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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
Management of renal AKI
Refer for biopsy and specialist treatment
26
Management of post-renal AKI
Catheter, nephrostomy or urological intervention
27
General management of AKI
Fluid balance | Renal replacement therapy if severe - dialysis
28
Risk factors for testicular cancer
Undescended testes, infant hernia, infertility
29
Types of testicular cancers
o Seminoma o Non-seminomatous germ cell tumour (NSGCT) o Mixed germ cell tumour o Lymphoma
30
Staging of testicular cancer
1. No evidence of mets 2. Infradiaphragmatic node involvement 3. Supradiaphragmatic node involvement 4. Lung involvement
31
Investigations for testicular tumour
CXR, CT, excision biopsy
32
Management of testicular cancer
o Radical surgical resection o Seminomas - + radiotherapy o NSGCT - + chemotherapy
33
Epidemiology of prostate cancer
Commonest male malignancy, incidence increases with age - 80% in men >80yrs
34
Risk factors for prostate cancer
FH, high testosterone
35
Symptoms of prostate cancer
o Asymptomatic o Nocturia, hesitancy, poor stream, terminal dribbling or obstruction o Weight loss and bone pain suggest mets
36
Investigations for suspected prostate cancer
``` o PSA - high (can be normal) o DRE - hard irregular gland o Transrectal US and biopsy o Bone scan o CT/MRI - staging ```
37
Management of prostate cancer
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
38
Side effects of hormonal treatment of prostate cancer
Osteoporosis , gynaecomastia, sexual dysfunction
39
What is the most common type of bladder cancer in the UK?
Transitional cell carcinoma
40
What factors are associated with bladder cancer?
Smoking, aromatic amines (rubber industry), chronic cystitis, schistosomiasis, pelvic irradiation, paraplegia
41
Signs and symptoms of bladder cancer
Painless haematuria, recurrent UTIs, voiding irritability
42
Investigations for suspected bladder cancer
o Bloods – FBC, U&E, PSA, glucose o Cystoscopy with biopsy o Urine dipstick – microscopy/cytology o Imaging – USS/CT
43
Management of transitional cell bladder carcinoma
``` o Trans-urethral resection of bladder tumour (TURBT) o If mets: - Cystectomy - Radiotherapy - +/- chemotherapy o BCG therapy ```
44
How does BCG therapy work?
Stimulates a non-specific immune response
45
Risk factors for renal carcinoma
Obesity, smoking, HTN
46
Signs and symptoms of renal cancer
Haematuria, flank pain, mass, weight loss, node enlargement
47
Investigations for suspected renal cancer
o Bloods – FBC, U&E, PSA, glucose o Cystoscopy with biopsy o Urine dipstick – microscopy/cytology o Imaging – USS/CT/MRI
48
What blood disorder can renal cell carcinoma cause?
Polycynthaemia from EPO production
49
Management of renal cell carcinoma
o Radical nephrectomy o Cryotherapy and radiofrequency ablation o RCC radio and chemo resistant
50
What is chronic kidney disease?
Abnormal kidney structure or function, present for >3 months, with implications for health
51
What factors are used to classify CKD?
o GFR category – G1-G5 o Presence of albuminuria – A1-A3 o Underlying disease
52
Causes of CKD
* Diabetes * HTN * Chronic glomerulonephritis * Obstructive uropathy * AKI * Cystic disease
53
Symptoms of CKD
* SOB, ankle swelling (fluid overload) * Anorexia * Nausea + vomiting * Fatigue, weakness * Bone pain * Amenorrhoea * Pruritus
54
Signs of CKD
* Oedema * Anaemia * Jaundice * Cardiomegaly
55
Investigations for suspected CKD
``` • Bloods - U&E, Hb (anaemia), glucose (DM), low Ca, high phosphate • Urine dipstick - proteinuria • USS - size, asymmetry, obstruction • Renal biopsy ```
56
Treatments to slow progression of renal disease
o BP management – ACE-i/ARB o DM glycaemic control o Lifestyle advice – exercise, healthy weight, smoking cessation, reduced salt intake
57
Management of CKD
o BP lowering drugs - ACE-i/ARB o Treat complications o Renal replacement therapy o Transplantation
58
What are the 2 types of renal replacement therapy?
Peritoneal dialysis, haemodialysis
59
What is peritoneal dialysis?
Involves infusing a sugary solution into the | abdomen which draws off toxins
60
What is the main problem with peritoneal dialysis?
Infection risk
61
Where and how often is peritoneal dialysis done?
1-multiple times per day, at home/work place
62
What is the process of haemodialysis?
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
Where and how is haemodialysis done?
3x per week for 4hrs, dialysis centre
64
Contraindications for kidney transplant
Cancer w/mets, infection, replicating HIV, unstable CVD, congestive HF
65
Complications of kidney transplantation
1. Surgical 2. Delayed graft function 3. Rejection – acute or chronic 4. Immunosuppression – increases infection and malignancy risk 5. Increased CVD risk
66
What is benign prostate hyperplasia?
Non-cancerous enlargement of the prostate gland
67
Epidemiology of benign prostate hyperplasia
Incidence increases with age - 82% of males 71-80yrs
68
Pathology of benign prostate hyperplasia
• 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
What zone of the prostate enlarges in benign prostate hyperplasia?
Inner zone
70
What zone of the prostate enlarges in carcinoma?
