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ICM Revision > RENAL/GU > Flashcards

RENAL/GU Flashcards

1
Q

when should you perfom a urine dip?

A

abdo pain
UTI symptoms
fevers
pregnancy

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2
Q

when to send a urine culture?

A

women with impaired renal function, abnormal urinary tract, immunosuppression
pregnancy
men -> UTI is clinically suspected

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3
Q

What is included in a basic renal fucntion test:

A 
urea 
creatinine 
eGFR 
sodium 
potassium 
bicarb 
chloride
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4
Q

what can cause raised urea?

A

high protein diet, AKI, CKD, dehydration, GI bleed, sepsis, decreased renal perfusion

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5
Q

what can cause lowered urea?

A

low protein diet
pregnancy
advanced liver cirrhosis

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6
Q

What is PSA and when is it tested for?

A

PSA - an enzyme produced by cells in the prostate

used alongside DRE to decide when to biopsy prostate

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7
Q

What are the causes of elevated PSA?

A 
enlarged prostate 
prostatitis 
prostate cancer 
recent Ejaculation 
DRE
Vigorous exercise
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8
Q

pros of PSA

A
  • quick pick up of prostate cancer
  • may help pick up a fast-growing cancer/early stage
  • high risk patients can check changes to PSA levels
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9
Q

cons of PSA

A

raised PSA level - need a biopsy
PSA test can miss prostate cancers = 1/7 with normal PSA can develop prostate cancer
diagnosis = slow-growing cancer with no associated problems/shortening of life

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10
Q

what are Investigations for renal calculi?

A
  • urine dip = blood ++
  • sometimes may have raise Cr and WCC
  • imaging - non-contrast CTKUB
    IV urogram
  • us if pregnant
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11
Q

What are the interventions for confirmed renal calculi?

A

calculi <5mm = manage expectantly
<2cm calculi = extra-corporeal shock wave lithotripsy
<2cm in pregancy - uteroscopy = rigid (stone in ureter) or flexible (fragment stones)
complex or staghorn calculi - PCNL = removal of stones in the kidney or upper ureter
- Nephrectomy

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12
Q

what are the indications for 24hr urinary collection?

A
  1. kidney stones - stones risk assessment - 2x24hr
  2. phaeochromocytoma - 24hr metanephrines
  3. cushing syndrome - 24hr free urinary cortisol
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13
Q

Indications for CT in the urinary tract?

A
  • frank haematuria
  • upper and lower tract disease
  • locoregional staging
  • metastatic disease
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14
Q

Indications for CT urogram?

A

haemturia
collecting system anatomy
upper tract transitional cell cancer (TCC)

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15
Q

Indications for CT angio in kidneys?

A
  • renal artery stenosis

- persistent haematuria

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16
Q

what is the best CTU for stones?

A

non-contrast CTU

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17
Q

CTU in the nephrogenic phase is best for….

A

…detection of focal renal masses

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18
Q

CTU in the excretory phase is best for…..

A

….visualising filling defects in ureter and bladder

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19
Q

Indications for Urinary Tract US?

A

haematuria, loin pain, hydronephrosis, renal impairment
LUTS
testicular masses, pain, torsion or infertility
peyronie’s disease and erectile dysfunction

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20
Q

pros of US urinary tract?

A

very safe
easily available
portable machines
visualise soft tissues

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21
Q

cons of US urinary tract?

A

can be difficult in obese/ill pts

some structures invisible - ureters, bowel and internal structure of bone (trickier to visualise)

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22
Q

what is doppler US used for?

A

useful in identifying narrowing/obstruction in renal arteries or veins

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23
Q

Indications for MRI in renal/GU?

A

staging of prostate cancer
renal imaging - renal masses
staging bladder cancer
MR urography - complicated urogenital anatomy, pregnancy and obstructive uropathy
penile imagining - staging penile cancer or penile trauma

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24
Q

pros of MRI in Renal/GU…

A

no radiation risk
tissue contrast
allows local staging

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25
Q

cons of MRI renal/GU….

A 
claustrophobia
cost - expensive 
can't use with pacemakers 
children need ga 
slow/longer procedure
26
Q

Investigations for haematuria?

A
  1. urine dip - persistent if 2/3 samples tested 2-3weeks apart
  2. renal functions, ACR/PCR, BP
  3. Urine MC&S
27
Q

Investigations in suspected AKI?

A

Blood - raised creatinine levels

  • 26micromol/L + in 48hrs
  • 50% + rise within the past 7days (1.5x baseline)

check ureas, Na+/K+

asses/monitor urine output - 0.5ml/kg/hr for more than 6hrs
- done via insertion of catheter

urinanalysis - dip/MC&S

Imaging - Renal US for any non-identifiable cause of aki and also for any risk of obstruction

28
Q

Investigations in suspected CKD?

A

bloods - U+Es , eGFR<60ml/min
- rpt within 2/52

urinary ACR = 3-70 = if >70 suggestive of significant proteinuria

urine dip - MSU sample
- r/o UTI

Check nutritional status - BMI, BP, HbA1c, and lipid profile - assess for CVD RFs

29
Q

Investigations in suspected Membranous glomerulonephritis?

A

EM = thickened GBM, ‘spike and dome appearance’
effacement of foot processes

Immunofluorescence = granular appearance

30
Q

Investigations in suspected Membranoproliferative glomerulonephritis?

A

Light microscopy = ‘tram track’ appearance

immunofluorescence = granular appearance

EM + biopsy = intramembranous dense deposits

31
Q

Investigations in suspected Rapidly progressive Glomerulonephritis ?

A

light microscopy = crescent shaped cells in the glomeruli

32
Q

Investigations in suspected Post-Strep Glomerulonephritis?

