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Phase 2a > Renal/GU > Flashcards

Renal/GU Flashcards

1
Q

What is renal colic?

A

Pain caused by a urinary tract stone

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2
Q

Epidemiology of urinary tract stones

A

M>F, 30-50yrs

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3
Q

Causes of urinary tract stones

A

• Anatomical factors - congenital (horseshoe, duplex),
obstruction, trauma
• Urinary factors - metastable urine, dehydration,
hypercalcaemia
• Infection

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4
Q

Symptoms of urinary tract stones

A 
•   Asymptomatic
•   Renal colic
•   UTI symptoms – dysuria, strangury, urgency, 
    frequency
•   Recurrent UTIs
•   Haematuria
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5
Q

Investigations for suspected urinary tract stone

A

• Urinalysis
• Bloods - FBC, U+E, Calcium, Uric acid
• Imaging - NCCT-KUB (non-contrast computerised
tomography – kidney, urethra, bladder), KUBXR, USS

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6
Q

Differentials for urinary tract stones

A

Ruptured AAA, diverticulitis, appendicitis, ectopic pregnancy, ovarian/testicular torsion, musculoskeletal

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7
Q

Initial management of renal colic

A

o Analgesia
o +/- IV fluids
o Antibiotic if infection
o Observe for sepsis

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8
Q

Management of renal/ureteric stones

A

o <5mm, most spontaneously pass, increase fluids
o >5mm:
- Medical expulsion therapy (alpha-blockers)
- Extracorporeal Shockwave Lithotripsy - ESWL
- Ureteroscopy with laser
- Percutaneous Nephrolithotomy (PCNL – keyhole)

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9
Q

What is ESWL?

A

Extracorpeal shockwave lithotripsy - US waves shatter stone

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10
Q

What the main side-effect of ESWL?

A

Renal injury

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11
Q

What is PCNL?

A

Percutaneous Nephrolithotomy - keyhole procedure to remove renal stones

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12
Q

Prevention of urinary tract stones

A 
o	Overhydration 
o	Low salt diet
o	Reduce BMI 
o	Active lifestyle
o	Urine pH balance
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13
Q

What is acute kidney injury (AKI)?

A

Abrupt decline in renal function

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14
Q

Pre-renal causes of AKI

A

Sepsis, drugs, major surgery, hypovolaemia/cardiogenic shock

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15
Q

Give a renal cause of AKI

A

Hepatorenal syndrome

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16
Q

Post-renal causes of AKI

A

Stones, malignancy

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17
Q

Risk factors for AKI

A
  • Pre-existing CKD
  • Age
  • Male sex
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18
Q

Comorbidities for AKI

A

DM, CVD, malignancy

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19
Q

Investigations for suspected AKI

A
  • Bloods – LFTs, platelets, autoantibodies
  • Imaging – USS, small kidneys/asymmetry
  • Urine dipstick – proteinuria, haematuria
  • Fluid balance and current volume
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20
Q

What are the 3 potential diagnostic criteria for AKI?

A
  • Creatinine rise >26micromol/L above baseline in 48 hrs
  • Creatinine rise > 50% above baseline
  • Urine output < 0.5ml/kg/hr for > 6 consecutive hours
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21
Q

Complications of AKI

A

Hyperkalaemia, acidosis

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22
Q

Management of hyperkalaemia

A

Insulin + glucose, salbutamol

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23
Q

Signs and symptoms of AKI

A
  • Anuria
  • Polyuria may occur due to reduced fluid reabsorption
  • Urinary retention
  • Nausea + Vomiting
  • Dehydration + Confusion
  • Hypertension, postural hypotension
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24
Q

Management of pre-renal AKI

A

Correct volume depletion and/or ↑renal perfusion via circulatory/cardiac support, treat any underlying sepsis

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25
Q

Management of renal AKI

A

Refer for biopsy and specialist treatment

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26
Q

Management of post-renal AKI

A

Catheter, nephrostomy or urological intervention

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27
Q

General management of AKI

A

Fluid balance

Renal replacement therapy if severe - dialysis

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28
Q

Risk factors for testicular cancer

A

Undescended testes, infant hernia, infertility

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29
Q

Types of testicular cancers

A

o Seminoma
o Non-seminomatous germ cell tumour (NSGCT)
o Mixed germ cell tumour
o Lymphoma

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30
Q

Staging of testicular cancer

A
  1. No evidence of mets
  2. Infradiaphragmatic node involvement
  3. Supradiaphragmatic node involvement
  4. Lung involvement
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31
Q

