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SJ Phase 2a > Renal + Genitourinary > Flashcards

Renal + Genitourinary Flashcards

1
Q

Define nephrolithiasis

A
  1. Renal stones
  2. Consists of crystal aggregates
  3. Stones form in collecting ducts
  4. May be deposited anywhere from renal pelvis -> urethra
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2
Q

Aetiology and risk factors of nephrolithiasis

A
  1. Dehydration
  2. Infection
  3. Hypercalcaemia/oxaluria/calciuria/uricaemia
  4. Primary renal disease
  5. Drugs
    • Diuretics
    • Antacids
    • Corticosteroids
    • Aspirin
    • Vit C & D
  6. Diet
  7. Gout
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3
Q

State aetiology of calcium stone based nephrolithiasis

A
  1. Hyperparathyroidism
  2. Excess dietary Ca2+
  3. Idiopathic hypercalciuria (increased absorption in gut)
  4. Primary renal disease
  5. HYPEROXALURIA
    • Dietary oxalate rich food (spinach, rhubarb, chocolate, tea)
    • Low dietary Ca2+
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4
Q

Aetiology of infection induced stones

A
  1. UTI organism hydrolyse urea -> ammonium hydroxide
  2. Ammonium ions + alkalinity -> stone formation
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5
Q

Aetiology of cystine stones

A
  1. Cystinuria - autosomal recessive condition -> affects cysteine in epithelial cells of renal tubules
  2. Excessive urinary excretion and formation of cysteine stones
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6
Q

Clinical presentation of renal colic

A
  1. Rapid onset
  2. Excruciating ureteric spasm (writhing in pain)
  3. Loin to groin pain in waves
  4. Cannot lie still (differentiates from peritonitis)
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7
Q

Differential diagnosis of renal colic

A
  1. Vascular accident (AAA)
  2. Bowel pathology
  3. Ectopic pregnancy or ovarian cyst torsion
  4. Testicular torsion
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8
Q

Diagnosis of renal stones/colic

A
  1. FIRST LINE
    • Kidney Ureter Bladder X-ray
  2. GOLD STANDARD
    • Non-contrast CT of Kidney Ureter Bladder (KUB)
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9
Q

Treatment of renal stones/colic

A
  1. Strong analgesic for colic (IV DICLOFENAC)
  2. Antibiotics if infection
  3. Antiemetics for vomiting
  4. Medical expulsion therapy
    • Oral NIFEDIPINE or Oral TAMSULOSIN to promote expulsion and reduce analgesia use
  5. Extracorporeal Shockwave Lithotripsy (ESWL) - ultrasound to fragment stones
  6. Endoscopy with laser for larg stones
  7. Percutaneous Nephrolithotomy (PCNL) - keyhole surgery
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10
Q

Define AKI

A
  1. Abrupt sustained rise in serum urea and creatinine
  2. Rapid decline in GFR
  3. Failure to maintain fluid, electrolyte and acid-base homeostasis
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11
Q

Criteria for diagnosing AKI

A
  1. Rise in creatinine > 26 micromol/L in 48h
  2. Rise in creatinine > 1.5x baseline
  3. Urine output < 0.5mL/kg/h for more than 6 consecutive hours
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12
Q

Aetiology of AKI

A
  1. Ischaemia
  2. Sepsis
  3. Nephrotoxins
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13
Q

Clinical presentation of AKI

A
  1. Palpable bladder, kidneys, pelvic masses, rashes
  2. Oliguria (low urine output)
  3. Arrhythmia
  4. High urea symptoms
    • fatigue, anorexia, N&V
  5. Oedema
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14
Q

Differential diagnosis of AKI

A
  1. AAA
  2. alcohol toxicity
  3. Ketoacidosis
  4. CKD
  5. Metabolic acidosis
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15
Q

Treatment of AKI

A
  1. PRE RENAL
    • Correct volume loss
    • Treat sepsis
  2. INTRINSIC RENAL
    • Refer to nephrology
  3. POST RENAL
    • Catheter
    • If signs of obstruction; treat obstruction
  4. Stop nephrotoxic drugs
    • NSAIDS
    • ACEi
    • Gentamicin
    • Amphotericin
  5. Renal Replacement Therapy (RRT)
    • Haemodialysis
    • Haemofiltration
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16
Q

Define CKD

A
  1. Longstanding progressive impairment
  2. In renal function
  3. GFR < 60mL/min/1.73m2
  4. > 3months
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17
Q

Aetiology of CKD

A
  1. Diabetes mellitus T2>T1
  2. Hypertension
  3. Atherosclerotic renal vascular disease
  4. Polycystic kidney disease
  5. Tuberous sclerosis
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18
Q

