
The kidneys cannot cope with all of the glomerular hyperfiltration and it results in the loss of further nephrons.
What investigations would you do in CKD?
Bloods (U&E) creatinine, phosphate, potassium. FBC , anaemia
Urinalysis - haematuria, proteinuria, glycosuria, UTI
Renal ultrasound
ECG?
How do you treat CKD?
Refer to nephrology if GFR lower than 30.
Recommend lifestyle changes for modifiable risk factors.
Treat underlying causes i.e. hypertension or diabetes.
When is dialysis considered in CKD>
For end-stage renal failure
What is haemodialysis?
3 times 4 hours per week. using an AV fistula
What is peritoneal dialysis?
Peritoneal catheter inserted, glucose solution pumped into peritoneum for exchange of solutes across peritoneal membrane.
What unit is used to express eGFR?
mL/min/1.73m^2
What is the most common cause of CKD?
Diabetes and hypertension
What is AKI?
A syndrome of decreased renal function determined by serum creatinine and urea output.
What are the diagnostic criteria for AKI?
Rise in serum creatinine >26umol/L within 48hours
Rise in serum creatinine >1.5 x baseline within 7 days
Urine output <0.5mL/kg/h for >6 consecutive hours
What is the issue with using creatinine levels?
They are not the most accurate measure as it depends on muscle mass of a patient and dilution.
What are the 3 major classes of AKI?
Pre-renal, renal and post-renal
Pathophysiology of prerenal causes of AKI?
Decreased blood flow to the kidneys leading to ischaemia and loss of function.
What are some pre-renal causes of AKI?
Haemorrhage, sepsis, pancreatitis
HYPOVOLEMIA
What are renal causes of AKI?
Usually progressed from pre-renal if not treated.
Diseases which cause renal causes of AKI>
Glomerulonephritis, tubular disease, interstitial disease, vascular disease.
What is the pathophysiology of post renal causes of AKI>
Extrinsic compression of the renal tract, e.g. obstruction along the urinary tract from kidney to urethra.
What are some causes of post renal AKI?
Renal stones, prostate enlargement, prostate, cervical or bladder cancer, lower UTI
What are the risk factors for AKI?
Hypertension, volume depletion, CKD, diabetes, Cirrhosis, nephrotoxic meds, Cancer, trauma
What drugs should be stopped in patients with AKI>
NSAIDs, ACEi, ARB’s, metformin, lithium, digoxin
How to treat AKI?
Treat underlying cause, treat underlying complications such as electrolyte imbalances. If severe may need dialysis
what changes show on ECG with hyperkalemia?
Tall tented T-WAVES, increased PR interval, small or absent p waves
what drugs can be used to treat hyperkalemia?
Insulin, as it drives glucose and potassium into the cells.
What drug must be given alongside insulin in hyperkalemia?
Dextrose to conteract the hypoglycaemia.
What is the definition of nephritic syndrome?
Causes both haematuria and proteinuria, increased permeability of glomeruli allows movement of RBC’s into filtrate.
What are some causes of nephritis syndrome?
IgA nephrophathy, SLE, Postsrep GN, rapidly progressive GN
How does nephritic syndrome present?
Oedema, visible haematuria, oliguria, uraemic signs
Signs and symptoms of nephritis syndrome?
Fatigue, SOB, cough, Haemoptysis, prior UTI. purpuric rash.
Key clinical signs of nephritic syndrome?
Proteinuria, haematuria and hypertension
What is nephrotic syndrome?
Damage to the glomerulus, specifcally the podocytes.
What is the result of damage to the podocytes?
Proteinuria
What are the clinical presentations of nephrotic syndrome?
Proteinuria >3.5g/24hours
Hypercholesterolaemia
Hypoalbuminaemia
peripheral oedema
What is the pathophysiology of nephrotic syndrome?
