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Finals!!! > Nephrology and GU > Flashcards

Nephrology and GU Flashcards

1
Q

What is BPH and how might it present?

A
  • BPH= Benign Prostatic Hyperplasia. Testosterone fuelled hyperplasia/ hypertrophy in transitional zone.
  • Presentation:
    • Frequency
    • Urgency
    • Nocturia
    • Incontinence
    • Voiding Sx- hesitancy, poor stream, dribble, intermittence, abdo strainging
    • PR- smooth enlarged prostate
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2
Q

Complications of BPH

A
  • UTI
  • Acute/ chronic retention –> ?palpable bladder
  • Haematuria
  • Stone formation
  • Obstructive renal failure
  • NOT PROSTATE CA
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3
Q

Ix and Tx of BPH

A
  • Ix: (need to rule out cancer)
    • Bedside- PR, MSU
    • Bloods- U+Es, PSA
    • Imaging- Transrectal USS + biopsy
    • Advanced- cystoscopy, renal USS ?hydronephrosis
  • Tx:
    • Cons- reduce caffeine/ alcohol, bladder training, relax when voiding, watchful waiting
    • Medical (monotherapy/ combo):
      • Tamsulosin (alpha blockers)- reduce tone
      • Finasteride- reduce testosterone. SE ED
    • Surgical- transurethral. ?resection ?prostatectomy. Risk= impotence
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4
Q

Prostate cancer RF

A
  • = Adenocarcinoma
  • Hormonal- testosterone/ IGF-1
  • Age
  • FHx (BRCA1/2)
  • Vasectomy
  • Prostatitis
  • Ethnicity
  • Obesity
  • Diet- high calcium/ cadmium
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5
Q

Prastate Cancer 2 week wait

A
  • Feels malignant on PR
  • ?PSA in:
    • Lower urinary tract Sx
    • ED
    • Visible haematuria
  • –> 2ww if PSA above age-specific range
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6
Q

Presentation of prostate cancer

A
  • 30% men 40-65y
  • Incidental - increased PSA
  • Lower UT Sx- Hesitance, dribbling, nocturia, poor stream
  • Haematuria
  • Pain- hips, pelvis, spine
  • ED
  • Pain on ejaculation
  • Renal failure
  • Metastatic spread - back pain, weight loss, anaemia
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7
Q

Diagnosis + Ix of prostate cancer

A
  • Bedside- DRE (large + craggy, no sulcus), MSU
  • Bloods- FBC, serum PSA >4ng/mL –> 2ww for USS
  • Imaging:
    • Transrectal USS - size and stage
    • X-ray + isotope bone scan
    • CT/ MRI - spread
  • Special - needle biopsy + histology
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8
Q

Management of prostate cancer by stage

A
  • Confined to prostate:
    • Cons- active monitoring + PSA
    • Med- hormonal therapy/ tamsulosin for Sx
    • Surg- severe Sx/ obstruction. ?radical prostatectomy ?radiotherapy ?brachytherapy (radioactive pellets). Complications of resection- incontinence, retrograde ejac, impotence
  • Locally advanced= incurable –> palliation
    • 80% adrogen dependent –> hormone therapy. Tx= LHRH agonists (abiraterone, goserelin), anti-androgens. SE: hot flushes, lethargy, ED, gynaecomastia
  • Metastatic: Hormone therapy, chemo, radio
  • Bone pain- radiotherapy/ bisphosphonates
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9
Q

Presentation, Ix and Tx of prostatitis

A
  • Acute/ chronici infection/ inflammation
  • Usually present >35y
  • Acute causes= S. faecalis, E. coli
  • Presentation:
    • Flu like Sx
    • Pain - perianal, lower back
    • UTIs
    • Retention
    • Haematospermia
    • DRE- swollen/ boggy
  • Ix- rule out DDx (abscess, BPH, UTI)
  • Tx- analgesia, ABx- levofloxacin
  • Chronic = >3m. May not be infective. Tx= NSAIDs, tamsulosin, prostatic massage.
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10
Q

What is renal calculus and what types/ causes are there?