Pathophysiology of CKD

A
  1. When nephrons fail, burden of filtration fall on remaining nephrons
  2. Remnant nephrons experience increased flow/nephron (hyperfiltration) as blood flow remains the same
  3. Nephrons adapt by: glomerular hypertrophy and reduced arteriolar resistance
  4. -> Increased flow, pressure and shear stress
  5. -> Cycle of raised intraglomerular capillary pressure and strain
  6. .˙. accelerates remnant nephron failure
  7. Therapy aims to inhibit Angiotensin II and proteinuria through ACEI and angiotensin receptor antagonists
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19
Q

Clinical presentation of CKD

A
  1. Serum urea and creatinine used to measure accumulation of metabolites
  2. Serum urea > 40mmol/L -> symptoms
  3. Anorexia + weight loss
  4. Insomnia
  5. Nocturia + polyuria
  6. Itching
  7. D+V
  8. Oedema
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20
Q

Differential diagnosis of CKD

A
  1. AKI
    • history
    • duration of symptoms
      NORMOCHROMIC ANAEMIA
      SMALL KIDNEYS
      RENAL OSTEODYSTROPHY
      —–> CKD
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21
Q

Diagnosis of CKD

A
  1. Urinalysis
    • Haematuria
    • Proteinuria
    • Albumin:Creatinine (ACR)
    • Protein:Creatinine (PCR)
  2. Serum biochem
    • U+E, Bicarb, creatine
    • Low eGFR
    • Raised alkaline phosphatase
    • Raised PTH
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22
Q

Treatment of CKD

A
  1. Treat reversible causes
    • Obstruction
    • Nephrotoxic drugs
    • Smoking cessation
    • Glucose + weight control
  2. Limit progression
    • BP target = <130/80
    • ACEi = RAMIPRIL
    • Angiotensin receptor blocker = CANDESARTAN (preferred if diabetes present)
    • Diuretics = oral BENDROFLUMETHIAZIDE
    • CCB = VERAPAMIL
    • BONE DISEASE
      • PTH
      • Phosphate restriction + binders = decrease gut absorption
      • Vit D + Ca2+ supplements
    • CVD
      • Statins (cholesterol) = SIMVASTATIN
      • Aspirin
    • ACIDOSIS
      • Systemic acidosis -> increased serum K+
      • Treat = SODIUM BICARB
    • OEDEMA = FUROSEMIDE
  3. Renal Replacement Therapy
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23
Q

Define pyelonephritis

A
  1. Infection of renal parenchyma and soft tissues of renal pelvis and upper ureter
  2. Caused by KEEPS
    • Klebsiella spp.
    • E.coli
    • Enterococcus spp.
    • Proteus spp.
    • Staph spp.
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24
Q

