renal tract Flashcards
bladder cancer:
- commonest type?
- commonest risk factors? 3
- rare risk factors? 5
transitional cell carcinoma (>90%)
- increased age
- male
- tobacco smoking
- some chemicals (dye, rubber industry etc)
- FH
- pelvic radiation
- schistosomiasis (get squamous cell carcinoma)
- chronic cystitis
bladder cancer:
- symptoms?
- main investigation?
- other investigations? 2
- painless haematuria
- recurrent UTIs
- voiding irritability
cystoscopy with biopsy
- MSU (may show sterile pyuria)
- CT (for staging/spread)
bladder cancer:
- 1st line treatment?
- other treatment options?
transurethral resection of bladder tumour (TURBT)
- radical cystectomy
- radiotherapy (worse survival but preserves bladder)
- neoadjuvant chemo with any of above
renal cancer:
- commonest type?
- risk factors? 4
renal cell carcinomas (90%)
nb kids get wilms tumours (nephroblastomas)
- male
- increased age (mean 55)
- smoking
- haemodialysis
renal cancer:
- % found incidentally?
- local symptoms/signs? 3
- systemic symptoms/signs? 4
- % that have mets at presentation?
50%
- haematuria
- loin pain
- abdominal mass
- anorexia
- malaise
- weight loss
- pyrexia
25%
renal cancer:
- BP findings?
- FBC findings?
- other blood test to order?
- 1st line imaging?
- CXR findings w lung mets?
BP raised (increased renin)
polycythaemia (epo secretion)
U+Es
Ultrasound
cannon ball mets (on CXR)
renal cancer:
- 1st line treatment?
- 2nd line/palliative treatment?
- surgery (radical or partial nephrectomy)
- biological therapy and immune modulators (though not great!)
chemo + radiotherapy are NOT effective
- radio may be used for bony mets
urinary tract stones:
- Latin name?
- age + gender most commonly affected?
- other risk factors? 6
- commonest type of stone?
nephrolithiasis
- men (3:1)
- 20-40y (can happen at any age)
- obesity
- dehydration
- FH (important!!)
- high calcium (e.g. high PTH)
- high salt diet
- gout
calcium oxalate (75%)
“stag horn calculi are a type of kidney stone - OXes are like stags -> OXalate”
urinary tract stones:
- symptoms? 4
- sign? 1
- common complication?
can be asymptomatic (esp if small)
- excruciating renal colic (loin to groin)
- nausea/vomiting
- can’t lie still (differentiates from peritonitis)
- haematuria (can get anuria)
nb pain often localises to where stone is (e.g. kidney, mid ureter etc, so not always in loin)
- may be renal angle tenderness but not always
- infection (pyelonephritis)
urinary tract stones:
- bloods? 6
- other bedside test? 1
- imaging?
- FBC
- U+E
- Ca2+
- Phosphate
- glucose
- urate
- urine dipstick (90% positive for blood)
can sieve urine + send stone for biochemistry if unsure of cause
- non-contrast CT = gold!
- XR (80% show up)
- USS for hydronephrosis
urinary tract stones:
- acute treatment for all? 3
- small stones? 1
- large or non-resolving? 2
- secondary prevention? 1
- analgesia
- IV fluids (if can’t take oral)
- Abx (if infection)
small
- wait to pass
large or non-resolving
- medical expulsive therapy (alpha-blockers or nifedipine)
- if still not, lithotripsy
(can do surgery but v rare!)
- drink plenty
(nb advice normal dietary calcium as low can increase oxalate excretion!)
urinary tract stones:
- important differentials? 2
- leaking AAA (esp first presentation over 60)
- appendicitis
