RENAL/GU Flashcards
when should you perfom a urine dip?
abdo pain
UTI symptoms
fevers
pregnancy
when to send a urine culture?
women with impaired renal function, abnormal urinary tract, immunosuppression
pregnancy
men -> UTI is clinically suspected
What is included in a basic renal fucntion test:
urea creatinine eGFR sodium potassium bicarb chloride
what can cause raised urea?
high protein diet, AKI, CKD, dehydration, GI bleed, sepsis, decreased renal perfusion
what can cause lowered urea?
low protein diet
pregnancy
advanced liver cirrhosis
What is PSA and when is it tested for?
PSA - an enzyme produced by cells in the prostate
used alongside DRE to decide when to biopsy prostate
What are the causes of elevated PSA?
enlarged prostate prostatitis prostate cancer recent Ejaculation DRE Vigorous exercise
pros of PSA
- 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
cons of PSA
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
what are Investigations for renal calculi?
- urine dip = blood ++
- sometimes may have raise Cr and WCC
- imaging - non-contrast CTKUB
IV urogram - us if pregnant
What are the interventions for confirmed renal calculi?
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
what are the indications for 24hr urinary collection?
- kidney stones - stones risk assessment - 2x24hr
- phaeochromocytoma - 24hr metanephrines
- cushing syndrome - 24hr free urinary cortisol
Indications for CT in the urinary tract?
- frank haematuria
- upper and lower tract disease
- locoregional staging
- metastatic disease
Indications for CT urogram?
haemturia
collecting system anatomy
upper tract transitional cell cancer (TCC)
Indications for CT angio in kidneys?
- renal artery stenosis
- persistent haematuria
what is the best CTU for stones?
non-contrast CTU
CTU in the nephrogenic phase is best for….
…detection of focal renal masses
CTU in the excretory phase is best for…..
….visualising filling defects in ureter and bladder
Indications for Urinary Tract US?
haematuria, loin pain, hydronephrosis, renal impairment
LUTS
testicular masses, pain, torsion or infertility
peyronie’s disease and erectile dysfunction
pros of US urinary tract?
very safe
easily available
portable machines
visualise soft tissues
cons of US urinary tract?
can be difficult in obese/ill pts
some structures invisible - ureters, bowel and internal structure of bone (trickier to visualise)
what is doppler US used for?
useful in identifying narrowing/obstruction in renal arteries or veins
Indications for MRI in renal/GU?
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
pros of MRI in Renal/GU…
no radiation risk
tissue contrast
allows local staging
cons of MRI renal/GU….
claustrophobia cost - expensive can't use with pacemakers children need ga slow/longer procedure
Investigations for haematuria?
- urine dip - persistent if 2/3 samples tested 2-3weeks apart
- renal functions, ACR/PCR, BP
- Urine MC&S
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
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
Investigations in suspected Membranous glomerulonephritis?
EM = thickened GBM, ‘spike and dome appearance’
effacement of foot processes
Immunofluorescence = granular appearance
Investigations in suspected Membranoproliferative glomerulonephritis?
Light microscopy = ‘tram track’ appearance
immunofluorescence = granular appearance
EM + biopsy = intramembranous dense deposits
Investigations in suspected Rapidly progressive Glomerulonephritis ?
light microscopy = crescent shaped cells in the glomeruli
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)
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
Investigations in suspected IgA Nephropathy?
Light microscopy = mesangial proliferation - expansion
Electron microscopy = immune deposits in mesangium
Immunofluorescence = immune complexes present
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
Investigations in suspected Polycystic kidney disease ?
Bloods - FBC, U&E, creatinne, eGFR and bone profile
urinanalysis and urine MCS
Imaging - US or CT
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
Investigations in suspected Goodpasture’s syndrome?
Renal biopsy = linear IgG deposits along GBM
pulmonary haemorrhages - raised transfer factor
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
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
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
Investigations in suspected Priapism?
Cavernosal blood gas analysis
- ischaemia if pH & O2 low and if PCO2 high
Doppler or duplex US
FBC & toxicology screen
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
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
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
Investigations in suspected Varicocele?
?mainly clinical
US with doppler studies
Investigations in suspected in paraphimosis?
Urethral swab - may be taken to confirm the nature of infection
Investigations in suspected testicular torsion
clinical diganosis
- requires urgent surgical exploration - bilateral fixation
Investigations in suspected Peyronie’s disease?
usually a clinical diagnosis
USS - presence of scar tissue and blood flow to penis
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
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
Investigations in suspected Bladder Carcinoma?
Cystoscopy and biopsies / TURBT
Diagnosis - histological
MRI/CT - to scan for spread, node of uncertain significance using PET CT
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
Investigations in suspected Wilm’s Tumour?
Bloods - FBC, U&Es
urinanalysis
CT/MRI - ?confirm unilateral malignancy
histology to confirm
Investigations in suspected testicular cancer?
seminomas - hCG may be elevated
non-seminomas - raised AFP & bHCG
LDH
Diagnosis - first line is US -
Investigations in suspected in Pyelonephritis?
mainly a clinical diagnosis - urine dip and MCS
Investigations in suspected Epididymo-orchitis?
STI screen
Urine dip
Investigations in suspected Urethritis?
urethral swab - leukocytes and gram -ve diplococci
NAATs - chlamydia commonly diagnosed
Investigations in suspected Prostatitis?
Clinical examination and history
- clinical diagnosis
‘tender, boggy prostate’
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
Investigations in suspected Cystitis?
urine dip and MCS
- in men get an MSU sample
pregnant women and men always need sample cultured
