Renal Tract

Question 1

Define a UTI

Answer 1

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

Question 2

What makes it a complicated UTI?

Answer 2

Anatomical, functional or pharmacological factors predispose to persistent infection

Question 3

Risk factors for UTI

Answer 3

Instrumentation, Structural Abnormalities, Female, Diabetes and Immunocomprimised

Question 4

Symptoms of UTI

Answer 4

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

Question 5

UTI investigations

Answer 5

Urine dip, bladder exam

Question 6

UTI Treatment/ Organism

Answer 6

Nitrofurantoin/ Trimethoprim - E.coli most common organism

Question 7

Define pyelonephritis

Answer 7

Bacterial infection within the renal pelvis

Question 8

Risk factors for pyelonephritis

Answer 8

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

Question 9

Common organisms for pyelonephritis

Answer 9

E.coli, Klebsiella pneumoniae, proteus and pseudomonas species

Question 10

Symptoms of pyelonephritis

Answer 10

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

Question 11

Pyelonephritis investigations

Answer 11

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

Question 12

Pyelonephritis treatment

Answer 12

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

Question 13

Where can hydronephrosis occur?

Answer 13

Anywhere from renal calculi to external urethral meatus

Question 14

Causes of hydronephrosis? (3 groups)

Answer 14

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

Question 15

Symptoms - Upper and Lower, Acute and Chronic

Answer 15

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

Question 16

Hydronephrosis investigations

Answer 16

Urine dip, bloods, PSA. USS

Question 17

Hydronephrosis treatment

Answer 17

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

Question 18

Define AKI

Answer 18

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

Question 19

Staging of AKI

Answer 19

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

Question 20

AKI risk factors

Answer 20

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

Question 21

3 different types of AKI

Answer 21

Pre -renal
Intra-renal
Post-renal

Question 22

Pre- renal causes of AKI

Answer 22

Hypovolaemia, oedema, hypotension, cardiac/renal hypoperfusion

Question 23

Causes of intra-renal AKI

Answer 23

Glomerular disease, Nephritis, Eclampsia

Question 24

Causes of post-renal AKI

Answer 24

Obstruction, BPH, Prostate, bladder or pelvic malignancy

Question 25

Presentation of AKI

Answer 25

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

Question 26

AKI investigation

Answer 26

Urinalysis, Blood, USS

Question 27

AKI Treatment

Answer 27

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

Question 28

Risk factors of CKD

Answer 28

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

Question 29

Causes of CKD

Answer 29

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

Question 30

Staging of CKD

Answer 30

``` 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

Question 31

Presentation of CKD

Answer 31

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

Question 32

CKD investigations

Answer 32

eGFR - Creatinine, Sex, Age, Race | Glucose for DM, FBC for anaemia, Urine dip, ECG/Echo, USS/MRI/CT

Question 33

CKD Treatment

Answer 33

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

Question 34

Cause of BPH

Answer 34

Failure of apoptosis - actual cause unknown

Question 35

Presentation of BPH

Answer 35

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

Question 36

BPH investigations

Answer 36

PSA, Bloods, USS

Question 37

BPH Treatment

Answer 37

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

Question 38

What is the most common male cancer diagnosis?

Answer 38

Prostatic Carcinoma

Question 39

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

Answer 39

Adenocarcinoma in the peripheral zone

Question 40

Risk factors for prostatic carcinoma?

Answer 40

Age, afro-caribbean

Question 41

Presentation of prostatic carcinoma

Answer 41

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

Question 42

Investigations of prostatic carcinoma + findings

Answer 42

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

Question 43

Staging of prostatic carcinoma

Answer 43

Gleason/TNM

Question 44

Treatment of prostatic carcinoma

Answer 44

Surgical prostatectomy +/- radio/chemo therapy | If metastatic must remove adrenergic drive by removing both testes - Bilateral Orchiectomy