Pathophysiology of pyelonephritis

A
  1. Infection from bacteria from patient’s own gut flora
  2. Commonly via ascending transurethral route
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25
Clinical presentation of pyelonephritis
1. Loin pain + fever + pyuria (pus in urine) 2. Rigors 3. N+V
26
Differential diagnosis of pyelonephritis
1. Diverticulitis 2. AAA 3. Renal stones 4. Cystitis 5. Prostatitis
27
Diagnosis of pyelonephritis
1. Tender loin on examination 2. Urine dipstick - Nitrites - Leucocyte elastase - Odour - Protein 3. MIDSTREAM URINE MICROSCOPY = GOLD STANDARD
28
Treatment of pyelonephritis
1. Cranberry juice + fluids 2. Analgesia 3. Antibiotics - Mild = CIPROFLOXACILLIN or CO-AMOXICLAV - Severe = IV GENTAMICIN or IV CO-AMOXICLAV
29
Define cystitis
Urinary infection of bladder
30
Clinical presentation of cystitis
1. Dysuria (painful/burning urine) 2. Frequency 3. Urgency 4. Suprapubic pain 5. Haematuria
31
Diagnosis of cystitis
1. Microscopy and sensitivity of sterile mid-stream urine - GOLD STANDARD 2. Dipstick urinalysis - +ve leucocytes, blood and nitrites
32
Treatment of cystitis
1st line - TRIMETHOPRIM or CEFALEXIN
33
Define prostatitis
Infected and inflamed prostate gland
34
Aetiology of prostatitis
ACUTE 1. Strep. faecalis 2. E. coli 3. Chlamydia CHRONIC 1. Bacterial 2. Non-bacterial - elevated prostatic pressure - pelvic floor myalgia
35
Clinical presentation of acute prostatitis
1. Fever, rigor, malaise 2. Pain on ejaculation 3. LUTS symptoms 4. Pelvic pain
36
Clinical presentation of chronic prostatitis
1. Acute symptoms for > 3 months 2. Recurrent UTIs
37
Diagnosis of prostatitis
DRE - Tender or hot to touch - Hard from calcification
38
Define IgA nephropathy
1. IgA deposition in mesangium (structural support of glomerulus) of kidney 2. Attack on kidney
39
Treatment of IgA nephropathy
BP control - ACEi - ARB
40
Clinical presentation of IgA nephropathy
1. Haematuria 2. Proteinuria 3. Hypertension + oedema 4. Oliguria 5. Deteriorating kidney function + GFR
41
Diagnosis of IgA nephropathy
1. eGFR 2. Proteinuria 3. Serum U+E and albumin 4. Culture from throat or skin 5. Urine dipstick
42
Define post-strep glomerulonephritis
Triggered by immune response from infection
43
Clinical presentation of post-strep glomerulonephritis
1. Typically children 2. 1-3 weeks after strep infection (tonsillitis) 3. STREP PYOGENES
44
Pathophysiology of post-strep glomerulonephritis
Bacterial antigen trapped in glomerulus -> diffuse proliferative glomerulonephritis
45
Define BPH
Increase in prostate size without malignancy
46
Clinical presentation of BPH
LUTS symptoms
47
Diagnosis of BPH
1. DRE 2. Serum electrolytes and renal ultrasound 3. Transrectal ultrasound 4. PSA
48
Treatment of BPH
1. Avoid caffeine and alcohol 2. Void twice in a row 3. Alpha 1 antagonists = TAMSULOSIN - Relax smooth muscle of bladder neck 4. 5-alpha-reductase inhibitor = FINASTERIDE - Blocks conversion of testosterone to dihydrotestosterone 5. Surgery - Transurethral resection of prostate (TURP) = GOLD STANDARD
49
Define prostate cancer
1. Adenocarcinoma in peripheral zone of prostate gland 2. Metastases in bone and lymph nodes
50
Pathophysiology of prostate cancer
Androgen receptor on prostate responsible for malignancy
51
Clinical presentation of prostate cancer
1. LUTS symptoms 2. Weight loss, bone pain, anaemia = metastasis
52
Diagnosis of prostate cancer
1. DRE - Hard irregular prostate 2. Raised PSA (>16 ng/mL) 3. Trans-rectal ultrasound + biopsy - Gleason score
53
Treatment of prostate cancer
1. Confined to prostate - Radical prostatectomy - Radiotherapy + hormone therapy - Brachytherapy 2. Metastatic disease - Endocrine therapy - Orchidectomy - Luteinising Hormone Receptor Hormone agonist = SC GOSERELIN or LEUPRORELIN - Androgen receptor blocker = BICALUTAMIDE
54
Define varicocele
1. Abnormal dilation of testicular veins 2. In pampiniform venomous plexus 3. Caused by venous reflux
55
Aetiology of varicocele
1. Left most common 2. Due to angle at which left testicular vein enters left renal vein 3. Increased reflux from renal vein compression 4. lack of effective valves between testicular and renal veins
56
Clinical presentation of varicocele
1. Distended scrotal blood vessels (bag of worms sensation) 2. Dull ache 3. Scrotum hangs lower on side of varicocele
57
Differential diagnosis of varicocele
Kidney or retroperitoneal tumour
58
Diagnosis of varicocele
1. Venography 2. Colour doppler ultrasound
59
Treatment of varicocele
Surgery
60
Define testicular torsion
1. Torsion of spermatic cord 2. Occlusion of testicular blood vessels 3. Lead to rapid ischaemia + infarct 4. Potential loss of testis
61
Aetiology of testicular torsion
Belt-clapper deformity - testis not fixed to scrotum completely -> free movement
62
Clinical presentation of testicular torsion
1. Abdominal pain 2. Sudden onset in one testis 3. Physical exertion -> pain 4. N+V 5. Inflammation of one testis
63
Differential diagnosis of testicular torsion
1. Epididymo-orchitis - Older + symptoms of UTI + gradual onset 2. Tumour/trauma 3. Torsion of epididymal appendage - younger (7-12) - Less pain - Small blue nodule under scrotum - Due to surge of gonadotrophin
64
Diagnosis of testicular torsion
1. Doppler ultrasound = lack of blood flow 2. Urinalysis = exclude infection
65
Where are renal stones classically present?
- Pelviureteric junction - Pelvic brim - Vesicoureteric junction
66
State the pre renal causes of AKI
1. Renal hypoperfusion -> drop in GFR 2. Hypovalaemia - dehydration or haemorrhage 3. Hypotension without hypovalaemia 4. Low CO
67
State the intrinsic renal causes of AKI
INTRINSIC RENAL - requires biopsy - renal parenchyma damage - Acute tubular necrosis - Renal vasculature thrombosis - Malignant hypertension - Glomerulonephritis
68
State the post renal causes of AKI
Urinary tract obstruction
69
State the stages of CKD and GFR
S1 = ≥ 90 S2 = 60-89 S3a = 45-59 S3b = 30-44 S4 = 15-29 S5 = < 15
70
What is the difference between nephritic and nephrotic?
Nephritic = inflammation -> haematuria Nephrotic = increased permeability -> proteinuria

SJ Phase 2a (13 decks)

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