GU to work on Flashcards
1
Q
what are the risk factors for testicular cancer?
A
- Cryptorchidism (undescended testes)
- Family history
- previous testicular cancer
- HIV
- age 20-45
- Caucasian
- infant hernia
2
Q
How do you manage nephritic syndrome?
A
Treat underlying cause
Blood pressure control- ACE-I/ARB. This reduces proteinuria and preserves renal function
Corticosteroids- this is to reduce the inflammation causing damage to the kidney
3
Q
What can nephrotic syndrome be secondary to?
A
- DM
- SLE
- Amyloidosis
- Infection
- Drugs
4
Q
How is minimal change disease treated?
A
High dose corticosteroids = prednisolone
- Frequent relapse or steroid-dependent disease is treated with CYCLOPHOSPHAMIDE or CICLOSPORIN/TACROLIMUS
5
Q
How would you diagnose membranous nephropathy?
A
Serum anti-PLA2R antibodies
Renal biopsy = thickened glomerular basement membrane (sub epithelial IgG and C3 complement deposits)
6
Q
What is the management of membranous nephropathy?
A
Managed with ACE-I/ARB in all.
In patients with high risk of progression, prednisolone and cyclopshosphamide.
7
Q
Describe the treatment for nephrotic syndrome
A
Fluid and salt restriction
Loop diuretics- to manage oedema
Treat cause
ACE-I/ARB to reduce protein loss
Manage complications
8
Q
Give 3 complications of nephrotic syndrome
A
- Infections (Ig loss, complement activity decrease)
- Thromboembolism (more clotting factor) manage with heparin
- Hyperlipidaemia - loss of albumin increases cholesterol formation. Manage with statins
9
Q
What is the treatment for IgA nephropathy?
A
- BP control - ACEi / ARB
- steroids if renal function declines
10
Q
Give 5 potential causes of urinary tract stones
A
- Congenital abnormalities - horseshoe kidney, spina bifida
- Hypercalcaemia/high urate/high oxalate
- Hyperuricaemia
- Infection
- Trauma
11
Q
When are urinary tract stone removed?
A
<5mm = watch and wait
> 5mm:
- Oral nifedipine (CCB) or alpha blocker (tamsulosin)
- Extracorporeal shock wave lithotripsy (ESWL) - break stone into smaller fragment using shockwaves
- Ureteroscopy (laser/basket)
12
Q
What investigations might you do to find out what is causing someone’s renal colic?
A
- Bloods - including calcium, phosphate, urate
- Urinalysis
- MSU MCS (mid-stream urine microscopy, culture & specificity)
- NCCT-KUB (non-contrast CT scan of kidney, ureter and bladder) = gold standard
13
Q
What is the GFR?
A
Volume of fluid filtered from the glomeruli into Bowman’s space pre unit time
14
Q
What is the effect of NSAIDs on the afferent arteriole of glomeruli?
A
NSAIDs inhibit prostaglandins and so lead to afferent arteriole vasoconstriction = reduced GFR
15
Q
What is the effect of AECi on the efferent arteriole of glomeruli?
A
ACEi cause efferent arteriole vasodilation = reduced GFR
16
Q
How is CKD diagnosed?
A
- eGFR < 60,
or: - eGFR < 90 + signs of renal damage,
or: - Albuminuria > 30mg/24hrs (Albumin:Creatinine > 3mg/mmol)
17
Q
Briefly describe the pathophysiology causes CKD
A
Hyper-filtration for nephrons that work –> glomerular hypertrophy and reduced arteriolar resistance –> raised intraglomerular capillary pressure and strain –> accelerates remnant nephron failure (progressive)
18
Q
Name 4 cause of CKD
A
- DM - 24% of patients
- Hypertension
- Glomerulonephritis
- Congenital - polycystic kidney disease
- Urinary tract obstruction
- drugs - NSAIDs, ACEi, antidepressants, many antibiotics
19
Q
Give 3 signs of CKD
A
Often asymptomatic until very low kidney function
- Fluid retention
- oedema and raised JVP
- Oliguria - 0.5 mL/kg/h or <500mL/day
- Effects of uraemia
- pruritus = ureamic frost, yellow/grey complexion, nausea, reduced appetite - cardiac arrhythmias - hyperKa
- Fatigue, pallor - anaemia
- Bone pain - hyperphosphatemia (CKD-MBD)
20
Q
What investigations might be done in someone who has CKD?
