Renal Medicine Core Conditions ALL Flashcards
Epidemiology of UTI
Most common type of infection Most common form: infectious cystitis 20% of all UTIs in men Risk in men increases w/age Rarely develop in men <50 10% of >18yo will have 1 every 12 months 20-40% of women develop recurrent UTI problems
Most common causative agent of UTIs
E. coli
Other causative agents of UTIs in men
Klebsiella
Proteus
Enterococcus
Staphylococcus
Other causative agents of UTIs in women
Staphylococcus Saprophyticus Proteus Klebsiella Pseudomonas
Pathophysiology of UTIs in men
<50 - possible due to sexual intercourse or alteration to host defence
> 50 - due to structural or functional abnormalities of the urinary tract or alteration to host defence
- prostate disease
- stones
- external/intrinsic devices
- catheters
Pathophysiology of UTIs in women
Ascending pathway vagina>urethral meatus>urethra
Classification of UTIs
Nosocomial or comment acquired
Complicated or uncomplicated
Recurrent
Relapse
Who should be tested for asymptomatic bacteriuria?
pregnant women
RFs for UTI in men
Prostate hypertrophy Stones Urological surgery Age >50 Catheterisation Previous UTI
RFs for UTI in women
Sexual activity Use of spermicide Positive FHx Post menopause Previous UTI
Clinical presentation of UTIs
Dysuria Urgency Frequency In men: suprapubic pain In women: back/flank pain
Investigations to consider in UTI
Urine dipstick + MCS
Imaging to rule out obstruction
Management of UTIs
Trimethoprim or quinolone such as cipro/levofloxacin
What is acute pyelonephritis?
Inflammatory disease of the renal parenchyma, chalices and pelvis, caused by enteric bacteria that ascend from the lower urinary tract or haematogenous spread
Aetiology of pylenophritis
Major causative pathogen = gram -ve bacteria
- E.coli 60-80%
- Others: proteus, klebsiella, enterobacter, pseduo
RFs for pyelonephritis
Frequent sexual intercourse Prev/ongoing UTI DM Occlusion to urinary tract Anatomical/functionaal abnormality Immunosuppressed state Pregnancy
Clinical presentation of pyelonephritis?
Flank/costovertebral angle pain + fever
Investigations to order in pyelonephritis
Urine MCS FBC ESR CRP Imaging Cultures
Management of pyelonephritis
Cephalosporin such as Cefiximine
What is hydronephrosis?
Dilation of the renal pelvis with or with our obstruction. Obstructions can be obstructive nephropathy or uropathy
Epidemiology of hydronephrosis
Increasing prev. in whites
Peak 30-50yo
Aetiology
Anything that can interrupt urine flow by narrowing or blocking the tract:
- stones
- BPH
- Ca
- Bladder tumours
Pathophysiology of hydropnephrosis
Obstructive condition > back pressure on kidney > decreased renal blood flow = decreased GFR = increased RAS pathway = atrophy and apoptosis of renal tubule cells
RFs for hydronephrosis
BPH Constipation Medication: antichols., narcotics, alpha recap. agonists Spinal cord injury Malignancy
Clinical presentation of someone with hydronephrosis
Flank pain Fever Lower urinary fact symptoms inability to urinate costovertebral angle tenderness haematuria palpable bladder Hypertensive
Investigations to consider in hydronephrosis
urine dipstick renal use urea and creating abc CT pyelogram
Mx of hydronephrosis
Depends on the underlying cause:
- Stones < 10mm - medical management + ?lithotrip
- Stones >10mm - surgery
- Obstruction: surgery + Abx
- Bilateral obstruction: catheter and Abx
Causes of AKI
Pre renal: reduced renal perfusion
Intrinsic:
- Acute tubular necrosis due to ischaemia
- Acute TIN
- Nephritic syndrome
Post renal: SNIPPIN
- Stones
- Neoplasm
- Infection
- Prostate
- Posterior urethra valves
- Inflammation
- Neuropathic
Mnemonic for causes of AKI
patients can’t VOID RIGHT
Vasculitis Obstruction Infection Drugs Renal artery stenosis Interstitial nephropathy Glomerular nephropathy Hypovolemia Thromboembolism
What is the most common cause of AKI
Ischemia causing acute tubular necrosis
RFs for AKI
Increased age underlying renal disease malignant HTN DM Trauma Haemorrhage Sepsis Pancreatitis Drug overdose Surgery HF
Clinical presentation of AKI
Uraemia/Azotaemia Acidosis Hyperkal Fluid overload signs Vomitting Dizziness Orthopnea Tachycardia
Investigations to consider in AKI
Basic metabolic profile Urea:Cr ratio FBC ABG Renal USS CXR ECG changes
Mx of AKI
ABG/VBG to asses K+ status
ECG to assess K+ status (Tents on flat Plains)
-proceed to treat if needed
Assess volume status: BP
- low: fluids until BP>100
- high: diuretics
Catheterise to assess hourly output
Definition of CKI
Diseased kidney state where GFR <60 for >3 months
Most common causes of CKI
- DM
- HTN
Others: RAS, GN, Polycystic disease, SLE
Preventative values for CKI
HbA1c <7%
BP <140/90
Stop smoking
BMI <27
RFs for CKI
DM
HTN
Age >50
Clinical presentation of CKI
Fatigue Oedema Nausea Anorexia Enlarged prostate Pruritus
Investigations in CKI
Serum Cr Urinalysis Urine mucroalbumin Renal USS eGFR
Mx of CKI
Stage 1-2 uncomplicated: ACEi + satin
Stage 3-4 uncomplicated: increased dose ACEi + statin
Stage 5 or uraemia: Dialysis or transplant
Complications of CKI
CRF HEALS
CVD Renal osteodystrophy Fluid HTN Electrolyte disturbance Anaemia Leg restlessness Sensory neuropathy
