Renal Flashcards
1
Q
What are the functions of the kidney?
A
- filter or secrete waste substances
- retain albumin + circulating cells
- control BP
- activate 25-hydroxy vitamin D
- synthesises EPO
2
Q
What is the normal GFR?
A
120ml/min
3
Q
What is fanconi syndrome?
A
A rare condition
Failure of the PCT to absorb
4
Q
How does fanconi syndrome present?
A
Polyuria, glycosuria, aminoaciduria, rickets, phophaturia, metabolic acidosis
5
Q
What can cause fanconi syndrome?
A
- cystinosis
- tenofovir
- paraprotein disease
- Wilson’s disease
- glycogen storage disorders
- sjorgren’s syndrome
- nephrotic syndrome
6
Q
What is IgA nephropathy?
A
aka Bergers disease or mesangioproliferative GN
Abnormality in IgA glycosylation leads to deposition of IgA in the mesangial cells surrounding the glomerular capillaries.
7
Q
What is the commonest cause of glomerulonephritis worldwide?
A
IgA nephropathy
8
Q
What is IgA nephropathy often assoc with?
A
Tonsillitis
Macroscopic haematuria
9
Q
What are the common locations for renal stones?
A
Pelviureteric junction
Pelvic brim
Vesicoureteric junction
10
Q
RF for renal stones?
A
Anatomical abnormalities (e.g. obstruction) Family history Chemical composition of urine Dehydration Infection Primary renal disease Gout Diet (high oxalate levels) Drugs (diuretics)
11
Q
What are some different types of renal stones?
A
Calcium stones
Uric acid stones
Infection induced stones
Cystine stones
12
Q
How do renal stones present?
A
Mostly asymptomatic Renal colic Dysuria Recurrent UTIs Haematuria
13
Q
Describe renal colic?
A
Rapid onset Excruciating ureteric spasms Pain is from loin to groin and comes and goes in waves Worse when fluid loading N+V
14
Q
How are renal stones diagnosed?
A
1st line: Kidney-Ureter Bladder X-Ray
Gold standard: Non-contrast Computerised Tomography (NCCT-KUB)
Other: USS, bloods, urine dipstick
15
Q
How are renal stones treated?
A
IV diclofenac
IV cefuroxime if infection
Antiemetics
If <5mm in lower ureter, 90% pass spontaneously
If >5mm and pain = medical expulsive therapy:
- oral nifedipine
If still not passing:
- Extracorporeal shockwave lithotripsy
- Endoscopy with YAG
- Percutaneous nephrolithotomy
16
Q
How can you prevent renal stones?
A
Active lifestyle
Over hydration
Low salt and calcium diet
Allopurinol (prevents uric acid stones)
17
Q
What is AKI?
A
An abrupt sustained rise in serum urea and creatinine due to a rapid decline in GFR, leading to failure to maintain fluid, electrolytes and acid-base homeostasis.
18
Q
What staging system is used to classify AKI?
A
KDIGO
Criteria:
1. rise in creatinine >26umol/L in 48hours
2. rise in creatinine >1.5 x baseline
3. urine output <0.5mL/kg/h for >6hrs consecutively
Need ONE to diagnose
19
Q
What are some pre-renal causes of AKI?
A
Renal hypoperfusion
Hypovolaemia
Low cardiac output
20
Q
What are some intrinsic renal causes of AKI?
A
Acute tubular necrosis Glomerular: glomerulonephritis or nephrotic syndrome Drugs Renal parenchyma damage Vascular - renal artery/vein thrombosis - vasculitis - HUS
21
Q
What are some post renal causes of AKI?
A
Urinary tract obstruction
Stones, clots
Extrinsic compression (e.g. malignancy)
Strictures (e.g. malignancy)
22
Q
RF for AKI?
A
>75years Heart failure Poor fluid intake/increase loss Peripheral vascular disease Sepsis Diabetes Prostate cancer
23
Q
How does AKI present?
A
O/E:
- palpable bladder + kidneys
- pelvic masses
- oedema
Oliguira Thirst Pericarditis SOB Postural hypotension High urea Sx
24
Q
What are symptoms of high urea levels?