Investigations for testicular tumour

A

CXR, CT, excision biopsy

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32
Q

Management of testicular cancer

A

o Radical surgical resection
o Seminomas - + radiotherapy
o NSGCT - + chemotherapy

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33
Q

Epidemiology of prostate cancer

A

Commonest male malignancy, incidence increases with age - 80% in men >80yrs

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34
Q

Risk factors for prostate cancer

A

FH, high testosterone

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35
Q

Symptoms of prostate cancer

A

o Asymptomatic
o Nocturia, hesitancy, poor stream, terminal dribbling
or obstruction
o Weight loss and bone pain suggest mets

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36
Q

Investigations for suspected prostate cancer

A 
o   PSA - high (can be normal)
o   DRE - hard irregular gland 
o   Transrectal US and biopsy
o   Bone scan
o   CT/MRI - staging
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37
Q

Management of prostate cancer

A

o Localised (low risk) – active surveillance
o Confined to gland – radical
prostatectomy/radiotherapy
o Metastatic (low stage) – hormone therapy or chemo
o Metastatic (high stage) – surgical castration +
palliative care

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38
Q

Side effects of hormonal treatment of prostate cancer

A

Osteoporosis , gynaecomastia, sexual dysfunction

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39
Q

What is the most common type of bladder cancer in the UK?

A

Transitional cell carcinoma

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40
Q

What factors are associated with bladder cancer?

A

Smoking, aromatic amines (rubber industry), chronic cystitis, schistosomiasis, pelvic irradiation, paraplegia

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41
Q

Signs and symptoms of bladder cancer

A

Painless haematuria, recurrent UTIs, voiding irritability

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42
Q

Investigations for suspected bladder cancer

A

o Bloods – FBC, U&E, PSA, glucose
o Cystoscopy with biopsy
o Urine dipstick – microscopy/cytology
o Imaging – USS/CT

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43
Q

Management of transitional cell bladder carcinoma

A 
o   Trans-urethral resection of bladder tumour (TURBT)
o   If mets:
      -	Cystectomy 
      - Radiotherapy
      - +/- chemotherapy
o  BCG therapy
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44
Q

How does BCG therapy work?

A

Stimulates a non-specific immune response

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45
Q

Risk factors for renal carcinoma

A

Obesity, smoking, HTN

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46
Q

Signs and symptoms of renal cancer

A

Haematuria, flank pain, mass, weight loss, node enlargement

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47
Q

Investigations for suspected renal cancer

A

o Bloods – FBC, U&E, PSA, glucose
o Cystoscopy with biopsy
o Urine dipstick – microscopy/cytology
o Imaging – USS/CT/MRI

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48
Q

What blood disorder can renal cell carcinoma cause?

A

Polycynthaemia from EPO production

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49
Q

Management of renal cell carcinoma

A

o Radical nephrectomy
o Cryotherapy and radiofrequency ablation
o RCC radio and chemo resistant

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50
Q

What is chronic kidney disease?

A

Abnormal kidney structure or function, present for >3 months, with implications for health

51
Q

What factors are used to classify CKD?

A

o GFR category – G1-G5
o Presence of albuminuria – A1-A3
o Underlying disease

52
Q

Causes of CKD

A
  • Diabetes
  • HTN
  • Chronic glomerulonephritis
  • Obstructive uropathy
  • AKI
  • Cystic disease
53
Q

Symptoms of CKD

A
  • SOB, ankle swelling (fluid overload)
  • Anorexia
  • Nausea + vomiting
  • Fatigue, weakness
  • Bone pain
  • Amenorrhoea
  • Pruritus
54
Q

Signs of CKD

A
  • Oedema
  • Anaemia
  • Jaundice
  • Cardiomegaly
55
Q

Investigations for suspected CKD

A 
•   Bloods - U&amp;E, Hb (anaemia), glucose (DM), low Ca, 
    high phosphate
•   Urine dipstick - proteinuria 
•   USS - size, asymmetry, obstruction
•   Renal biopsy
56
Q

Treatments to slow progression of renal disease

A

o BP management – ACE-i/ARB
o DM glycaemic control
o Lifestyle advice – exercise, healthy weight, smoking
cessation, reduced salt intake

57
Q

Management of CKD

A

o BP lowering drugs - ACE-i/ARB
o Treat complications
o Renal replacement therapy
o Transplantation

58
Q

What are the 2 types of renal replacement therapy?

A

Peritoneal dialysis, haemodialysis

59
Q

What is peritoneal dialysis?