A
  • = Renal stone. crystal aggregates form in collecting ducts –> deposited anywhere in renal tract. Types:
    • Calcium oxalate- high PTh, hypercalcaemia, kidney disease, sarcoid, cancer
    • Struvite- post-UTI
    • Uric acid - gout, high protein diet
    • Cystin- abnormal anatomy
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11
Q

Different presentation of renal stones

A
  1. ASx
  2. Renal colic- loin- groin. N+V. Can’t lie still
  3. Renal obstruction. Upper ureter- mimics appendicitis. Lower- bladder irritability. Bladder/ urethra- pelvic pain, dysuria, inability to void, interrupted flow
  4. UTI/ pyelonephritis
  5. Haematuria
  6. Proteinuria
  7. Sterile pyuria
  8. Aneuria
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12
Q

Signs and Sx of renal stones

A
  • ASx
  • Aneuria
  • Dysuria
  • Frequency
  • Proteinuria/ Haematuria
  • Colic - loin-groin. Restless
  • N+V
  • +/- UTI
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13
Q

RF for renal stones + prevention

A
  • Dehydration
  • Foreign body
  • Drugs- ABx, antacides, diuretics
  • FHx
  • Frequent UTIs
  • UT abnormalities
  • Diet - high ammonia (red meat), oxalate (chocolate, tea, rhubarb, strawberries)
  • Hypercalcaemia
  • Prevention- hydration, normal Ca2+ intake, thiazide diuretic, allopurinol in gout
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14
Q

Ix and Tx of renal calculus

A
  • Ix:
    • Bedside- urine dip + MSU
    • Bloods- FBC, U+Es, Ca2+, PO43-, glucose, bicarbonate, urate
    • Imaging- CT KUB, (AXR monitoring known stones)
  • Tx:
    • Cons- fluids. Stones <5mm pass spont.
    • Med- analgesia, nifedipine/ tamsulosin for stones >5mm not passing
    • Surg- Stones >5mm not passing with IVT and med managment. Extracorporeal shockwave lithotripsy –> keyhole nephrolitotomy
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15
Q

Diagnosis of AKI

A
  1. Serum creatinine 1.5x baseline
  2. Serum creatinine >26 mmol/L
  3. UO <0.5mL/kg/h over 6 hours

Raised creatinine and low UO = severe!

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16
Q

Causes of AKI

A
  • Pre-renal:
    • Hypotension- absolute (D+V, burns) and relative (HF, sepsis) loss
    • Drugs that reduce BF - ACEi
    • Renal artery stenosis
  • Renal:
    • Acute tubular necrosis- contrast, NSAIDs, aminoglycosides
    • Gomerulonephritidies (blood, protein)
    • Drugs- PPI, cisplatin
    • Vasculitis- GPA
    • Goodpasture’s
    • Systemic- HTN, DM, SLE
  • Post-renal:
    • Compression- malignancy, BPH, strictures
    • Blockage- kidney stones, clots, blocked catheter
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17
Q

Presentation of AKI

A
  • Non-specific! Signs of cause?
  • Reduced UO
  • Dehydration
  • Overload- pulm. + peripheral oedema, raised JVP
  • Lethargy
  • Acidosis
  • Confusion
  • Arrhythmias
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18
Q

Nephrotoxic drugs

A
  • NSAIDs
  • ACEi
  • Contrast
  • Aminoglycoside eg gentamicin
  • Metformin
  • Methotrexate
  • Lithium
  • ?Diuretics
  • DAMN- Diuretics, Aminoglycosides, Metformn, NSAIDs
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19
Q

Ix of AKI

A
  • Bedside- ECG, urine: dip, MSU, ouput, albumin:creatinine. Catheter flushing?
  • Bloods- FBC, U+Es, CRP, LFTs, CK, ESR, clotting, phosphate
  • Imaging- CXR, renal USS
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20
Q