A
Fatigue, weakness, anorexia, N+V, confusion, seizures, coma, pruritus, bruising
25
How is AKI diagnosed?
```
Serum calcium, phosphate and uric acid
Urine disptick
Blood count (v high ESR)
USS (obstruction)
ECG
CXR (pul oedema)
CTKUB
Renal biopsy
```
26
How is AKI treated?
Pre-renal: correct volume depletion with fluids, treat sepsis with Abx
Intrinsic renal: refer to nephrology
Post renal: catheterise, CTKUB, cystoscopy + retrograde stents
```
> sodium bicarbonate for acidosis
> diuretics for pul oedema
> optimise fluid balance
> stop nephrotoxic drugs
> consider dialysis
```
27
What is the most common cause of AKI?
Acute tubular necrosis
28
What is acute tubular necrosis?
Necrosis of renal tubular epithelial cells severely affects the functioning of the kidney. It is reversible in the early stages if the cause is removed.
29
What can cause acute tubular necrosis?
Renal ischaemia
- shock, sepsis, decreased renal perfusion
Toxins
- ahminoglycosides, tumour lysis syndrome, myoglobin secondary to rhabdomyolysis, contrast agents, urinary cast proteins
30
What are the phases of acute tubular necrosis?
Oliguric - Polyuric - Recovery
31
What are the features of acute tubular necrosis?
Raised: urea, creatinine, potassium
| Muddy brown casts in urine
32
What is seen on histology for acute tubular necrosis?
Tubular epithelium necrosis
- no nuclei, eosinophilic homogenous cytoplasm
Dilation of tubules
Necrotic cells obstruct tubule lumen
33
What is glomerulonephritis?
Group of parenchymal kidney diseases that all result in inflammation of the glomeruli and nephrons:
- acute nephritic syndrome
- nephrotic syndrome
- asymptomatic urinary abnormalities
- CKD
34
What is acute nephritic syndrome?
Often caused by an immune response triggered by infection of other disease. Characterised by:
- haematuria
- proteinuria
- HTN
- oedema
35
What is the commonest cause of acute nephritic syndrome?
IgA nephropathy
36
What can cause acute nephritic syndrome?
```
Post-strep infection
SLE
IgA nephropahty
Infective endocarditis
Good pastures disease
Systemic sclerosis
ANCA-assoc vasculitis
Malaria, schistomiasis, hep B+ C
Bacterial infection (e.g. MRSA)
```
37
What is good pastures disease?
Type 2 hypersensitivity reaction
Co-existance of acute glomerulonephritis and pulmonary alveolar haemorrhage and circulation antibodies directed against an intrinsic antigen to BM of kidney and lung.
Tx: plasma exchange
38
How does acute nephritic syndrome present?
```
Haematuria
Proteinuria
Hypertension + oedema
Oliguira
Uraemia
```
39
How is acute nephritic syndrome diagnosed?
Measure eGFR, urine analysis
Culture throat swabs
Renal biopsy if necesary
40
How is acute nephritic syndrome treated?
Depends on what causes it
| Treat HTN with salt restriction, loop diuretics and CCB
41
What is the triad in nephrotic syndrome?
1. proteinuria >3.5g/24hrs
2. hypoalbuminaemia
3. oedema
42
What can cause nephrotic syndrome?
Primary causes:
- minimal change disease
- membranous neuropathy
- focal segmental glomerulosclerosis
Secondary causes:
- diabetes
- amyloid
- infections
- SLE, RA
- drugs
- malignancy
43
How does nephrotic syndrome present?
Frothy urine
Pitting oedema of ankles, genitals, abdominal wall + face
Proteinuria
Hypoalbuminaemia
44
How is nephrotic syndrome diagnosed?
Renal biopsy
Urine dipstick
CXR or USS
Antiphosplipase A2 receptor antibody
45
Complications of nephrotic syndrome?
Susceptibility to infection
Thromboembolism
Hyperlipidaemia
46
How is nephrotic syndrome treated?
Reduce oedema: diuretics
Reduce proteinuria: ACE-i, ARB
Reduce risk of compilations: anticoagulants, statins
47
What is minimal change disease?
Disease of kidney that can cause nephrotic syndrome. Mainly in boys under age of 5.
