RENAL 3 Flashcards
What are the risk factors for renal cell carcinoma?
- Smoking
- Male
- Obese
- Hypertension
What are the symptoms of renal cell carcinoma?
- Haematuria
- Flank pain
- Abdominal/flank mass
- Appetite loss, malaise, weight loss
- Shortness of breath: aneamia as erythpoeitin production is hindered
What is the gold standard investigation for renal cell carcinoma?
CT abdo/pelvis: definitive diagnosis and staging
What bloods are measured for renal cell carcinoma
- FBC: anaemia from chronic disease, ethroycytosis from lack of erythropoietin
- U+Es: idea of kidney function
- LDH: poor prognostic marker in advanced RCC
- Calcium
- LFTs: liver mets
- Coagulation
- ALSO URINALYSIS
What are the causes of urinary tract calculi?
- Idiopathic
2. Metabolic (↑Ca2+, ↑urea)
What are the risk factors of urinary tract calculi?
- Low fluid intake
- Structural urinary tract abnormalities
- Crystalluria
- High protein and salt intake
What are the 3 common sites of impaction or obstruction?
- Ureteropelvic junction
- Crossing of the iliac artery (midureter)
- Uretero-vesical junction
What is crystalluria?
- Stone formers (especially calcium oxalate stones) frequently excrete more calcium oxalate crystals in the urine
- Increased urinary excretion of cystine, struvite, and uric acid crystals is also a risk factor for stone formation
What are the 4 types of stone?
- Calcium oxalate (most common)
- Urate stones
- Magnesium ammonium phosphate stones
- cysteine stones
What are the symptoms of urinary tract calculi?
- Often asymptomatic
- Severe loin to groin pain
- Nausea and vomiting
- Urinary frequency/urgency
- Haematuria
What are the investigations for urinary tract calculi?
- Urinalysis
- Non contrast CT-KUB (Gold standard)
- U+Es
- FBC
- Urine pregnancy test
What is the difference between renal stone and peritonitis?
Flank/ loin to groin pain:
- If patient is writhing around in pain = renal stone
- If patient is lying still = peritonitis (as move too painful)
What is the management of urinary tract calculi?
- Analgesia – NSAIDs, Paracetamol (same as opiates in terms of controlling ureteric colic pain)
- Increase Fluid intake
- Anti-emetics
- Tamsulosin (α1- antagonist) or Nifedipine (CCB) – to relax smooth muscle
What do you do if the stone is <5mm?
pass spontaneously
What do you do if the stone is >5mm?
surgery
What must you check for in urinary tract calculi?
pregnancy and for infection higher up the tract
What are the 3 surgical options for stone removal?
- Ureteroscopic lithotripsy
- Extracorporeal schockwave lithotripsy (ESWL)
- Percutaneous Nephrolithotomy (PCNL)
What are utis?
presence of a pure growth of >10^5 organisms per mL in MSU
What is an upper UTI?
- pyelonephritis (infection of kidney/ renal pelvis)
2. Ureters (ureteritis)
What is a lower UTI?
- bladder: cystitis
- urethra (urethritis)
- prostatitis in male
What are risk factors for UTI
- Sexual intercourse
- Spermicide use
- Pregnancy
- DM
- Obstruction to the urinary tract
What is the most common causative agent of uti?
E.coli
What other bacteria is found in utis in immunocompromised people?
Klebsiella and candida
Why are women more commonly affected by utis than men?
shorter urethra
How would pyelonephritis present (kidneys)?
- Fever
- rigors
- vomiting
- loin pain
- costovertebral pain
- Cystitis symptoms
How would cystitis present? (bladder)
- FUND: frequency urgency nocturia (elderly), dysuria (storage symptoms)
- Suprapubic pain
- Polyuria and haematuria
How would prostatitis present?
- Flu-like symptoms
- loin pain
- low back ache
- Swollen or tender prostate on PR
- HIPS: hesitancy, intermittent flow, poor stream (obstructive symptoms)
What is the first line investigation of UTI?
urine dipstick:
- leucocytes: infection
- nitrites: presence of bacteria
- haematuria
What are the other investigations of UTIs?
- Urine microscopy (can identify organism tyoe
- Urine culture and sensitivity (more specific and sensitive test- measures growth of colonies)
- May also consider doing blood tests if patient is systematically unwell or imaging if pt has recurring UTIs
What is the prophylactic management of UTIs?
- high fluid intake
- regular micturition to keep bladder empty
- cranberry-based products
What antibiotics would you give for cystitis/lower UTI?
- trimethoprim
- nitrufuratoin
- don’t give trimethoprim in pregnancy as it is a folic acid antagonist (therefore alternative treatment would be using nitrofurantoin)
What antibiotics do you give for pyelonephritis?
- Oral: Cefalexin, orciprofloxacin.
- IV antibiotics if unwell such as gentamicin are given – give before result from cultures comes back to prevent deterioration
What are the complications for UTIs?
- Septicaemia
- AKI
- Pyelonephritis
- Confusion (elderly)
What are the common types of bladder cancer?
> 90% are transitional cell carcinomas in the UK
What condition is associated with squamous cell carcinoma?
Schistosomiasis = rare in the West (so is adenocarcinoma)
What are the risk factors for bladder cancer?
- smoking
- those= hx of working in industrial and manufacturing plants (aromatic amines= risk factor AZO DYES= made up of aromatic amines)
- chronic cystitis
- More common in men
- elderly
What is the presentation of bladder cancer?
- Painless haematuria
- Recurrent UTIs
- FUND
Why are there no HIPS symptoms of bladder cancer?
does not affect urethra
What are the investigations for bladder cancer?
- Cystoscopy (+urinary cytology key for diagnosis) - GOLD STANDARD
- US
- Intravenous urography
- CT/MRI for staging