Inflammation from immune cells, damage to podocytes, increased liver activity (to increase the albumin which is lost)
Reduced oncotic pressure, leading to oedema.
What is the most common cause of nephrotic syndrome in kids?
Minimal change disease
What is minimal change disease?
A condition where lots of protein is lost in the urine. its idiopathic
What are the most common causes of nephrotic syndrome in adults?
Diabetic nephropathy, membranous nephropathy, Focal segmental glomerulosclerosis, amyloidosis
How to treat nephrotic syndrome?
12weeks prednisalone
low salt diet (oedema)
Statins for prolonged hyperlipidaemia
What is Von hippel lindau disease?
A genetic disease that affects people of all ethnicities characterised by tumour development in the CNS, kidneys, adrenal glands and pancreas
How is von hippel lindau inherited?
Autosomal dominant pattern
Pathophysiology of VHL?
VHL is a tumour suppressor gene, and there is a mutation in is causing tumours in many organs
How many people are affected by VHL>
1 in 36000
What is the most common malignancy in VHL?
Renal cell carcinoma
Presentation of RCC>
Haematuria, flank pain, abdominal mass
B sympotoms: weight loss, fever, fatigue, night sweats and disturbed sleep.
Investigations for VHL
Screening, annual BP and abdominal ultrasound. CT head, chest and abdo MRI baseline scan Bloods Renal biopsy if tumour
How to manage VHL?
SUrgical excision once tumour is bigger than 3cm. cant remove tumours too often otherwise there may be no functioning kidney.
What is PKD?
Inherited condition where clusters of cysts develop within the kidneys
What is the pathophysiology of PKD>
Cysts develop overtime in the tubular portion of the nephron.
compression of renal architecture and vasculature
progressive impairment which gets worse with age.
What is the presentation of PKD?
Hypertension, abdo/flank pain, headaches, LUTS, palpable mass.
How to treat PKD?
Treat hypertension, if infected give antibiotics or drain, surgical remove the kidney, dialysis or transplant.
Complications of PKD?
Berry anneurysms, Cysts in other oragans, 50% ventricular hypertrophy, premalignant
A 45-year-old man presents to his A&E with swelling around his eyes and ankles. He has previous travel to South East Asia. He admits to vomiting and diarrhoea (which is clay coloured) and pain in his RUQ. Blood and urine tests were run and a kidney needle biopsy was performed. Fluorescence microscopy showed IgG and C3 deposits in the glomerulus. What is the most likely diagnosis?
Mebranous glomerulonephritis?
What is the most common type of RCC?
Malignant cancer of the PCT
How does kidney cancer present?
Often asymptomatic
vague loin pain, haematuria, abdo mass
What investigations for renal cancer?
Ultrasound first line
CT chest/abdo/pelvis
Renal biopsy diagnostic
Complications of RCC?
Polycythaemia, HTN, hypercalcaemia and cushings.
What is post-streptococcal glomerulonephritis?
Occurs after a throat or skin infection. streptococcal deposits in the glomerulus leading to immune complex deposition.
What is BPH?
Non-cancerous growth of the prostate gland which is often considered a normal part of aging
What percentage of men at age 60 have BPH?
50%
What percentage of men have BPH at age 85?
90%
What 3 zones make up the prostate?
Peripheral zone, central zone, transitional zone
Which enzyme converts testosterone into dihydrotestosterone?>
5 alpha reductase
Whats the role of androgen s in the prostate?
they cross the cell membrane and bind to receptors within the cell inhibiting apoptosis
What is the pathophysiology of BPH?
Dihydrotestosterone is 10 times more potent than testosterone and causes cell hypertrophy, leading to an increase in size of the prostate.
What are the lower urinary tract symptoms?
Nocturia, frequency, urgency, post micturation dribbling, poor stream/ flow, hesistancy, overflow incontinence, haematuria, bladder stones UTI
What are the first line investigations for BPH?
DRE showing an enlarged prostate
What other tests can be done for BPH?
