Renal & Genitourinary Flashcards
1
Q
Sites of ureteric constriction (sites where urinary stones can lodge)
A
- Pelvicureteric junction
- Pelvic Brim
- Vesicoureteric junction
2
Q
Anatomy of kidney
A
3
Q
Structure of nephron
A
4
Q
Pathophisiology of kidney stones (nephrolithiasis)
A
Within tubule of nephrons crystal like structures can form. These crystal like structures are precipitance of electrolytes that have acculumated. Urine supersaturation with stone forming salts -> crystal formation
If crystal is small it will pass in urine.
If crystal remains in kidney it becomes a stone
Continue on pic
5
Q
Clinical presentation of kidney stones
A
Triad: fever, vomiting, flank pain
6
Q
Risk Factors for developing kidney stones
A
7
Q
What do the risk factors in developing kidney stones increase/decrease ?
A
Increase urinary solutes (Calcium, uric acid, oxalate and sodium)
Decrease stone inhibitors (citrate and magnesium)
=this causes urine supersaturation leading to urinary crystal formation
8
Q
What factors contribute to urine supersaturation and therefore urinary crystal formation
A
Increase urinary solutes (calcium, uric acid, oxalate and sodium)
Decrease stone inhibitors (citrate and magnesium)
Dcerease urinary volume
Increase/decrease urinary pH
9
Q
Stone pathology
A
10
Q
Investigations for kidney/urinary stone formation
A
11
Q
Acute management of kidney stones
A
12
Q
Management of kidney stones
A
Percutaneous nephrostomy (symptomatic relief)
Ureteric stent insertion
Percutaneous nephrolithotomy
Endoscopic treatment/open surgery
Extracorporeal shock wave lithotripsy
13
Q
What is acute kidney injury
A
sudden deterioration in kidney function
14
Q
What is kidney fucntion measured in?
A
Glomelular Filtration Rate
15
Q
What is GFR?
A
Flow rate of filtered fluid through the kidney
16
Q
How is GFR measured?
A
Difficult to measure directly, estimated using creatinine clearance
Cockcroft-Gault formula:
17
Q
Causes of Acute Kidney Injury
A
18
Q
Signs and symptoms of acute kidney injury
A
19
Q
Diagnosis of acute kidney injury
A
Definition:
1. Increase in serum creatinine of 26micromol/l in 48h
2. Increase in serum creatinine of 1.5x of baseline
3. Urine production below 0.5mol/kg/h
20
Q
List some nephrotoxic medication (DAMN)
A
D:iuretics
A: CEi/ARB/antibiotics
M: etformin
N: SAIDs
21
Q
Tretment for AKI
A
22
Q
Indications for acute dialysis
A
23
Q
What is chronic kidney disease
A
Progressive, irreversible condition characterised by reduced kidney function or kidney damage (Any cause), lasting for >=3 months
24
Q
Classification of chronic kidney disease
A
Based on GFR
25
Symptoms and complication of chronic kidney disease
26
Aetiology of CKD
Most common causes:
1.Type 2 diabetes mellitus (30-50%)
Type 1 diabetes mellitus (4%)
2. Hypertension
27
Pathophysiology of CKD
28
Epidemiology + Risk Factors for CKD
29
Diagnosis of CKD
30
Treatment for CKD
+Renal Replacement therapy:
Usually later stages but not based on GFR alone
Extracorporeal: haemodialysis/haemofiltration, peritoneal dialysis, renal replacement
31
What is a urinary tract infection
Bacterial infection of the urinary tract
Causative agents:
1. E-coli (80%)
2. Enterobacteriae
3. Proteus mirabilis
4. Klebsiella pneumoniae
32
Why are women at a greater risk of getting a UTI
Urethra is shorter than males
33
Lower Urinary Tract Infection
1. Cystitis (bladder)
2. Prostatitis (prostate)
3. Urethritis (urethra)
4. Epidydmo-Orchitis
34
Upper Urinary Tract Infection
Pyelonephritis (kidney)
35
Pathogenesis of UTI
1. Contamination
2. Colonisation in urethra/bladder
3. Inflammatory response
4. Neutrophil infiltration
5. Bacteria multiply: Immune system evasion (virulence)
6. Ascension to the kidney
7. Colonisation of kidney
8. Bacteremia
36
Risk Factors for UTI
37
Signs and symptoms of UTI
38
Classification of UTI
39
Investigations + Diagnosis for UTI
40
Treatment for UTI
41
Prevention of UTI
42
What is nephritic syndrome?
