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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
Q

Investigations of BPH

A

Urinalysis (Pyuria, nitrates, bacteria, lymphocytes)
U&Es (Check renal function)
MSU (MC&S)
PSA (Raise)

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26
Q

Management of BPH

A 
Catheterise in emergency
Lifestyle advice (Avoid caffeine, alcohol, relax when voiding)
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27
Q

What is the medical management of BPH

A

Tamsulosin - Alpha blockers

Finasteride - 5alpha reductase inhibitors

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28
Q

What are the surgical managements of BPH

A

TURP
TUIP
Open prostatectomy

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29
Q

Complications of BPH

A 
Recurrent UTI
Urinary retention
Urinary stasis
Obstructive renal failure
AKI
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30
Q

Prognosis of BPH

A

Mild symptoms can be controlled well medically

TURP has good response

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31
Q

What is Bladder Cancer

A

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

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32
Q

What are the Risk Factors of Bladder cacner

A

Smoking
Aromatic amines - rubber industry, dye stuff
Chronic cystitis
Cyclophosphamide treatment
Pelvic irradiation
Schistosomiasis - increased risk of squamous cell carcinomas

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33
Q

What are the symptoms of bladder cancer?

A 
Blood clots / Haematuria
Pain/Burning while urinating
Frequent urination
Urgency
Nocturia
Lower back pain
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34
Q

What are the signs of Bladder cancer

A

Haematuria

Nothing else

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35
Q

Investigations for bladder cancer

A 
Urine dip (Blood ++)
Cystoscopy (Find tumour/red patch)
Biopsy
Ultrasound (imaging)
MRI (imaging)
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36
Q

Define CKD

A

Pathological abnormality of kidney function

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37
Q

What causes CKD?

A

Diabetes is the most common cause

Hypertension & Glomerular disorders due to causing kidney damage

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38
Q

Risk Factors for CKD

A 
Diabetes
Hypertension
AKI history
Nephrotoxic drug use
Smoking
Family history of Diabetes and HTN
60+
People of colour
Male
CVD
Proteinuria
Obstructed urinary flow
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39
Q

Staging of CKD

A 
1 - GFR >/= to 90
2 - GFR 60-89
3a - GFR 45-59
3b - GFR 30-44
4 - GFR 15-29
5 - GFR < 15
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40
Q

Symptoms of CKD

A

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

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41
Q

Investigations for CKD

A

Serum Creatinine
Urinalyis
Renal ultrasound (atrophy and/or hydronephrosis)
eGFR
Antibodies (ANA [SLE], c-ANCA [Wegener’s], Anti-GBM [Goodpasture’s])

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42
Q

Signs of CKD

A

Proteinuria
Haematuria
Rash

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43
Q

What are LUTS symptoms

A 
FUND HIPS
F - Frequency
U - Urgency
N - Nocturia
D - Dysuria
H - Hesitancy
I - incomplete voiding
P - Poor Stream
S - Smell/odour
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44
Q

What is the definition of Epididymitis

A

Swelling / pain in the epididymis

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45
Q

What is the definition of Orchitis

A

Swelling/pain in the testicle

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46
Q

What are the causes of Epididymitis / Orchitis?

A

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

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47
Q

What are the Risk Factors for Epididymitis & Orchitis?

A 
Frequent UTIs
Bacterial Prostatitis
Bacterial STD
Urinary Catheterisation
Unprotected sex
Compromised Immunity
Bladder obstruction
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48
Q

What are the symptoms of Epididymitis & orchitis

A

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)
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49
Q

Investigations of Epididymitis & Orchitis

A

Gram stain
Urethral swab
Doppler (Exclude torsion)
ESR/CRP - Raised

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50
Q

Management plan for Epididymitis & Orchitis

A

If Gonococcal/Chlamydial - Ceftriaxone + Doxycycline

If <14 or 35< - Ofloxacin

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51
Q

Complications of Epididymitis & Orchitis

A

Abscess + Testicular infarct, may spread

May need Epididymectomy

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52
Q

Define Glomerulonephritis

A

An immunological mediated inflammation of the Renal glomeruli and nephron

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53
Q

What are the early signs of Glomerulonephritis/

A

Puffy face
Less often urinating
Haematuria
Coughing

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54
Q

What are the 2 classes of Glomerulonephritis and what are the types within them?

A

Non-Proliferative

  • Minimal change
  • Focal Segmental
  • Membranous

Proliferative

  • IgA Nephropathy
  • Membranoproliferative
  • Post infectious
  • Rapidly progressive (Has two types: Good Pastures and Vasculitic)
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55
Q

Of all the types of Glomerulonephritis, ‘Rapidly progressive’ has types, what are they?