Outer zone
71
Cause of prostate cancer
Assumed relationship to androgens (dihydrotestosterone)
72
Signs and symptoms of benign prostate hyperplasia
• Storage – frequency, nocturia • Voiding – post micturition dribbling, poor flow, hesitancy, overflow incontinence • Haematuria, bladder stones, UTI
73
Investigations for suspected benign prostate hyperplasia
* Bloods * MSU * Trans-rectal USS * PSA * Digital rectal exam (DRE) * Transrectal US and biopsy
74
What tool is used to assess severity of benign prostate hyperplasia?
IPSS (International Prostate Symptom Score)
75
Management of benign prostate hyperplasia?
• 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
Side effect's of alpha-blockers
Drowsiness, depression, dizziness, dry mouth, ejaculatory failure
77
What is the mechanism of 5α-reductase inhibitors?
↓conversion of testosterone -> dihydrotestosterone
78
Side effects of 5α-reductase inhibitors
Impotence, decreased libido
79
TURP side effects
Impotence, incontinence, bleeding, infection, post TURP syndrome (hyponatraemia)
80
TUIP advantages compared to TURP
Less destruction and less risk to sexual function
81
What is an uncomplicated UTI?
UTI in an individual with normal renal structure and function
82
What is a complicated UTI?
UTI in an individual with a structural/functional abnormality of genitourinary tract
83
What is pyelonephritis?
Upper urinary tract infection -> inflammation of the kidney
84
Risk factors for UTI
Female, sexual intercourse, indwelling catheter, DM, urinary tract obstruction, urinary stasis
85
Pathology of pyelonephritis
Failure of vesicoureteral orifice (primary congenital defect, bladder outlet obstruction) -> vesicoureteral reflux
86
Complications of pyelonephritis
Renal abscess, recurrent infections -> chronic pyelonephritis
87
Symptoms of pyelonephritis
Fever, N&V, chills, flank pain, costosternal angle tenderness
88
Investigations for suspected UTI
o Urine dipstick – WBC o Urine culture o CT, USS o Renal biopsy
89
Management of pyelonephritis/upper UTI
o Initially co-amoxiclav (broad) | o Antibiotics specific to culture
90
Management of lower UTI
o Empirical trimethoprim o 3 days in women, 7 days in men o Culture specific antibiotics if empirical fails
91
How can UTI's be prevented?
Hydration and good hygiene
92
What are the main organsims that cause UTI?
E. coli, Klebsiella pneumonia, Enterobacter
93
Signs and symtpoms of lower UTI
``` o Suprapubic pain o Dysuria o Frequency o Urgency o Confusion in elderly ```
94
What is urethritis?
Isolated inflammation of the urethra
95
What are the main organisms that cause urethritis?
Neisseria gonorrhoea, chlamydia
96
What is glomerulonephritis?
• 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
What is nephritic syndrome?
Haematuria due to inflammatory damage to the glomerulus
98
Causes of nephritic syndrome
IgA nephropathy, rapidly progressing GN (Goodpasture’s disease, small vessel vasculitis), Streptococci infection
99
Signs and symptoms of nephritic syndrome
``` o Oedema o Low urine production (<500ml/24hr) o Haematuria o HTN o Fever, weakness, malaise o Abdominal pain, N&V ```
100
Investigations for suspected glomerulonephritis
o Bloods o Urine dipstick – protein, blood o Imaging – CXR, renal USS o Renal biopsy
101
What would results of a urine sample from an individual with nephritic syndrome show?
Haematuria (red cell casts), slight proteinuria
102
What results would a urine sample and blood sample from an individual with nephrotic syndrome show?
Urine - proteinuria (urine looks frothy) | Bloods - hypoalbuminaemia (->oedema), hyperlipidaemia
103
Management of nephritic syndrome
``` 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
Name a common loop diuretic
Furosemide
105
Treatment of IgA nephropathy
ACE-i and corticosteroids
106
What is nephrotic syndrome?
Proteinuria due to podocyte pathology
107
What are the 3 diagnostic criteria for nephrotic syndrome?
o Proteinuria >3g/hr o Hypoalbulaemia o Oedema
108
What is the main cause of nephrotic syndrome?
Minimal change disease
109
Signs and symptoms of nephrotic syndrome
Generalised severe pitting oedema
110
Management of nephrotic syndrome
o Oedema – fluid + salt restriction, diuretics o BP control – ACE-i/ARB o Dialysis if severe o Treat cause – steroids
111
Management of minimal change disease
Prednisalone 1st line | Ciclosporine 2nd line
112
What is polycystic kidney disease (PKD)?
Genetic disorder characterised by formation of innumerable cysts in the kidneys
113
Causes of PKD
85% have mutations in PKD1 gene (chromosome 16) - autosomal dominant
114
Signs and symptoms of PKD
* Loin pain * Visible haematuria * Renal calculi * High blood pressure * Renal failure
115
Extrarenal features of PKD
Liver cysts, intracranial aneurysm -> SAH
116
Investigations for suspected PKD
USS, genetic testing
117
Management of PKD
* High water intake * Antihypertensives – ACE-i/ARB, * Cyst decompression if severe pain * Dialysis * Kidney transplant
118
What are the main organsims that can cause epididymitis?
E. coli, chlamydia
119
What is an epididymal cyst?
A benign fluid-filled sac which grows at the top end of the testicle
120
What is a hydrocele?
Excessive fluid within the tunica vaginalis (serous space surrounding testis)
121
What is varicocele?
Dilated veins of pampiniform plexus - 'bag of worms'
122
Why is trimethoprim contraindicated in pregnancy?
Folate antagonist
123
What antibiotics should be given to a pregnant woman with a UTI?
Nitrofurantoin

Phase 2a (9 decks)

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