Collection of signs and symptoms as a result of glomerulonephritis
43
Nephritic syndrome vs nephrotic syndrome
44
Anatomy of Glomerulus
45
Pathophysiology of nephritic syndrome
Cause -> Inflammation: cell proliferation, complement, leukocyte recruitment, protease/free radials -> injury
46
Signs and symptoms of nephritic syndrome
Characteristics of nephritic syndrome:
1. Proteinuria
2. Haematuria: Acanthocyte
3. RBC casts: suggestive of GN
4. Sterile pyuria
5. RAAS activation -> Hypertension
6. Decrease GFR -> Oliguria
47
Causes of nephritic syndrome
1. Rapidly progressive glomerulonephritis (RPGN) aka "crescentic GN"
a. Anti glomerular basement membrane (Goodpasture's)
b. Immune complex mediated
-IgA neuropathy (Berger disease)
-Post Streptococcal Glomerulonephritis
-Diffuse proliferative glomerulonephritis
48
Anti glomerular basement membrane (Goodpasture's)
49
IgA neuropathy (Berger disease)
50
Post Streptococcal Glomerulonephritis
51
Diagnosis of nephritic syndrome
52
Treatment for nephritic syndrome
53
SLE neuropathy (Lupus nephritis)
caused by lupus and can present as nephrotic and nephritic syndrome
occurs due to immune complexes in the nephron. It is a type III hypersensitivity.
inflammation can be detected by biopsy
Treatment is the same as lupus:
-corticosteroids
-mycophenolate
-cyclophosphamide
54
Pathophisiology of nephrotic syndrome
Injury to structures -> Excessive protein loss -> Hypoalbuminemia
55
Signs and symptoms of nephrotic syndrome
56
Causes of nephrotic syndrome
1.Minimal change disease
2.Focal segmental glomerulosclerosis
3.Membranous nephropathy
Can be primary (idiopathic) or secondary
57
Minimal change disease
95% cases in children
abnormalities seen on electron microscopy
mostly primary
secondary causes include: hodgkin's lymphoma & NSAIDs
58
Focal segmental glomerulosclerosis
Primary possible
More commonly secondary: HIV, obesity, reflux nephropathy, drugs: lithium, biphosphanates
Genetic: Nephrin (slit diaphragm), laminin 2 (GBM)
59
Membranous nephropathy (membranoproliferative glomerulonephritis)
Thickening of basement membrane
Spike and dome pattern of immune deposits in the suepithelial space
70% primary, 1/3 secondary
Secondary causes: malignancy, hepatitis, syphilis, lupus, drugs (penicillamine, NSAIDs)
60
Epedimiology/Risk Factors of nephrotic syndrome
61
Diagnosis of nephrotic syndrome
62
Treatment for nephrotic syndrome
63
What is benign prostatic hyperplasia (BPH)
non-cancerous growth of the prostate gland
common in men over 50
not premalignant
characterised by nodular prostatic hyperplasia
64
Anatomy of the prostate
65
Anatomy of prostate gland
66
Symptoms of BPH
67
Diagnosis of BPH
68
Treatment for BPH
69
Causes of BPH
70
What is prostate cancer
prostate cancer is a tumor or growth that originates in the prostate gland
71
Types of prostate cancer
1.Prostate adenocarcinoma: arises from luminal/basal cells
2.Transitional cell cancer: arises from prostatic urethra thransitional epithelium cells
3.Small cell prostate cancer: arises from neuroendocrine cells
72
Prostate adenocarcinoma
most common type
genetic mutation in a luminal cell or basal cell
mutation in 2 genes (BRCA1 & BRCA2)
Risk Factors:
1. Old age
2. Obesity
3. High fat/low fiber diet
73
Symptoms of prostate cancer
early on there are no symptoms
if cancer does compress urethra or bladder:
difficulty urinating
bleeding
pain with urination and ejaculation
if metastatic, spreads to bones (e.g vertebrae or pelvis) -> hip/lower back pain
74
Diagnosis of prostate cancer
Digital rectal exam
Transrectal ultrasound or MRI
Prostate cancer can cause elevation in prostate specific antigen
=ULTIMATELY REQUIRES BIOPSY for GLEASON GRADING SYSTEM
75
What is the Gleason Grading system
Identifies 2 most common cell patterns for prostate cancer
Score (1-5)
Numbers added = total gleason score (2-10)
1: Normal (well differentiated)
5: Abnormal cells
76
Treatment for prostate cancer
77
Scrotal diseases:
