Renal Flashcards
UTI:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - inflammatory reaction in renal epithelium in response to pathogen
Epidemiology - second most common infection amongst non-hospital patients
Pathogenesis - e.coli - poor hygiene, sexual intercourse, catheter
Presentation - dysuria, increase urinary frequency, haematuria, cloudy urine
Investigations - urinalysis, ultrasound if suspected obstruction, urine microscopy, urine culture
Differentials - Men: BPH, prostatitis, urinary stones, STI, cancer of urinary tract
Women: overactive bladder, urinary tract cancer, foreign body in bladder
Risk Factors - sexual activity, spermicide, recurrent UTI
Treatment -
Men: 1st: ciprofloxacin
2nd: trimethoprim
Women: 1st:nitrofurantoin
2nd: trimethoprim
If pregnant: amoxicillin
Acute pyelonephritis:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - severe infectious inflammatory disease of renal parenchyma, calicles, and pelvis that can be acute or recurrent
Epidemiology - 200,000 hospitalisations
Pathogenesis - Ascending UTI, can have haematogenous seeding of kidneys in patients with bacteraemia
Presentation - fever, nausea, vomiting, dysuria, frequency, urgency
Investigations - urinalysis, wbc>10, rbs>5, FBC, ESR (raised), CRP (raised), Prolatonin (raised), blood culture, gram stain and urine culture
Differentials - chronic pyelonephritis, pelvic inflammatory disease, pelvic pain syndrome, cystitis, acute prostatitis, lower lobe pneumonia
Risk Factors - frequent sexual intercourse, UTI, diabetes, stress incontinence, foreign body in urinary tract
Treatment - 1st line: cefixine or ciprofloxacin
2nd line: levofloxacin/trimethoprim
Severe: gentamicin IV
Chronic Pyelonephritis:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - chronic tubulointerstitial inflammation and deep segmental cortical renal scarring + clubbing of pelvic calyces as papillae retract into scars
Epidemiology - more common in children and women
Pathogenesis - renal damage over a long period of time, Hx of vesicoureteral reflux
Presentation - nausea, dysuria, fever, rigours, vomiting
Investigations - urinalysis, renal function, FBC, renal ultrasound, CT, urine culture, electrolyte panel
Differentials - acute pyelonephritis, renal cancer, renal calculi
Risk Factors - acute pyelonephritis,VUR, renal calculi, obstruction, diabetes
Treatment - treatment of underlying cause
Hydronephrosis - obstructive uropathy:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - blockage of urinary flow due to obstruction
Epidemiology - ureteral stones
Pathogenesis - BPH, obesity, hot dry climate
Presentation - flank pain, lower UTI, distended abdomen, haematuria, increased age, costovertebral angle tenderness
Investigations - urinalysis, U&E, creatinine, FBC, renal ultrasound, CT pyelogram
Differentials - paraplegic cysts, AAA, hydronephrosis of pregnancy, appendicitis, gynaecological disorders, ectopic pregnancy, bowel obstruction
Risk Factors - BPH, constipation, medication, urotheliasis, spinal cord injury, malignancy
Treatment - Sepsis treatment, trial of passage with analgesia + rehydration, active stone movement, ureteric stent + paracetamol + gentamicin or merepenem
Acute Renal Failure:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - acute decline in renal function leading to a rise in serum creatinine +/- fall in urine output
Epidemiology - 15% of emergency hospital admissions
Pathogenesis - impaired perfusion of kidneys with blood due to increase of hypovolaemic, hypotension, impaired cardiac pump efficiency
Presentation - alteration of urine vol, drowsiness, orthopnoea, hypotension
Investigations - urinalysis, U&E, renal ultrasound, CXR, fractional excretion of sodium and urea, fluid challenge, catheterisation
Differentials - intrinsic + post renal AKI
Risk Factors - >65, CKD, sepsis, hypovolaemia, oliguria, sepsis
Treatment - Stop meds - DAAMN
Diuretics
ACEi
Aminoglycosides
Metformin
NSAIDs
Pre renal - IV fluids
Post renal - relieve obstruction
Chronic Renal Failure:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - pathological abnormality of kidneys
Epidemiology - 11% of adult population
Pathogenesis - increase in glomerular permeability to macromolecules