Tx of AKI

A
  • Cons- encourage oral intake, IVT, catheter for obstruction
  • Med:
    • Sepsis - ABx
    • HF/ overload - furosemide
    • Shock - IVT +/- inotropes
    • Hyperkalaemia - calcium gluconate, insulin, salbutamol
  • Surg- remove blockage
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21
Q

Complications of AKI

A

AHOPE = indications for renal replacement therapy

  • Acidosis <7.15
  • Hyperkalaemia
  • Oedema
  • Pericarditis
  • Encephalopathy/ uraemia

Other complications of renal failure- loss of lean body mass, anaemia, bone disease (high PTH, low Ca2+), HTN

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22
Q

Definition of CKD and end stage renal failure

A
  • eGFR <60ml/min/1.732 for >3m
  • End stage renal failure= GFR <15mL/min/1.732 or need for renal replacement therapy
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23
Q

Causes and screening of CKD

A
  • Causes:
    • DM
    • HTN
    • Hypercholesterolaemia
    • Glomerulonephritis
    • Drugs- NSAIDs, lithium, omeprazole
    • Polycystic kidneys
  • Screening in those at risk: DM, HTN, CVS disease, stones, BPH, frequent UTIs, VUR, FHx
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24
Q

Classification/ stages of CKD

A

Based on GFR

  1. >90
  2. 60-89
  3. a= 45-59, b= 30-44
  4. 16-29
  5. <15

Stages 1-3 can be managed in GP

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25
Q

Signs and Sx of CKD

A
  • Oligouria/ nocturia/ polyuria
  • Weight loss
  • Oedema + SOB
  • Amenorrhoea
  • Bone pain
  • Fatigue
  • Pruritis
  • Yellow- uraemic tinge
  • Asterixis
  • N+V
  • Muscle cramps
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26
Q

Ix of CKD

A
  • Bedside- urine: dip, C+S, albumin:creatinine ratio, bence jones protein
  • Bloods- FBC (aneamia), U+Es, ESR, glucose, hypocalcaemia, high phosphate, high ALP, high PTH. Immune- ANA, dsDNA, ANCA, GMB, C3/4, Ig, Hep
  • Imaging- CXR, AXR/CT KUB, renal USS (usually small), bone x-ray
  • Special- renal biopsy
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27
Q

Management of CKD

A
  • Tx the cause! Stop nephrotoxic drugs. Manage the Sx
  • Cons- healthy eating, exercise, Na/phosphate/fluid restriction. Phosphate= milk, cheese, eggs
  • Med:
    • CVS risk- statins, aspirin
    • HTN- BP target <140/90 (130/80 in DM)
    • Oedema- furosemide
    • Bone disease- calcichew, vit D, ca supplements
    • Anaemia
    • Restless legs- clonazepam
  • Renal replacement
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28
Q

What is renal replacement?

A
  • Dialysis: (risk= infection)
    • Haemodialysis
    • Peritoneal dialysis
  • Renal transplant= gold standard.
    • Types- deceased, live donor
    • Before- check ABO blood group, HLA match
    • Contraindications- active infection, cancer, severe heart disease
    • After- NB immunosuppression- steroid, monoclonal Ab, tacrolimus
    • Complications- bleeding, graft thrombosis, infection, urinary leaks, CVD, rejection
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29
Q

Renal causes of hypertension (and hypotension)

A
  • Chronic glomerulonephritis
  • Recurrent pyelonephritis
  • Renal artery stenosis
  • ADPKD - Autosomal dominant polycystic kidney disease.
  • Genetic- Liddle’s, Gordon’s
  • Genetic –> hypotension- Gittleman’s, Bartter’s
30
Q

