nephrology/urology Flashcards
causes of urinary retention
- obstruction of the urethra
- nerve problems
- medications
- weakened bladder muscles
history of acute urinary retention
- gradual worsening voiding symptoms
- UTI symptoms
- clot formation (tumour)
- back pain (cauda equina)
- MS presentation
- gynea symptoms
- new meds
- bowel habit
examination for acute urinary retention
- uncomfortable, tachycardia, palpable bladder
- neuro: perineal + perianal sensation + anal sphincter tone , lower limb tone, sensation and reflexes
- prostate exam
management for acute urinary retention
- catherisation + note residual urine volume + dipstick for UTI
- PSA
- ultrasound pelvis for masses (women)
common causes of haematuria
- malignancy (upper tract urothelial cancer, bladder cancer, prostate cancer)
- renal calculi
- UTI
- nephrological causes
investigations of painless visible haematuria
- MSU (rule out infection )
- U&E (renal disease)
- flexible cystoscopy (bladder tumour)
- CT urogram (renal and ureteric tumours + kidney stones)
- serum PSA (rule out prostate cancer)
what else can can cause positive dipstick for haematuria or red coloured urine
pos dipstick: myoglobin
red coloured urine: beetroot, rifampicin, porphyrins
pain and urology
kidney pain: fixed constant flank pain/ colicky pain superimposed on a constant dull pain
ureteric distention: loin to groin pain, colicky pain
investigations of urology/kidney problems
- urine analysis: dipstick (protein:renal disorder, nitrites and leucocytes: infection), microscopy, culture, cytology
- blood tests, FBC, biochemistry, culture
- imagine: KUB, IV pyelogram, USS, MRI, angiography
why do you use KUB X ray
calcification (renal and urinary tract stones)
why do you use IV pyelography
assess: anatomy (nb of kidneys, ureters), drainage, function (of kidneys), access (for surgery)
when do you use USS in urology/nephrology
assess kidney architecture
when do you use CT scan in urology/nephrology
stones
after USS: staging of malignancy, kidney disease that was visible
causes of urological stones
- metabolic 50% (type 1 renal tubular acidosis, hyperparathyroidism, cystinuria, sarcoidosis, Crohns disease)
- urological (outflow obstruction and lesions)
- infection
- immobilisation (resorption of bone)
types of urological stones
- 75% calcium oxalate
- 10% struvite ‘staghorn’ (magnesium ammonium phosphate)
- 10% urate (radiolucent)
- 5% mixed calcium phosphate and calcium oxalate
- 1-2% cysteine stones
management of urological stones
- increase fluid intake
- diet: reduce animal protein, sugar, Na, oxalate
- treat infection
- for urate stones: alkalinise urine
- medications (bendroflumethazide, allopurinol, penicillamine)
surgery:
- no need < 5 mm, lower ureter, no obstruction
- ESWL -> ureteroscopic -> percutaneous -> laparoscopu -> open operation
types of kidney tumours
benign: angiomyolipomas, oncocytoma
malignant: renal cell carcinoma, transitional cell carcinoma
renal cell carcinoma
- aetiology/ presentation
- clinical features
- male:female 2:1, ‘th-6th decades
- clinical features: triad haematuria, pain, mass + paraneoplastic syndromes + metastatic disease
- management: surgical for resectable disease or immunotherapy
papillary necrosis
- risk factors
- complications
- management
- risk factors: paracetamol/NSAIDs, DM, sickle cell disease, infection
- complications: obstruction and pyelonephrosis
management: urgent drainage and antibiotic treatment
ADPKD
- aetiology
- symptoms
- diagnosis
aetiology:
-autosomal dominant (PKD1, PKD2)
symptoms:
- loin pain/haematuria (cyst haemorrhage)
- loin/abdominal discomfort (size)
- subarachnoid haemorrhages (Berry aneurysm)
- hypertension, uraemia, anaemia
- liver, pancreas and spleen cysts
- mitral valve prolapse
diagnosis:
-ultrasound/ CT scan
management:
- BP control
- renal function monitoring
von Hippel-Lindau disease
- aetiology
- clinical manifestations
- screening
aetiology:
- autosomal dominant, present within 2-3rd decade
clinical manifestations: cortical renal cyst, renal cell carcinoma, renal haemangioblastoma, renal cell adenoma, renal hemangioma, retinal angioma, CNS haemangioblastoma
screening:
-anual USS, CT abdo every 3 years
renal colic differentials
renal stones pyelonephritis ectopic pregnancy, sorted ovarian cyst appendicitis, diverticulitis pancreatitis, cholecystitis ruptured AAA musculo-skeletal pain
haematuria investigations protocols
> 45yo macroscopic haematuria w/out infection:
- blood tests (FBC, U&Es, PSA)
- flexible cystoscopy
- CT urogram or renal USS
> 45yo microscopic haematuria
- cystoscopy
- renal USS
<45yo macroscopic haematuria w/out infection
- cystoscopy
- upper tract imaging
<45 yo microscopic haematuria: nothing unless:
- increase urinary frequency and urgency: cystoscopy (+ renal function, BP, urine protein excretion)
- loin pain: non contrast CT (+ renal function, BP, urine protein excretion)
name of upper urinary tract infection
pyelonephritis (kidney)