A

Good pastures syndrome

Vasculitic disorders

  • Wegners granulomatosis
  • Microscopic polyangitis
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56
Q

What are the risk factors for glomerulonephritis?

A 
Hypertension
Diabetes
Cancer
Recent strep throat
Regular NSAID use
Bacterial endocarditis
Viral infection
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57
Q

What are the investigations for Glomerulonephritis?

A

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)

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58
Q

What are the symptoms of Glomerulonephritis?

A 
Haematuria
SC oedema
Polyuria or Oliguria
History of recent infection
Symptoms of uraemia or chronic infection
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59
Q

Patients with Glomerulonephritis present specific syndromes what are they?

A

Nephritic

Nephrotic

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60
Q

What is Nephrotic syndrome?

A

Increased permeability of the glomerulus leading to loss of proteins into the tubules - losing proteins

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61
Q

What are common causes of Nephrotic syndrome?

A

Primary:
Membranous glomerulonephritis
Minimal change disease
Mesangiocapillary glomerulonephritis

Secondary:
Diabetes
SLE (Class V nephritis)
Amyloidosis
Hepatitic B/C
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62
Q

What is Nephritic syndrome?

A

Thin glomerular basement membrance with pores that allow protein and blood into the tubule

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63
Q

Causes of Nephritic syndrome?

A

Primary:
IgA Nephropathy
Mesangiocapullary GN

Secondary:
Post streptococcal
Vasculitits
SLE 
Anti-GBM disease
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64
Q

What are the signs of GN

A 
Hypertension
Proteinuria
Haematuria (especially IgA nephropathy)
Renal failure
Nephrotic triad
Niphritic triad
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65
Q

What do you see in Nephrotic syndrome on examination?

A

Normal/Elevated BP
Proteinuria
Normal/lowered GFR

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66
Q

What is the triad of Nephrotic syndrome?

A

Proteinuria >3.5g/24hrs
Low Serum album <24g/L
Oedema
Note: Hypoalbminaemia leads to hyperlipidaemia by liver compensation

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67
Q

What do you see in Nephritic syndrome on examination?

A

Moderate-severe raised BP
Haematuria (mild-macro)
Moderate/severe decreased GFR

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68
Q

What is the triad of Nephritic syndrome?

A

Hypertension
Proteinuria
Haematuria

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69
Q

What is a Hydrocele?

A

Abnormal colection of fluid remnants of the processus vaginalis

70
Q

What are the 3 types of hydrocele?

A

Simple
Communicating
Non-communicating

71
Q

What is a simple hydrocele?

A

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
Q

What is a communicating hydrocele?

A

Persistence of processus vaginalis in older boys/men, allowing peritoneal fluid to commnuicate freely between the scrotum and the abdomen

73
Q

What is a non-communicating hydrocele?

A

Imbalance in secretion/reabsorption of fluid

Secondary to minor trauma, torsion, epididymitis, varicocele

74
Q

How does a hydrocele present?

A

Scrotal enlargement with non-tender, smooth cystic swelling
Painless unless infected
Palpable
Anterior and inferior to testis and illuminates

75
Q

Investigations for Hydrocele

A

Ultrasound scan - determine underlying pathology
Doppler US - Distinguish hydrocele or varicocele
Serum Alpha-fetoprotein and hCG - should be negative

76
Q

What is Nephrotic Syndrome?

A

Clinical syndrome showing heavy proteinuria & hypoalbuminaemia

77
Q

What are the primary causes of Nephrotic syndrome?

A

Primary causes
Minimal change disease (most common in kids)
Focal segmental GN (most common in adults)
Other types of GN

78
Q

What are secondary causes of Nephrotic syndrome?

A 
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
Q

What are symptoms of Nephrotic syndrome?

A 
Facial swelling with periorbital oedema
Peripheral oedema
Frothy urine
Hypercoagulability
Poor appetitie
Weakness
80
Q

Signs of Nephrotic syndrome

A 
Oedema
Tiredness
Leukonychia
Breathlessness
Fluid overload (High JVP)
Dyslipidaemia
81
Q

Investigations for Nephrotic syndrome

A 
Urine Dipstick (Proteinuria, haematuria)
MSU (MC&amp;S)
Albumin:Creatinine
Clotting screen (hypercoagulability)
Renal function test ( decreased)
82
Q

What is the definition of Polycystic kidney disease?

