Renal Tract Flashcards
Define a UTI
Presence of characteristics and significant bacteriuria (>10(5)CFU/ml)
What makes it a complicated UTI?
Anatomical, functional or pharmacological factors predispose to persistent infection
Risk factors for UTI
Instrumentation, Structural Abnormalities, Female, Diabetes and Immunocomprimised
Symptoms of UTI
Frequency, Urgency, Incontinence, Haematuria, Dysuria, cloudy urine, suprapubic pain, rigors, fever, confusion
UTI investigations
Urine dip, bladder exam
UTI Treatment/ Organism
Nitrofurantoin/ Trimethoprim - E.coli most common organism
Define pyelonephritis
Bacterial infection within the renal pelvis
Risk factors for pyelonephritis
Female, 15-19 yrs, structural abnormalities, instrumentation, pregnancy, diabetes, immunocompromised
Common organisms for pyelonephritis
E.coli, Klebsiella pneumoniae, proteus and pseudomonas species
Symptoms of pyelonephritis
Loin and suprapubic pain, fever, rigors, anorexia, kidney tenderness
Pyelonephritis investigations
Urine dip + culture + microscopy, blood for inflammatory markers, USS for structural abnormalities
Pyelonephritis treatment
Rest, fluids, analgesia, Abx - Ciprofloxacin/ Co-amoxiclav
Where can hydronephrosis occur?
Anywhere from renal calculi to external urethral meatus
Causes of hydronephrosis? (3 groups)
Within the lumen: Clot, stone, tumour
Within the wall: Strictures, bladder neck obstruction
Pressure from outside: Tumours, BPH, fibrosis, Crohn’s
Symptoms - Upper and Lower, Acute and Chronic
Upper:
Acute - Flank pain radiates to inguinal area/ testes, restlessness
Chronic - Abdo pain and CKD
Lower:
Acute - Suprapubic pain, distended bladder
Chronic - LUTS
Hydronephrosis investigations
Urine dip, bloods, PSA. USS
Hydronephrosis treatment
If partial blockage and no infection = supportive
Blockage = catheter
If no resolution possible = urinary diversion (SPC etc)
Define AKI
Abrupt loss of renal function resulting in retention of urea and electrolytes and dysregulation of extracellular volume and electrolytes
Staging of AKI
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
AKI risk factors
> 65 yrs, CKD, previous AKI, cardiac/liver disease, DM, NSAID’s, ACEi’s and diuretics
3 different types of AKI
Pre -renal
Intra-renal
Post-renal
Pre- renal causes of AKI
Hypovolaemia, oedema, hypotension, cardiac/renal hypoperfusion
Causes of intra-renal AKI
Glomerular disease, Nephritis, Eclampsia
Causes of post-renal AKI
Obstruction, BPH, Prostate, bladder or pelvic malignancy
Presentation of AKI
Oliguria/Anuria (Although may be polyuria due to reduced reabsorption by damaged tubules), Nausea, vomiting, dehydration, confusion, palpable bladder, JVP, oedema
AKI investigation
Urinalysis, Blood, USS
AKI Treatment
Mostly supportive - stop nephrotoxic drugs, treat any infections/obstruction
Treat acute complications - Hyperkalemia, acidosis, oedema and bleeding
Risk factors of CKD
CVD, proteinuria, hypertension, DM, smoking, afrocarribbean. NSAIDs, urinary obstruction
Causes of CKD
Renal Arterial disease, hypertension, DM, Glomerulonephritis, hypercalcaemia, SLE
Staging of CKD
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
Presentation of CKD
Usually asymptomatic and found on routine tests but can cause anorexia, nausea, fatigue, oedema, polyuria
CKD investigations
eGFR - Creatinine, Sex, Age, Race
Glucose for DM, FBC for anaemia, Urine dip, ECG/Echo, USS/MRI/CT
CKD Treatment
Mild rarely progresses to severe so just monitor eGFR
Lifestyle changes, control DM + BP
RRT for stage 5 - Haemo/peritoneal dialysis or transplant
Cause of BPH
Failure of apoptosis - actual cause unknown
Presentation of BPH
LUTS - frequency, urgency, dysuria, nocturia, weak stream, hesitancy, terminal dribbling, incomplete voiding, retention, incontinence.
Palpable bladder, enlarged prostate on PR,
BPH investigations
PSA, Bloods, USS
BPH Treatment
Depending on severity of symptoms - alpha blockers/ 5-a-reductase antagonists.
What is the most common male cancer diagnosis?
Prostatic Carcinoma
What is the most common prostate cancer and where is it normally?
Adenocarcinoma in the peripheral zone
Risk factors for prostatic carcinoma?
Age, afro-caribbean
Presentation of prostatic carcinoma
LUTS
Locally invasive = Haematuria/spermia
Metastatic = Bone pain/ sciatica, lymph nodes + weight loss
Investigations of prostatic carcinoma + findings
DRE - hard, nodular, asymmetrical, tethered lump.
PSA/PCA3
Trans-rectal Ultrasound Guided Biopsy - TRUS
Staging of prostatic carcinoma
Gleason/TNM
Treatment of prostatic carcinoma
Surgical prostatectomy +/- radio/chemo therapy
If metastatic must remove adrenergic drive by removing both testes - Bilateral Orchiectomy