A
FBC = anaemia
U+Es = raised phosphate, uric acid, urea, creatine and decreased Calcium
Urine dipstick = haematuria and proteinuria
GFR Imaging - USS, CT KUB, ECG, Xrays
21
Q
Describe the management of CKD
A
Slow progression of disease
- DM treatment
- HTN treatment
- Glumeronephritis treatment
Reduce risk of CVD
- Atorvastatin- 20mg
Manage complications
- Mineral bone disease- low Vit D
- HTN
- Proteinuria
- Anaemia-> ESA
- RRT- haemodialysis, peritoneal dialysis, transplant
22
Q
Give 5 potential complications of haemodialysis
A
- Hypotension
- Cramps
- Nausea
- Chest pain
- Fever
- Blocked or infected dialysis catheter
23
Q
Give 4 potential complications of peritoneal dialysis
A
- Infection (peritonitis/catheter exit site infection)
- Peri-catheter leak
- Abdominal wall herniation
- Intestinal perforation
24
Q
Give 3 contraindications for renal transplant
A
- ABO incompatibility
- Active infection
- Recent malignancy
- Morbid obesity
- Age >70
- AIDS
25
Define Acute Kidney Injury (AKI)
Sudden decline in renal function determined by increased serum creatinine +/- ↓ urine output.
Results in imbalance in electrolytes and azotaemia (↑ creatinine / nitrates)
26
Give 5 risk factors for AKI
1. Increasing age
2. CKD
3. HF
4. DM
5. Nephrotoxic drugs - NSAIDs, ACEi
6. hypertension
27
How does AKI present?
1. Uraemia (high urea) = fatigue, weakness, vomiting, seizures
2. Acidosis
3. Arrhythmias
4. Oliguria
5. Oedema
6. high creatinine
28
What is the diagnostic criteria for AKI?
1/3 = diagnostic
1. Rise in CR >26 mmol/L in 48 hours
2. Rise in Cr >50% in 48 hours
3. Urine output fall to < 0.5 ml/kg/h for 6 hours
29
Give 4 risk factors of UTI's
1. Catheter
2. Female
3. Prostatic hypertrophy (obstructs)
4. Low urine volume
5. Urinary tract stones
6. Pregnancy
30
Give 3 bacterial virulence factors that aid their ability to cause UTI's
1. Fimbriae/pili that adhere to urothelium
2. Acid polysaccharide coat resists phagocytes
3. Toxins (e.g. UPEC releases cytotoxins)
4. Enzyme production (e.g. urease)
31
Give 3 host defence mechanisms against UTIs
1. Antegrade flushing of urine
2. Tamm-horsfall protein
3. GAG layer
4. Low urine pH
5. Commensal flora
6. Urinary IgA
32
Describe the management for someone who is having recurrent UTIs
1. Increase fluid intake
2. Regular voiding
3. Void pre and post intercourse
4. Abx prophylaxis
5. Vaginal oestrogen replacement
33
what are the risk factors for cystitis?
1. Urinary obstruction
2. Previous damage to bladder epithelium
3. Poor bladder emptying
4. bladder stones
34
what are the symptoms of cystitis?
1. Dysuria
2. Frequency and urgency
3. Suprapubic pain
4. Offensive smelling/cloudy urine
5. Haematuria
35
What is the treatment for cystitis?
1st line = Trimethoprim or nitrofurantoin (avoid trimethoprim in pregnancy -> teratogenic)
2nd line = ciprofloxacin or Co-amoxiclav
36
what are the causes of prostatitis?
acute:
- streptococcus faecalis
- e.coli
- chlamydia
chronic:
- bacterial (as above)
- non-bacterial - elevated prostatic pressure, pelvic floor myalgia
37
Give 4 symptoms of acute prostatitis
1. Fever
2. Rigors
3. Malaise
4. Voiding LUTS
5. Pelvic --> anal pain
6. pain on ejaculation
very tender prostate
38
Give 3 symptoms of chronic prostatitis
1. Recurrent UTI's
2. Pelvic --> anal pain
3. acute symptoms
Symptoms for > 3 months
39
What investigations might you do in someone with prostatitis?
1. Urinalysis and MSU = blood, WBC and bacteria
2. DRE = boggy, tender and hot to touch
3. STI screen
4. Microbiology = uropathogens in urine
5. Imaging - TRUSS +/- CT abdo/pelvis
40
How would you treat prostatitis?
Quinolone (ciprofloxacin) or trimethoprim (if unable to take quinolones) for 4-6 weeks
Treat pain = paracetamol/ibuprofen
41
what are the causes of urethritis?