Levels of PSA, urinalysis to rule out UTI
How to manage BPH?
Finasteride (5 alpha reductase inhibitor)
Terazosin, binds to the smooth muscle receptors in the neck of the bladder, prostate and urethra
What is the surgical procedure called that corrects BPH?
TURP
What is nephrolithiasis?
Stones
What are stones commonly made of?
Calcium oxalate
What are the risk factors for kidney stones?
Chronic dehydration, obesity, high protein/salt diet, recurrent UTIs, hyperparathyroidism
What is the management for small stones?
Symptomatic relief: hydration, NSAIDS/opiods. small stones should pass spontaneously
What is the treatment for large kidney stones?
ESWL (break stone into smaller fragments using shockwaves), or use a nephroscope to remove the stone.
How do patients with renal stones present?
Renal colic (severe uni;ateral abdo pain starting in loin) restlessness, nausea and vomiting, haematuria, dysuria
Investigations for Stones?
Dipstick for haematuria, leucocytes, nitrites.
Bloods: FBC, CRP, U&E’s
USS, non contrast CT
What’s the gold standard investigation for stones?
Non-contrast CT
What’s lifestyle advice for kidney stones?
Decrease sodium and protein intake, increased citrus fruit, adequate fluid intake.
What’s the most common type of bladder cancer?
Transitional cell carcinoma of the bladder
Whats the average age of diagnosis for bladder cancer?
73
What are the risk factors for bladder cancer?
Smoking, exposure to chemicals, cyclophosphamide, age over 40
Where are the most common sites of metastases for bladder cancer?
Lymph nodes, bones, lung, liver
What is the presentation of bladder cancer?
Painless visible haematuria, urgenct, suprapubic pelvic mass, recurrent UTI, symptoms of systemic spread
How would you investigate bladder cancer?
Haematuria clinic: bloods, urine sample for microscopy, culture, ultrasound, flexible cystoscopy.
How do you manage bladder cancer?
Radio therapy, chemotherpapy, TURBT procedure, cystectomy.
How common is prostate cancer?
The most common male malignancy
Risk factors for prostate cancer?
Afro-carribean, family history/genetic, increasing age, anabolic steroids
What is the presentation of prostate cancer?
LUTS, weight loss, fatigue, bone pain, night sweats
What investigations are done in the community for prostate cancer?
DRE and PSA blood test
What tests are diagnostic for prostate cancer?
Transrectal ultrasound and biopsy
What is the Gleason grading system>
How to grade prostate cancer
How to treat prosate cancer if local?
Prostatectomy and active surveillance, radiotherapy aswell of over 70.
How to treat metastatic prostatic cancer?
Chemo, radio, bilateral orchidectomy,
Goserelin (LHRH receptor blocker)
Which age group is testicular cancer most prevalent in?
Most common solid tumour in men aged 20-45
What cell type are the majority of testicular cancers?
Germ cell tumours (90%)
Risk factors for testicular cancer>
Age 20-45, caucasian,cryptoorchidism, previous testicular cancer, HIV and family history
Presentation of testicular cancer
Palpable lump within the testes, non-transilluminable (light can’t get through tumour), May be painful, haematospermia.
Investigations for testicular cancer
Urgent ultrasound of the testes
Management of testicular cancer?
Radical inguinal orchidectomy, semen cryopreservation, treatment for metastatic disease.
WHat is pyelonephritis?
Infection of the kidneys/upper ureter
How is pyelonephritis commonly acquired?
Ascending transurethral spread, or via blood or lymphatics
What bacteria causes the majority of pyelonephritis?
E.coli
WHat is the triad in pyelonephritis>
Loin pain, fever and pyuria
Other symptoms of pyelonephritis
Back pain, severe headache, nausea and vomiting,
Investigations for pyelonephritis?