A

LM = enlarged and hypercellular gomeruli

EM = subepithelial deposits = appear as humps

Immunofluorescence = granular ‘starry sky’ appearance

Bloods = Anti-DNAse B, raised ASO titre, decreased complement (C3)

33
Q

Investigations in suspected Focal segmental Glomerulosclerosis?

A

urinanalysis - increased protein and lipid

light microscopy =segmental sclerosis and hyalinosis

Bloods test - drop in RBC, Lipids and protein

Kidney biopsy = scarring and ‘glassy’ appearance

34
Q

Investigations in suspected IgA Nephropathy?

A

Light microscopy = mesangial proliferation - expansion

Electron microscopy = immune deposits in mesangium

Immunofluorescence = immune complexes present

35
Q

Investigations in suspected in minimal change disease?

A

Light microscopy = normal glomeruli

Electron microscopy = fused podocytes and effacement of foot processes

Immunofluorescence - negative - no changes resulting from immune complexes

36
Q

Investigations in suspected Polycystic kidney disease ?

A

Bloods - FBC, U&E, creatinne, eGFR and bone profile

urinanalysis and urine MCS

Imaging - US or CT

37
Q

Investigations in suspected Vasculitis?

A

urinanalysis - check for haematuria or proteinuria

bloods

  • FBC = normocytic anaemia and thrombocytosis
  • CRP is raised
  • U&Es (raised urea, creatinine)
  • ANCA testing
38
Q

Investigations in suspected Goodpasture’s syndrome?

A

Renal biopsy = linear IgG deposits along GBM

pulmonary haemorrhages - raised transfer factor

39
Q

Investigations in suspected in urinary retention?

A

Urinanalysis - after urinary catheterisation

serum U&Es and creatinine - AKI

FBC/CRP - ?infection

Diagnosis is confirmed with a bladder US - volume of >200cc confirmational

40
Q

Investigations in suspected Haematuria?

A

Urine dip - test of choice

Bloods - U+Es, ACR/PCR

check BP - ?HTN in nephritic syndroe

Urine MCS - detect RBCs in urine

41
Q

Investigations in suspected Fournier’s gangrene?

A 
Bloods - FBC, U+Es, glucsose 
ABG - lactate in ischaemia 
Blood and urine culture 
INR 
Imaging - CT to assess for severity 
AXR = gas forming structures
42
Q

Investigations in suspected Priapism?

A

Cavernosal blood gas analysis
- ischaemia if pH & O2 low and if PCO2 high

Doppler or duplex US

FBC & toxicology screen

43
Q

Investigations in suspected urinary incontinence?

A

usually pt asked to keep a diary for a min of 3 days

exclude prolapse

Urine dip and culture

Urodynamic studies

44
Q

Investigations in suspected Renal stones?

A

Urine dip - haemturia, nitrals and leukocytes

U&Es - creatinine, GFR

FBC and CRP - ?infection

Calcium/urate - underlying cause?

BC if pt pyrexial

non contrast CT KUB within 14hrs of admission

45
Q

Investigations in suspected in hydrocele?

A

diagnosis is usually clinical

US done if there is any doubt in diagnosis and also if testis cannot be palpated

46
Q

Investigations in suspected Varicocele?

A

?mainly clinical

US with doppler studies

47
Q

Investigations in suspected in paraphimosis?

A

Urethral swab - may be taken to confirm the nature of infection

48
Q

Investigations in suspected testicular torsion

A

clinical diganosis

- requires urgent surgical exploration - bilateral fixation

49
Q

Investigations in suspected Peyronie’s disease?

A

usually a clinical diagnosis

USS - presence of scar tissue and blood flow to penis

50
Q

Investigations in suspected Benign Prostate Hyperplasia?

A

DRE - enalrged prostate

Dipstick can be done to exclude infection

U&E - eGFR, creatinine to exclude ant retention, recurrent UTI

PSA - to exclude any outlet obstruction of prostate cancer

51
Q

Investigations in suspected Prostate Cancer?

A

if clinically suspected to have a localised prostate cancer = first line is a multiparametric MRI

TRUS biopsy

PSA levels check to see if raised

52
Q

Investigations in suspected Bladder Carcinoma?

A

Cystoscopy and biopsies / TURBT

Diagnosis - histological

MRI/CT - to scan for spread, node of uncertain significance using PET CT

53
Q

Investigations in suspected Renal Cell Carcinoma?

A

Imaging - can be USS/CT/MRI

definitive dx = biopsy/histopathology

CXR/MRI brain - check for any mets at time of presentation

54
Q

Investigations in suspected Wilm’s Tumour?

A

Bloods - FBC, U&Es
urinanalysis
CT/MRI - ?confirm unilateral malignancy
histology to confirm

55
Q

Investigations in suspected testicular cancer?

A

seminomas - hCG may be elevated

non-seminomas - raised AFP & bHCG

LDH

Diagnosis - first line is US -

56
Q

Investigations in suspected in Pyelonephritis?

A

mainly a clinical diagnosis - urine dip and MCS

57
Q

Investigations in suspected Epididymo-orchitis?

A

STI screen

Urine dip

58
Q

Investigations in suspected Urethritis?

A

urethral swab - leukocytes and gram -ve diplococci

NAATs - chlamydia commonly diagnosed

59
Q

Investigations in suspected Prostatitis?

A

Clinical examination and history
- clinical diagnosis

‘tender, boggy prostate’

60
Q

Investigations in suspected Balanitis?

A

mainly a clinical diagnosis - history and clinical examination

if suspecting an infectious cause - swab and culture
- commonly Staph Spp

uncertain cause/extensive skin changes - can do biopsy

61
Q

Investigations in suspected Cystitis?

A

urine dip and MCS
- in men get an MSU sample

pregnant women and men always need sample cultured

ICM Revision (19 decks)

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