48
How does minimal change disease present?
- proteinuria
- oedema (mainly face)
- fatigue
- frothy urine
49
What is seen on electron microscopy in minimal change disease?
Fusion of food processes of podocytes
| > diagnosed on biopsy
50
How is minimal change disease treated?
High dose corticosteroids (e.g. prednisolone)
| Relapse: cyclophosphamide or ciclosporin
51
What can cause asymptomatic urinary abnormalities?
IgA nephropathy
| Thin membrane disease
52
What is CKD?
Longstanding, usually progressive, impairment in renal function for >3months.
GFR<60ml/min/1.73m^2 for >3months with or without evidence of kidney damage.
53
What can cause CKD?
```
T2DM
HTN
PCKD
Amyloidosis
FHx
```
54
How does CKD present?
```
Asymptomatic in early stages
Itching
Anorexia + weight loss
Nocturia + polyuria
Peripheral or pulmonary oedema
N,V,diarrhoea
```
55
Complications of CKD?
```
Anaemia
Bone disease
Postural hypotension
CVD
Pruritus
```
56
How is CKD diagnosed?
```
Urinalysis: haematuria, proteinuria
Urine microscopy: WCC, eosinophilia
High urea + creatinine, high alk phosphatase
Biopsy + histology
Imaging
```
57
How is CKD treated?
Treat underling cause of renal disease and limit progression of complications
58
What is third space?
Where fluid doesn't normally collect in large amounts
- pul oedema + pleural effusion
- ascites
- bowel obstruction
- intra-abdominal collection/bleed
59
What is euvolaemia?
No signs or symptoms of hypo or hypervolaemia
60
How do you manage hypovolaemia?
Oral fluid if able
| IV fluid if very ill
61
How do you manage hypervolaemia?
Diuretics (oral or IV)
| Fluid restriction
62
What are the types of IV fluid?
Crystalloid
| Colloid
63
Explain crystalloid fluid
Small molecules which pass through cell membrane. Move from intravascular space to extravascular space.
Salt containing fluid stays in intravascular space a bit longer than 5% dex.
e.g. Isotonic solutions:
5% dextrose, 0.9% NaCl, Hartmann's solution
64
Explain colloid fluid
Large molecules which do not pass through cell membrane. Remains in intravascular compartment. Also expand intravascular volume through higher oncotic pressure.
e.g. gelofusine (contains modified fluid gelatine)
65
What is renal cystic disease?
Solitary or multiple renal cysts
| - simple, polycystic, hydronephrosis, acquired cystic disease, medullary sponge, dysplasia
66
Describe congenital renal cysts?
Present at birth
- uni/bilateral
- isolated to kidney
- autosomal dom/rec
- genetic mutation leads to predisposition for cyst formation
67
Describe acquire renal cysts?
```
Develop over time
No genetic mutation
- bilateral/unilateral
- isolated to kidneys
- normal/small kidney size
- assoc with CKD
```
68
What is ADPKD?
Autosomal dominant polycystic kidney disease
Multiple cysts develop, gradually + progressively, throughout the kidney resulting in renal enlargement and kidney tissue destruction.
> commonest inherited kidney disease
> high penetrance
69
What is the mutation in ADPKD?
85%: PKD1 gene on Chr 16
| 15%: PKD2 gene on Chr 4
70
How does ADPKD present?
```
Can be clinically silent for many years
Loin pain
Haematuria
Nocturia
Renal stones
Bilateral kidney enalrgemtn
Renal colic
HTN
SAH
Pancreatitis
Ovarian cysts
```
71
How is ADPKD diagnosed?
USS
Screening
Genetic testing
72
How is ADPKD treated?
```
No specific treatment
BP control
Analgesia
Laparoscopic removal of cysts
Nephrectomy
Counselling
```
73
What is ARPKD?
Autosomal recessive polycystic kidney disease
- disease of infancy
- rarer than ADPKD
74
What is the mutation in ARPKD?
PKHD1 mutation on long arm of Chr 6
75
How does ARPKD present?
Multiple renal cysts and congenital hepatic fibrosis
Enlarged polycystic kidneys
Kidney failure (30%)
76
How is ARPKD diagnosed?
