Renal Flashcards
AKI diagnosis
Serum creatinine >1.5x baseline
Urine volume <0.5ml/kg/h for 6h
AKI management
Pulmonary oedema:
IV furosemide
Uraemia:
Haemodialysis
Metabolic acidosis:
Sodium bicarbonate
Hyperkalaemia:
IV calcium gluconate
IV insulin & dextrose
STOP DAMN:
diuretics
ACEi/ARB
Metformin
NSAIDs
Nephrotic syndrome signs and symptoms
Frothy/foamy urine
Leg/facial swelling
Nephrotic syndrome causes
Adults:
Women->SLE
Men->membranous glomerulonephritis
Children:
Minimal change glomerulonephritis
Nephrotic syndrome diagnosis
Oedema
Hypoalbuminaemia <30g/L
Proteinuria >3g/24h
Nephrotic syndrome management
LMWH if serum albumin <20g/L
Prevent PE and DVT
ACEi to reduce proteinuria
Diet to manage hypoalbuminaemia and hyperlipidaemia
Prednisolone
CKD signs and symptoms
Normocytic anaemia
Hypocalcaemia
Hyperphosphataemia
Hypertension
Pleural effusion
Weight loss
Pruritus
Impotence
CKD investigations
Bloods: FBC, U&E, glucose, calcium, PTH
ECG
Urine dipstick
USS KUB
CKD management
Low phosphate diet
Low potassium diet
BP control
Erythropoietin injection
Vit D
Peritoneal/haemodialysis
Epididymo-orchitis signs and symptoms
Tender scrotal lump, usually unilateral
Sexual history/recent UTI
Urinary symptoms
Epididymo-orchitis investigations
Young: urethral swab + NAAT
Old: mid stream urine sample
Scrotal Doppler ultrasound
Bloods: CRP, FBC
Normal cremasteric reflex
Epididymo-orchitis management
Ceftriaxone 1mg IM single dose
Doxycycline 100mg oral BD 10-14 days
Testicular torsion signs and symptoms
High lying sudden onset unilateral testicular pain
Absent cremasteric reflex
Normal urine dipstick
Testicular torsion management
Analgesia
Exploratory surgery and bilateral orchidopexy/orchidectomy
Bladder cancer risk factors and type of cell
TCC(commonest):
Smoking
Rubber/dye industry
SCC:
Schistosomiasis
Smoking
Bladder cancer signs and symptoms
Painless haematuria
Persistent microscopic haematuria
Suprapubic pain
Lower urinary tract symptoms and UTI
Metastatic disease symptoms
Bladder cancer investigations
Painless visible haematuria:
CT uro gram
Renal function test
Flexible cystoscopy
Persistent non-visible haematuria:
Flexible cystoscopy
Ultrasound KUB
Suspected cancer:
CT renal triple phase
CT CAP staging
Bone scan if symptomatic
Bladder cancer management
Cystoscopy + TURB (can be curative)
Non-muscle invasive -> TURB + chemo/BCG
Muscle invasive -> cystectomy, radiotherapy, palliative treatment
Prostate cancer risk factors
Usually adenocarcinoma
Usually asymptomatic unless metastatic
Age
Western nations
Afrocarribean ethnicity
Prostate cancer investigations
PSA (sensitive but not specific): cancer, UTI, prostatitis
Gold standard: MRI
Transperineal prostate biopsy
Prostate cancer management
Conservative:
Anti-androgen e.g. GnRH antagonist
Young and fit:
High grade->radical prostatectomy/radiotherapy
Low grade->active surveillance(PSA, MRI, biopsy)
Old and unfit:
High grade->hormone therapy
Low grade->PSA monitoring
Prostatectomy side effects and monitoring
Commonest: retrograde ejaculation
Proximal urethral sphincter damage->urinary incontinence
Cavernous nerve damage->ED
Monitor PSA:
Should be undetectable or <0.01ng/ml
>=0.02ng/ml -> relapse
Testicular cancer signs and symptoms
Non tender lump, solid on ultrasound
25-40y
History of cryptorchidism
Could have gynaecomastia
Testicular cancer investigations
Seminoma:
PLAP, LDH raised
30-40y
Solid, homogenous
Teratoma:
AFP, LDH raised
25-35y
Solid and cystic
hCG raised if gynaecomastia
CT CAP
Testicular cancer management
Inguinal orchidectomy
Teratoma -> chemo(bleomycin, etopiside, cisplatin)
Seminoma -> radiotherapy
Monitor tumour markers
BPH signs and symptoms
Hesitancy in starting urination
Poor stream
Post micturition dribble
High frequency, nocturia
Acute retention
Testosterone therapy
BPH investigations
Exclude: prostate cancer, cauda equina syndrome, high pressure chronic retention
Urine dipstick
Voiding diary
PSA
USS KUB
Uro dynamics
Cystoscopy if bladder cancer suspected
BPH management
1: Weight loss, reduce caffeine/fluid intake in evening
2: Alpha blocker (tamsulosin/alfuzosin)
3: 5 alpha reductase inhibitor (finasteride)
4: TURP
Stress urinary incontinence signs and symptoms
Involuntary leakage on exertion/coughing/sneezing
Smoking
Obesity
Age
Route of foetal delivery
Stress incontinence investigations
Stress test with noticeable urine loss
Urodynamics
Stress incontinence management
Pelvic floor exercises
Surgical mid urethral sling
Duloxetine
Overactive bladder signs and symptoms
Urinary urgency
Nocturia
No evidence of UTI
Overactive bladder investigations
Urine dipstick
Voiding diary
Overactive bladder management
Anticholinergics: oxybutynin(can cause dry mouth)
Beta 3 agonist: mirabegron
Urinary tract calculi signs and symptoms
Loin to groin colicky pain
N+V
Haematuria
Urinary tract calculi investigations
Urinalysis: possible UTI signs
CT KUB non contrast
Urinary tract calculi management
IV fluid and anti-emetic
IV paracetamol/PR diclofenac
IV antibiotics if pyonephrosis
> 5mm:
Percutaneous nephrostomy insertion if pyonephrosis
Shockwave lithotripsy
Ureteroscopy
Percutaneous nephrolithotomy (only if other 2 fail/staghorn calculi)
Dehydration investigations
FBC
Glucose
TFT
Calcium
U&E
UTI signs and symptoms
Increased urinary frequency and urgency
Dysuria
Suprapubic pain
Fever
Confusion
UTI investigations
Urine dipstick: leukocyte, nitrite
UTI management
Lower: Trimethoprim 200mg BD 3(F) or 7(M) days
Pyelonephritis: trimethoprim 200mg BD 14/7
nitrofurantoin
co-amoxiclav 500mg TDS 7-10/7
AKI causes
Pre renal: sepsis, hypovolaemia
Renal: drugs, glomerulonephritis
Post renal: obstruction
