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Renal Conditions Flashcards

Conditions in Renal for 3rd year ICSM

1
Q

Define Acute Kidney Injury

A

Sudden episode of kidney failure / damage leading to an increased nitrate formation

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2
Q

What are the three different classifications of cause of AKI?

A

Pre-Renal
Renal
Post-Renal

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3
Q

What Pre-Renal causes are there of AKI?

A

Hypovolaemia (Haemorrhage, GI bleed)
Decreased CO
Drugs that lower BP, volume or renal flow (ACEi, ARBs, NSAIDs, Loop diruetics)

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4
Q

What are the Renal causes of AKI?

A

Toxins + Drugs (ABx, Chemo)
Vascular (Vasculitis, thrombosis)
Glomerular (Glomerulonephritis)
Tubular (Acute tubular necrosis, rhabdomyolysis)
Interstitial causes (Interstitial nephritis, lymphatic infiltration)

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5
Q

What are the Post-Renal causes of AKI?

A

Obstruction (Renal cancer, Enlarged prostate, neurogenic bladder)

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6
Q

What are the Risk Factors for AKI?

A 
75+
Hx of AKI
CKD
Sepsis
Nephrotoxic drugs
Iodinated agents
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7
Q

What are the signs of AKI

A 
Depends on the Cause!
Decreased urinary output
Jaundice
Hypertension
Hearing loss
Pulsatile abdomen
Pelvic or Renal mass
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8
Q

How do you stage AKI?

A

1 - Creatinine up by 1.5-2x, 20.5mL/kg/hour >6hrs
2- 2-3x Creatinine, <0.5mL/kg/hour in >10hrs
3- >3x base creatinine, <0.3mL/kg/hour for 12hrs

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9
Q

What Investigations to be done for AKI?

A

U&Es - Raised Creatinine, Hyperkalaemia
Urinalysis - RBC, WBC, nitrites, proteins, bacteria
FBC - Anaemia, leucocytosis, thrombocytopenia
CXR - look for HF

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10
Q

How do you manage AKI?

A

Furosemide
Bicarbonate
IV glucose and Insulin (hyperkalaemia)
Insert Catheter

If needed: Haemodialysis

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11
Q

In AKI, what constitutes an urgent referral

A

Suspect rapidly progressive glomerulonephritis
Indication for dialysis
Stage 3 or Stage 2 without improvement for 1-2 days, renal target, dialysis needed

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12
Q

What constitutes a non-urgent referral for AKI

A

Stage 2 AKI
Nephrotic syndrome
Positive ANCA/ANA
Malignant hypertension

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13
Q

Complications of AKI

A 
Volume Overload
Electrolyte disturbances
Acid-Base disturbances
Anaemia 
Increased infection risk
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14
Q

What does an ECG of someone with Hyperkalaemia look like?

A 
Tented T waves
Prolonged PR interval
Wide, flat P waves
Widened QRS
ST depression
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15
Q

Define Amyloidosis

A

Excess amount of amyloid in the body - illness caused by excess deposition of amyloid proteins in organs

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16
Q

What are the classifications of amyloidosis?

A

Primary Amyloidosis - AL (immunoglobulin light chain) - most common, bones produce abnormal Abs that cant be broken down

Secondary - AA (Familial) and AF (non familial)

Dialysis-related - Protein in blood deposits in joints and tendons

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17
Q

Where do the different types of amyloidosis affect?

A

AL - Kidneys, Heart, nerves, gut, vasculature

AA - Kidneys, Liver, spleen

AF - Liver, nerves, heart and kidney

Dialysis - Joints + tendons

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18
Q

Risk Factors of amyloidosis

A 
People of Colour
60+
Men
Chronic disease
Dialysis 
Family history
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19
Q

Signs and symptoms of amyloidosis

A

Based on organ affected:
Renal - Proteinuria, nephrotic syndrome, renal failure
Cardiac: Restrictive cardiomyopathy, HF, arrhythmia, angina
Neuro: Sensory/motor/autonomic neuropathy, carpal tunnel
Skin: Waxy, easy bruising
Joints: Painful enlargement of anterior shoulder

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20
Q

Investigations for amyloidosis

A

Serum/Urine immunofixation (monoclonal protein)