Features, Ix and Tx of ADPKD

A
  • = Genetic. PKD1/2. ESRF by 50/70
  • Features:
    • Renal enlargement with cysts
    • Abdo pain
    • +/- haematuria
    • Renal calculi
    • HTN
    • Progressive renal failure
    • Also- SAH, diverticulitis, liver/ overian cysts
  • Ix: BP, U+Es, USS, Biopsy, genetics
  • Tx: More water, less sodium. –> Dialysis/ transplant
31
Q

Causes, features, Ix and Tx of renal artery stenosis

A
  • Causes- Atherosclerosis, fibromuscular dysplasia, antiphospholipid, post-renal transplant, VTE, external compression
  • Presentation- refractory HTN, flash pulm oedema, bruit, weak leg pusles
  • Ix- USS, CT/MR angiography
  • Tx- antihypertensive, surgical angioplasty/stent/revascularisation
32
Q

What is a UTI?

A
  • Symptomatic with positive urine culture/ dipstick
  • >105 organisms/ mL fresh MSU
33
Q

What makes a UTI complicated?

A
  • Male
  • Pregnancy
  • Abnormal renal anatomy - stones, duplex
  • Abnormal renal function eg CKD
  • Immunocompromised
34
Q

UTI organisms

A
  • E. Coli (gut flora)
  • Proteus (stones)
  • S. saphrophyticus (sex)
  • Klebsiella
35
Q

UTI RF

A
  • Age
  • Neuropathic bladder/ reduced emptying eg MS
  • Female
  • VUR
  • Catheter
  • Stones
  • Poor immunity
36
Q

UTI presentation

A
  • Abdominal/ suprapubic/ back pain
  • LUT Sx- frequency, urgency, hesistancy
  • Dysuria
  • Haematuria
  • Fever
  • Tachycardia
  • Foul smelling cloudy urine
  • Confusion
  • Pyelonephritis - loin- groin pain, vomiting, rigors, fever
37
Q

Ix and Tx for UTI

A
  • Ix- urine dip + MSU, FBC, U+Es, cultures, USS (children, men, recurrent, pyelonephritis)
  • Tx:
    • Conservative- hydration, urinate often, hygiene
    • Med: ABx 3 days uncomplicated, 7 days complicated
      • Nitrofurantoin (not in renal impairment)
      • Trimethoprim (not in 1st trimester)
      • Alt- cefalexin, co-amox
    • Pyelonephritis- 7-10d ABx. cefalexin/co-amox
    • ?prophylaxis- trimeth/nitro
    • Catheter associated- REPLACE, ABx
38
Q

Causes and presentation of urethritis

A
  • Causes- Gonorrhoea, chlamydia, HPV, HSV, CMV
  • Presentation:
    • Frequency
    • Dysuria
    • Burning/ irritation at urethral opening
    • Discharge
39
Q

Organism, presentation and complications of chlamydia

A
  • Organism- chlamydia trachomatis
  • Presentation:
    • Vaginal discharge
    • Dysuria
    • Lower back pain
    • Fever
    • IMB/ PCB
    • Deep dyspareunia
    • Cervicitis
    • Adnexal tenderness
    • Males- urethritis, epididymo-orchitis, mucopurulent discharge
  • Complications- PID, infertility, ectopic
40
Q

Ix and Tx of chlamydia

A
  • Ix:
    • Women- vulvovaginal swab
    • Men- 1st catch urine sample –> NAAT
  • Tx:
    • Cons- partner notification, screen for other STIs
    • 1g azithromycin 1 dose
    • OR Doxycycline 100mg BD for 7 days
41
Q

Organism and presentation of gonorrhoea

A
  • Neisseria gonorrhoea
  • Presentation: Usually ASx!
    • Vaginal discharge
    • Lower abdominal pain
    • IMB/ menorrhage
    • Dysuria
    • Men- penile discharge, dysuria, irritation, redness at opening
42
Q