- N. gonorrhoea
- chlamydia
- trauma
- urethral stricture
- irritation
- urinary calculi
42
what are the symptoms of urethritis?
- skin lesion
- dysuria +/- discharge (blood/pus)
- urethral pain
- penile discomfort/Pruritis
43
what is the treatment for urethritis?
STI treatment = Abx - ceftriaxone and doxycycline
| partner notification
44
What investigations might you do in someone with pyelonephritis?
1. urine dipstick (1st line)
2. mid-stream urine MC+S (gold standard)
3. urgent USS to detect stones, obstruction or incomplete bladder emptying
45
Describe the treatment for pyelonephritis
Antibiotics: cefalexin for 7-10 days. Trimethoprim or amoxicillin if sensitive.
Analgesia- paracetamol
46
what is the management for urinary tract stones?
- Strong analgesia- diclofenac
- Antibiotics
- Tamsulosin/nifedipine- relaxes smooth muscle and helps expulsion
- Percutaneous nephrolithotomy- used to expulse stones over 10mm
47
what are the risk factors for urinary tract stones?
- chronic dehydration
- obesity
- high protein/salt diet
- recurrent UTIs
- hyperparathyroidism (hypercalcaemia)
- congenital abnormalities
48
what is the pathophysiology of intra-renal AKI?
- glomerular - glomerulonephritis
o this causes barrier damage and protein leakage
o this decreases oncotic pressure which decreases GFR- tubular
- necrosis
o complex blood supply causes cells to infarct, break away and plug tubules
o this decreases hydrostatic pressure and decreases GFR
- vascular - vasculitis
o damaged vasculature decreases O2 which causes necrosis
- interstitial - acute interstitial nephritis
o inflammation and immune cells cause damage
49
what are the risk factors for prostate cancer?
- family history
- increasing age
- black
- genetic
- HOXB13, BRCA2
50
what are the investigations for varicocele?
● Venography
| ● Colour doppler ultrasound to see blood flow
51
what are the investigations for testicular torsion?
- doppler ultrasound - lack of blood flow to testis
- urinalysis - exclude infection and epididymis
- prehn's sign = negative (raising scrotum exacerbates pain)
- DO NOT DELAY SURGICAL EXPLORATION
52
what are the risk factors for pyelonephritis?
- renal structural abnormalities
- calculi (stones)
- catheterisation
- pregnancy
- diabetes
- immunocompromised
53
what are the risk factors for prostatitis?
```
STI
UTI
indwelling catheter
post-biopsy
increasing age
```
54
what are the investigations for hydrocele?
- USS
| - serum alpha-fetoprotein and hCG to exclude malignant teratomas and germ cell tumours
55
what are the clinical features of nephritic syndrome that is specific to SLE?
- rash
- arthralgia
- kidney failure
- neurological symptoms
- pericarditis
- pneumonitis
56
what is the treatment for nephritic syndrome caused by SLE?
- immunosuppression
- steroids
- cyclophosphamide
- rituximab
57
what are the investigations for urethritis?
- STI testing
- microscopy and culture of urethral discharge
- urine dipstick
- urethral smear
- ?flexible cystoscopy
58
what are the causes membranous nephropathy?
- idiopathic
- drugs - penicillamine, gold, NSAIDs
- autoimmune - SLE, thyroiditis
- infection, hep B or C, schistosomiasis
- cancer - lung, colon. stomach, breast
59
what are the causes of focal segmental glomerulosclerosis?
- idiopathic
secondary
- HIV
- sickle cell anaemia
- heroin
- interferon treatment
60
what are the investigations for focal segmental glomerulosclerosis?
needle biopsy = focal sclerosis and GBM thickening
61
what is the pathophysiology of focal segmental glomerulosclerosis?
- Scarring that is focal and only some glomeruli involved and segmental (only part of glomerulus affected)
- CD80 in podocytes resulting in increased permeability in glomeruli and thus proteinuria and haematuria
- Secondary hypertension and renal impairment
62
what is the treatment for nephrotic syndrome caused by focal segmental glomerulosclerosis?
Give steroids in idiopathic disease
| All patients should receive ACE-I/ARB blood pressure control
63
what are the risk factors/causes of minimal change disease in nephrotic syndrome?
- can be idiopathic
- atopy - allergic reaction can trigger
- drugs - NSAIDs, lithium, antibiotics, bisphosphonates, sulfasalazine
- hep C, HIV, TB
- associated with hodgkins lymphoma
64
what is the clinical presentation of minimal change disease?