Immunoglobulin free light chain assay: Abnormal kappa:Lambda

Bloods (Checks function)

  • CRP
  • LFTs
  • U&Es

SAP scan: Show amyloid deposits

Tissue Biopsy: Green bifringence when stained with congo red

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21
Q

Define Benign Prostatic hyperplasia (BPH)

A

A common noncancerous enlargement of the prostate

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22
Q

What are the causes of BPH

A

Hormonal changes as we age

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23
Q

What are the Risk Factors of BPH

A 
Age (1/3 of people at 60, 1/2 of people at 80)
Family history
Diabetes
Heart disease
Obesity
Non-Asian race
Cigarrette smoking
Male pattern baldness
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24
Q

Symptoms and Signs of BPH

A 
LUTS
Acute retention symptoms (Severe pain)
Chronic retention (Painless, nocturia)
Haematuria
Bladder sotnes
UTI
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25
Investigations of BPH
Urinalysis (Pyuria, nitrates, bacteria, lymphocytes) U&Es (Check renal function) MSU (MC&S) PSA (Raise)
26
Management of BPH
``` Catheterise in emergency Lifestyle advice (Avoid caffeine, alcohol, relax when voiding) ```
27
What is the medical management of BPH
Tamsulosin - Alpha blockers | Finasteride - 5alpha reductase inhibitors
28
What are the surgical managements of BPH
TURP TUIP Open prostatectomy
29
Complications of BPH
``` Recurrent UTI Urinary retention Urinary stasis Obstructive renal failure AKI ```
30
Prognosis of BPH
Mild symptoms can be controlled well medically | TURP has good response
31
What is Bladder Cancer
Malignancy of bladder cancer - Most are transitional cell carcinomas - Rarely squamous cell carcinomas with chronic inflammation 9th most common in world More common in Egypt, Western Europe and North America
32
What are the Risk Factors of Bladder cacner
Smoking Aromatic amines - rubber industry, dye stuff Chronic cystitis Cyclophosphamide treatment Pelvic irradiation Schistosomiasis - increased risk of squamous cell carcinomas
33
What are the symptoms of bladder cancer?
``` Blood clots / Haematuria Pain/Burning while urinating Frequent urination Urgency Nocturia Lower back pain ```
34
What are the signs of Bladder cancer
Haematuria | Nothing else
35
Investigations for bladder cancer
``` Urine dip (Blood ++) Cystoscopy (Find tumour/red patch) Biopsy Ultrasound (imaging) MRI (imaging) ```
36
Define CKD
Pathological abnormality of kidney function
37
What causes CKD?
Diabetes is the most common cause | Hypertension & Glomerular disorders due to causing kidney damage
38
Risk Factors for CKD
``` Diabetes Hypertension AKI history Nephrotoxic drug use Smoking Family history of Diabetes and HTN 60+ People of colour Male CVD Proteinuria Obstructed urinary flow ```
39
Staging of CKD
``` 1 - GFR >/= to 90 2 - GFR 60-89 3a - GFR 45-59 3b - GFR 30-44 4 - GFR 15-29 5 - GFR < 15 ```
40
Symptoms of CKD
Stage 1-3: Asymptomatic and found accidentally Stage 4-5: Weight loss, anorexia, swollen ankles, SOB, Tiredness, Haematuria, Urgency, Nocturia, Insomnia, itchy skin, muscle cramps, nausea, headache, rash, dyspnoea
41
Investigations for CKD
Serum Creatinine Urinalyis Renal ultrasound (atrophy and/or hydronephrosis) eGFR Antibodies (ANA [SLE], c-ANCA [Wegener's], Anti-GBM [Goodpasture's])
42
Signs of CKD
Proteinuria Haematuria Rash
43
What are LUTS symptoms
``` FUND HIPS F - Frequency U - Urgency N - Nocturia D - Dysuria H - Hesitancy I - incomplete voiding P - Poor Stream S - Smell/odour ```
44
What is the definition of Epididymitis
Swelling / pain in the epididymis
45
What is the definition of Orchitis
Swelling/pain in the testicle
46
What are the causes of Epididymitis / Orchitis?
Acute: In children - E. Coli In Men - Usually an STD Sometimes caused by: Enlarged prostate, prostatitis, blocked urethra, recurrent catheter use, amiodarone, bloodstream infections (TB) Chronic: After acute, often idiopathic
