GU and Renal Flashcards
What is the epidemiology of renal stones (4)
- 10-15% risk in lifetime
- 50% re-occurrence rate
- Most are calcium urate or calcium phosphate
- More common in males, 20-40
What are the risk factors for renal stones (7)
- Hypercalcaemia
- Dehydration
- Infection
- Renal disease
- Family history
- Anatomical abnormalities
- Gout
Describe the pathophysiology of renal stones
- Stones formed in supersaturated urine
- Most are calcium oxolate (60-65%), calcium phosphate (10%) or uric acid
- Often can cause obstruction leading to hydronephrosis (blockage and dilatation of renal pelvis) which can lead to permanent damage
Where are the most common sites for renal stones to get stuck (3)
- Pelvic brim
- Pelvoureteric junction
- Vesicoureteric junction
How might kidney stones present (4)
- Renal colic
- Sudden onset excruciating abdo pain
- Patient writhing in pain, cannot lie still
- Loin to groin in waves
- Nausea and vomiting
- Dysuria
- Haematuria
- Frequency
How would you diagnose renal stones (4)
- Urine dipstick/midstream sample
- KUB X-ray
- Non-contrast CT KUB (gold standard/diagnostic)
- Ultrasound
How would you treat renal stones (6)
- Analgesia
- Antibiotics if infection
- Anti-emetics
- Surgery
- Lithotripsy
- Medical expulsive therapy eg. Tamsulosin
Define acute kidney injury (AKI)
- An abrupt sustained rise in serum Urea and Creatanine due to a rapid decline in GFR leading to inability to maintain acid base, fluid and electrolyte homeostasis
What is the criteria for AKI (3)
- Rise in serum Cr >26umol/L in 48 hours
- Rise in serum Cr >1.5x baseline
- Urine output <0.5ml/kg/hour for 6+ hours
What is the epidemiology of AKI (2)
- Common (occurs in 18% of hospital patients)
- Common in the elderly
What are the 3 causes of AKI
- Pre-renal
- Intra-renal
- Post-renal
What are pre-renal causes of AKI (3)
- Hypoperfusion
- Hypotension/hypovolaemia
- Dec. cardiac output
- Shock
What are Intra-renal causes of AKI (4)
- Nephrotoxic drugs
- Vasculitis
- Acute tubular necrosis
- Glomerulonephritis
What are post-renal causes of AKI (3)
- Blockage
- Tumour
- Stone
- BPH
What are the risk factors for AKI (6)
- Age >75
- Heart failure
- CKD/glomerulonephritis
- Diabetes
- Nephrotoxic drugs
- Prostate cancer/BPH
How might AKI present (4)
- Depends on cause
- Oliguria
- Oedema
- Thirst
How would you diagnose AKI (2)
- Using criteria
- Find underlying cause (biopsy, scans etc.)
What is the treatment for AKI
- Treat underlying cause
- Stop nephrotoxic drugs
- Dialysis (hamofiltration/haemodialysis)
How can glomerulonephritis present (4)
- Acute nephritic syndrome
- Nephrotic syndrome
- Asymptomatic urine abnormalities
- Chronic kidney disease
What is acute nephritic syndrome characterised by (4)
- Haematuria
- Proteinuria
- Oedema
- Hypertension
What are the causes of acute nephritic syndrome (4)
- IgA nephropathy (most common)
- Infection/post infection
- SLE
- Systemic sclerosis
How might acute nephritic syndrome present (6)
- Haematuria
- Proteinuria
- Oedema
- Hypertension
- Oliguria
- Decreasing kidney function
How do you diagnose acute nephritic syndrome (3)
- Mid stream urine/dipstick
- Renal biopsy
- Bloods (Raised Cr, Urea, Low albumin and eGFR)
How do you treat acute nephritic syndrome (2)
- Treat cause
- Hypertension (CCB/diuretics)
What are the characteristics of nephrotic syndrome (4)
- Proteinuria
- Hypoalbuminaemia
- Hyperlipidaemia
- Oedema
What can cause nephrotic syndrome (2)
- Associated with podocyte damage
- Minimal change disease (primary)
- Diabetes (secondary)
How might nephrotic syndrome present (3)
- Proteinuria (frothy urine)
- Oedema
- May be hypertension
How do you diagnose nephrotic syndrome (3)
