renal and uro SBAs Flashcards
A 17 year old male presents with a 1 week history of fever, malaise, pain on swallowing + has found lumps in the neck. On examination a tender scrotal swelling is also noted.
Mumps - parotitis and swelling of parotid gland(s) which is present in 95% of symptomatic mumps. Mumps epididymo-orchitis is also a common feature shown as a tender scrotal swelling. Treatment of this viral infection involves isolation and supportive care with paracetamol or ibuprofen.
Acute features of kidney failure
Oliguria & acute rise in Cr/urea
Electrolyte imbalance (hyperK+)
Nausea and vomiting
Drowsiness (malaise)
Chronic features of kidney failure
Oedema Poor appetite Drowsiness (malaise) Anaemia Bone weakness (high phosphate, renal osteodystrophy, low calcitriol, high oestrogen)
Renal colic medical Rx (suitable for <10mm calculi)
Analgesia e.g. diclofenac IV fluids to rehydrate Drugs to reduce ureteric spasm: -Tamsulosin (a-blocker) -Nifedipine (CCB) Active stone removal if stone >7mm
Long-term diet changes, hydration, allopurinol
Which pathogens are most likely to cause epididymo-orchitis in patients <35 years and >35 years?
<35years = STIs (Chlamydia trachomatis and Neisseria gonorrhoeae) >35years = UTIs (E coli)
Commonest cause of nephrotic syndrome in children is
Minimal change glomerulonephritis
Commonest causes of nephrotic syndrome in adults
Diabetes mellitus
Membranous glomerulonephritis
n.b. any type of glomerulonephritis can cause nephrotic syndrome but these are just the most common.
Nephrotic syndrome
Hypoalbuminaemia
Oedema
Proteinuria
(hypercholesterolaemia)
SLE can cause glomerulonephritis. What would you test for to confirm this?
ANA
Anti-dsDNA
Goodpasture’s syndrome can cause glomerulonephritis. What would you test for to confirm this?
Anti-GBM antibodies
Wegener’s polyangiitis antibody
cANCA
Main causes of renal artery stenosis
Atherosclerosis (older) Fibromuscular dysplasia (younger)
Fibromuscular dysplasia resembles a string of beads on angiography. What conditions is it associated with?
Causes RAS in the young.
Associated with collagen disorders, neurofibromatosis, Takayasu’s disease, and microaneurysms in renal arteries.
Renal artery stenosis gold standard investigation
Digital subtraction angiography
Types of renal calculi
Calcium oxalate (65%) Calcium phosphate (15%) Magnesium ammonium phosphate (10%) Uric acid (5%) Cysteine (1%)
Renal calculi risk factors
Dehydration
UTIs
Changes in urinary pH
HyperCa2+, hyperoxaluria, hyperuricaemia, cystinuria
Kidney functions
Maintains fluid compartments (ECF Na+ and ICF H2O)
Electrolyte/acid-base balance (K+ and pH)
Excretion of waste products (urea)
Hormone production (erythropoietin and vit D)
Causes of pre-renal AKI
40-70% of AKI
Renal hypoperfusion
e.g. hypotension:
hypovolaemia, sepsis
Renal artery stenosis ±ACEi
Causes of intrinsic renal AKI
(10-50%) These may require renal biopsy for diagnosis.
Tubular - ATN (pre-renal damage, nephrotoxic drugs, rhabdomyolysis, myeloma)
Glomerular - autoimmune
Interstitial - acute interstitial nephritis (drugs, infiltration)
Vascular - vasculitis, thrombus
Causes of post-renal AKI
10-25%
Urinary tract obstruction
e.g. stones, blood clots, malignancy, retroperitoneal fibrosis
Pulmonary oedema Rx
Sit up, give O2 ±CPAP
IV GTN
IV furosemide
IV diamorphine
Complications of AKI that need to be treated
HyperK+
Metabolic acidosis
Pulmonary oedema
Acute kidney injury Rx
after complications have been treated
IV fluids Treat infection - Abx Stop nephrotoxic drugs (ACEi and NSAIDs) Treat intrinsic renal disease Relieve obstruction Optimise nutrition Consider future dialysis
Epidydimo-orchitis
<35years Chlamydia: doxycycline/ azithromycin Gonorrhoea: + ceftriazone >35years UTIs: ciprofloxacin/oflaxacin
Antibiotics should be used for 2-4weeks
Analgesia, scrotal support, drainage of abscess
Nephrotoxic agents
NSAIDs
Aminoglycosides (gentamicin, streptomycin)
Contrast agents
ACEi
Immunosuppressants (ciclosporin, methotrexate)
Obstructive LUTS
Stream (poor) Hesitancy Incomplete voiding Terminal dribbling Overflow incontinence Near retention
Irritative LUTS
Frequency (polyuria)
Urgency
Nocturia
Dysuria
Prostate cancer most commonly metastases to…
Bones
Lymph nodes
Liver
Brain
Bladder cancer histology
transitional cell carcinoma
Renal cell carcinoma (von Grawitz tumour) classical triad
Haematuria
Loin pain
Abdominal mass
Testicular cancers germ cell cancer examples are…
seminomas (40%) - epithelium of seminiferous tubules
teratomas (10%) - all 3 germ cell layers
Seminoma + teratoma tumour markers
Seminomas - b-hCG
Teratomas - b-hCG and AFP
Seminoma + teratoma prognosis
Seminomas - better prognosis
Teratomas - more aggressive, poorer prognosis
Non-resolving urge incontinence best investigation
Urodynamic study
A 62year old Afro-Caribbean man complains of waking up 2-3 times at night to pass urine for the past 8 months. He takes a while to start going and occasionally wets himself by the time he gets back in bed. Urine dipstick is normal. What would be the best investigation to diagnose his condition?
Transrectal USS
Measures prostate size and assists prostate biopsy
Henoch-Scholein Purpura (HSP) presents with …
Arthritis of large joints
Abdo pain
Purpuric rash of lower limb skin
A 40 year old man presents with a painless swelling in his scrotum which is fluctuant & transilluminable. Both testes are easily palpable. What is the likely diagnosis?
Epididymal cyst
A 45 year old man presents with a painless swelling in his scrotum. His left testis cannot be felt. The swelling transilluminates. What is the likely diagnosis?
Hydrocoele
Extracorporeal shockwave lithoscopy (ESWL)
Provides non-invasive outpatient treatment and usually combined with medical treatment. Usually suitable for smaller stones in the kidneys or ureter.
Cystoscopy for renal stones
allows visualization of the stone and urinary tract as well as laser to break up the stone
What is the treatment for calculi >2cm or not suitable for other modalities (e.g. ESWL or cystoscopy)?
Percutaneous nephrolithotomy
Commonly used antibiotics for cystitis UTI
Females: Oral co-trimoxazole Trimethoprim Nitrofurantoin or Amoxicillin
(ciprofloxacin in males)
Antibiotics for pyelonephritis
IV gentamicin, cefuroxime or ciprofloxacin
Causes of acute tubular necrosis (this is an intrinsic cause of AKI)
Ischaemia (hypoperfusion, rhabdomyolysis)
Nephrotoxic drugs
Multiple myeloma
Weakness Arrythmias Palpitations Nausea+vomiting are signs of ...
hyperK+
Hyperuriaemia may result in what heart condition
Pericarditis
Stages of CKD by GFR (mL/min)
1 - >90 (kidney damage) 2 - 60-89 (mild) 3 - 30-59 (moderate) 4 - 15-29 (severe) 5 - <15 (ESRF)