Ix and Tx of gonorrhoea + complications

A
  • Ix:
    • Men- Urine NAATs, swab of penile discharge
    • Women- high vaginal + cervical swab +/- urethra
  • Tx: ceftriaxone 500mg IM + 1g azithromicin
  • Complications- PID, chronic pelvic pain, infertility, ectopic
43
Q

Presentation, Ix and Tx of trichomonas vaginalis

A
  • Pres- offensive, bubbly, fish smelling discharge
  • Signs- strawberry cervic
  • Ix- wet vaginal film (motile protozoan)
  • Tx- metronidazole + Tx partner
44
Q

Organisms + presentation/ stages of syphilis

A
  • Organism- treponema pallidum
  1. Primary- Primary lesion= indurated ulcer (chancre)
  2. Secondary- 6w after primary lesion. Generalised maculopapular rash on soles and palms
  3. Latent syphilis - +ve serology, no Sx
  4. Tertiary syphilis:
    • Neurosyphilis- tabes dorsalis, dementia
    • CVS- aortitis/ aneurysm, angina
    • Gumma
45
Q

Ix and Tx of syphilis

A
  • Ix:
    • Bloods- IgG + IgM
    • HIV screening - facilitates transmission of HIV
  • Tx:
    • Benzathine penicillin
    • 2nd line- 1g azithromicin
46
Q

Organism, presentation, Ix and Tx of genital herpes

A
  • Organism= HSV. 1= oral, 2= genital
  • Presentation:
    • Primary- blisters –> open sores. Flu like Sx, discharge, dysuria, malaise
    • Recurrent infection- reactivation –> tingling, blisters, sores, ulcers
  • Ix- swabs, screen for other STI
  • Tx- primary infection= aciclovir. Outbreaks- clean with salty water, ice packs, fluids. >6 outbreaks/ year –> prophylactic aciclovir
47
Q

Organism, presentation, Ix and Tx of genital warts

A
  • Organism= HPV (6, 11)
  • Presentation= visible painless warts. Flat/ raised, smooth/ lumpy
  • Ix- Examination. ?biopsy
  • Tx- topical creams, cryotherapy, electrocautery.
48
Q

Risk factors and presentation of bladder cancer

A
  • RF:
    • Occupational exposure to rubber
    • Male
    • Smoking
    • Chronic cystitis
    • >50y
    • Diet
    • Pelvic irradiation
  • Presentation:
    • Painless haematuria
    • LUT Sx- frequency, urgency, dysuria, voiding irritability
    • Frequent UTIs
49
Q

2 ww referral criteria for bladder cancer

A
  • >45y with unexplained haematuria (no UTI/ treated)
  • >60y with non-visible haematuria + dysuria or raised WCC
  • ?>60y with recurrent UTIs
50
Q

Ix and Tx of bladder cancer

A
  • Ix:
    • Bedside- urine microscopy + cystology
    • Bloods- WCC, CRP
    • Imaging- cystoscopy, CT/ MRI
  • Tx:
    • Cons- palliation
    • Med- radio/ chemo
    • Surg- radical cystectomy
51
Q

NB things to assess in Hx and exam of a patient with urinary incontinence?

A
  • Hx:
    • Urinary Sx- urgency, frequency, leakage, dysuria, poor stream, haematuria
    • Fluid intake + caffeine consumption
    • SHx- effect on lifestyle
    • PMH- Obs, pelvic trauma, DM, chronic cough, faecal incontinence, MS, PD, stroke
    • ??Cord compression/ cauda equina??
  • O/E:
    • Ask to cough - ?leakage
    • Abdo/ pelvic masses
    • Prolapse
52
Q

Types of urinary incontinence and their treatments

A
  • Stress - leakage on exercise, coughing, laughing. Overactive bladder. Tx: lifestyle, pelvic floor traing, fluid restriction, transvaginal tape, duloxetine
  • Urge- overactive detrusor. Tx- pelvic floor training, accupuncture, electrical stimulation, topical oeatrogen, anticholinergics- oxybutinin, tolterodine. Intravesicular botulinum. ?Surgical
  • Mixed= stress + urge. Tx= magnetic stimulation of nerves in sphincter and pelvic floor
  • Overflow= chronic retention. Tx= catheter
  • Function- reduced mobility, can’t get to toilet
  • Nocturnal- ?chronic retention. Tx- bladder training, ?anticholinergics
53
Q