- Urine dipstick (proteinuria)
- Bloods (hypoalbuminaemia, may be raised Cr/urea)
- Renal biopsy
How do you treat nephrotic syndrome (4)
- Diuretics (oedema)
- B.P control (proteinuria) (ACE-i)
- Simvastatin (hyperlipidaemia)
- Warfarin (low albumin can cause thrombosis)
What is chronic kidney disease (CKD) (2)
- A longstanding, usually progressive impairment of renal function for 3 months+
- Defined as GFR <60ml/min/1.73m2 for more than 3 months
What is the epidemiology of CKD (2)
- More common in females
- Inc. with age
What can cause CKD (9)
- Diabetes
- AKI
- SLE
- Idiopathic
- PKD
- Atherosclerosis
- Family history
- Malignancy
- Hypercalcaemia
Describe the pathophysiology of CKD
- Progressive scarring of nephrons leads to their failure
- This means that the flow of blood is re-directed to other nephrons
- This causes and increased flow and stress on the nephrons accelerating their scarring and failure
How might CKD present (7)
- Early stages are asymptomatic (kidney has large reserve volume
- Malaise
- Weight loss/anorexia
- Polyuria/nocturia
- Oedema
- Nausea/vomiting/diarrhoea
- Itching
- Amenorrhea/E.D
How would you diagnose CKD (4)
- Urine sample
- Renal biopsy
- Ultrasound (small kidneys)
- Bloods (raised Cr and Urea, Low eGFR and Ca)
How do you treat CKD (5)
- Control progression/complications
- B.P control
- Biphosphonates/Calcitriol (low calcium)
- Simvastatin and warfarin (CVD)
- Duiretics (oedema)
- RRT
- Transplant
What are the indications for dialysis in CKD/AKI (4)
- Hyperkalaemia
- Symptomatic uricaemia
- Pulmonary oedema
- Acidosis
What are the 3 types of Renal replacement therapy (RRT)
- Haemofiltration
- Haemodialysis
- Peritoneal dialysis
Describe Haemofiltration
- Blood drawn through double lumen catheter by pump and replacement solution is infused in.
Describe Haemodialysis
- Blood drawn out through A.V fistula passed over semi-permeable membrane with solution passing other way allowing solutes to move down conc. gradient
Describe Peritoneal dialysis
- Peritoneum used a membrane for solute exchange with blood
What are the potential complications of RRT (3)
- Hypertension (stroke/MI)
- Malignancy
- Infection
Describe the epidemiology of autosomal dominant polycystic kidney disease (ADPKD) (3)
- Most common inherited kidney disease
- More common in males
- Presents in early adulthood
What mutations occur in ADPKD and ARPKD (3)
- PKD 1 on chromosome 16
- PKD 2 on chromosome 4
- PKHD 1 on chromosome 6 (ARPKD)
Describe the pathophysiology of PKD
- Cysts cause mechanical pressure and reactive fibrosis leading to progressive renal failure
- The rate of renal decline depends on the size and growth rate of cysts
How might PKD present (5)
- Haematuria
- Loin pain
- Palpable enlarged kidney
- Nocturia
- Stones
How would you diagnose (AD/AR) PKD (2)
- Ultrasound
- Enlarged cystic kidneys
- 15-39 (3)
- 40-59 (2 on each)
- 60+ (4 on each)
- Family history/genetic testing
How do you treat PKD (4)
- B.P control
- Laproscopic removal/nephrectomy
- Family screening
- RRT for ESRF
How do you tell different diseases by testicular palpitation (5)
- Can’t get above it = Hernia or hydrocele
- Separate and cystic = epididymal cyst
- Separate and hard = varicocele
- Testicular and cystic = hydrocele
- Testicular and hard = tumour
What is the epidemiology of epididymal cyst (3)
- Cyst containing milky fluid
- Not uncommon
- Most common about 40
How might epididymal cysts present (4)
- Usually have noticed a lump
- May be multiple and bilateral
- Symptomatic if large
- Palpable separate from testis and cystic
How do you diagnose and treat epididymal cysts
- Testicular ultrasound
- Surgery if symptomatic
What is the Epidemiology of hydrocele (2)