Antenatally or neonatally
USS
CT/MRI
Genetic testing
77
Treatment for ARPKD?
```
None
Genetic counselling
Laparoscopic removal of cysts
BP control
Analgesia
```
78
Describe haemodialysis?
Blood is passed over a semi-permeable membrane against dialysis fluid flowing in the opposite direction, thus blood is always meeting a less concentrated solution and diffusion of small solutes occurs down concentration gradient. Larger solutes do not clear as effectively.
> blood taken from artery and returned into vein at AV fistula
> allows good clearance of solutes in short periods but pt must be harm-dynamically stable
79
Advantages and disadvantages of haemodialysis?
+ good for visually impaired, dementia, poor state of health
+ 3x a week for 4hrs
- time consuming
- travel restrictions
- have to come to hosp
- dietary restrictions
80
Describe peritoneal dialysis?
Mainly used in CKD. Process uses the patient's peritoneum in the abdomen as a membrane across which fluid + solutes are exchanged with blood.
81
Advantages and disadvantages of peritoneal dialysis?
+ can do it at home at night
+ portable equipment, fewer travel restrictions
+ less dietary restrictions
- risk of peritonitis
- has to be done every day
- catheter into abdomen
- can cause reduction in protein levels = lack of energy = malnutrition
- SE: weight gain
82
Complications of haemodialysis?
```
Hypotension/cramps
Nausea/headaches
Chest pain
Fever/rigors
Infected dialysis catheter
```
83
Complications of peritoneal dialysis?
Infection
Abdominal wall herniation
Intestinal perforation
84
What is BPH?
Benign prostatic hyperplasia
Increase in size of the prostate, without the presence of malignancy.
Inner transitional zone enlarges in contrast to the peripheral layer expansion in prostate carcinoma.
85
Clinical features of BPH?
LUTS
Enlarged bladder on abdo exam
Acute urinary retention
86
How is BPH diagnosed?
Digital rectal exam (prostate feels large but SMOOTH)
Transrectal US
PSA
Biopsy + endoscopy
Flow rates + residual volume (<10ml per second suggestive of obstruction due to BPH)
Frequency volume chart
MSU
87
How do you treat BPH?
```
Lifestyle: avoid caffeine + alcohol
Drugs:
Oral tamulosin
> alpha-1-antagonist
> relaxes smooth muscle
```
Oral finasteride
> 5-alpha-reductase inhibitor
> blocks conversion of testosterone to dihydrotesterone which is responsible for prostatic growth
Surgery:
- transurethral resection of prostate (TURP)
- transurethral incision of prostate (TUIP)
88
SE of tamulosin?
Drowsiness, dizzy, depression, ejaculatory failure, EPSE, increased weight and nasal congestion
Avoid in postural hypotension
89
SE of finasteride?
Impotence
| Decreased libido
90
Complications of BPH if left untreated?
Bladder calculi
UTI
Haematuria
Acute retention
91
Describe prostate cancer
Mainly adenocarcinomas arising in the peripheral zone of the prostate gland.
92
Where does prostate cancer commonly metastasise to?
Bone
| Lymph nodes
93
RF for prostate cancer?
FHx
Genetic: HOXB13 + BRCA2 gene
Increasing age
Black
94
Clinical presentation of prostate cancer?
LUTS
Weight loss
Bone pain
Anaemia
95
How is prostate cancer diagnosed?
```
DRE: hard, irregular prostate
Urine biomarkers: PCA3 or gene fusion protein
Endorectal coli MRI
Trans-rectal US + biopsy = diagnostic
PSA
```
96
What grading system is used in prostate cancer?
Gleason - looks at how well differentiated the cancer is histologically.
Sample from peripheral zone is scored, higher the score the more aggressive it is.
97
How is prostate cancer treated?
Confined to prostate:
- radical prostatectomy if <70 years
- radio therapy
- hormonal therapy
Metastatic disease:
1. endocrine therapy
- SC Gosorelin/leuprorelin
- bicalutamide
2. symptomatic
- anaglesia
- radiotherapy
Surgery
- radical prostatectomy
98
What is TURP syndrome?