Ix of urinary incontinence + general lifestyle management

A
  • Bedside- urine: MSU, glucose, urine diary
  • Bloods- PSA
  • Imaging- USS, cystoscopy
  • Special-
    • urodynamics: uroflowometry + cystometry
    • Sphincter electromyography
    • Residual vol after voiding
  • Lifestyle- weight loss, reduce caffeine, stop smoking, treat prolapse
54
Q

Complications of renal failure

A
  • Uraemia- pruritis, N+V, lethargy, confusion, bleeding, fits, coma, yellow
  • Protein loss and Na+ retention- polyuria, polydipsia, SOB, oedema, raised JVP, HTN
  • Acidosis- SOB, confusion, kussamul breathing
  • Hyperkalaemia- Palpitations, chest pain, tented T waves
  • Anaemia- SOB, lethargy, pallow, tachycardia
  • Vitamin D deficiency - bone pain, osteopoenia
55
Q

What is glomerulonephritis and how might it present? + Causes

A
  • Group of disorders resulting from glomerular damage.
  • Presentations:
    • ASx haematuria
    • Nephrotic syndrome
    • Nephritic sundrome
  • Causes:
    • Idiopathic
    • Amyloid
    • Immune- SLE, vasculitis, goodpasture’s
    • Infection- HBV, HCV, strep, HIV
    • Drugs- penicillamine, gold
56
Q

Ix and general Tx of glomerulonephritidies

A
  • Ix:
    • Bedside- Urine- dipstick, C+S, RBC casts, bence jones protein. ECG.
    • Bloods- FBC, U+Es (esp eGFR), C3/4, Abs (ANA, dsDNA, ANCA, GBM), immunoglobulins, electrophoresis, culture, ASOT (strep), HBC, HCV, albumin, CRP
    • Imaging- CXR, renal USS +/- biopsy. ?CT/MRI (avoid contrast)
  • General Tx:
    • Refer to nephrologist!
    • Keep BP <130/80 (ACEi)
57
Q

What is nephrotic syndrome? + complications

A
  • Pathology- injury to podocytes
  • Triad of:
    • Proteinuria >3.5g/24h (urine albumin:creatinine + plasma albumin)
    • Oedema - pitting, periorbital
    • Hypoalbuminaemia <25g/L
  • Signs- leukonychia, corneal arcus, xanthelasma, frothy urine
  • Complications:
    • More susceptible to infection
    • Hypercoaguable
    • Dyslipidaemia
    • Progressive renal impairment
58
Q

General management of nephrotic syndrome

A
  • Oedema- loop diuretics
  • Proteinuria- ACEi, ARB
  • Complications- anticoagulation, statin, vaccinations
  • TREAT THE UNDERLYING CAUSE
59
Q

What are the conditions that might cause nephrotic syndrome?

A
  • Secondary to systemic disease - SLE, amyloid, DM
  • Minimal change GN
  • Membranous GN
  • Focal segmental GN
  • Mesangioglomerulonephritis
60
Q

Key features of DM nephropathy

A
  • Nephrotic
  • Glomerulosclerosis
  • LM- kimmel stiel wilson nodules (clover)
  • Monitor urine dip –> ACEi
61
Q

Key features of minimal change disease

A
  • Nephrotic
  • Common in children. Usually idiopathic (or drugs eg NSAIDs)
  • Histology - LM normal, EM effacement of podocytes
  • Tx- steroids –> cyclophosphamide
62
Q