- Abnormal collection of fluid in tunica vaginalis
- Can be primary or secondary
How might hydrocele present (2)
- Non tender, smooth swelling of testicles
- Only painful if infected
How do you diagnose/treat hydrocele
- Testicular ultrasound
- Needle aspiration or surgery if symptomatic
What is the epidemiology of varicocele (3)
- Abnormal swelling of testicular veins due to venous reflux
- Incidence increases after puberty
- More common on the left side
How might varicocele present (3)
- ‘Bag of worms’
- Hard and separate
- Dull ache and heavy scrotum
How do you diagnose/treat varicocele
- Venography
- Surgery is symptomatic
What is the epidemiology of testicular torsion (2)
- Twisting (torsion) of spermatic cord leading to vessel occlusion and hence ischaemia and infarct
- Left side is more commonly affected
How might testicular torsion present (4)
- Sudden onset severe testicular pain
- Abdominal pain
- Nausea and vomiting
- Very hot, swollen, tender testicle
How do you diagnose testicular torsion
- DO NOT DELAY SURGERY
- Doppler ultrasound
What is the treatment for testicular torsion
- Rapid surgery (6 hours to save testicle)
- Orchidectomy
What are the storage LUTS (4)
- Overflow incontinence
- Urgency
- Frequency
- Nocturia
What are the voiding LUTS (7)
- Haematuria
- Dysuria
- Hesitancy
- Poor stream
- Post micturition dribbling
- Poor emptying
- Straining
What is acute urinary retention and how might it present
- A painful inability to pass urine, usually with over 500ml urine in the bladder
- Cannot pass urine, painful/tender palpable bladder
What can cause acute urinary retention (6)
- LUT obstruction (stones/tumour)
- BPH/Prostate cancer
- Cauda equina syndrome
- Alcohol
- Post op
- Infection
How do you treat acute urinary retention (4)
- Catheterise
- Tamsulosin (alpha 1 blocker)
- Finasteride (5 alpha reductase inhhibitor)
- Treat underlying cause
What is the epidemiology of benign prostate hyperplasia (BPH) (3)
- Inc. with age
- Common (40% of over 60)
- Afro-Caribbeans more affected
How might BPH present
- Nocturia (most common)
- Typical LUTS
How do you diagnose BPH (4)
- DRE (smooth, enlarged prostate)
- Serum PSA raised
- Ultrasound
- Urine dipstick/midstream to exclude infection
How do you treat BPH (3)
- Alpha 1 antagonists (tamsulosin)
- 5 alpha reductase inhibitors (finasteride)
- Surgery (transurethral resection of prostate)
What is the epidemiology of renal cell carcinoma (RCC) (3)
- Most common renla tumour in adults
- Rare under 40
- More common in males
What are the risk factors for RCC (6)
- Smoking
- Obesity
- Hypertension
- PKD
- Von Hippel Lindau syndrome
- Renal replacement therapy
Describe the pathophysiology of RCC
- Malignancy of the proximal convuluted tubule epithelium
- 25% metastases on presentation
How might RCC present (5)
- Haematuria
- Loin/flank pain
- Palpable mass
- Anorexia, weight loss, malaise
- Hypertension (some RCC secrete renin)
How do you diagnose RCC (3)
- Renal biopsy
- Ultrasound
- MRI (staging)
How do you treat RCC (3)
- Total/partial nephrectomy
- Chemotherapy
- Radiotherapy
What is the epidemiology of transitional cell carcinoma (TCC) (3)
- 50% bladder
- 4th most common cancer in men, 8th in women
- More common in older people
What are the risk factors for TCC (6)
- Male
- Smoking
- Rubber/chemical industry
- Inc. age
- Catheter
- Family history
How might TCC present (2)
- Painless haematuria
- Voiding irritability
How do you diagnose TCC (3)
- Cystoscopy (diagnostic)
- CT/MRI
- Urine dipstick/mid-stream sample
How do you treat TCC (4)
- Resection of tumour
- Radical cystectomy
- Radical radiotherapy
- Chemotherapy
What is the epidemiology of prostate cancer (5)
- 4th most common cancer in men
