Renal and GU Flashcards
What is renal colic?
Renal colic is a SYMPTOM:
- Acute, unilateral pain
- ‘Loin to groin’ distribution
What is the main cause of renal colic?
Kidney stones (renal calculi)
What are the three most common sites for kidney stones to get stuck?
- Pelviureteric junction
- Pelvic brim
- Vesicoureteric junction
What is a kidney stone likely to be composed of?
Calcium oxalate (75% of stones)
What causes kidney stones?
Supersaturation of urine with salt/minerals
Describe the symptoms of kidney stones
- Acute unilateral pain with a ‘loin to groin’ distribution (renal colic)
- Problems associated with passing urine: dysuria, urinary retention, haematuria
- Nausea and vomiting
What investigations are required in a case of suspected renal colic?
- Bloods/urinalysis
- Diagnostic: CT abdomen (picks up 99% of stones)
Describe the management of renal colic.
- Pain relief
- Stones <5mm in diameter = pass spontaneously
- Stones >5mm in diameter = require medical intervention - either extracorporeal shock wave lithotripsy (ESWL) or percutaneous nephrolithotomy (PCNL)
How are future kidney stones prevented?
Drink plenty of water!
Nephrotic syndrome: causes, pathology and clinical presentation
Causes:
- Minimal change glomerular disease
- Membranous nephropathy
- Focal segmental glomerulosclerosis
Pathology:
-Glomerular damage without inflammation
Clinical presentation:
- Proteinuria
- Hypoalbuminaemia
- Oedema
Nephritic syndrome: causes, pathology and clinical presentation
Causes:
- Post-streptococcal glomerulonephritis/IgA nephropathy (presents days/weeks after URTI)
- Autoimmune glomerulonephritis (EITHER anti-glomerular basement membrane disease (which with lung involvement is called Goodpasture’s syndrome) OR anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis
Pathology:
-Glomerular damage WITH INFLAMMATION
Clinical presentation:
- Haematuria
- Proteinuria
- Hypertension
- Low urine volume
Describe the pathophysiology of ADPKD.
- Caused by mutations in PKD1/PKD2 gene
- This results in alterations in polycystin 1/2 respectively (protein)
- Polycystins regulate tubular and vascular development in the kidney as well as other organs (e.g liver, heart)… This leads to cyst development
- As cysts grow, there is renal enlargement and progressive decline in renal function due to destruction of healthy tissue
Describe the symptoms and signs of ADPKD
Symptoms:
- Acute loin pain (caused by cyst haemorrhage/infection and renal calculi)
Signs:
- Decline in renal function
- Hypertension
- Hepatomegaly
What is the diagnostic investigation for ADPKD?
Abdominal US
Describe the management of ADPKD.
- No cure
- Patient/family counselling
- Frequent monitoring to check disease progression
- Treat complications, e.g. hypertension
- Dialysis for end stage renal failure
What is benign prostatic hyperplasia?
Benign proliferation of the musculofibrous/glandular tissue of the transitional (inner) zone of the prostate due to the effect of dihydrotestosterone
Describe the clinical presentation of BPH.
LUTS!! - separated into ‘storage’ and ‘voiding’ symptoms
What are the ‘storage’ LUTS?
- Urgency
- Frequency
- Nocturia
What are the ‘voiding’ LUTS?
- Urinary retention
- Hesitancy
- Poor stream
- Post-micturition dribbling
- Overflow incontinence
Which investigations are carried out in a case of suspected BPH?
- DRE = smooth and enlarged
- PSA test +/- TRUSS (trans-rectal ultrasound scan) to exclude malignancy
Describe the conservative management of BPH.
Reduce alcohol/caffeine intake
Describe the pharmacological management of BPH.
- 1st line = alpha blocker, e.g. Tamsulosin
- 2nd line = 5-alpha reductase inhibitor, e.g. finasteride
Describe the interventional management of BPH.
- Catheterisation (if urinary retention/overflow incontinence)
- TURP (trans-urethral resection of prostate)
What are the red flag symptoms which may indicate prostate cancer rather than BPH?
- Haematuria
- Bone pain
What kind of cancer is prostate cancer?
Adenocarcinoma (usually of peripheral zone of prostate)
What are the common sites of prostate cancer metastasis?
- Adjacent structures
- Bone
- Brain
- Liver
- Lung
Which investigations would be carried out in a case of suspected prostate cancer?
- DRE = hard and irregular
- PSA test
- Biopsy
- TRUSS
- Bone scan
How is prostate cancer staged?
- Gleason score
- TNM staging
What kind of cancer is renal cell carcinoma?
Adenocarcinoma
What are the common sites of metastasis for renal cell carcinoma?