Varicocele
Testicular torsion
Epididymal cyst
Hydrocele
78
What is a varicocele
testicular disorder of young adults characterised by dilatation of pampiniform venous plexus, internal spermatic vein
most common cause of scrotal enlargement in young adults
usually let sided (>80%) due to increase in flow of resistance from left testicular vein drainage into left renal vein; right testicular vein drains directly to inferior vena cava (decrease flow resistance)
79
Types of varicocele
Large: easily identified by inspection as distention
Moderate: identified by palpation as "bag of worms"
Small: identified only as bearing down -> Increase abdominal pressure -> impeding drainage -> Increase varicocele size
80
Causes of varicocele
81
Signs and symptoms of varicocele
throbbing/dull pain: worse on standing
dragging sensation
infertility
82
Diagnosis of varicocele
Doppler ultrasound
CT scan
Semen analysis
83
Treatment for varicocele
surgery
84
What is testicular torsion
Rotation of the testicle with strangulation of its blood supply
Emergency
Can lose testicle in 6 hours
Ages 12-18
85
Symptoms of testicular torsion
Severe local pain
Nausea/vomiting
Scrotal oedema
Testis may be horizontally elevated
Loss of cremasteric reflex: stroke inner thigh, pulls up testis
(-) Prehn's sign: elevate testis, pain is NOT relieved in testicular torsion
86
Diagnosis of testicular torsion
Color doppler ultrasound
Contrast enhanced MRI
87
Treatment for testicular torsion
Manual detorsion
Surgical
88
Risk factor for testicular torsion
Bell Clapper deformity
89
What is testicular cancer
Malignant tumours that form in one or both testes
often detected in the early stages
good prognosis
90
testes anatomy
91
semineferous tubule anatomy
92
Types of germ cell tumours
Seminomas: most common
Yolk sac tumour: most common germ cell tumour in children
Teratomas
Choriocarcinoma
Embryonal carcinoma
93
seminomas
made of germ cells that multiply without differentiating into other types of cells
germ cells: big with central nuclei surrounded by clear cytoplasm "fried egg"
surrounded by fibrous tissue
placental alkaline phosphatase
94
Yolk sac tumour
95
Teratomas
96
Choriocarcinoma
97
Embryonal carcinoma
98
Sex cord/gonadal stromal tumours
Sertoli cell tumours
Leydig cell tumours
99
Sertoli cell testicular tumours
100
Leydig cell tumours
101
Risk Factors for testicular cancer
cryptorchidism
klinefelter syndrome
in utero exposure: pesticides, synthetic sex hormones
genetic
102
Symptoms for testicular cancer
103
Complications of testicular cancer
104
Diagnosis for testicular cancer
105
Treatment for testicular cancer
106
Bladder carcinoma
common urogenital cancer
common in the lederly and is strongly associated with smoking
107
Types of bladder carcinoma
1.urothelial carcinoma (transitional cell carcinoma)
2.Squamous cell carcinoma
3.Adenocarcinoma
108
Risk Factors for bladder cancer
109
Signs and symptoms of bladder cancer
110
Investigations for bladder cancer
111
Staging of bladder cancer
PET scan/CT scan
Who staging:
Low malignancy potential
Low grade
High grade
112
Management of bladder cancer
113
What is polycystic kidney disease?
Condition characterised by development of multiple cysts within the renal tubules. It is the most common hereditary renal disease
114
Pathophisiology of polycystic kidney disease
1.May begin in utero
2.Size ranges - microscopic to cm
3.Cyst formation + compression -> dysfunctional tubules -> intially compensated
But over time GFR falls -> end stage renal disease
115
Types of polycystic kidney disease
Autosomal Dominant Polycystic Kidney Disease
Autosomal Recessive Polycystic Kidney Disease
116
Autosomal Dominant Polycystic Kidney Disease
117
Autosomal Recessive Polycystic Kidney Disease
118
Signs and symptoms of polycystic kidney disease
119
Complications of polycystic kidney disease
120
Diagnosis of polycystic kidney disease
121
Treatment for polycystic kidney disease
122
What is an epididymal cyst?
