Kidney and urology

Question 1

AKI definition

Answer 1

• Creatinine rise >25 in 48hrs
• ≥50% rise creatinine in 7 days
  Urine output <0.5 mL/kg/hour for >6 hours
• 25% or greater fall in eGFR in children and young people within the past 7 days.

Question 2

AKI Ix

Answer 2

Urinalysis
USS KUB
Review nephrotoxic drugs - ACEi, ARB, Metformin, Diuretics, NSAIDs

Question 3

CKD definition

Answer 3

ACR ≥3 (any eGFR)
eGFR <60

Repeat test in 2 weeks to exclude AKI

Repeat test in 3 months to confirm diagnosis

Question 4

When to refer CKD to Nephrology

Answer 4

• eGFR<30
• ACR >70
• ACR >30 + haematuria.
• Progressive CKD
• Suspected renal artery stenosis
• ≥4 antihypertensives.

Question 5

CKD Mx

Answer 5

Offer Statin as primary prevention

BP <140/90 in diabetics <130/80 (SBP >120)

Consider starting ACEi - for renal protection

Question 6

PSA Counselling points

Answer 6

• Prostate cancer is not the only cause of a raised PSA.
• PSA cannot distinguish between aggressive and slow-growing cancers that would never have caused a
  problem.
• 15% of men with prostate cancer will have normal PSA.
• Prostate biopsies are negative in three out of four men with raised PSA.
• Prostate biopsy may cause infection and bleeding.
• Treatment of prostate cancer includes surgery, radiotherapy, hormones with side effects of incontinence, ED and fertility loss.
• NOT having test will avoid side effects of treatment – but may mean that early treatable cancers are
  missed.

Question 7

Overactive bladder Mx

Answer 7

1st - Conservative
Bladder training.
* Avoid caffeine and alcohol.
* Pelvic floor exercises
* Offer containment devices, e.g. pads or external sheaths to help whilst problem is being investigated.

2nd - Drug
- oxybutynin OR tolterodine. If first fails, offer alternative. (SE dizziness, drowsiness, dry mouth, blurred vision, constipation, headache,
indigestion and abdominal pain.

Do not offer oxybutynin to frail older men due to the
risk of impairment of daily functioning, chronic confusion, or acute delirium (less common).

3rd- mirabegron.

Question 8

2WW Haematuria

Answer 8

> 45yo
- unexplained visible haematuria
- visible haematuria despite UTI Mx

> 60
- unexplained non visible haematuria AND dysuria or raised WCC

Identifiable mass

Question 9

Causes of erectile dysfunction

Answer 9

Alcohol and drugs

Psychological

Vascular - HTN, smoking, hypercholesterolaemia, DM

Foreskin disorder - phimosis, lichen sclerosis

Neuro - tumour, spinal cord, MS, Parkinson’s, stroke

Endocrine - hypogonadism, hypothyroid, Cushing’s

Iatrogenic - diuretics, SSRI, antipsychotics

Question 10

Erectile dysfunction Mx

Answer 10

Address underlying cause
Check PSA

1st Sildenafil (viagra)
- contraindications: nitrate, ACS, optic neuropathy, recent MI or stroke
- SE: headaches, flushing, nausea + vomiting

2nd psychosexual refer, counselling, vacuum pumps, Tadalafil

Question 11

BPH Mx

Answer 11

1st - conservative
reduce caffeine, alcohol, bladder training.

2nd - alpha block (Tamsulosin)
- “relaxes the prostate”
SE: light headed, drowsiness
rv in 4-6 weeks

3rd - 5-alpha reductase inhib (Finasteride)
- “blocks hormones that increase the size of the prostate”
SE: ED, gynaecomastia
rv 3-6 months (can take 6 months to work). also reduced PSA.

4th - Refer - TURP