- Bone
- Brain
- Liver
- Lung
Describe the symptoms of RCC.
- Loin pain
- Haematuria
- Abdominal mass
- Urinary outflow obstruction
- Weight loss, fatigue
What investigations would be carried out for suspected RCC?
- Bloods (FBC, U+E. LFTs)… FBC mayshow ploycythaemia as tumour may cause increased EPO production
- Urine dip (haematuria)
- Abdo Ultrasound - visualise tumour
Describe the management of RCC.
- Localised = radical nephrectomy
- Metastatic = biological therapy, e.g. mTOR inhibitors (temsirolimus)
What types of bladder cancer are there? Which is the most common?
- Transitional cell carcinoma (90%)
- Squamous cell carcinoma
- Adenocarcinoma
What is the key red flag symptom for a suspected bladder cancer?
PAINLESS HAEMATURIA
What are the risk factors for bladder cancer?
- Occupation (azo dyes, rubber)
- Lifestyle - smoking
- Bladder conditions - schistosomiasis, chronic cystitis
What are the investigations for suspected bladder cancer?
- Bloods (FBC, U+E, LFTs)
- Urine dip -haematuria
- Cystoscopy and biopsy
Describe the management of bladder cancer.
- Localised = TURBT (transurethral resection of bladder tumour) or radical cystectomy
- Metastatic - chemo/radiotherapy
What is the most common type of testicular tumour?
Seminoma (germ-cell tumour)
What is the key red flag symptom for suspected testicular cancer?
Painless testicular lump
What are the risk factors for testicular cancer?
- Undescended testes
- Infant hernia
- Infertility
What are the investigations for a suspected testicular cancer?
- Bloods = serum tumour markers: alpha-fetoprotein (a-FP), beta-human chorionic gonadotrophin (b-hCG) and lactate dehydrogenase (LDH)
- Testicular US
- Testicular lump biopsy
Describe the management of testicular cancer.
- Seminomas = radical orchidectomy + radiotherapy
- Non-seminomas = chemotherapy
What is the definition of UTI?
Pure growth of >10^5 organisms per mL of fresh mid-stream urine (MSU)
How are UTIs categorised?
Anatomically:
- Upper: pyelonephritis, ureteritis
- Lower: cystitis, urethritis, prostatitis
Complicated (pregnant/men/catheterised) and uncomplicated (everyone else!)
Which organisms are commonly associated with UTIs?
- E. coli
- Klebsiella
- Enterococci
Compare/contrast symptoms of upper and lower UTIs.
Lower:
- PAIN - suprapubic
- Haematuria
- Dysuria
- Urgency
- Frequency
Upper:
- PAIN - loin
- Fever
- N + V
What are the investigations for suspected UTI?
- MC+S of fresh MSU (gold standard)
- OR Urine dip (leukocytes, nitrites, haematuria)
Describe the pharmacological management of UTI
- Abx: lower UTI = trimethoprim/nitrofurantoin, upper UTI = ciprofloxacin/co-amoxiclav (if complicated case refer to specialist)
- Pain relief
- Fluid intake
What is testicular torsion?
Twisted spermatic cord, which cuts off blood supply to the testes (ischaemia)
MEDICAL EMERGENCY
Describe the symptoms of testicular torsion
- Sudden onset testicular pain/swelling (unilateral)
- N+V
Describe the management of testicular torsion
Surgery without delay
What is the definition of acute kidney injury? What are the criteria used to define AKI?
Sudden decline in renal function over hours to days
Criteria:
- Rise in creatinine > 26 micromol/L in 48 hours
- Rise in creatinine > 1.5 x baseline
- Urine output < 0.5 ml/kg/hr for > 6 consecutive hours
Give some causes of acute kidney injury (how are these causes classified?)
Pre-renal causes:
- Hypoperfusion, e.g. hypotension, renal artery stenosis, drugs (e.g. NSAIDs, ACEi/ARBs)
Renal causes:
- Acute tubular necrosis (most common)
- Glomerulonephritis
Post-renal causes:
- Urinary tract obstruction, e.g. stones, malignancy
Describe the symptoms of acute kidney injury
- Oliguria/anuria (urinary retention)
- N+V
- Dehydration
- Confusion
Describe the management of acute kidney injury
- Aim for euvolaemia
- Stop nephrotoxic drugs
- Treat complications, e.g. hyperkalaemia (give insulin/dextrose or salbutamol neb with calcium gluconate)
What is chronic kidney disease?
Progressive decline in renal function over time
Give some risk factors for developing CKD
- Hypertension
- DM
- Glomerular disease
Describe the investigation of CKD
Abdo US = bilaterally small kidneys
Describe the conservative management of UTI
Increase fluid intake
Regularly void
Void post coitus
