Renal

Question 1

What is the management plan for Acute Kidney Injury?

Answer 1

If Hypovolaemic

• 1st Line - ABCDE fluid rescuscitaiton e.g. Hartmann’s
  
  • Review medication and stop nephrotoxics
  • Identify + treat underlying cause
  • After fluid bolus review with daily fluid monitoring + U+Es
• If Hyperkalaemia add calcium gluconate followed by glucose/insulin
• If metabolic acidosis add sodium bicarbonate

If Hypervolaemic e.g. oedema/ raised JVP

• 1st Line - ABCDE approach with Loop diuretic and sodium restriction
  
  • Identify and treat underlying cause

2nd Line in both cases - consider renal replacement therapy

Question 2

What is the management plan for BPH?

Answer 2

In Acute BPH w/ urinary retention - Catheterisation

Chronic

• Asymptomatic - monitoring + conservative management e.g. decrease caffeine/alcohol and distraction exercises
• Symptomatic w/out surgery
  
  • 1st Line - Tamsulosin (alpha blocker)
  • 2nd Line - Tamsulosin + Finasteride ( 5-a reductase inhibitor)/ PDE-5 inhibitor
• Symptomatic w/ surgery
  
  • <80mg = TURP or TUIP (transurethral incision of prostate)
  • >80mg = Open prostectomy

Question 3

What is the management plan for Epididymitis?

Answer 3

• 1st Line - Ceftriaxone IM + 14 day oral Doxycycline
  
  • If >35 STI unlikely so use Oflaxacin
  • NSAIDs + bed rest and scrotal elevation
• If induced by amiodorone, reduce or take off drug
• If abscess develops, consider drainage

Question 4

What is the management plan for Testicular Torsion?

Answer 4

• 1st Line - Emergency scrotal exploration + repair and urological consulation - <6 hours
  
  • plus Morphine and Ondansetron
• 2nd Line - If unavailable in <6 hours perform a Manual de Torsion procedure
• If testicle is necrotic perform orchidectomy

Question 5

What is the management plan for Ureteric Calculi?

Answer 5

Conservative - 95% of stones <5mm self resolve

• Analgesia - 75mg IV diclofenac or morphine sulphate
• Ondansetron
• If bacterial cause - Nitrofurantoin
  
  • If infection as well - gentamicin
• Bed rest and fluid replacement too
• Treat cause of stone - increase fluid etc

Removal of stone

• >5mm or unresolving - Tamsulosin or Nifedipine
• If >10mm or still unresolving - ESWL followed by urethroscopy
• Consider Percutaneous Nephrolithotomy - large complex stones

If patient presents with sudden onset AKI - urgent nephrostomy

Question 6

What is the management plan for UTI?

Answer 6

• Empirical treatment for uncomplicated - presumed E.Coli
  
  • Trimethoprin or Nitrofurantoin - oral 3-5 days
  • If complicated - consider Co-Amoxiclav or Cefaloxin if pregnent
  • Note: men may require a longer course of Abx
• If severe UTI or Pyelonephritis - admit with IV gentamicin
  
  • Followed by 7 day course of Co-Amoxiclav
• If recurrent - consider LD prophylactic or Post-coital Abx depending on cause