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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
cons of MRI renal/GU....
``` claustrophobia cost - expensive can't use with pacemakers children need ga slow/longer procedure ```
26
Investigations for haematuria?
1. urine dip - persistent if 2/3 samples tested 2-3weeks apart 2. renal functions, ACR/PCR, BP 3. Urine MC&S
27
Investigations in suspected AKI?
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
Investigations in suspected CKD?
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
Investigations in suspected Membranous glomerulonephritis?
EM = thickened GBM, 'spike and dome appearance' effacement of foot processes Immunofluorescence = granular appearance
30
Investigations in suspected Membranoproliferative glomerulonephritis?
Light microscopy = 'tram track' appearance immunofluorescence = granular appearance EM + biopsy = intramembranous dense deposits
31
Investigations in suspected Rapidly progressive Glomerulonephritis ?
light microscopy = crescent shaped cells in the glomeruli
32
Investigations in suspected Post-Strep Glomerulonephritis?
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
Investigations in suspected Focal segmental Glomerulosclerosis?
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
Investigations in suspected IgA Nephropathy?
Light microscopy = mesangial proliferation - expansion Electron microscopy = immune deposits in mesangium Immunofluorescence = immune complexes present
35
Investigations in suspected in minimal change disease?
Light microscopy = normal glomeruli Electron microscopy = fused podocytes and effacement of foot processes Immunofluorescence - negative - no changes resulting from immune complexes
36
Investigations in suspected Polycystic kidney disease ?
Bloods - FBC, U&E, creatinne, eGFR and bone profile urinanalysis and urine MCS Imaging - US or CT
37
Investigations in suspected Vasculitis?
urinanalysis - check for haematuria or proteinuria bloods - FBC = normocytic anaemia and thrombocytosis - CRP is raised - U&Es (raised urea, creatinine) - ANCA testing
38
Investigations in suspected Goodpasture's syndrome?
Renal biopsy = linear IgG deposits along GBM pulmonary haemorrhages - raised transfer factor
39
Investigations in suspected in urinary retention?
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
Investigations in suspected Haematuria?
Urine dip - test of choice Bloods - U+Es, ACR/PCR check BP - ?HTN in nephritic syndroe Urine MCS - detect RBCs in urine
41
Investigations in suspected Fournier's gangrene?
``` 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
Investigations in suspected Priapism?
Cavernosal blood gas analysis - ischaemia if pH & O2 low and if PCO2 high Doppler or duplex US FBC & toxicology screen
43
Investigations in suspected urinary incontinence?
usually pt asked to keep a diary for a min of 3 days exclude prolapse Urine dip and culture Urodynamic studies
44
Investigations in suspected Renal stones?
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
Investigations in suspected in hydrocele?
diagnosis is usually clinical US done if there is any doubt in diagnosis and also if testis cannot be palpated
46
Investigations in suspected Varicocele?
?mainly clinical | US with doppler studies
47
Investigations in suspected in paraphimosis?
Urethral swab - may be taken to confirm the nature of infection
48
Investigations in suspected testicular torsion
clinical diganosis | - requires urgent surgical exploration - bilateral fixation
49
Investigations in suspected Peyronie's disease?
usually a clinical diagnosis USS - presence of scar tissue and blood flow to penis
50
Investigations in suspected Benign Prostate Hyperplasia?
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
Investigations in suspected Prostate Cancer?
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
Investigations in suspected Bladder Carcinoma?
Cystoscopy and biopsies / TURBT Diagnosis - histological MRI/CT - to scan for spread, node of uncertain significance using PET CT
53
Investigations in suspected Renal Cell Carcinoma?
Imaging - can be USS/CT/MRI definitive dx = biopsy/histopathology CXR/MRI brain - check for any mets at time of presentation
54
Investigations in suspected Wilm's Tumour?
Bloods - FBC, U&Es urinanalysis CT/MRI - ?confirm unilateral malignancy histology to confirm
55
Investigations in suspected testicular cancer?
seminomas - hCG may be elevated non-seminomas - raised AFP & bHCG LDH Diagnosis - first line is US -
56
Investigations in suspected in Pyelonephritis?
mainly a clinical diagnosis - urine dip and MCS
57
Investigations in suspected Epididymo-orchitis?
STI screen Urine dip
58
Investigations in suspected Urethritis?
urethral swab - leukocytes and gram -ve diplococci NAATs - chlamydia commonly diagnosed
59
Investigations in suspected Prostatitis?
Clinical examination and history - clinical diagnosis 'tender, boggy prostate'
60
Investigations in suspected Balanitis?
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
Investigations in suspected Cystitis?
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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