Rare and life threatening complication of TURP. Venous destruction and absorption of the irrigation fluid.
Biochem: hyponatraemia + metabolic acidosis
Sx:
- headache, tachypnoea, restless
- resp distress, hypoxia, pul oedema, convulsion, acute renal failure
99
Describe renal cell carcinoma (RCC)
Arises from the proximal convoluted tubular epithelium.
| - von hippel lindau syndrome is an autosomal dominant condition that is a RF for RCC
100
Clinical features of RCC?
```
Often asymptomatic
TRIAD:
1. Haematuria
2. Loin/flank pain
3. Abdominal/flank mass
```
101
How is RCC diagnosed?
```
USS
CT chest + abdo with contrast
Bone scan
Renal biopsy
MRI
BP
```
102
How is RCC treated?
Nephrectomy
Cryoablation + radiotherapy
IL-2 + interferon alpha
103
What is Wilm's tumour?
Nephroblastoma
Childhood tumour of the primitive renal tubules and mesenchymal cells
> abdominal mass
Tx: nephrectomy, radiotherapy + chemotherapy
104
Describe bladder cancer
```
A transitional cell carcinoma
RF:
- smoking
- exposure to carcinogens (benzidine, azo-dyes)
- cyclophosphamide
- schistomiasis
```
105
How does bladder cancer present?
Painless haematuria
Recurrent UTIs
Voiding irritability
106
How is bladder cancer diagnosed?
```
Cystoscopy with biopsy
CT/MRI of pelvis
Urine microscopy
CT urogram
Urinary tumour markers
```
107
Treatment for bladder cancer?
Surgical resection
Chemo
Radical cystectomy
108
How does a testicular tumour present?
```
Painless lump in testicle
Testicular pain/abdo pain
Hydroecele
Cough + dyspnoea
Back pain
Abdo mass
```
109
How do you diagnose a testicular tumour?
```
Serum tumour markers: AFP + b-HCG (seminomas)
Lactate dehydrogenase
Scrotal USS
Biopsy + histology
XR + CT
```
110
What are the different types of testicular tumours?
Germ cells origin (>96%)
- serminomas
- teratomas
Non-germ cell origin (4%)
- leydig cell tumours
- Sertoli cell tumours
- sarcomas
111
How are testicular tumours treated?
Radical orchidectomy
Radiotherapy + chemo
Sperm storage
112
What is Bozniak classification?
Developed to help differentiate between benign cystic lesions + cancerous lesions of the kidney.
113
What is a UTI?
Inflammatory response of the urothelium to bacterial invasion, usually associated with bacteria + pyuria.
Caused by the presence and multiplication of microorganisms in the urianry tract.
>10^5 organisms/ml or fresh MSU
114
What pathogens can cause UTI?
```
Klebsiella
E.coli
Enterococci
Proteus
Staphylococcus
```
115
How do UTIs present?
Polyuria
Dysuria
Haematuria
116
How are UTIs diagnosed?
Urinalysis
Urine sample
Microscopy
Culture
117
How do you treat UTIs?
Asymptomatic bacteriuria >65 = DO NOT TREAT
Encourage fluid intake, hygiene
Abx:
- nitrofurantoin
- trimethoprim (NOT in pregnancy)
118
What is prostatitis?
Infection and inflammation of the prostate gland. Acute or chronic.
119
What can cause prostatitis?
```
Acute:
- strep faecalis
- e coli
- chalmydia
Chronic:
- bacterial (above)
- non-bacterial (elevated prostate pressure, pelvic floor myalgia)
```
120
RF for prostatitis?
STI, UTI, increasing age
Indwelling catheter
Post-biopsy
121
How does prostatitis present?
```
Type 1: acute
- systemically unwell
- fevers, riggers ,malaise
- pain on ejaculation
- voiding LUTS
- pelvic pain
O/E: boggy exquisitely tender prostate
```
Type 2: chronic
- acute sx >3months
- recurrent UTIs
- pelvic pain, voiding lUTS
- uropathogen in urine +/- blood
Type 3: CPPS
- chronic pelvic pain
- +/- LUTS/UTIs
122
How is prostatitis investigated?