A

Heterogenous group of disorders by Renal cysts & numerous sytemic & extra renal manifestations

2 types: Autosomal Recessive and Autosomal dominant

83
Q

Causes of PKD?

A 
PKD1 mutation (85%)
PKD2 mutation (15%)
84
Q

Risk Factors for PKD?

A 
Large Kidneys
Episodes of gross haematuria
Headaches
Hypertension
Male
White
Family history
85
Q

What are symptoms of PKD?

A 
Flank/Abdominal pain
Renal Colic
Gross Haematuria
Headaches
Dyuria
Cystitis
Suprapubic pain
Urgency
Nausea
Early satiety
86
Q

What are signs of PKD?

A 
Palpable renal mass
Early onset HTN
Hernias
Rectus abdominis diastasis
May have murmur
87
Q

How many cysts are needed to diagnose PKD?

A

<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
Q

Investigations for PKD

A 
Renal US - first line
CTAP
MRIAP
Genetic testing for PKD1/2
MRI for SAH
89
Q

Define Prostate Cancer

A

Adenocarcinoma of peripheral prostate gland

90
Q

Where does prostate cancer usually metastasise?

A

Bone and lymph nodes

91
Q

What are the risk factors of Prostate cancer?

A 
Increasing age
Afro-Carribean
Genetic predisposition
Alcohol consumption
Chronic inflammation
Family History
Raised testosterone
Occupation exposure to cadmium
92
Q

What are the Symptoms of Prostate cancer?

A 
LUTS
Haematuria - locally invasive Cancer
Haematospermia
Loin pain
Anuria
AKI/CKD
Tenasmus
- if mets: Bone Pain/sciatica, paraplegia
93
Q

What are the signs of prostate cancer?

A

Hard, irregular prostate

Asymmetry of gland, nodule in lobe, lack of mobility, palpable seminal vesicles

94
Q

Investigations for Prostate Cancer?

A

PSA (Not super specific but first line)
DRE
Transrectal ultrasound guided biopsy - gold standard
Isotope bone scan for mets

95
Q

Definition of Renal artery stenosis?

A

Narrowing of Renal artery lumen.

96
Q

At what point does Renal artery stenosis become significant?

A

50%

97
Q

When does it start?

A

Onset typically before 30
Atherosclerosis accounts for 90% of RAS
2-10x more likely in Women

98
Q

There are 3 types of RAS causes, what are they?

A

Atherosclerosis
FIbromuscular dysplasia
Other

99
Q

What are the causes of atherosclerotic RAS?

A

Atherosclerosis
Diabetes mellitus
Dyslipidaemia
Smoking

100
Q

What are the causes of Fibromuscular dysplasic RAS?

A

Fibromsucular dysplasia
Intimal and adventitial fibroplasia
Smoking

101
Q

Other causes of RAS

A 
Post-transplant
Renal artery disease
Renal artery aneurysm
Takayasu's arteritis
Atheroemboli
Williams syndrome 
Neurofibromatosis
Truama
102
Q

Risk Factors of RAS

A 
Obesity
Dyslipidaemia
Smoking
Sedentary lifestule
Diabetes
HF
Hyperkalaemia
103
Q

Symptoms of RAS

A 
Foot and Ankle swelling
Continued HTN
Nausea and Vomiting
Weight loss
Cramps
Darkened skin
Change in urination
Accelerated HTN with ACEi
104
Q

Signs of RAS

A 
Hypertension
Decreased kidney function
Oedema in ankles and feet
Increased proteinuria
Renal artery bruits
105
Q

Investigations for RAS?

A 
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
Q

Define Renal cell carcinoma?

A

Most common tumours of kidney in adults
Wilm’s tumours most common in children
Benign renal tumours are uncommon

107
Q

What are the Risk Factors for Renal cell carcinoma?

A 
von Hippel-Lindau disease
Tuberous sclerosis
PKD
Familial renal cell cancer
Smoking
Chronic dialysis
108
Q

What are the symptoms of Renal cell carcinoma?

A

Present late
Asymptomatic in 90%
Triad: Haematuria, Flank pain, abdominal mass

Systemic signs of malignancy: Weight loss, Malaise, Paraneoplastic syndrome

109
Q

What are the types of Renal cell carcinoma?

A

Renal cell carcinoma
Papillary carcinoma
Transitional cell carcinoma

110
Q

What is the difference in presentation with Transitional cell carcinoma and Renal cell carcinoma?

A

Transitional cell carcinoma presents earlier with Haematuria

111
Q

What are the signs of Renal cell carcinoma?

