Renal Conditions Flashcards
Who is most likely to suffer from hyrdronephrosis?
Women aged 20-60
Men (due to prostate involvement)
What is the cause for hydronephrosis?
It is described as an acute unilateral obstructive uropathy
- RENAL CALICULI
- MALFORMITY IN URETEROPELVIC JUNCTION
- ENLARGED PROSTATE
- PREGNANCY
- TUMOURS
What are the risk factors involved in hydronephrosis?
NON-MODIFIABLE- Ethnicity (African, Afro-Caribbean, Asian)
MODIFIABLE- smoking, NSAID use
PMH- AKI, pregnancy, prostatic disease
What are the symptoms associated with hydronephrosis?
PAIN- due to distention of the bladder Renal/Ureteral colic Anuria Fever Frequency Asymptomatic
What are the clinical signs of hydronephrosis?
Palpable kidney
Lower extremity oedema
Palpable bladder
What are some of the differential diagnoses for hydronephrosis?
Peripelvic cyst Congenital malignancies Calyceal diverticula High urine outfow Pyelonephritis
What investigations are necessary in suspected hydronephrosis?
Urinalysis
BLOODS: U+Es, eGFR, FBC, LFTs, PSA
IMAGING: CT, USS, DOPPLER
What treatment is used for hydronephrosis?
Antibiotics for infection
Urethral Catheterization
Ureteral stent
Who is most affected by prostate carcinoma?
It is the most common cancer in MEN
Usually affects men over age 50
What is the cause of prostate carcinoma?
Genetic mutations affect the androgen receptors are known to have a role in the development of prostate cancer
What are the risk factors involved in prostate cancer?
Age
Family history
Ethnicity
BRCA 1/2 mutation holders
What are the symptoms of prostate carcinoma indicating local disease?
Raised PSA
Weak stream, hesitancy, sensation of incomplete emptying, urinary frequency, urgency, urge incontinence
UTI
What are the symptoms of prostate carcinoma indicating locally invasive disease?
Haematuria, Dysuria, incontinence Haematospermia Perineal + suprapubic pain Ureteric obstruction, causing loin pain, AKI and CKD symptoms Impotence Rectal symptoms
What are the symptoms of prostate carcinoma indicating metastatic disease?
Bone pain Paraplegia secondary to spinal cord compression Lymph node enlargement Lethargy Weight loss
What are the clinical signs associated with prostate carcinoma?
Palpable bladder due to outflow obstruction
Hard irregular prostate on PR examination
- asymmetry
- palpable seminal vesicles
- lack of mobility (adhesions)
What are the differential diagnoses for prostate carcinoma?
UTI Urinary tract obstruction BPH Prostatitis Bladder tumours
What investigations are necessary in suspected prostate carcinoma?
PSA (high sensitivity but low specificity)- elevated age specific levels could indicate the need for biopsy
TRANSRECTAL ULTRASOUND (TRUS)- needle biopsy can accompany this, guided by the ultrasound, with antibiotic prophylaxis
PELVIC MRI
LAPAROSCOPIC NODE BIOPSY
ISOTOPE BONE SCAN
What treatments are used in prostate carcinoma?
No active treatment
Radical treatment: radical prostatectomy, external beam radiotherapy, brachytherapy
Focal treatment: high intensity focused ultrasound
Adjuvant treatment: Hormonal treatment
What treatments are used in locally advanced/ metastatic prostate carcinoma?
Adjuvant hormonal treatment
Radiotherapy: External beam radiotherapy and brachytherapy
Prostatectomy: Radical prostatectomy, high intensity focused ultrasound and cryotherapy
Chemotherapy
Who is typically affected by pyelonephritis?
WOMEN aged 15-29
Men over 65
What are the main causes of pyelonephritis?
Usually caused by an infection within the renal pelvis secondary to UTI
- E. coli
- Klebsiella spp.
- Proteus spp.
- Enterococcus
- Pseudomonas
What are the risk factors associated with pyelonephritis?
PMH- Caliculi, urinary tract catheterization, Stents/drainage procedures, pregnancy, diabetes, primary biliary cirrhosis, immunocompromised, prostate enlargement
What symptoms accompany pyelonephritis?
Loin pain, fever, malaise, nausea, vomiting, anorexia
What are the clinical signs associated with pyelonephritis?
Raised CRP
Raised ESR
