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Core Conditions > Renal Tract > Flashcards

Renal Tract Flashcards

1
Q

Define a UTI

A

Presence of characteristics and significant bacteriuria (>10(5)CFU/ml)

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2
Q

What makes it a complicated UTI?

A

Anatomical, functional or pharmacological factors predispose to persistent infection

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3
Q

Risk factors for UTI

A

Instrumentation, Structural Abnormalities, Female, Diabetes and Immunocomprimised

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4
Q

Symptoms of UTI

A

Frequency, Urgency, Incontinence, Haematuria, Dysuria, cloudy urine, suprapubic pain, rigors, fever, confusion

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5
Q

UTI investigations

A

Urine dip, bladder exam

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6
Q

UTI Treatment/ Organism

A

Nitrofurantoin/ Trimethoprim - E.coli most common organism

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7
Q

Define pyelonephritis

A

Bacterial infection within the renal pelvis

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8
Q

Risk factors for pyelonephritis

A

Female, 15-19 yrs, structural abnormalities, instrumentation, pregnancy, diabetes, immunocompromised

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9
Q

Common organisms for pyelonephritis

A

E.coli, Klebsiella pneumoniae, proteus and pseudomonas species

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10
Q

Symptoms of pyelonephritis

A

Loin and suprapubic pain, fever, rigors, anorexia, kidney tenderness

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11
Q

Pyelonephritis investigations

A

Urine dip + culture + microscopy, blood for inflammatory markers, USS for structural abnormalities

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12
Q

Pyelonephritis treatment

A

Rest, fluids, analgesia, Abx - Ciprofloxacin/ Co-amoxiclav

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13
Q

Where can hydronephrosis occur?

A

Anywhere from renal calculi to external urethral meatus

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14
Q

Causes of hydronephrosis? (3 groups)

A

Within the lumen: Clot, stone, tumour
Within the wall: Strictures, bladder neck obstruction
Pressure from outside: Tumours, BPH, fibrosis, Crohn’s

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15
Q

Symptoms - Upper and Lower, Acute and Chronic

A

Upper:
Acute - Flank pain radiates to inguinal area/ testes, restlessness
Chronic - Abdo pain and CKD
Lower:
Acute - Suprapubic pain, distended bladder
Chronic - LUTS

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16
Q

Hydronephrosis investigations

A

Urine dip, bloods, PSA. USS

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17
Q

Hydronephrosis treatment

A

If partial blockage and no infection = supportive
Blockage = catheter
If no resolution possible = urinary diversion (SPC etc)

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18
Q

Define AKI

A

Abrupt loss of renal function resulting in retention of urea and electrolytes and dysregulation of extracellular volume and electrolytes

19
Q

Staging of AKI

A

Serum creatinine and Urine Output
1 = 1.5-1.9 x baseline creatinine or < 0.5ml/kg/h urine output for 6-12 hrs
2 = 2-2.9 x baseline or <0.5 ml/kg/h > 12 hrs
3 = >3x baseline or increase of > 4 mg/dl or RRT or <0.3 ml/kg/h for 24 hrs or Anuria for 12 hrs

20
Q

AKI risk factors

A

> 65 yrs, CKD, previous AKI, cardiac/liver disease, DM, NSAID’s, ACEi’s and diuretics

21
Q

3 different types of AKI

A

Pre -renal
Intra-renal
Post-renal

22
Q

Pre- renal causes of AKI

A

Hypovolaemia, oedema, hypotension, cardiac/renal hypoperfusion

23
Q

Causes of intra-renal AKI

A

Glomerular disease, Nephritis, Eclampsia

24
Q

Causes of post-renal AKI

A

Obstruction, BPH, Prostate, bladder or pelvic malignancy

25
Q

Presentation of AKI

A

Oliguria/Anuria (Although may be polyuria due to reduced reabsorption by damaged tubules), Nausea, vomiting, dehydration, confusion, palpable bladder, JVP, oedema

26
Q

AKI investigation

A

Urinalysis, Blood, USS

27
Q

AKI Treatment

A

Mostly supportive - stop nephrotoxic drugs, treat any infections/obstruction
Treat acute complications - Hyperkalemia, acidosis, oedema and bleeding

28
Q

Risk factors of CKD

A

CVD, proteinuria, hypertension, DM, smoking, afrocarribbean. NSAIDs, urinary obstruction

29
Q

Causes of CKD

A

Renal Arterial disease, hypertension, DM, Glomerulonephritis, hypercalcaemia, SLE

30
Q

Staging of CKD

A 
eGFR
1 = > 90 ml/min/1.73m(2) + evidence of CKD*
2 = 60-89
3a = 45-60
3b = 30-45
4 = 15-30
5 = <15 or RRT
  • = Microalbuminuria, Proteinuria, Haematuria, Structural abnormalities or Glomerulonephritis
31
Q

Presentation of CKD

A

Usually asymptomatic and found on routine tests but can cause anorexia, nausea, fatigue, oedema, polyuria

32
Q

CKD investigations

A

eGFR - Creatinine, Sex, Age, Race

Glucose for DM, FBC for anaemia, Urine dip, ECG/Echo, USS/MRI/CT

33
Q

CKD Treatment

A

Mild rarely progresses to severe so just monitor eGFR
Lifestyle changes, control DM + BP
RRT for stage 5 - Haemo/peritoneal dialysis or transplant

34
Q

Cause of BPH

A

Failure of apoptosis - actual cause unknown

35
Q

Presentation of BPH

A

LUTS - frequency, urgency, dysuria, nocturia, weak stream, hesitancy, terminal dribbling, incomplete voiding, retention, incontinence.
Palpable bladder, enlarged prostate on PR,

36
Q

BPH investigations

A

PSA, Bloods, USS

37
Q

BPH Treatment

A

Depending on severity of symptoms - alpha blockers/ 5-a-reductase antagonists.

38
Q

What is the most common male cancer diagnosis?

A

Prostatic Carcinoma

39
Q

What is the most common prostate cancer and where is it normally?

A

Adenocarcinoma in the peripheral zone

40
Q

Risk factors for prostatic carcinoma?

A

Age, afro-caribbean

41
Q

Presentation of prostatic carcinoma

A

LUTS
Locally invasive = Haematuria/spermia
Metastatic = Bone pain/ sciatica, lymph nodes + weight loss

42
Q

Investigations of prostatic carcinoma + findings

A

DRE - hard, nodular, asymmetrical, tethered lump.
PSA/PCA3
Trans-rectal Ultrasound Guided Biopsy - TRUS

43
Q

Staging of prostatic carcinoma

A

Gleason/TNM

44
Q

Treatment of prostatic carcinoma

A

Surgical prostatectomy +/- radio/chemo therapy

If metastatic must remove adrenergic drive by removing both testes - Bilateral Orchiectomy

Core Conditions (10 decks)

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