Presentation - fatigue, oedema, nausea, pruritus, anorexia, arthralgia, enlarged prostate
Investigations - urinalysis, creatinine, eGFR<60, renal ultrasound, urine micro albumin
Differentials - diabetic kidney disease, hypertensive nephrosclerosis, ischaemic nephropathy, obstructive uropathy, nephrotic syndrome
Risk Factors - diabetes, hypertension, age>50, kidney disease
Treatment -
Stages 1-4: 1st line - ACEi or AT2 antagonist - lisinopril + statin
2nd line - non-dihydropyridine calcium channel blocker - diltiazem
Stage 5: 1st line - dialysis
2nd line - kidney transplant
Benign Prostatic Hyperplasia:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - multifactorial smooth muscle hyperplasia
Epidemiology - common infection + malignancy, elderly men
Pathogenesis - hyperplasia of both epithelial + stroll prostatic components
Presentation - frequency/urgency, nocturne, weak stream
Investigations - urinalysis, DRE, PSA
Differentials - overactive bladder, prostatitis, prostate cancer, UTI, bladder cancer, neurogenic bladder, urethral stricture
Risk Factors - age>50
Treatment - 1st line: alpha blocker - terazosin/doxazosin
2nd line: combination of increased alpha blockers and Sa-reductase inhibitor
Prostate Carcinoma:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - malignant tumour of glandular origin situated in prostate
Epidemiology - second leading cause of cancer mortality, men>50
Pathogenesis - cellular proliferation within pre existing ducts + glands with cytological changes, spreads along capsular surface of gland and may invade seminal vessels
Presentation - nocturne, urinary frequency, hesitancy, dysuria
Investigations -PR exam, PSA, testosterone, LFTs, FBC, renal function, prostate biopsy
Differentials - BPH, chronic prostatitis
Risk Factors - over 50, black, history of prostate cancer, increased dietary fat
Treatment - 1st line: active surveillance + additional biopsies
Hormone therapy - goserellin + anti-androgen tumour flare
Bladder Carcinoma:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - urothelial carcinoma - transitional cell carcinoma
Low grade - papillary + generally easy to visualise
High grade - flat or in situ - hard to visualise
Epidemiology - 9th in world cancer incidence
Pathogenesis - smoking most common cause, aromatic amines, chemical carcinogens
Presentation - haematuria, dysuria, increased frequency
Investigations - urinalysis (pyuria + haematuria), renal and bladder ultrasounds
Differentials - BPH, haemorrhage cystitis, prostatitis, UTI, nephrotheliasis, renal cell carcinoma, renal urothelial carcinoma
Risk Factors - tobacco exposure, over 55, Fx
Treatment - 1st line: transurethral resection
2nd line: radical/partial cystectomy
Renal Carcinoma:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - renal malignancy from parenchyma
Epidemiology - 85% of renal cancers clear cell adenocarcinoma
Pathogenesis - smoking, obesity, hypertension,
Presentation - Triad: haematuria, loin pain, abdominal mass
pyrexia, left varicocele
Investigations - urinalysis, coagulation, FBC, LDH, LFT, corrected calcium, abdominal/pelvic ultrasound, CT abdomen/pelvis
Differentials -benign renal cyst, ureteric cancer, bladder cancer, secondary metastases
Risk Factors - smoking, male, age 55-84, flank pain
Treatment - 1st line: surgical resection, adjunct molecular therapy - sorafenib, sunifinib - targeted vascular endothelial growth factor receptors
Urinary Tract Stones:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - nephrotheliasis, crystalline stones in urinary system
Epidemiology - 7-10% lifetime risk
Pathogenesis - renal colic from nephrotheliasis
Presentation - pain from urinary calculi due to local inflammation, acute sever flank pain, nausea, vomiting, haematuria, testicular pain, urinary frequency and urgency
Investigations - urinalysis (+leukocytes and +RBC,WBC, bacteria), FBC, U&E, electrolytes, creatinine, pregnancy test
Differentials - acute appendicitis, ectopic pregnancy, ovarian cyst, diverticular disease, bowel obstruction, testicular torsion
Risk Factors - increase protein intake, increase salt intake, white, male, dehydration, obesity
Treatment - Hydration, pain control and anti-emetics - crystalloids, ketorolac and/or morphine sulphate, ondansetron
