Renal system Flashcards
(36 cards)
Causes of hematuria
> Trauma
- Urinary catheterisation
- Flexible cystoscopy
- Post-TURP
> Infection
- Tuberculosis
- Cystitis
- Prostatitis
- UTI
> Tumor
- Transitional cell carcinoma (bladder, ureter)
- BPH
> Stones
Most common site of bladder Ca
Most bladder cancers start in the innermost lining of the bladder, which is called the urothelium or transitional epithelium.
Imaging found suspicious lesion at bladder, next step?
Flexible/ Rigid cystoscopy KIV Transurethral Resection of Bladder Tumor (TURBT)
- Diagnostic, therapeutic and staging
- Direct visualize + Cell brushing and biopsy
Renal vs Bladder Ca in history
> Renal
- Triad: flank pain, painless hematuria, palpable flank mass
> Bladder
- Persistent painless hematuria
- Irritative symptoms
- Obstructive symptoms
Diagnostic investigation bladder Ca
- Urine cytology for malignant cells
- IVU/ CT
- Flexible cystoscopy + cell brushing and cytology
Management for bladder Ca
> Superficial (T1)
- TURBT
- Intravesical therapy (eg: BCG)
> Muscle invasive (T2 and above)
- Radical cystectomy with urinary diversion (eg: ileal conduit)
Risk factor bladder Ca
- Male, Age>50
- Occupational exposure to aromatic amine (eg: printing, plastic industries)
- Cigarette smoking
- Chronic cystitis
Type of bladder Ca
- Transitional cell carcinoma (>90%)
- SCC (7-9%; long term catheter, untreated bladder stone)
- Adenocarcinoma (1%)
Describe ileal conduit
- Segment of ileum is selected (avoid terminal 15cm to maintain absorption of bile salt, Vit B12, and fat soluble vitamins)
- The ureters are implanted into it, ileum brought to skin surface, and stoma is created
- Urine will drain from kidneys through ureter into the piece of ileum and collected in an external bag
How to differentiate renal and gallstone in X-ray
- Do lateral X-ray and the gallstone will be in front of the kidney
- Gallbladder is an intraperitoneal organ while kidney is a retroperitoneal organ
Management for urolithiasis
> Conservative (<5mm)
- Pain control
- Daily alpha blocker therapy
- High fluid intake
- Diet modification
- Chemical dissolution
> Surgical (>10mm)
- ESWL
- PCNL
- Open surgery (eg: pyelolithotomy, ureterolithotomy)
> Adjuncts
- Double J-stent
Mechanism of ESWL
- High-energy shock waves transmitted through water and focused on the stone
- The change in tissue density between the soft kidney tissue and hard stone cause release of energy at the stone surface
Complication of ESWL
- Ureteral blockage due to stone fragment
- Urinary tract infection
- Transient hematuria
Presentation of stone at different site: kidney, ureter, bladder
> Renal stone
- Vague flank pain
> Ureteric stone
- Intermittent loin to groin pain
- Hematuria
- Frequency, urgency, dysuria
> Bladder stone
- Frequency, urgency
- Hematuria
Type of urinary calculi
- Calcium Oxalate (75%) [sharp projection, alkaline urine]
- Struvite (15%)
[strongly alkaline urine, eg: staghorn calculus] - Urate (5%)
[Acid urine, radiolucent] - Cysteine (2%)
[Acid urine and metabolic origin]
Cause of renal calculi
- Supersaturation
- Infection (eg: struvite stone/ magnesium ammonium phosphate in Proteus vulgaris infection - splits urea into ammonium, generating alkaline urine)
- Drug-induced
Management renal cell carcinoma
> Surgery +- adjuvant chemotherapy
- Partial nephrectomy (T1 <7cm)
- Total nephrectomy (>=T2, >7cm)
- Radical nephrectomy (>=T2)
Significant of Nitrate in urine
- Detect products of nitrate reductase, which produced by urease-splitting organisms
- Eg: Proteus species, E. coli
- However, negative in Enterococcus infection
Complication of PNL (for stones >20mm or staghorn stones)
- Significant bleeding (8%)
- Renal pelvis perforation (3%)
- Hydrothorax (2%)
- Septic shock (2.4%)
Cause of hypercalcemia
> Most common (>90%)
- Primary hyperparathyroidism
- Malignancy (eg: bone metastasis, multiple myeloma)
> Other
- Increase calcium intake
- Hypervitaminosis D
Cause of hyperparathyroidism
> Primary
- Parathyroid adenoma/ carcinoma
- Hyperplasia
> Secondary
- Vit D deficiency
- Decrease calcium intake
- Chronic renal failure
Investigation for primary hyperparathyroidism
- Serum calcium (confirm the hypercalcemia)
- Serum PTH
- 24 hour urinary calcium
- Serum 25-hydroxyvitamin D (Differentiate of secondary hyperparathyroidism due to Vit D deficiency from Primary Hyperparathyroidism)
Common pathogen in UTI
- E. coli (Most common)
- Enterobacteriaceae (eg: Klebsiella, Proteus spp)
- Pseudomonas
- Staphylococci
Pre-procedure assessment for IV Urogram
- BUSE/ Cr to assess renal function
- As it required contrast administration.
- Non-contrast CT is use more often to assess renal stone