47
What are the Risk Factors for Epididymitis & Orchitis?
``` Frequent UTIs Bacterial Prostatitis Bacterial STD Urinary Catheterisation Unprotected sex Compromised Immunity Bladder obstruction ```
48
What are the symptoms of Epididymitis & orchitis
Swollen testis Red, firm, tender, warm & spreads Sources: - Urethritis (Pain/burning w/ haematuria) - Cystitis (lower abdo pain, urgency with burning) - Prostatitis (Pain scratures) - Pyelonephritis (Fever, testis pain)
49
Investigations of Epididymitis & Orchitis
Gram stain Urethral swab Doppler (Exclude torsion) ESR/CRP - Raised
50
Management plan for Epididymitis & Orchitis
If Gonococcal/Chlamydial - Ceftriaxone + Doxycycline | If <14 or 35< - Ofloxacin
51
Complications of Epididymitis & Orchitis
Abscess + Testicular infarct, may spread | May need Epididymectomy
52
Define Glomerulonephritis
An immunological mediated inflammation of the Renal glomeruli and nephron
53
What are the early signs of Glomerulonephritis/
Puffy face Less often urinating Haematuria Coughing
54
What are the 2 classes of Glomerulonephritis and what are the types within them?
Non-Proliferative - Minimal change - Focal Segmental - Membranous Proliferative - IgA Nephropathy - Membranoproliferative - Post infectious - Rapidly progressive (Has two types: Good Pastures and Vasculitic)
55
Of all the types of Glomerulonephritis, 'Rapidly progressive' has types, what are they?
Good pastures syndrome Vasculitic disorders - Wegners granulomatosis - Microscopic polyangitis
56
What are the risk factors for glomerulonephritis?
``` Hypertension Diabetes Cancer Recent strep throat Regular NSAID use Bacterial endocarditis Viral infection ```
57
What are the investigations for Glomerulonephritis?
Urinalysis (Haematuria, Proteinuria, dysmorphic RBCs, Leucocytes, epithelial casts) Metabolic profile (Liver enzymes, hypoalbuminaemia, FBC (anaemia) Albumin:Creatinine ratio (>220) Antibodies (ANA, Anti-dsDNA, ANCA, Anti-GBM anitbody)
58
What are the symptoms of Glomerulonephritis?
``` Haematuria SC oedema Polyuria or Oliguria History of recent infection Symptoms of uraemia or chronic infection ```
59
Patients with Glomerulonephritis present specific syndromes what are they?
Nephritic | Nephrotic
60
What is Nephrotic syndrome?
Increased permeability of the glomerulus leading to loss of proteins into the tubules - losing proteins
61
What are common causes of Nephrotic syndrome?
Primary: Membranous glomerulonephritis Minimal change disease Mesangiocapillary glomerulonephritis ``` Secondary: Diabetes SLE (Class V nephritis) Amyloidosis Hepatitic B/C ```
62
What is Nephritic syndrome?
Thin glomerular basement membrance with pores that allow protein and blood into the tubule
63
Causes of Nephritic syndrome?
Primary: IgA Nephropathy Mesangiocapullary GN ``` Secondary: Post streptococcal Vasculitits SLE Anti-GBM disease ```
64
What are the signs of GN
``` Hypertension Proteinuria Haematuria (especially IgA nephropathy) Renal failure Nephrotic triad Niphritic triad ```
65
What do you see in Nephrotic syndrome on examination?
Normal/Elevated BP Proteinuria Normal/lowered GFR
66
What is the triad of Nephrotic syndrome?
Proteinuria >3.5g/24hrs Low Serum album <24g/L Oedema Note: Hypoalbminaemia leads to hyperlipidaemia by liver compensation
67
What do you see in Nephritic syndrome on examination?
Moderate-severe raised BP Haematuria (mild-macro) Moderate/severe decreased GFR
68
What is the triad of Nephritic syndrome?
Hypertension Proteinuria Haematuria
69
What is a Hydrocele?
Abnormal colection of fluid remnants of the processus vaginalis
70
What are the 3 types of hydrocele?
Simple Communicating Non-communicating
71
What is a simple hydrocele?
Accumulation of fluid in tunica vaginalis in kids In adults caused by trauma, varicoceles, epididimo-orchitis, testicular torsion or a hernia May have generalised oedema
72
What is a communicating hydrocele?