A 
Palpable renal mass
Hypertension
Plethora
Anaemia
Left-sided can cause a left-sided varicocele
112
Q

What are the investigations for Renal cell carcinoma

A 
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
Q

Definition of Testicular cancer

A

95% from Germ cells
Subdivided into seminomatous and non-seminomatous

NSGC include: Leydig cell tumours, sertoli cell tumours and Sarcomas

114
Q

Risk Factors of Testicular cancer

A 
Cryptorchidism or testicular maldescent
Klinefelter's syndrome
Family history
Male infertility
Low birth weight
Young Parental age
Taller
115
Q

Symptoms of testicular cancer

A 
>95% present with testicular lump
Usually painless
Dragging sensation
Gynaecomastia
Teratomas undergo blood borne spread to liver, lung bases + brain
116
Q

Signs of Testicular cancer

A

Palpable lungs

Malignant testis usually lack sensation

117
Q

Investigations for Testicular cancer

A

Tumour marker assay (Alpha fetoprotein - yolk sac elements; Beta HcG made by trophoblastic elements)
B/L testicular US
CXR
Diagnosis by US

118
Q

What tumour markers do the different types produce?

A

Seminomas - PLAP
Teratoma - AFP
Sometimes teratomas produce HCG
LDH levels non-specific for big tumours of both types

119
Q

Define Testicular torsion

A

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
Q

Causes of testicular torsion?

A

Bell clapper deformity

Trauma

121
Q

Risk Factors for Testicular torsion

A 
12-18
Neonate
Bell clapper deformity
Trauma/Exercie 
Intermittent testicular pain
Undescended testicle
Cold weather
122
Q

Symptoms and Signs of Testicular torsion

A 
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
Q

Investigations for Testicular torsion

A 
Grey Scale US (Whirlpool sign, presence of fluid)
Colour doppler (No/decreased flow)
Urinalysis (Normal)
FBC (Normal)
CRP (Normal)
124
Q

Management of Testicular torsion

A

Urgent Orchidopexy/orchidectomy
Neonates - no intervention needed
Manual de-torsion: Only if surgery unavailable 6-13 hours since started

125
Q

Complications of Testicular torsion

A 
Testicular infarction/permanent loss
Infertility
Psychological implication
Cosmetic deficiency
Recurrent torsion
126
Q

Prognosis for Testicular torsion

A

Can be recurrent

127
Q

Definition of Urinary Tract Calculi

A

Formed when urine supersaturated with Salt and minerals e.g. Calcium oxalate, struvite, uric acid + cysteine

128
Q

What can make up a Kidney Stone?

A 
Calcium Oxalate - most common
Struvite - quite common
Urate - 5%
Hydroxyapatite - 5%
Cysteine - 2%
Magnesium ammonia phosphate - staghorn calculus
129
Q

What are the causes of Kidney stones

A

Metabolic causes (Hypercalciuria, -uricaemia, -cystinuria)
Infection
Drugs (Diuretics, Antacids, corticosteroids, indinavir)
Tract abnormalities
Foreign bodies (Stents, Catheters)

130
Q

Risk Factors for Kidney Stones

A

Low Fluid intake
Diet: Chocolate, tea, rhubarb, strawberries, nuts, spinach (Increase oxalate levels)
Season: Vitamin D
Structural abnormality e.g. horseshoe kidney

131
Q

Who are most affected by Kidney Stones

A

Men
20-50
Bladder stones more common in developing countries
Upper tract stones more common in western countries

132
Q

What are the symptoms of Nephrolithiasis?

A 
Often asymptomatic
SEVERE loin->groin pain
Nausea and vomiting
Unable to lie still
Urgency
Haematuria
133
Q

What are the signs of Nephrolithiasis?

A

Loin to lower abdominal tenderness - not on palpation
No signs of peritonitis
Signs of sepsis if obstruction

134
Q

What are the investigations for Urinary tract calculi?

A 
Urine dipstick (Haematuria)
Non-contrast CT KUB [Gold standard]
Ultrasound
U&amp;Es for renal function
Pregnancy test for women in case of ectopic - do USS instead of CT
135
Q

What is the management of Urinary tract calculi acutely?

A

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
Q

How do you remove a calculus?

A

Stones <5mm pass naturally with increased fluid

Stones >5mm / painful use medical treatment - if that doesnt work: ESWL or urethroscopy or PCNL

137
Q

What medicines do you use to remove a calculus?