- Increases with age
- By 80, 80% of men have a malignancy, but most are inactive
- Mostly adenocarcinoma in peripheral zone of prostate
- More common in black people due to raised testosterone
What are the risk factors for prostate cancer (4)
- Increasing age
- Black
- Family history
- Genetic
How might prostate cancer present (3)
- Nocturia
- LUTS
- Malaise, weight loss, anorexia
How do you diagnose prostate cancer (3)
- Trans-rectal ultrasound with biopsy
- DRE (hard, irregular)
- Serum PSA
How do you treat prostate cancer (3)
- Often just monitoring
- Endocrine therapy
- Androgen receptor blockers (bicalutamide)
- Radiotherapy
What is the epidemiology of testicular cancer (3)
- Most common cancer in men aged 15-44
- 10% occur in undescended testis
- > 96% arise from germ cells
What are the risk factors for testicular cancer (3)
- Family history
- Undescended testis
- Infertility
How might testicular cancer present (4)
- Hard lump in testicle (may be painless)
- Testicular (w/without abdominal) pain
- Hydrocele
- Weight loss/malaise
How do you diagnose testicular cancer (3)
- Testicular ultrasound
- Biopsy
- CT (staging)
How do you treat testicular cancer (4)
- Orchidectomy
- Radiotherapy
- Chemotherpay
- Sperm storage
Define UTI (2)
- Inflammation of urothelium in response to bacterial colonisation
- 10^5 organisms/ml in fresh mid-stream urine sample
What 5 pathogens usually cause UTI
- KEEPS
- Klebsiella spp
- E.coli (most common)
- Enterococci
- Proteus spp
- Staphylococcus spp
What is the epidemiology of pyelonephritis (2)
- More common in women <35
- Associated with significant sepsis
What are the risk factors for pyelonephritis (6)
- Structural abnormality
- Stones
- Catheter
- Pregnancy
- Diabetes
- Immunosupression
How might pyelonephritis present (5)
- TRIAD: loin pain, fever, pyuria
- Severe headache
- Oliguria
- Rigors/malaise
- Nausea and vomiting
How do you diagnose pyelonephritis (2)
- Urine dipstick
- Mid stream urine microscopy
How do you treat pyelonephritis
- Rest, water, cranberry juice
- Analgesia
- IV/oral co amoxiclav
What are the risk factors for cystitis (4)
- Catheter
- Stones/obstruction
- Previous bladder damage
- Incomplete bladder emptying
How might cystitis present (2)
- LUTS
- Abdo./loin pain/tenderness
How do you diagnose cystitis (2)
- Urine dipstick
- Mid stream urine microscopy
How do you treat cystitis
- Trimethoprim
- Co amoxiclav if severe/non-responsive
How might prostatitis present (4)
- Voiding LUTS
- Pelvic pain
- Fever, rigors, malaise
- Pain on ejaculation
How do you diagnose prostatitis (4)
- Mid-stream urine sample
- Urine dipstick
- DRE (warm, swollen and tender)
- Trans-urethral ultrasound
How do you treat prostatitis (2)
- Acute
- IV co amoxiclav and gentamicin
- Chronic
- Ciprafloxacin
What is the epidemiology of urethritis (2)
- Primarily caused by STI (chlamydia most common and gonorrhoea)
- Most common urological condition in men
How might urethritis present (4)
- Dysuria +/- blood and pus
- Urethral pain
- Penile discomfort
- Systemic symptoms
How do you diagnose urethritis (2)
- First void urine in men, vaginal swab in women (microscopy)
- Urethral swab
How do you treat Urethritis (2)
- Chlamydia (azithromycin)
- Gonorrhoea (azithromycin and ceftriaxone)
What is the aetiology of epididymo-orchitis (4)
- <35 STI
- > 35 UTI
- Mumps
- Catheter
How might epididymo-orchitis present (3)
- Unilateral swollen and painful testis
- Sweats/fever
- May be dysuria
How do you diagnose Epididymo-orchitis (2)
- First void urine microscopy
- Urethral swab/smear
How do you treat epididymo-orchitis
- Chlamydia (azithromycin)
- Gonorrhoea (azithromycin and im ceftriaxone)
- UTI (ciprofloxacin)