Persistence of processus vaginalis in older boys/men, allowing peritoneal fluid to commnuicate freely between the scrotum and the abdomen
73
What is a non-communicating hydrocele?
Imbalance in secretion/reabsorption of fluid | Secondary to minor trauma, torsion, epididymitis, varicocele
74
How does a hydrocele present?
Scrotal enlargement with non-tender, smooth cystic swelling Painless unless infected Palpable Anterior and inferior to testis and illuminates
75
Investigations for Hydrocele
Ultrasound scan - determine underlying pathology Doppler US - Distinguish hydrocele or varicocele Serum Alpha-fetoprotein and hCG - should be negative
76
What is Nephrotic Syndrome?
Clinical syndrome showing heavy proteinuria & hypoalbuminaemia
77
What are the primary causes of Nephrotic syndrome?
Primary causes Minimal change disease (most common in kids) Focal segmental GN (most common in adults) Other types of GN
78
What are secondary causes of Nephrotic syndrome?
``` Infection (HIV, Hep B/C, syphilis, shistosomiasis) Collagen vascular disease Metabolic disease (DM) Inherited disease (Alport's syndrome) Carcinomas Drugs (NSAIDs, ACEi) Toxins (bee sting) Pregnancy Transplant rejection ```
79
What are symptoms of Nephrotic syndrome?
``` Facial swelling with periorbital oedema Peripheral oedema Frothy urine Hypercoagulability Poor appetitie Weakness ```
80
Signs of Nephrotic syndrome
``` Oedema Tiredness Leukonychia Breathlessness Fluid overload (High JVP) Dyslipidaemia ```
81
Investigations for Nephrotic syndrome
``` Urine Dipstick (Proteinuria, haematuria) MSU (MC&S) Albumin:Creatinine Clotting screen (hypercoagulability) Renal function test ( decreased) ```
82
What is the definition of Polycystic kidney disease?
Heterogenous group of disorders by Renal cysts & numerous sytemic & extra renal manifestations 2 types: Autosomal Recessive and Autosomal dominant
83
Causes of PKD?
``` PKD1 mutation (85%) PKD2 mutation (15%) ```
84
Risk Factors for PKD?
``` Large Kidneys Episodes of gross haematuria Headaches Hypertension Male White Family history ```
85
What are symptoms of PKD?
``` Flank/Abdominal pain Renal Colic Gross Haematuria Headaches Dyuria Cystitis Suprapubic pain Urgency Nausea Early satiety ```
86
What are signs of PKD?
``` Palpable renal mass Early onset HTN Hernias Rectus abdominis diastasis May have murmur ```
87
How many cysts are needed to diagnose PKD?
<30 years old: 2/ kidney or 2 total cysts 30-59 years old: 2 per kidney >60 years old: 4 per kidney With Family history, >10 per kidney
88
Investigations for PKD
``` Renal US - first line CTAP MRIAP Genetic testing for PKD1/2 MRI for SAH ```
89
Define Prostate Cancer
Adenocarcinoma of peripheral prostate gland
90
Where does prostate cancer usually metastasise?
Bone and lymph nodes
91
What are the risk factors of Prostate cancer?
``` Increasing age Afro-Carribean Genetic predisposition Alcohol consumption Chronic inflammation Family History Raised testosterone Occupation exposure to cadmium ```
92
What are the Symptoms of Prostate cancer?
``` LUTS Haematuria - locally invasive Cancer Haematospermia Loin pain Anuria AKI/CKD Tenasmus - if mets: Bone Pain/sciatica, paraplegia ```
93
What are the signs of prostate cancer?
Hard, irregular prostate | Asymmetry of gland, nodule in lobe, lack of mobility, palpable seminal vesicles
94
Investigations for Prostate Cancer?
PSA (Not super specific but first line) DRE Transrectal ultrasound guided biopsy - gold standard Isotope bone scan for mets
95
Definition of Renal artery stenosis?
Narrowing of Renal artery lumen.
96
At what point does Renal artery stenosis become significant?
50%
97
When does it start?
Onset typically before 30 Atherosclerosis accounts for 90% of RAS 2-10x more likely in Women
98
There are 3 types of RAS causes, what are they?
Atherosclerosis FIbromuscular dysplasia Other
99
What are the causes of atherosclerotic RAS?
Atherosclerosis Diabetes mellitus Dyslipidaemia Smoking
100
What are the causes of Fibromuscular dysplasic RAS?
