renal medicine Flashcards
What are some complications of leaving LUTS untreated?
Risk of infection
Renal and bladder calculi due to stagnation
Overflow incontinence if chronic obstruction
Renal failure
Bilateral hydronephrosis
Acute renal failure with BPH
How are patients with haematuria investigated?
Initial
Urinalysis (check for nitrates/leucocytes to indicate infection. Trace blood not haematuria, needs to be >1+)
Baseline bloods (FBC, U+E’s, Clotting)
PSA after counselling
If deranged renal function take ACR
Refer to specialists
Specialist Ix
Flexible cystoscopy is gold standard
Urine cytology
US KUB imaging for Non visible haematuria
CT Urogram for visible haematuria
What are some investigations that are done when acute urinary retention is suspected?
- PR/PV exam
-Post-void bedside bladder scan
- Post catheterisation CSU/MSU
- Routine bloods (FBC, U+E’s, CRP)
- US KUB scan if suspect high pressure retention to look for hydronephrosis
- Monitor for post-obstructive diuresis
what is the pathophysiology behind chronic urinary retention?
Most common in men: BPH
Most common in women: pelvic prolapse (such as cystocele, rectocele, or uterine prolapse)
Other: urethral strictures, prostate cancer, pelvic masses (fibroids), peripheral neuropathies, UMN diseases (MS)
What are the clinical features of renal calculi and what are some differential diagnoses?
Sudden onset one sided severe pain radiating from flank to pelvis (loin to groin ureteric colic) due to increased peristalsis around obstruction
N+V
Haematuria (usually non-visible)
May have fever, rigors or lethargy if associated with infection (CONSIDER SEPSIS)
Exam usually remarkable, may be some flank/renal angle tenderness but no suprapubic tenderness
DD: pyelonephritis, ruptured AAA, biliary pathology, bowel obstructon, MSK pain, lower lobe pneumonia
What is the aetiology of bladder stones, how do they present and what issues arise if they are not treated?
Urinary stasis from chronic urinary retention or secondary to schistosomiasis or as passed ureteric stones
Present with LUTS
Treated by cystoscopy allowing them to drain or lithotripsy
Chronic irritation if left can cause SCC of the bladder
What are some risk factors for developing pyelonephritis?
- Factors reducing antegrade flow of urine: e.g BPH, spinal cord injury
- Factors promoting retrograde ascent of bacteria: female short urethra, indwelling catheters and JJ stents, VUR
- Factors predisposing to infection or immunocompromise: DM, untreated HIV, corticosteroids
- Factors causing colonisation: renal calculi, menopause (less oestrogen), sexual intercourse
What are some of the complications of pyelonephritis?
Severe sepsis
Renal scarring leading to CKD
Premature labour
Pyonephrosis
Chronic Pyelonephritis
Emphysematous Pyelonephritis
What is the aetiology of RCC?
Most common: smoking
Industrial exposure to carcinogens (cadmium, lead, aromatic hydrocarbons)
Dialysis
HTN
Obesity
Anatomical abnormalities (horseshoe, PCKD)
Genetic disorders (BAP1, Birt-Hogg-Dube syndrome)
how does RCC present?
Triad:
Haematuria (V or NV)
- Flank pain
- Flank mass
Vague symptoms like weight loss
Left sided by have left varicocele as tumour compresses testicular vein
Polycythaemia from EPO secretion
what is the difference between simple and complex cysts?
Fluid filled sacs:
Simple: Well defined outline and homogenous features. Made from renal tubule epithelium in response to previous ischaemia
Complex: thick walls, septations, calcification, or heterogeneous enhancement on imaging. Classified with Bosniak classification and have risk of malignancy
What investigations are done when a bladder cancer is suspected?
- Urgent flexible cystoscopy under local anaesthetic
Rigid cystoscopy under general if suspicious lesion found on flexible
Biopsy on cystoscopy and consider TURBT
- CT staging to look for muscle invasive and plan TURBT
- Urine cytology (if cancer in cytology but not on cystoscopy then random biopsy on cystoscopy)
How can you tell the difference between renal calculi and peritonitis due to appendicitis and the difference between renal calculi and pyelonephritis?
Peritonitis patient will lay still but renal calculi patient will be rolling around in pain as calculi not irritating the peritoneum
Pyelonephritis has LUTs but renal calculi will not unless calculi has reached VUJ
What else can chronic high pressure retention present as and why is it important to pick up?
Overflow incontinence overnight
Can lead to hypoK and cardiac arrhythmias so need admitting ASAP with catheter and monitoring for post-obstructive diuresis (hourly urine output, weight BD, U+Es BD)
What are some unusual presentations of renal colic?
Lower abdominal pain
Testicular pain (VUJ)
Labia pain (VUJ)
