Renal Flashcards by Galvin Chiam

AKI diagnosis

Serum creatinine >1.5x baseline
Urine volume <0.5ml/kg/h for 6h

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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

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Nephrotic syndrome signs and symptoms

Frothy/foamy urine
Leg/facial swelling

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Nephrotic syndrome causes

Adults:
Women->SLE
Men->membranous glomerulonephritis

Children:
Minimal change glomerulonephritis

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Nephrotic syndrome diagnosis

Oedema
Hypoalbuminaemia <30g/L
Proteinuria >3g/24h

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Nephrotic syndrome management

LMWH if serum albumin <20g/L
Prevent PE and DVT
ACEi to reduce proteinuria
Diet to manage hypoalbuminaemia and hyperlipidaemia
Prednisolone

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CKD signs and symptoms

Normocytic anaemia
Hypocalcaemia
Hyperphosphataemia
Hypertension
Pleural effusion
Weight loss
Pruritus
Impotence

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CKD investigations

Bloods: FBC, U&E, glucose, calcium, PTH
ECG
Urine dipstick
USS KUB

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CKD management

Low phosphate diet
Low potassium diet
BP control
Erythropoietin injection
Vit D
Peritoneal/haemodialysis

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Epididymo-orchitis signs and symptoms

Tender scrotal lump, usually unilateral
Sexual history/recent UTI
Urinary symptoms

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Epididymo-orchitis investigations

Young: urethral swab + NAAT
Old: mid stream urine sample

Scrotal Doppler ultrasound
Bloods: CRP, FBC
Normal cremasteric reflex

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Epididymo-orchitis management

Ceftriaxone 1mg IM single dose
Doxycycline 100mg oral BD 10-14 days

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Testicular torsion signs and symptoms

High lying sudden onset unilateral testicular pain
Absent cremasteric reflex
Normal urine dipstick

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Testicular torsion management

Analgesia
Exploratory surgery and bilateral orchidopexy/orchidectomy

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Bladder cancer risk factors and type of cell

TCC(commonest):
Smoking
Rubber/dye industry

SCC:
Schistosomiasis
Smoking

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Bladder cancer signs and symptoms

Painless haematuria
Persistent microscopic haematuria
Suprapubic pain
Lower urinary tract symptoms and UTI
Metastatic disease symptoms

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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