Fibromsucular dysplasia Intimal and adventitial fibroplasia Smoking
101
Other causes of RAS
``` Post-transplant Renal artery disease Renal artery aneurysm Takayasu's arteritis Atheroemboli Williams syndrome Neurofibromatosis Truama ```
102
Risk Factors of RAS
``` Obesity Dyslipidaemia Smoking Sedentary lifestule Diabetes HF Hyperkalaemia ```
103
Symptoms of RAS
``` Foot and Ankle swelling Continued HTN Nausea and Vomiting Weight loss Cramps Darkened skin Change in urination Accelerated HTN with ACEi ```
104
Signs of RAS
``` Hypertension Decreased kidney function Oedema in ankles and feet Increased proteinuria Renal artery bruits ```
105
Investigations for RAS?
``` Serum Creatinine (Raised/Normal) Serum Potassium (Raised/Normal) Urinalysis (normal w/o diabetic retinopathy) Digital subtraction renal angiography - gold standard but done after CT/MRI ```
106
Define Renal cell carcinoma?
Most common tumours of kidney in adults Wilm's tumours most common in children Benign renal tumours are uncommon
107
What are the Risk Factors for Renal cell carcinoma?
``` von Hippel-Lindau disease Tuberous sclerosis PKD Familial renal cell cancer Smoking Chronic dialysis ```
108
What are the symptoms of Renal cell carcinoma?
Present late Asymptomatic in 90% Triad: Haematuria, Flank pain, abdominal mass Systemic signs of malignancy: Weight loss, Malaise, Paraneoplastic syndrome
109
What are the types of Renal cell carcinoma?
Renal cell carcinoma Papillary carcinoma Transitional cell carcinoma
110
What is the difference in presentation with Transitional cell carcinoma and Renal cell carcinoma?
Transitional cell carcinoma presents earlier with Haematuria
111
What are the signs of Renal cell carcinoma?
``` Palpable renal mass Hypertension Plethora Anaemia Left-sided can cause a left-sided varicocele ```
112
What are the investigations for Renal cell carcinoma
``` Urinalysis (Haematuria, Cytology) FBC (Polycythaemia) ALP - Bony mets Calcium LFTs ESR (Raised) Abdominal Ultrasound (Distinguish solid masses and cystic structures) CT/MRI (Useful for staging) CXR (Cannon ball mets) ```
113
Definition of Testicular cancer
95% from Germ cells Subdivided into seminomatous and non-seminomatous NSGC include: Leydig cell tumours, sertoli cell tumours and Sarcomas
114
Risk Factors of Testicular cancer
``` Cryptorchidism or testicular maldescent Klinefelter's syndrome Family history Male infertility Low birth weight Young Parental age Taller ```
115
Symptoms of testicular cancer
``` >95% present with testicular lump Usually painless Dragging sensation Gynaecomastia Teratomas undergo blood borne spread to liver, lung bases + brain ```
116
Signs of Testicular cancer
Palpable lungs | Malignant testis usually lack sensation
117
Investigations for Testicular cancer
Tumour marker assay (Alpha fetoprotein - yolk sac elements; Beta HcG made by trophoblastic elements) B/L testicular US CXR Diagnosis by US
118
What tumour markers do the different types produce?
Seminomas - PLAP Teratoma - AFP Sometimes teratomas produce HCG LDH levels non-specific for big tumours of both types
119
Define Testicular torsion
Urological emergency causes by twisting of testicle on the spermatic cord leading to constriction of vascular supply and time-sensitive ischaemia and / or necrosis of testicular tissue
120
Causes of testicular torsion?
Bell clapper deformity | Trauma
121
Risk Factors for Testicular torsion
``` 12-18 Neonate Bell clapper deformity Trauma/Exercie Intermittent testicular pain Undescended testicle Cold weather ```
122
Symptoms and Signs of Testicular torsion
``` Testicular Pain (Nausea + Vomiting) Intermittent, acute on-off pain No pain relief on scrotal elevation Swelling Erythema Reactive hydrocele Raised testicle Horizontal testicle Abdo pain Fever ```
123
Investigations for Testicular torsion
``` Grey Scale US (Whirlpool sign, presence of fluid) Colour doppler (No/decreased flow) Urinalysis (Normal) FBC (Normal) CRP (Normal) ```
124