Key features of FSGN

A
  • Nephrotic
  • Usually idiopathic. Associations- sickle cell, HIV, heroin, vasculitis
  • Histology- hyalinosis, focal deposits of IgM and complement
63
Q

Key features of Membranous Nephropathy

A
  • Nephrotic
  • More common in adults
  • Autoantibodies/ IC deposition
  • Cause- usually idiopathic. Associations- malignancy, HBV, drugs (gold, penicillamine, NSAIDs), AI eg SLE
  • Histology- LM= thickened GBM, EM- GBM spikes. widespread granular appearance
  • Tx- cause. steroids.
64
Q

Key features of mesangioglomerulonephritis

A
  • Nephrotic
  • Immune complex/ complement mediated
  • Associated with Hep C
  • Nephrotic/ nephritis
  • Histology- thickened BM with track appearance
  • Tx= steroids
65
Q

What is nephritis syndrome and it’s causes?

A
  • Triad of:
    • Azotaemia (high urea)
    • Haematuria (+ red cell casts)
    • Proteinuria <3.5g/L
  • Histology- crescent formation, breaks in GBM
  • Causes:
    • Post-streptococcal
    • Goodpasture’s
    • IgA nephropathy
    • Pauci immune- Wegner’s, churg-straus
66
Q

Key features of Post-streptococcal GN

A
  • Nephritic
  • 1-12w after infection eg throat/ skin
  • Strep antigen deposited on glomerulus –> host reaction + IC formation
  • Bloods- high ASOT, low C3
  • Histology- LM- crescents, EM- subepithelial deposits
  • Biopsy- IgC + C3 deposition
  • Tx= supportive
67
Q

Key features of Goodpasture’s

A
  • Nephritic
  • =Anti-GBM
  • Cause= auto Ab to type 4 collaged in glomerulus and lung
  • Presentation- haematuria, haemoptysis
  • CXR- infiltrates
  • Tx= ASAP! Plasmapheresis, immunosuppression (steroid +/- cytotoxics)
68
Q

Key features of IgA nephropathy

A
  • Nephritic
  • IgG against abnormal IgA –> imparied IgA breakdown
  • Urine- red cast cells
  • Histology- LM- mesangial proliferation. EM- IC deposition, IgA positive
  • Tx= steroids after 1w
69
Q

What is Acute Tubulointerstitial Nephritis + Ix + Tx?

A
  • = Nephritis affected the areas between the renal tubules
  • Causes:
    • Drugs- NSAIDs, ABx (cephs, penicillin), diuretics, allopurinol
    • Infection- staph, strep
    • Immune disorder- SLE, Sjogren’s
  • Ix:
    • Urine- high WCC, white cell casts, high protein. no bacteria.
    • Bloods- High IgE, eosinophilia
    • Biopsy- ++ eosinophils
  • Tx- stop cause. Prednisolone
70
Q

What is haematuria and what causes it? + Ix

A
  • = >1 microL blood lost in urine/ day
  • Causes:
    • Malignancy- kidney, bladder
    • Kidney stones
    • UTI (+WCC)
    • Rhabdomyeolysis –> ++CK –> haemoglobinuria
    • Glomerulonephritis (RBC casts + proteinuria)
  • Ix:
    • 2ww for renal/ bladder Ca? Imaging of renal tract + cystoscopy
    • No urological cause –> quntify amount of haematuria and proteinuria
71
Q

What is proteinuria and what causes it? + Ix

A
  • Microalbuminuria= >2.5 (3 for women)
  • Proteinuria= >30mg/mol
  • Causes:
    • Significant= >1g/d = GLOMERULAR
    • <1g/day= damage to tubules- tubulointerstitial disease, UTI, kidney stones. Transient- fever, exercise, HF, pre-eclampsia, orthostatic
  • Ix:
    • Quantify- (24h urine collection), albumin:creatinine ratio
    • BP
    • Bloods + GFR
    • USS
    • ??biopsy- with haematuria + persistent

Finals!!! (19 decks)

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