Urine dipstick first line,
MID STREAM URINE microscopy and culture
Urgent ultrasound to detect stones
Management of pyelonephritis
Analgesia, antibiotics
What is cystitis?
An infection of the bladder
WHo is more likely to get cystitis?
Females as they have a shorter urethra
Acronym for the most common bacteria?
KEEPS
What does KEEPS stand for?
Klebsiella, E.coli, Enterococci, Proteus species, Staph aureus
What is the presentation of cystitis?
Dysuria, frequency, urgency, suprapubic pain, haematuria, polyuria
What are the investigations for cystitis?
1 st line urine dipstick
gold standard mid stream microscopy and culture
Management of cystitis?
Trimethoprim/ nitrofurantoin
What is urethritis?
Urethral inflammation due to infectious or non-infectious cause
What are the main causes of urethritis?
N.gonnorhoea, chlamydia , trauma (urethral stricture)
What are the presentatios of urethritis?
Skin lesion, dysuria, discharge/pus, urethral pain, penile discomfort/ prutitus
What investigations would you do fo urethritis?
STI testing, Microscopy and culture of urethral discharge, blood cultures, urine dipstick to exclude UTI, urethral smear
What is the management of urethritis?
Antibiotics and partner notification
What is prostatitis?
infection and inflammation of the prostate gland
What are the causes of prostatitis?
E.coli, strep faecalis, chlamydia
Risk factors for prostatitis?
STI, UTI, Indwelling catheter, post biopsy, increasing age
Presentation of prostatitis?
Fever, rigors, malaise, pain on ejaculation, poor intermittent stream, hesitancy, incomplete emptying, dribbling, straining, dysuria.
Investigations of prostatisis?
DRE: prostate is tender or hot to touch, hard from calcification
Urine dipstick is positive for leucocytes and nitrites.
What does an epidydimal cyst feel like?
Testis is palpable separate from the cyst, smooth spherical cyst, will transilluminate as fluid filled
What is a hydrocele?
Abnormal collection of fluid within the tunica vaginalis
What would be felt in a hydrocele?
Scrotal enlargement with a non-tender, smooth. cystic swelling. Testis are palpable but may be difficult to palpate in large hydrocele
What is a varicocele?
Abnormal dilation of the testicular veins above the testes
what does varicocele feel like?
Distended scrotal blood vessels that feel like a bag of worms, dull ache or scrotal heaviness
What is a testicular torsion?
Twisting of the spermatic cord resulting in occlusion of the testicular blood vessels
Presentations of testicular torsion?
Sudden onset of pain in one testis making walking uncomfortable, often comes on during sport or physical activity.
At what age does chlamydia most likely occur?
age 20
Whereabouts can chlamydia affect?
Urethra, endocervical canal, rectum, pharynx, conjunctiva
What are the symptoms for chlamydia and gonnhorea in men?
Dysuria and urethral discharge
Incubation period for GC
2-5days
Incubation period for CT?
7-21 days
Complications of CT in men?
Epididymoorchitis, where the infection spreads to the testis
Symptoms for chlamydia and gonnhorea in women?
Discharge, menstrual irregularity, dysuria
What complications for GC and CT in femals?
Pelvic inflammatory disease, neonatal transmission.
How is chlamydia diagnosed?
Nucleic acid amplification (PCR), vaginal swab in women, first void urine in men.
How to treat chlamydia?
Doxycycline for 7days, partner notification, test for other stis
How to diagnose gonorrhoea?
Urethral swab in males and female endocervix swab.
Microscopy of gram stained smears of genital secretions looking for gram negative diplococci.
How to treat gonorrhoea?
continuous surveillance of antibiotic sensitivity.
What is syphilis caused by?
Treponema pallidum
What does primary syphilis look like?
Primary macule (non-tender ulcer)
Secondary syphilis?
70% present with a skin rash
How to diagnose syphilis?
Early moist lesions, genital ulcers, rash.
What is the syphilis treatment?
Penicillin by injection
