Renal Conditions Flashcards

1
Q

Who is most likely to suffer from hyrdronephrosis?

A

Women aged 20-60

Men (due to prostate involvement)

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2
Q

What is the cause for hydronephrosis?

A

It is described as an acute unilateral obstructive uropathy

  • RENAL CALICULI
  • MALFORMITY IN URETEROPELVIC JUNCTION
  • ENLARGED PROSTATE
  • PREGNANCY
  • TUMOURS
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3
Q

What are the risk factors involved in hydronephrosis?

A

NON-MODIFIABLE- Ethnicity (African, Afro-Caribbean, Asian)
MODIFIABLE- smoking, NSAID use
PMH- AKI, pregnancy, prostatic disease

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4
Q

What are the symptoms associated with hydronephrosis?

A
PAIN- due to distention of the bladder
Renal/Ureteral colic
Anuria
Fever
Frequency
Asymptomatic
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5
Q

What are the clinical signs of hydronephrosis?

A

Palpable kidney
Lower extremity oedema
Palpable bladder

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6
Q

What are some of the differential diagnoses for hydronephrosis?

A
Peripelvic cyst
Congenital malignancies
Calyceal diverticula
High urine outfow
Pyelonephritis
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7
Q

What investigations are necessary in suspected hydronephrosis?

A

Urinalysis
BLOODS: U+Es, eGFR, FBC, LFTs, PSA
IMAGING: CT, USS, DOPPLER

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8
Q

What treatment is used for hydronephrosis?

A

Antibiotics for infection
Urethral Catheterization
Ureteral stent

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9
Q

Who is most affected by prostate carcinoma?

A

It is the most common cancer in MEN

Usually affects men over age 50

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10
Q

What is the cause of prostate carcinoma?

A

Genetic mutations affect the androgen receptors are known to have a role in the development of prostate cancer

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11
Q

What are the risk factors involved in prostate cancer?

A

Age
Family history
Ethnicity
BRCA 1/2 mutation holders

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12
Q

What are the symptoms of prostate carcinoma indicating local disease?

A

Raised PSA
Weak stream, hesitancy, sensation of incomplete emptying, urinary frequency, urgency, urge incontinence
UTI

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13
Q

What are the symptoms of prostate carcinoma indicating locally invasive disease?

A
Haematuria, Dysuria, incontinence
Haematospermia
Perineal + suprapubic pain
Ureteric obstruction, causing loin pain, AKI and CKD symptoms
Impotence
Rectal symptoms
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14
Q

What are the symptoms of prostate carcinoma indicating metastatic disease?

A
Bone pain
Paraplegia secondary to spinal cord compression
Lymph node enlargement
Lethargy
Weight loss
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15
Q

What are the clinical signs associated with prostate carcinoma?

A

Palpable bladder due to outflow obstruction
Hard irregular prostate on PR examination
- asymmetry
- palpable seminal vesicles
- lack of mobility (adhesions)

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16
Q

What are the differential diagnoses for prostate carcinoma?

A
UTI
Urinary tract obstruction
BPH
Prostatitis
Bladder tumours
17
Q

What investigations are necessary in suspected prostate carcinoma?

A

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

18
Q

What treatments are used in prostate carcinoma?

A

No active treatment
Radical treatment: radical prostatectomy, external beam radiotherapy, brachytherapy
Focal treatment: high intensity focused ultrasound
Adjuvant treatment: Hormonal treatment

19
Q

What treatments are used in locally advanced/ metastatic prostate carcinoma?

A

Adjuvant hormonal treatment
Radiotherapy: External beam radiotherapy and brachytherapy
Prostatectomy: Radical prostatectomy, high intensity focused ultrasound and cryotherapy
Chemotherapy

20
Q

Who is typically affected by pyelonephritis?

A

WOMEN aged 15-29

Men over 65

21
Q

What are the main causes of pyelonephritis?

A

Usually caused by an infection within the renal pelvis secondary to UTI

  • E. coli
  • Klebsiella spp.
  • Proteus spp.
  • Enterococcus
  • Pseudomonas
22
Q

What are the risk factors associated with pyelonephritis?

A

PMH- Caliculi, urinary tract catheterization, Stents/drainage procedures, pregnancy, diabetes, primary biliary cirrhosis, immunocompromised, prostate enlargement

23
Q

What symptoms accompany pyelonephritis?

A

Loin pain, fever, malaise, nausea, vomiting, anorexia

24
Q

What are the clinical signs associated with pyelonephritis?

A

Raised CRP

Raised ESR

25
Q

What are the differential diagnoses associated with pyelonephritis?

A
Abdo abscess
AAA
Appendicitis
Acute abdomen/loin pain
Diverticulitis
Ectopic pregnancy
Prostatitis
Endometritis
26
Q

What investigations are done in suspected pyelonephritis?

A

URINALYSIS
BLOODS: white cell count, FBC, cultures
IMAGING: CT

27
Q

What are the treatments available for pyelonephritis?

A
Monitor the BP
Treat the UTI with the THREE Cs
- ciprofloxacin
- co-amoxiclav
- cefalexin
Remove the caliculi
28
Q

Who is usually affected by UTI?

A

Mostly women aged 24

29
Q

What is the cause of UTI?

A

Usually caused by bacteria in the GI tract

  • E. coli (80%)
  • Staph
  • Proteus murabilis
  • Enterococci
  • Candida albicans (very rarely)
30
Q

What are the risk factors for UTI?

A
Incomplete voiding
Immunocompromised
Indwelling catheter
Atrophic urethritis + vaginitis
Sexual intercourse
31
Q

What are the symptoms associated with UTI?

A

Urinary frequency
Dysuria
Constant lower abdo pain
Offensive smelling urine

32
Q

What are the clinical signs of UTI?

A

Raised leucocytes
Raised nitrites
Positive urine culture

33
Q

What are the differential diagnoses for UTI?

A

Other genital infections (herpes simplex, chlamydia, Gardnerella)
Enlarged/inflamed prostate

34
Q

What investigations are best for suspected UTI?

A

Urinalysis (cloudy, offensive smell, take an MSU specimen)
Urine microscopy
Urine culture

35
Q

What is the first line treatment for UTI?

A

Trimethoprim/Nitrofurantoin

NSAIDs/paracetamol for symptomatic relief