```
DRE: hot + tender + hard prostate
Urine dipstick
STI screen
Blood cultures
MSU microscopy + sensitivity
Transurethral US
```
123
How is prostatitis treated?
| Name a complication
```
Acute:
IV gentamicin + IV co-amoxiclav
2-4 weeks on ciprofloxacin once well
2nd line: trimethoprim
TRUSS guided abscess drainage
```
```
Chronic:
Pain relief
Stool softener
Ciprofloxacin
Tamsulosin
```
Complications: urinary retention
124
What is urethritis?
Urethral inflammation due to infection or non-infectious causes. Mainly SEXUALLY ACQUIRED DISEASE.
- usually men at GUM clinics
125
Main causes or urethritis?
```
Neisseria gonorrhoea
Chlamydia
Trichomonas
Trauma
Urethral stricture Urinary calculi
```
126
RF for urethritis?
Sexually active
Unprotected sex
Male to male sex
Male
127
Clinical presentation of urethritis?
Dysuria +/- blood or pus
Urethral pain
Penile discomfort
Skin lesions
128
How is urethritis diagnoses?
NAAT
F: self collected vaginal swab
M: first void volume
Microscopy
Blood cultures
Urine dipstick
129
How is urethritis treated?
Chlamydia: oral azithromycin or 1 week doxyclince
Gonorrhoea: IM ceftriaxone + oral azithromycin
130
What is epidiymo-orchitis?
Pain, swelling and inflammation of the epididymis that can extent into the testis.
131
Causes of epidiymo-orchitis?
Under 35
- chlamydia
- gonorrhoea
Over 35
- Klebsiella
- e coli
- enterococci
- pseudomonas
- staph
Other:
- mumps
- trauma
- bechet's disease
- catheter (elderly)
132
Clinical features of epidiymo-orchitis?
```
Subacute onset of unilateral scrotal pain + swelling
Urethritis
UTI sx
Urethral discharge
Hydrocoele
Erythema +/- oedema of scrotum
Pyrexia
```
133
What must you rule out when diagnosing epidiymo-orchitis?
Testicular torsion
134
How do you diagnose epidiymo-orchitis?
NAAT
MSU
US
STD screening
135
How do you treat epidiymo-orchitis?
Usual tx for chlamydia/gonorrhoea/UTI
Scrotal support
Abstain from sexual intercourse
Partner notification + testing
136
What is cystitis?
Urinary infection of the bladder
- LUTS sx
- microcopy + sensitivity of sterile MSU
- Abx treatment
137
What is pyelonephritis?
Infection of the renal parenchyma and soft tissues of renal pelvis and upper ureter.
- main organisms KEEPS
138
Clinical presentation for pyelonephritis?
TRIAD
1. loin pain
2. fever
3. pyuria
O/E:
- tender loin
- renal angle tenderness
139
How is pyelonephritis diagnosed?
Urine disptick
MSU
Urgent US
140
Treatment for pyelonephritis?
Fluid replacement
Analgesia
IV ciprofloxacin
Surgery to remove calculi if necessary
141
What are some luminal causes of urinary tract obstruction?
Stones, blood ,clot, sloughed papilla, tumour
142
What are some mural causes of urinary tract obstruction?
Congenital or acquired stricture neuromuscular dysfunction or schistomiasis
143
What are some extra-mural causes of urinary tract obstruction?
Abdo or pelvic mass/tumour, BPH, prostate cancer, pregnancy, inflammation from peritonitis or diverticulitis
144
How does an acute upper urinary tract obstruction present?
Loin pain radiating to the groin
145
How does a chronic upper urinary tract obstruction present?
Flank pain, renal failure, infection + polyuria
146
How does an acute lower urinary tract obstruction present?
Acute urinary retention with severe suprapubic pain
147
How does a chronic lower urinary tract obstruction present?
Urinary frequency, hesitancy, poor stream, terminal dribbling, overflow incontinence
148
Treatment for upper urinary tract obstructions?
Nephrostomy
Tamsulosin
Finasteride
TURP
149
Treatment for lower urinary tract obstruction?
Urethral catheter
| Suprapubic catheter
150
What is hydronephrosis?
Dilatation of the renal pelvis or calyces as a result of obstruction of the outflow or urine distal to the renal pelvis.