- Proteinuria
- Oedema, predominantly around the face
- Fatigue
- Frothy urine
65
what are the risk factor for autosomal dominant polycystic kidney disease?
- family history of ADPKD- ESRF
| - hypertension
66
what is the clinical presentation of autosomal dominant polycystic kidney disease?
- hypertension
- abdo/flank pain (haemorrhage)
- LUTS (dysuria, urgency, pain)
- palpable
67
what are the investigations for autosomal dominant polycystic kidney disease?
Renal USS then renal biopsy for genes
<30yrs – at least 2 unilateral or bilateral cysts
30-59yrs – 2 cysts in each kidney
>60yrs – 4 cysts in each kidney
68
what is the treatment for autosomal dominant polycystic kidney disease?
- Treat hypertension – lifestyle, ACEi (ramipril)
- Infected – Abx or drain
- Surgical – removal (nephrectomy)
- Chronic – dialysis or transplant
69
what are the complications of polycystic kidney disease?
berry aneurysms
cysts on other organs
50% have ventricular hypertrophy
pre-malignant
70
what is the clinical presentation of autosomal recessive polycystic kidney disease?
- variable
- many present in infancy with multiple renal cysts and congenital hepatic fibrosis
- enlarged polycystic kidneys
- 30% develop kidney failure
71
what is the specific clinical presentation of pre-renal AKI?
- hypotension (D&V, syncope, pre-syncope)
| - signs of liver or heart failure (oedema)
72
what is the specific clinical presentation of intra-renal AKI?
infection, signs of underlying disease (vasculitis, glomerulonephritis, DM)
73
what is the specific clinical presentation of post-renal AKI?
LUTS (BPH)
74
what are the complications of AKI?
end stage renal failure
metabolic acidosis
uraemia
CKD
75
how does hypertension cause CKD?
thickening of afferent arteriole leading to ischaemia. Further fluid overloading due to activation of RAAS
76
what is the treatment for urinary tract stones?
- strong analgesic (IV diclofenac)
- antibiotics if infection (IV cefuroxime or IV gentomycin)
- antiemetics
- stone removal
77
which drugs are classed as nephrotoxic?
- NSAIDs
- aminoglycosides
- ACEi
- ARB
- loop diuretics
- metformin
- digoxin
- lithium
78
what is the management for epididymitis?
- IM ceftriaxone (if organism is unknown) + doxycycline
79
what is the clinical presentation of goodpastures disease?
Presents with SOB and oliguria due to respiratory and renal damage
80
what is the management for goodpasture's disease?
plasma exchange
steroids
cyclophosphamide (for immune suppression)
81
what is the clinical presentation of post strep glomerulonephritis?
Presents with haematuria. Can present with acute nephritis
82
what are the secondary causes of nephrotic syndrome?
```
DDANI
diabetes
drugs
autoimmune
neoplasia
infection
```
83
where does bladder cancer spread to?
spreads to the iliac and para-aortic nodes, and to the liver and lungs
84
what are the causes/risk factors of bladder cancer?
- Smoking = increases risk 2-4 times, accounts for half of male cases of bladder cancer
- Age over 55
- Pelvic radiation
- Exposure to occupational carcinogens
- Bladder stone- due to chronic inflammation
85
what is the presentation of bladder cancer?
- Painless haematuria- this is the most common presenting symptom for bladder cancer, assume pt has urothelial tumour till proven otherwise
- Ask about RF in history
- UTI symptoms without bacteriuria
86
what are the investigations for bladder cancer?
Urinalysis- sterile pyuria
Cystoscopy and biopsy- diagnostic
CTT urogram- allows staging
87
what is the management for bladder cancer?
T1: transurethral resection or local diathermy
T2-3: radical cystectomy
T4: palliative chemotherapy and radiotherapy
88
what is the equation for net filtration pressure for the glomerulus?
NFP = GHP - (GCOP + CHP)
```
NFP = net filtration pressure
GHP = glomerular hydrostatic pressure
GCOP = glomerular colloid oncotic pressure
CHP = capsular hydrostatic pressure
```
89
what is the innervation of the external urinary sphincter?
pudendal nerve S2-S4
90
what is the innervation of internal urinary sphincter?
pelvic splanchnic nerve S2-S4
91
what is the innervation of the bladder?
```
sympathetic = sympathetic chain T11-L2
parasympathetic = pelvic splanchnic S2-S4
```
