Renal Flashcards
sx of BPH
- weak/intermittent urine flow
- hesitancy
- terminal dribbling
- incomplete emptying
- urgency
- frequency
- nocturia
- urgency incontinence
Investigations of BPH
- urine dip
- PSA
- U&E
- IPSS
What is the IPSS
International Prostate Symptom Score (IPSS): classifying the severity of lower urinary tract symptoms and assessing the impact on quality of life
Management of BPH
1ST LINE: alpha-1 antagonists e.g. tamsulosin, alfuzosin
- 5 alpha-reductase inhibitors e.g. finasteride
Surgery : transurethral resection of prostate (TURP)
What is cystitis
inflammation of the bladder
Sx of cystitis
- urinary urgency
- dysuria
- polyuria
- haematuria
- suprapubic pain
Cystitis investigations
- urinalysis
- urine culture
- cystoscopy if underlying cause is suspected
Cystitis management
Nitrofurantoin/Trimethoprim
What is balanitis?
inflammation of the glans penis
Management of cystitis in pregnancy
Nitrafurantoin (trimethoprim contraindicated)
How is balanitis diagnosed?
clinical diagnosis
- swabs taken if suspected infective cause
- extensive skin change and doubt about cause = biopsy
Management of balanitis if ?candidiasis
topical clotrimazole
Bacterial balanitis management
oral flucloxacillin or clarithromycin (penicillin allergic)
Anaerobic balanitis management
saline washing and metronidazole if not settling
Management of dermatitis balanitis
topical corticosteroids
Lichen sclerosus balanitis management
high potency topical steroids or circumcision
Most common causes of balanitis
infective (bacterial and candidal)
Sx of balanitis
- penile soreness and itch
- urinary sx (dysuria, dypareunia)
Clinical signs of balanitis
- redness and swelling of glans penis
- tightening of foreskin/ unable to retract (phimosis)
- meatal stenosis (often in Lichen Sclerosus)
Most common pathogen associated with prostatitis
E.coli
Clinical features of prostatitis
- pain maybe be referred to perineum, penis, rectum, back
- obstructive voiding sx
- fever
- tender, boggy prostate gland
Investigation in suspected acute prostatitis
- MSU (urine dip, culture, sensitivity)
- blood culture
- FBC
- DRE
- consider STI screen
Management of acute prostatitis
14 day course quinolone - ciprofloxacin
Management of chronic prostatitis
- analgesia (paracetemol/NSAIDs)
- alpha blocker - doxazosin
- abx (trimethoprim/doxycyline)
What is urethritis?
inflammation of the urethra
How is urethritis categorised
gonococcal and non-gonococcal urethritis (NGU)
Investigations for urethritis
urethral swab
NAAT
Management of urethritis
7/7 doxycline / single dose azithromycin
What is pyelonephritis?
a type of UTI where one or both kidneys become infected
Common symptoms of acute pyelonephritis
- fever
- flank pain (usually unilateral)
- N&V
- UTI sx (urinary urgency, frequency, dysuria)
Investigation in suspected pyelonephritis
- MSU
- urine culture BEFORE starting empirical abx
- urine dip
Management of pyelonephritis
Cefalexin / Co-amox / Trimethoprim /Ciprofloxacin
change according to sensitivities
When should you admit a patient with pyelonephritis to hospital
Severe sx = ?sepsis
- tachy
- hypotension, - breathless
- confusion
Management of acute pyelonephritis in pregnant women
Cefalexin
What is epididymitis?
inflammation of the epididymis
Sx of epididymitis
- pain in 1 or both testicles
- tenderness
- swollen, red, warm scrotum
- discharge from penis
- blood in semen
- pain in suprapubic region
Which investigations should be ordered for suspected epididymitis?
- urine dipstick
- urine culture
Common causes of epididymitis
STI (gonorrhoea or chalmydia)
Enteric organisms
Amiadorone
Tx of epididymitis STINA CROSS CHECK ANSWER PLS THX BBS
Gonorrhoea/chlamydia suspected:
Ceftriaxone and doxycyline
Enteric organisms suspected
Levofloxacin
What causes AKI
PRERENAL: ischaemia
- poor cardiac output
- hypovolaemia (diarrhoea and vomiting)
- renal artery stenosis
INTRINSIC: intrinsic damage by toxins or immune-mediated
- glomerulonephritis
- rhabdomyolysis
- acute tubular necrosis
POSTRENAL: obstruction causing ‘backing up’ of urine
- kidney stone in ureter/bladder
- BPH
- external compression of ureter (tumours)
Define oliguria
urine output less than 0.5 ml/kg/hour
Which drugs can cause AKI
NSAIDs, aminoglycosides, ACEi, ARBs, diuretics
Clinical signs of AKI
- Reduced urine output
- pulmonary and peripheral oedema
- arrhythmias
- uraemia = encephelopathy or pericarditis
Which criteria are recommended by NICE to diagnose an AKI
a rise in serum creatinine of 26 micromol/litre or greater within 48 hours
a 50% or greater rise in serum creatinine known or presumed to have occurred within the past 7 days
a fall in urine output to less than 0.5 ml/kg/hour for more than 6 hours in adults
Investigations for suspected AKI
- U&E
- urinalysis
- renal ultrasound
How should a patient with an AKI be investigated if there is no identifiable cause or the patient is at risk of a urinary tract obstruction
renal ultrasound within 24 hours of assessment
prompt review by urologist
AKI Management
largely supportive
- fluid balance
- medication review
Which complication of an AKI needs prompt treatment
Hyperkalaemia
When is renal replacement therapy used (e.g haemodialysis)?
when a patient is not responding to medical treatment of complications (e.g hyperkalaemia, oedema, acidosis, uraemia)