Management of Testicular torsion
Urgent Orchidopexy/orchidectomy Neonates - no intervention needed Manual de-torsion: Only if surgery unavailable 6-13 hours since started
125
Complications of Testicular torsion
``` Testicular infarction/permanent loss Infertility Psychological implication Cosmetic deficiency Recurrent torsion ```
126
Prognosis for Testicular torsion
Can be recurrent
127
Definition of Urinary Tract Calculi
Formed when urine supersaturated with Salt and minerals e.g. Calcium oxalate, struvite, uric acid + cysteine
128
What can make up a Kidney Stone?
``` Calcium Oxalate - most common Struvite - quite common Urate - 5% Hydroxyapatite - 5% Cysteine - 2% Magnesium ammonia phosphate - staghorn calculus ```
129
What are the causes of Kidney stones
Metabolic causes (Hypercalciuria, -uricaemia, -cystinuria) Infection Drugs (Diuretics, Antacids, corticosteroids, indinavir) Tract abnormalities Foreign bodies (Stents, Catheters)
130
Risk Factors for Kidney Stones
Low Fluid intake Diet: Chocolate, tea, rhubarb, strawberries, nuts, spinach (Increase oxalate levels) Season: Vitamin D Structural abnormality e.g. horseshoe kidney
131
Who are most affected by Kidney Stones
Men 20-50 Bladder stones more common in developing countries Upper tract stones more common in western countries
132
What are the symptoms of Nephrolithiasis?
``` Often asymptomatic SEVERE loin->groin pain Nausea and vomiting Unable to lie still Urgency Haematuria ```
133
What are the signs of Nephrolithiasis?
Loin to lower abdominal tenderness - not on palpation No signs of peritonitis Signs of sepsis if obstruction
134
What are the investigations for Urinary tract calculi?
``` Urine dipstick (Haematuria) Non-contrast CT KUB [Gold standard] Ultrasound U&Es for renal function Pregnancy test for women in case of ectopic - do USS instead of CT ```
135
What is the management of Urinary tract calculi acutely?
Analgesia (Diclofenac 75mg IV/IM or 100mg PR) Bed Rest Fluid replacement - IV if cant do PO Urine collection to try and retrieve stone Obstructed, infected kidney is an emergency Antibiotics - Cefuroxamine or Gentamicin
136
How do you remove a calculus?
Stones <5mm pass naturally with increased fluid | Stones >5mm / painful use medical treatment - if that doesnt work: ESWL or urethroscopy or PCNL
137
What medicines do you use to remove a calculus?
Nifedipine or | Tamsulosin (Alpha blocker)
138
What is ESWL
Extracorporeal shock-wave lithotripsy Non-invasive Shockwave focused onto calculus breaks it up into smaller fragments that pass normally
139
What is urethroscopy?
A scope passed down the bladder and into ureter to visualise the stone Be removed or broken down with a laser IF it cant be broken, place a JJ stent allowing urine drainage
140
What is PCNL?
``` Percutaneous Nephrolithiotomy (PCNL) Performed for large, complex stones (e.g. staghorn) Make a nephrostomy tract, insert a nephroscope, allowing disintegration and removal of stones ```
141
What are possible complications of a Renal stone?
Infection (Pyelonephritis) Sepsis Urinary retention
142
What are possible complications of Ureteroscopy?
Perforation | False passage
143
What are possible complications of Lithotripsy?
Pain | Haematuria
144
What is Tumour Lysis syndrome?
Combination of metabolic and electrolyte abnormalities that occur in patients with cancer, usually after initiation of cytotoxic treatment
145
What causes Tumour lysis syndrome?
Haematological malignancies High proliferation rate: Non-hodgkin's lymphoma, ALL, AML, CLL and multiple myeloma Rarely solid tumours - Can be: Breast, small cell lung cancer, testicular
146
What are the Risk Factors for TLS?
``` Haematological malignancy Large tumour burden Chemosensitive tumours Recent chemo Renal impairment Dehydration Age Nephrotoxic drugs ```
147
Signs and Symptoms of TLS?
``` High Serum Creatinine Nausea and Vomiting Diarrhoea Lethargy Paraesthesia Hyper/hypotension Anorexia Syncope Chvostek sign ```
148