A

Involves infusing a sugary solution into the

abdomen which draws off toxins

60
Q

What is the main problem with peritoneal dialysis?

A

Infection risk

61
Q

Where and how often is peritoneal dialysis done?

A

1-multiple times per day, at home/work place

62
Q

What is the process of haemodialysis?

A
  1. Blood pumped out of catheter/fistula into blood line
  2. Heparin added to prevent clotting
  3. Blood flows into dialyzer – impurities, salt + excess
    fluid drawn out
  4. Cleaned blood is returned
63
Q

Where and how is haemodialysis done?

A

3x per week for 4hrs, dialysis centre

64
Q

Contraindications for kidney transplant

A

Cancer w/mets, infection, replicating HIV, unstable CVD, congestive HF

65
Q

Complications of kidney transplantation

A
  1. Surgical
  2. Delayed graft function
  3. Rejection – acute or chronic
  4. Immunosuppression – increases infection and
    malignancy risk
  5. Increased CVD risk
66
Q

What is benign prostate hyperplasia?

A

Non-cancerous enlargement of the prostate gland

67
Q

Epidemiology of benign prostate hyperplasia

A

Incidence increases with age - 82% of males 71-80yrs

68
Q

Pathology of benign prostate hyperplasia

A

• Increase in epithelial and stromal cells in periurethral
area of prostate due to increase in cell number
and/or decrease in apoptosis
• Inner zone enlarges

69
Q

What zone of the prostate enlarges in benign prostate hyperplasia?

A

Inner zone

70
Q

What zone of the prostate enlarges in carcinoma?

A

Outer zone

71
Q

Cause of prostate cancer

A

Assumed relationship to androgens (dihydrotestosterone)

72
Q

Signs and symptoms of benign prostate hyperplasia

A

• Storage – frequency, nocturia
• Voiding – post micturition dribbling, poor flow,
hesitancy, overflow incontinence
• Haematuria, bladder stones, UTI

73
Q

Investigations for suspected benign prostate hyperplasia

A
  • Bloods
  • MSU
  • Trans-rectal USS
  • PSA
  • Digital rectal exam (DRE)
  • Transrectal US and biopsy
74
Q

What tool is used to assess severity of benign prostate hyperplasia?

A

IPSS (International Prostate Symptom Score)

75
Q

Management of benign prostate hyperplasia?

A

• Lifestyle – avoid caffeine and alcohol, relax when voiding, void twice in a row, distraction methods for urgency, train bladder
• Drugs:
o α-blockers (tamsulosin)
o 5α-reductase inhibitors
• Surgery:
o Transurethral resection of prostate (TURP)
o Transurethral incision of the prostate (TUIP)
o Retropubic prostatectomy – if prostate large

76
Q

Side effect’s of alpha-blockers

A

Drowsiness, depression, dizziness, dry mouth, ejaculatory failure

77
Q

What is the mechanism of 5α-reductase inhibitors?

A

↓conversion of testosterone -> dihydrotestosterone

78
Q

Side effects of 5α-reductase inhibitors

A

Impotence, decreased libido

79
Q

TURP side effects

A

Impotence, incontinence, bleeding, infection, post TURP syndrome (hyponatraemia)

80
Q

TUIP advantages compared to TURP

A

Less destruction and less risk to sexual function

81
Q

What is an uncomplicated UTI?

A

UTI in an individual with normal renal structure and function

82
Q

What is a complicated UTI?

A

UTI in an individual with a structural/functional abnormality of genitourinary tract

83
Q

What is pyelonephritis?

A

Upper urinary tract infection -> inflammation of the kidney

84
Q

Risk factors for UTI

A

Female, sexual intercourse, indwelling catheter, DM, urinary tract obstruction, urinary stasis

85
Q

Pathology of pyelonephritis

A

Failure of vesicoureteral orifice (primary congenital defect, bladder outlet obstruction) -> vesicoureteral reflux

86
Q

Complications of pyelonephritis

A

Renal abscess, recurrent infections -> chronic pyelonephritis

87
Q

Symptoms of pyelonephritis

A

Fever, N&V, chills, flank pain, costosternal angle tenderness

88
Q

Investigations for suspected UTI

A

o Urine dipstick – WBC
o Urine culture
o CT, USS
o Renal biopsy

89
Q

Management of pyelonephritis/upper UTI

A

o Initially co-amoxiclav (broad)

o Antibiotics specific to culture

90
Q

Management of lower UTI

A

o Empirical trimethoprim
o 3 days in women, 7 days in men
o Culture specific antibiotics if empirical fails

91
Q

How can UTI’s be prevented?