151
What are some bilateral causes of hydronephrosis?
```
Stenosis of the ureter
Urethral valve
Prostatic enlargement
Extensive bladder tumour
Retroperitoneal fibrosis
```
152
What are some unilateral causes of hydronephrosis?
Pelvis-ureteric obstruction
Abnormal renal vessels
Calculi
Tumours of the renal pelvis
153
Ix for hydronephrosis?
USS
IV urogram
Ante/retrograde pyelography
CT scan
154
How is hydronephrosis managed?
```
Remove obstruction + drain urine
Nephrostomy tube (acute upper)
Ureteric stent or pyeloplasty (chronic upper)
```
155
What are some permanent kidney changes after obstruction?
Tubulointerstital fibrosis
Tubular atrophy + apoptosis
Interstital inflammation
156
What are the phases of renal recovery after obstruction?
Tubular function recovery
| GFR recovery
157
Explain the neural control of lower urinary tract?
Parasympathetic (Cholinergic): S3,4,5
- drives detrusor contraction
- smooth muscle sphincter relaxation
Sympathetic (noardrenergic): T10, L1, L2
- inhibits detrusor contraction
- urethral contraction
158
What is stress incontinence?
Small leak of urine when intra-abdominal pressure rises
Tx:
M: artificial sphincter, male sling
F: pelvic floor exercise, duloxetine, TVT
159
What is urge incontinence?
Strong desire to void and unable to hold urine
160
What is OAB?
Urgency with frequency
Tx: bladder exercises, control caffein intake, frequency volume charts, oxybutynin, mirabegron, botox
161
What are some features of spastic spinal cord injury?
- reflex bladder contractions + reflex bowel
- detrusor sphincter dyssynergia (loss of completion of voiding)
- poorly sustained bladder contraction
162
What are some features of flaccid spinal cord injury?
- areflexic bladder + bowel
- stress incontinence
- risk of poor compliance
163
What is an epididymal cyst?
Smooth, extratesticular, spherical cyst in the head of the epididymis
- contains clear + milky fluid (spermatcoele)
- lies above and behind the testis
164
How does an epididymal cyst present?
```
Lump
- often multiple, may be bilatera
Testis
- palpable quite separately from the cyst
Transluminate lump, well defined
Painful if large
```
165
How is an epididymal cyst diagnosed + treated?
Scrotal USS
Tx: not usually necessary but if painful then surgical excision
166
What is a hydrocele?
Abnormal collection of fluid within the tunica vaginalis.
- overproduction of fluid
- processus vaginalis fails to close, allowing the peritoneal fluid to communicate freely with the scroll portion
167
How does a hydrocele present?
Scrotal enlargement with a non-tender, smooth, cystic swelling
Pain not a feature unless infected
Testis usually palpable
Lies anterior to + below the testis and will transluminate
168
How is a hydrocele diagnosed + treated?
USS
Serum AFP + hCG
Tx:
- resolve spontaneously by 2yrs
- therapeutic aspiration or surgical removal
169
What is a variocoele?
Abnormal dilation of the testicular veins in the pampiniform venomous plexus, caused by venous reflux.
- left side more commonly affeted
170
How does a variocoele present?
- distended scrotal blood vessels that feel like 'a bag of worms'
- dull ache or scrotal heaviness
- scrotum hangs lower on side of varicocele
171
How is a variocele diagnosed and treated?
Venography
Colour doppler US
Tx: surgery if pain, infertility or testicular atrophy
172
What is testicular torsion?
Twisting of the spermatic cord resulting in occlusion of the testicular blood vessels which can rapidly lead to ischaemia + infarct = potential loss of testis.
***urological emergency***
173
RF for testicular torsion?
Underlying congenital malformation
| > belt-clapper deformity
174
Clinical presentation of testicular torsion?
Sudden onset of pain in 1 testis - often during physical activity
Pain in abdomen
N+V
Inflammation of 1 testis: tender, hot, swollen
Testis may lie high and transversley
175
How is testicular torsion diagnosed and treated?
Doppler US: lack of blood flow to testis
Urinalysis
Tx:
- surgery: expose + untwist testis
- orchiectomy
