Renal / GU Flashcards
What aids the diagnosis of UTI in a woman under 65 years
- Urine Dipstick
When do you send a urine sample for culture in UTI to confirm diagnosis.
- recurrent UTI, or possibility of antibiotic resistance.
- only positive for leukocyte.
- Have visible or non visible haematuria on UTI
- Older than 65
- Pregnant
- Has a catheter
Do you routinely perform a sub-preputial swab to confirm diagnosis of balantitis?
No - only if you suspect candida or bacterial culture
What do you use to support the initial diagnosis of renal colic?
Urine dipstick - the presence of haematuria supports renal or ureteric colic.
What do you use to confirm the diagnosis of suspected renal and ureteric colic?
Urgent imaging within 24 hours - Low dose non-contrast CT.
What do you do for asymptomatic renal stones that are less than 5mm
Watchful waiting. Can also do this if it is larger that 5mm.
What ECG changes do you notice in Hyperkalaemia
- Tall peaked (tented) T waves
- Loss of P wave
- widened QRS with tall T wave
What is the investigation used for Acute urinary retention
post-void bedside bladder scan - will show the volume of retained urine.
How is hydronephrosis diagnosed?
Ultrasound
Investigations for BPH ( Bladder problems (frequency, urgency, nocturia) and obstructive flow problems (hesitancy, terminal dribbling, intermittent flow, incomplete urine sensation from bladder (vesical tenesmus)
- Urinalysis (Hematuria)
- PSA (cannot differentiate between prostate cancer or BPH)
- DRE (assess the size and shape, surface of the prostate)
- IPPS (questionnaire on how it effects life, 0 best 5/6 worst)
- u&e’s to see the effect on the kidney damage
Cystitis - UTI (Lower urinary tract - urethra & bladder)
Urinalysis - leukocytes PLUS NITRITES
Culture (E.coli, klebsiella,
Cystoscopy (unsure why - looks into the bladder and the urethra)
Investigations for acute acute prostatitis?
MSU midstream specimen of urine (culture, microscopy, sensitivity) Blood cultures DRE FBC STI screening
Investigations for acute acute prostatitis?
MSU midstream specimen of urine (culture, microscopy, sensitivity) Blood cultures DRE FBC STI screening
Investigations for urethritis (Gonococcal or non-gonocchochal)
Urethral swab
NAAT
What do you test for epididymitis (commonly due to Gonorrhoea or chlamydia, enteric organisms) and what are the symptoms?
Urine dipstick
urine culture
swollen, red, warm, painful testicle (can be 1 or both), possible discharge from penis, blood in semen and pain in suprapubic region.
How do you diagnose AKI?
- creatinine rise by 26mmol/l within the last 48 hours
- 50% rise from baseline over 7 days
- less that 0.5 ml/kg per hour for more than 6 hours
What is defined as oliguria?
urine output of less than - 0.5ml/kg/hr
How is AKI detected symptomatically?
- decrease urine output 0.5ml/kg/hour
- fluid overload (pulmonary and peripheral oedema)
- increase in metabolites that are usually kept in control by kidneys, potassium (arrythmias), urea (features of uremia, encephalitis, pericarditis) and creatinine.
How is AKI detected?
U & E’s (sodium, potassium, urea and creatinine)
Urinalysis
Imagining renal US - if no detectable cause found within 24 hours.
What are the investigations for renal calculi (nephrolithiasis)
Urine dipstick (blood ++)
Non-contrast CTKUB
IV Urogram
US if pregnant
When would you intervene for a renal calculi?
<5mm watchful waiting
<2cm lithotripsy and uteroscopy in pregnancy
Complex or staghorm calculi (Staghorn stones are large and branching stones that fill part or all of the pelvicalyceal system) may lead to nephrectomy
what are the indications of 24 hr urinary collection?
Kidney stones - stone risk assessment 48 hrs.
Pheochromocytoma - 24 hr free metanephrines
Cushing syndrome - 24 hr free urinary cortisol
When do you do a CT in the urinary tract?
Staging of cancer
Metastatic disease
Frank haematuria
upper and lower tract disease
What is a urogram?
Imaging and contrast used to take images in the:
1. nephrogenic phase (will light up white, for masses and cysts)
2. excretory phase (once adminstered the contrast, can watch urination and see defects in this process.
Helps detect causes for frank haematuria, renal masses.
