Renal Tract Flashcards
Who is most likely to get a UTI?
Women, 16-35yrs
What is an upper UTI called?
Pyelonephritis
Most common cause of UTI Infection
Escherichia Coli (80%)
UTI Risk Factors
Female Anatomy, Sex, Diabetes, Obesity, Family Hx, Catheters
UTI Male Risk Factors
Large Prostate, Uncircumcised
UTI Presentation
Dysuria, Frequency, Incomplete emptying, Pain in lower back, Haematuria
UTI Presentation in Children
Fever, Incontinence, Vomit, Jaundice
UTI Presentation in Elderly
Incontinence, Confusion, Fatigue
What shows up on Urinalysis if a UTI is present?
Nitrites, Leukocyte esterase, Bacteria
Uncomplicated UTI Treatment
Short course (3-7 days)
Trimethoprim/Nirofurantoin
Most common cause of Pyelonephritis?
Escherichia Coli
Pyelonephritis Risk Factors
Sex, Prior UTI, Diabetes, Structural problems of tract, Spermicides, Kidney stones
Pyelonephritis Presentation
Fever, Flank tenderness, Nausea, Dysuria, Haematuria, Frequency, Vomiting
Rapid onset
Pyelonephritis Investigations
Urinalysis, FBC, Urine + Blood culture, Antibiotic sensitivity tests
Pyelonephritis Treatment
Ciprofloxacin or Ceftriaxone
Complicated = IV Fluids and IV Antibiotics
What makes a Pyelonephritis complicated?
Fever, Leucocytosis
Who is Hydronephrosis more common in?
Men and Children
What is Hydronephrosis?
Build up of urine/water in the kidneys as a result of obstruction
Causes of Hydronephrosis?
Anything that can cause obstruction
Stones, Clots, Fibrosis, Dysfunction, Tumours, UTI
Hydronephrosis Presentation
Intense pain in flank, Nausea/Vomiting
Hydronephrosis Signs
Elevated Urea and Creatinine, Elevated pH, Palpable mass
Hydronephrosis Investigations
Urinalysis, IV Urogram, USS, CT/MRI
Acute Hydronephrosis Treatment
Insert Nephrostomy Tube
Chronic Hydronephrosis Treatment
Insert Ureteric Stent / Pyeloplasty
Causes of Chronic Kidney Disease?
Diabetes, High BP, Glomerulonephritis, Obstruction, Stenosis
Chronic Kidney Disease Presentation
Leg swelling, Fatigue, Vomiting, Loss of Appetite, Confusion, High Potassium Symptoms, Trouble with Sex
What must the GFR be to diagnose Chronic Kidney Disease?
GFR = <60 for 3 months
Chronic Kidney Disease Investigations
GFR, Albumin (low), Creatinine, USS, Biopsy
Chronic Kidney Disease Treatment
Manage BP/Cholesterol/Sugar, Avoid Toxins (NSAIDs)
Severe = Dialysis, Transplant
Definition of Acute Kidney Injury
Urine output = <0.5ml/kg/hour for 6 hours
Rise of Creatinine of 26umol/L in 48 hours/>50% in last 7 days
Most common cause of Acute Kidney Injury?
Pre-renal = 90% (Low BP, Fluid depletion)
Acute Kidney Injury Risk Factors
Dehydration, Sever infection, Diabetes, Old age, CKD
Acute Kidney Injury Symptoms
Fatigue, Headache, Nausea/Vomiting, Pain in flanks, Thirst
Acute Kidney Injury Signs
Low urine output, High BP, Large bladder, Uraemia, Metabolic acidosis
What type of Kidney disease do you get a rash with?
Interstitial Nephritis
Acute Kidney Injury Investigations
Urinalysis, USS
Bloods, Catheter, Biopsy, CT/MRI
The 3 causes of Acute Kidney Injury
Pre-Renal (low BP)
Intrinsic (glomerular, nephritis, toxins)
Post-renal (obstruction)
Acute Kidney Injury Treatment
STOP
+ Remove blockage, Diuretics, Steroids, Dialysis, Catheter (depending)
Chronic Kidney Disease Risk Factors
Old age, Diabetes, Hypertension, Obesity, CVD
What type of cancer is Prostate Carcinoma?
Adenocarcinoma (glandular)
Where in the prostate is Prostate Carcinoma most common?
Peripheral zone
Where does Prostate Carcinoma most commonly invade?
Rectum, Bladder, Ureters
Prostate Carcinoma Risk Factors
> 50, Family Hx, African-American, Red meat, Milk, BRCA, Obesity
Prostate Carcinoma Presentation
Dysuria, Haematuria, Nocturia, Poor stream
Pain in pelvis, Fatigue, Sexual dysfunction (Bone pain)
What Scoring System is used for Prostate Carcinoma?
Gleason Score (2-10)
Prostate Carcinoma Investigations
PR, Imaging, Biopsy, Tumour markers (PSA)
Prostate Carcinoma Treatment
Surveillance, Surgery, Radiation/Hormone/Chemo
How many males over 80 are affected by Benign Prostatic Hypertrophy?
90%
What enzymes increase in activity as men age to cause Benign Prostatic Hypertrophy?
Aromatase, 5-Alpha Reductase
= more oestrogen and DHT
Where is Benign Prostatic Hypertrophy most common in the prostate?
Transition Zone
Median and Lateral lobes
Benign Prostatic Hypertrophy Risk Factors
Family Hx, Obesity, Diabetes, Erectile dysfunction
Benign Prostatic Hypertrophy Presentation
Frequency, Hesitancy, Nocturia, Weak stream, Anuria, Loss of bladder control, Urgency, Incomplete emptying, Dysuria
Benign Prostatic Hypertrophy Investigations
PR, Urinalysis, Bloods
Benign Prostatic Hypertrophy Treatment
Lifestyle, Alpha blockers, 5a-reductase inhibitors, Self-catheterization, Surgery
Most common type of Bladder Carcinoma?
Transitional Cell Carcinoma (90%)
Bladder Carcinoma Presentation
Haematuria, Frequency, Dysuria, Lower back pain, Mass, Peripheral Oedema
Bladder Carcinoma Risk Factors
Smoking, Family Hx, Radiation treatment, Frequent Cystitis
Bladder Carcinoma Investigations
Cystoscopy with Biopsy, CT, Bone scan
What percentage of Kidney Cancer is Renal Cell Carcinoma?
95%
Where does Renal Cell Carcinoma Originate?
Lining of the proximal convoluted tubule
Renal Cell Carcinoma Presentation
(hidden at first), Haematuria, Flank pain, Mass, Weight loss, Fever, Night sweats
What are the Paraneoplastic syndromes that are associated with Renal Cell Carcinoma?
High blood calcium, High RBCs, High Platelets, Secondary amyloidosis
Renal Cell Carcinoma Investigations
BLoods, USS, CT/MRI, Renal angiography, IV Pyelogram
What Treatment is not good for Renal Cell Carcinoma?
Chemo/Radiotherapy
What is the most common type of Urinary Tract Stone?
Calcium (85%)
Also: Uric acid, Cystine, Struvite
Urinary Tract Stone Causes
Hyperparathyroidism, Dehydration, Diet, Family Hx, Medication (indinavir)
Urinary Tract Stone Presentation
Colic Pain, Nausea, Sweating, Haematuria, Frequency, Fever, Dysuria, Cloudy urine
Urinary Tract Stone Investigations
CT, USS (misses small stone), X-Ray (for calcium stones), Urinalysis
Urinary Tract Stone Treatment
Fluid, Analgesia, Alpha blockers, Stent, Lithotripsy/Endoscopy