A

Hydration and good hygiene

92
Q

What are the main organsims that cause UTI?

A

E. coli, Klebsiella pneumonia, Enterobacter

93
Q

Signs and symtpoms of lower UTI

A 
o	Suprapubic pain 
o	Dysuria
o	Frequency 
o	Urgency 
o	Confusion in elderly
94
Q

What is urethritis?

A

Isolated inflammation of the urethra

95
Q

What are the main organisms that cause urethritis?

A

Neisseria gonorrhoea, chlamydia

96
Q

What is glomerulonephritis?

A

• Encompasses a number of conditions which:
o Are caused by pathology in glomerulus
o Present with proteinuria and/or haematuria
o Are diagnosed by renal biopsy
o Cause CKD
o Can progress to kidney failure

97
Q

What is nephritic syndrome?

A

Haematuria due to inflammatory damage to the glomerulus

98
Q

Causes of nephritic syndrome

A

IgA nephropathy, rapidly progressing GN (Goodpasture’s disease, small vessel vasculitis), Streptococci infection

99
Q

Signs and symptoms of nephritic syndrome

A 
o   Oedema
o   Low urine production (<500ml/24hr)
o   Haematuria
o   HTN
o   Fever, weakness, malaise
o   Abdominal pain, N&amp;V
100
Q

Investigations for suspected glomerulonephritis

A

o Bloods
o Urine dipstick – protein, blood
o Imaging – CXR, renal USS
o Renal biopsy

101
Q

What would results of a urine sample from an individual with nephritic syndrome show?

A

Haematuria (red cell casts), slight proteinuria

102
Q

What results would a urine sample and blood sample from an individual with nephrotic syndrome show?

A

Urine - proteinuria (urine looks frothy)

Bloods - hypoalbuminaemia (->oedema), hyperlipidaemia

103
Q

Management of nephritic syndrome

A 
o	Oedema – fluid + salt restriction, diuretics 
o	BP control – ACE-i/ARB
o	Medication to reduce inflammation
o	Dialysis if severe 
o	Treat cause – steroids, antibiotics
104
Q

Name a common loop diuretic

A

Furosemide

105
Q

Treatment of IgA nephropathy

A

ACE-i and corticosteroids

106
Q

What is nephrotic syndrome?

A

Proteinuria due to podocyte pathology

107
Q

What are the 3 diagnostic criteria for nephrotic syndrome?

A

o Proteinuria >3g/hr
o Hypoalbulaemia
o Oedema

108
Q

What is the main cause of nephrotic syndrome?

A

Minimal change disease

109
Q

Signs and symptoms of nephrotic syndrome

A

Generalised severe pitting oedema

110
Q

Management of nephrotic syndrome

A

o Oedema – fluid + salt restriction, diuretics
o BP control – ACE-i/ARB
o Dialysis if severe
o Treat cause – steroids

111
Q

Management of minimal change disease

A

Prednisalone 1st line

Ciclosporine 2nd line

112
Q

What is polycystic kidney disease (PKD)?

A

Genetic disorder characterised by formation of innumerable cysts in the kidneys

113
Q

Causes of PKD

A

85% have mutations in PKD1 gene (chromosome 16) - autosomal dominant

114
Q

Signs and symptoms of PKD

A
  • Loin pain
  • Visible haematuria
  • Renal calculi
  • High blood pressure
  • Renal failure
115
Q

Extrarenal features of PKD

A

Liver cysts, intracranial aneurysm -> SAH

116
Q

Investigations for suspected PKD

A

USS, genetic testing

117
Q

Management of PKD

A
  • High water intake
  • Antihypertensives – ACE-i/ARB,
  • Cyst decompression if severe pain
  • Dialysis
  • Kidney transplant
118
Q

What are the main organsims that can cause epididymitis?

A

E. coli, chlamydia

119
Q

What is an epididymal cyst?

A

A benign fluid-filled sac which grows at the top end of the testicle

120
Q

What is a hydrocele?

A

Excessive fluid within the tunica vaginalis (serous space surrounding testis)

121
Q

What is varicocele?

A

Dilated veins of pampiniform plexus - ‘bag of worms’

122
Q

Why is trimethoprim contraindicated in pregnancy?

A

Folate antagonist

123
Q

What antibiotics should be given to a pregnant woman with a UTI?

A

Nitrofurantoin

Phase 2a (9 decks)

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