Investigations for TLS
Raised Uric acid Raised phosphate Potassium (>6) LDH elevated Serum Creatinine (1.5x upper border of normal) Low Urine pH ECG (arrhythmia with hyperkalaemia, hyperphosphateaemia and hypocalcaemia)
149
Define UTI
Prescence of a pure growth of >10^5 organisms per mL of fresh MSU
150
What are the sub classifications of UTI?
``` Lower UTI (Urethritis, cystitis or prostatitis) Upper UTI (Renal pelvis [pyelonephritis]) ```
151
What are classifications of UTI?
Uncomplicated - normal renal tract and function | Complicated - Abnormal renal/genitourinary tract
152
What are the causative organisms of UTI?
Most caused by E. Coli Others: Staphylococcus saprophyticus Proteus mirabilis Enterococci Atypical causes: Klebsiella Candida albicans Pseudomonas aerugniosa
153
What are the Risk Factors for UTI?
``` Females Sexual intercourse Exposure to spermicide Pregnancy - often asymptomatic Menopause Immunosuppressoin Catheterisation Urinary tract obstruction Urinary tract malformation ```
154
What are the presenting symptoms of UTIs? (Cystitis)
``` Frequency Urgency Dysuria Haematuria Suprapubic pain ```
155
What are the presenting symptoms of UTIs? (Prostatitis)
Flu-like symptoms Low backache Few urinary symptoms Swollen or tender prostate on PR
156
What are the presenting symptoms of UTI? (Acute pyelonephritis)
``` High fever Rigors Vomiting Loin pain and tenderness Oliguria (if AKI) ```
157
What are the investigations for UTI?
Urine dipstick [First] - Leucocytes and nitrites If dipstick is negative send MSU for MC&S Always send for MC&S for male, child, pregnant, immunosuppressed and ill Urine culture Ultrasound - Rule out obstruction Bloods - FBC, U&Es, CRP, blood cultures
158
How do you manage UTIs?
E. Coli - Trimethoprim or Nitrofurantion for 3-6 days (Men may need a longer course) Can use Co-amoxiclav or Cefalexin
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What are possible complications of UTIs
``` Pyelonephritis Perinephric and Intrarenal abscess Hydronephrosis or pyronephrosis AKI Sepsis Prostatic involvement - common in men ```
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What is a Varicocele?
Dilated veins of the pampiniform plexus forming a scrotal mass
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What else is varicocele known as?
Lover's nut
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What causes a varicocele?
More common on Left (80-90%) | Due to venous incompetence
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Why are varicoceles more common on the left?
The angle that the left testicular vein meets the left renal vein Lack of effective valves between testicular vein and renal vein INcreased refluc from compression of renal vein
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What are the symptoms of Varicocele?
``` Asymptomatic Feels like a bag of worms Scrotal heaviness Incidental finding Visible as distended blood vessels Possibly feel a dull ache ```
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What are the signs of a Varicocele?
Patient must be standing for exam Side of scrotum with varicocele hangs lower Swelling reduces lying down Valsalva while standing increases dilatation Cough impulse
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What are investigations for Varicocele?
Sperm count | Colour doppler scan
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What are Storage symptoms of LUTS known as?
Irritative
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What are the irritative LUTS symptoms?
FUN F - Frequency U - Urgency N - Nocturia
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What are the voiding symptoms of LUTS known as?
Obstructive
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What are the obstructive LUTS symptoms?
``` WISE W - Weak Stream I - Intermittency S - Straining E - incomplete Emptying ```

Conditions (18 decks)

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