A

Nifedipine or

Tamsulosin (Alpha blocker)

138
Q

What is ESWL

A

Extracorporeal shock-wave lithotripsy
Non-invasive
Shockwave focused onto calculus breaks it up into smaller fragments that pass normally

139
Q

What is urethroscopy?

A

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
Q

What is PCNL?

A 
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
Q

What are possible complications of a Renal stone?

A

Infection (Pyelonephritis)
Sepsis
Urinary retention

142
Q

What are possible complications of Ureteroscopy?

A

Perforation

False passage

143
Q

What are possible complications of Lithotripsy?

A

Pain

Haematuria

144
Q

What is Tumour Lysis syndrome?

A

Combination of metabolic and electrolyte abnormalities that occur in patients with cancer, usually after initiation of cytotoxic treatment

145
Q

What causes Tumour lysis syndrome?

A

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
Q

What are the Risk Factors for TLS?

A 
Haematological malignancy
Large tumour burden
Chemosensitive tumours
Recent chemo
Renal impairment
Dehydration
Age
Nephrotoxic drugs
147
Q

Signs and Symptoms of TLS?

A 
High Serum Creatinine
Nausea and Vomiting
Diarrhoea
Lethargy
Paraesthesia
Hyper/hypotension
Anorexia
Syncope
Chvostek sign
148
Q

Investigations for TLS

A

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
Q

Define UTI

A

Prescence of a pure growth of >10^5 organisms per mL of fresh MSU

150
Q

What are the sub classifications of UTI?

A 
Lower UTI (Urethritis, cystitis or prostatitis)
Upper UTI (Renal pelvis [pyelonephritis])
151
Q

What are classifications of UTI?

A

Uncomplicated - normal renal tract and function

Complicated - Abnormal renal/genitourinary tract

152
Q

What are the causative organisms of UTI?

A

Most caused by E. Coli

Others:
Staphylococcus saprophyticus
Proteus mirabilis
Enterococci

Atypical causes:
Klebsiella
Candida albicans
Pseudomonas aerugniosa

153
Q

What are the Risk Factors for UTI?

A 
Females
Sexual intercourse
Exposure to spermicide
Pregnancy - often asymptomatic
Menopause
Immunosuppressoin
Catheterisation
Urinary tract obstruction
Urinary tract malformation
154
Q

What are the presenting symptoms of UTIs? (Cystitis)

A 
Frequency
Urgency
Dysuria
Haematuria
Suprapubic pain
155
Q

What are the presenting symptoms of UTIs? (Prostatitis)

A

Flu-like symptoms
Low backache
Few urinary symptoms
Swollen or tender prostate on PR

156
Q

What are the presenting symptoms of UTI? (Acute pyelonephritis)

A 
High fever
Rigors
Vomiting
Loin pain and tenderness
Oliguria (if AKI)
157
Q

What are the investigations for UTI?

A

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
Q

How do you manage UTIs?

A

E. Coli - Trimethoprim or Nitrofurantion for 3-6 days (Men may need a longer course)
Can use Co-amoxiclav or Cefalexin

159
Q

What are possible complications of UTIs

A 
Pyelonephritis
Perinephric and Intrarenal abscess
Hydronephrosis or pyronephrosis
AKI
Sepsis
Prostatic involvement - common in men
160
Q

What is a Varicocele?

A

Dilated veins of the pampiniform plexus forming a scrotal mass

161
Q

What else is varicocele known as?

A

Lover’s nut

162
Q

What causes a varicocele?

A

More common on Left (80-90%)

Due to venous incompetence

163
Q

Why are varicoceles more common on the left?

A

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

164
Q

What are the symptoms of Varicocele?

A 
Asymptomatic
Feels like a bag of worms
Scrotal heaviness
Incidental finding
Visible as distended blood vessels
Possibly feel a dull ache
165
Q

What are the signs of a Varicocele?

A

Patient must be standing for exam
Side of scrotum with varicocele hangs lower
Swelling reduces lying down
Valsalva while standing increases dilatation
Cough impulse

166
Q

What are investigations for Varicocele?

A

Sperm count

Colour doppler scan

167
Q

What are Storage symptoms of LUTS known as?

A

Irritative

168
Q

What are the irritative LUTS symptoms?

A

FUN
F - Frequency
U - Urgency
N - Nocturia

169
Q

What are the voiding symptoms of LUTS known as?

A

Obstructive

170
Q

What are the obstructive LUTS symptoms?

A 
WISE
W - Weak Stream
I - Intermittency
S - Straining
E - incomplete Emptying

Conditions (18 decks)

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