smooth, extratesticular, spherical cyst in the head of the epididymis
Usually develop around the age of 40
Not uncommon
Rare in children
123
Pathophisiology of an epididymal cyst
Contain clear and milky (spermatocele) fluid
Lie above and behind the testes
124
Signs and symptoms of an epididymal cyst
125
Epididymal cyst differential diagnosis
126
Diagnosis of an epididymal cyst
Scrotal ultrasound
127
Treatment of an epididymal cyst
Usually not necessary
If painful and symptomatic then surgical excision
128
What is a hydrocele
abnormal collection of serous fluid in tunic vaginalis
129
Types of hydrocele based on aetiology
Congential
Acquired
Acquired can be further subdivided into primary and secondary
130
What is primary acquired hydrocele
Defective absorption of fluid from tunica vaginalis
Most common hydrocele
131
Secondary acquired hydrocele
Excessive production of fluid
Causes:
1.Epididymo-orchitis (most common)
2.Torsion of testes
3.Testicular tumours
4.Trauma
132
Clinical Features of hydrocele
Primary:
Painless, progressive swelling
starts in scrotum (unlike hernia)
penis might be buried in scrotum
Secondary:
Testicular pain prior to swelling (epididymo-orchitis)
Sudden severe testicular pain (torsion)
Lied anterior to and below the testis and will transilluminate
133
Diagnosis of hydrocele
ultrasound
transilluminate
134
Treatment for hydrocele
Resolve spontaneously
Many of infancy resolve by 2 years
Therapeutic aspiration or surgical removal
135
What are lower urinary tract symptoms
Nocturia
Frequency
Urgency
Post-micturition dribbling
Poor stream/flow
Hesitancy
Overflow incontinence
Haematuria
Bladder stones
UTI
136
Classification of incontinence
overactive bladder (OAB)/urge incontinence: due to detrusor over activity
stress incontinence: leaking small amounts when coughing or laughing
mixed incontinence: both urge and stress
overflow incontinence: due to bladder outlet obstruction, e.g. due to prostate enlargement
137
Causes of urge continence
UTIs
CNS disorders: stroke, Parkinsons, MS
138
Causes of stress incontinence
Increased abdominal pressure: coughing, sneezing, laughing
Pregnancy
139
Causes of overflow incontinence
Problem with emptying:
-Blockage: BPH, prostate cancer,
-Ineffective detrusor muscle: diabetes mellitus, spinal cord injury, cauda equina syndrome
140
Incontinence table
141
Causes of retention
142
Diffuse proliferative glomerulonephritis
143
Membranoproliferative glomerulonephritis
144
Malignant renal tumour
Renal carcinoma
145
Types of renal carcinoma
Renal cell carcinoma: arises from renal tubule
Transitional cell carcinoma: arises from the renal pelvis
146
Clinical presentation of renal carcinoma
Haematuria
Abdominal mass
Lethargy
Anorexia
Weight loss
Abdominal pain
147
Pathophisiology of renal cell carcinoma
Can secrete PTH (hypercalcaemia), ACTH (Cushing like syndrome), EPO (polycythaemia), renin (HTN)
Common metastases: Lymphoma, lung, breast, skin
148
Common metastases of transitional cell carcinoma
Lymphoma
Lung
Breast
Skin
149
Causes of renal carcinoma
Smoking
Horshoe kidney
Adult polycystic kidney disease
Kidney failure
150
Sympotms and signs of renal carcinoma
Passing of blood in urine
Flank pain
Abdominal mass
151
Diagnosis of renal carcinoma
CT
Abdominal ultrasonography
152
Treatment of renal cell carcinoma
Surgery
Chemo/radiation therapy
153
What is chlamydia
It is a sexually transmitted disease caused by a bacteria chlamydia trachomatis
154
Signs and symptoms of chlamydia
Known as "silent" disease as there are usually no symtpoms
Symptoms appear within 1-3 weeks after exposure
Women:
Vaginal discharge
Pain during urination
Heavier periods
Irregular periods
Bleeding between periods
Pain and bleeding during/after sex
Men:
Pain in testicles
Pain during urination
Swelling of the testicles
Burning/itching of urethra
155
Pathophisiology of chlamydia
Women: bacteria intially infects the cervix and urethra. then spreads to fallopian tube. chlamydial infection of the cervix can spread to the rectum
156
Complication of chlamydia
Women:Pelvic Inflammatory Disease
-Pelvic pain
-Infertility
-Ectopic pregnancy
-5x more likely to get HIV
Arthritis
Skin lesions
Reiter's syndrome
Premature delivery
157
Treatment for chlamydia
Antibiotics: Azithromycin, doxycycline
158
Signs and symptoms of gonorrhea
Mostly asymptomatic
Men:
white/green/yellow discharge 1-14 days after infection
Women:
Painful urination
Increased discharge
Bleeding
-can be misdiagnosed as bladder/vaginal infection
159
Complications of gonorrhea
Women:
Can spread to infect the fallopian tubes/uterus
Causes pelvic inflammatory disease -> can result in infertility/ectopic pregnancy
Men:
Infertility
160
Pathophisiology of gonorrhoea
Gonorrhoea can spread through the blood via bacteria Neisseria gonorrhoeae
Disseminated Gonococcal Infection (DGI)
-can be life threatening
-causes arthritis
-other forms of inflammation
161
Diagnosis of gonorrhoea
culturiong a swab specifen in lab
testing swab specimen using nucleic acid amplification testing
162
Treatment for gonorrhoea
Antibiotics
163
What is syphilis
Syphilis is a bacterial infection which spread by sexual contact
Sexually transmitted disease
Infection is caused by Treponema pallidum
164
Stages of syphilis
Primary Stage (3-90 days after infection): stores at original site of infection
Secondary Stage (4-10 weeks after infection)
Latent stage
Tertiary Stage
165
Signs and symptoms of syphilis
Primary: sores on/around genitals, around anus/rectum, or in and around mouth
Secondary: Skin rash, swollen lymph nodes, fever
Latent stage: no symptoms
Tertiary: development of granulomatous lesions (gummas) in the liver, onset of cardiovascular lesions, characterised by degenerative changes in nervous system
