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Y3 Core Conditions > Renal Tract > Flashcards

Renal Tract Flashcards

1
Q

Urinary Tract Infection

A

The presence of a pure growth of >10^5 organisms/mL of fresh MSU. Can be uncomplicated or complicated

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2
Q

Who is commonly affected by UTI

A 
Newborn males
Teenage women 
Older me 
Women post-menopause
Women more than men
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3
Q

Cause of UTI

A

Bacteria from person’s own bowel flora transfer via ascending transurethral route but may be via blood stream, lymphatics or direct extension

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4
Q

How is virulence measured for UTI

A

Determined by the ability to adhere to epithelial cells

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5
Q

Bacteria associated with Cystitis

A

E.coli with type 1 fimbriae

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6
Q

Bacteria associated with Pyelonephritis

A

E.coli with type P fimbriae

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7
Q

What is Relapse

A

The recurrence of bacteriuria with the same organism within 7 days of completion of antibacterial treatment. Suggest failure to eradicate infection due to stones, scarred kidneys, polycystic disease or bacterial prostatitis

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8
Q

What is Reinfection

A

When bacteriuria is absent after treatment for at least 14 days, followed by recurrence of infection with the same or different organisms

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9
Q

Risk factors to UTI

A

Female, sexual intercourse, spermicide in females, pregnancy, menopause, immunosuppression, UTI stone, obstruction, long-time catheter

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10
Q

Symptoms for Cystitis (Bladder inflammation)

A

Frequency, urgency, nocturia, dysuria, haematuria, suprapubic pain

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11
Q

Symptoms for Pyelonephritis

A

Fevers, rigors, vomiting, loin pain and tenderness, oliguria

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12
Q

Symptoms for Prostatitis

A

Flu-like symptoms, low backache, swollen/tender prostate on PR,

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13
Q

Signs of UTI

A

Pyrexial, abdominal loin tenderness, foul-smelling urine, distended bladder, enlarged prostate

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14
Q

Differentials for UTI

A

Urethral Syndrome, Bladder pain syndrome, Chronic Pelvic pain syndrome, Vaginitis, STI

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15
Q

Investigations for UTI

A
  1. Urine Dipstick (high leucocyte and nitrates in infection )
  2. Urine Microscopy
  3. Blood tests
  4. Imagine: USS, Computed Tomography of Kidneys, Ureter and Bladder)
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16
Q

Management of UTI

A

Drink fluids and urinate often
Cranberry juice or cranberry concentrate tablets
Antibiotic Prophylaxis

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17
Q

Causes of sterile pyuria (pus in urine)

A 
Treated UTI 2 weeks prior 
Inadequately treated UTI
Appendicitis
Calculi
Prostatitis
Bladder Tumour
UTI with fastidious organism
Tubulointerstitial nephritis
Papillary necrosis
Polycystic kidney
Chemical cystitis
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18
Q

Referral criteria for lower UTI

A

Failure to respond to 2 courses of sensitive antibiotics
Suspected malignancy
Risk factors for recurrent UTI present e.g. Neisseria Gonnorhoeae
Referral for Men is routine

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19
Q

Referral criteria for Pyelonephritis

A

First episode in Men
Second or more episodes in women
Infection with Proteus species

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20
Q

Treatment for Lower UTI

A

Trimethoprim or Nitrofurantoin:
3 Days for non-pregnant women
5-10 days for non- pregnant women with complicated infection
7 days for men

Nitrofurantoin, Trimethoprim or Cefalexin:
7 days in pregnant women

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21
Q

Treatment for Pyelonephritis

A

IV then oral switch when afebrile
Ciprofloxacin for 7 days or Co-amoxiclav for 14 days for non-pregnant women, men and people with in-dwelling catheters
Cefalexin for 10-14 days for pregnant women who do not require admission

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22
Q

Treatment of UTI for pregnant women

A

Treat accordingly once sensitivies are known:
Amoxicillin for 7 days
Nitrofurantoin for 7 days
Trimethoprim for 7 days (Do not give for folate-deficient, give folic acid supplement if in first trimester)
Cefalexin for 7 days

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23
Q

Which antibiotics foster C. Diff

A 
Clindamycin 
Fluoroquinolones
Ciprofloxacin 
Penicillins
Cephalosporins e.g cefalexin
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24
Q

Pyelonephritis

A

Infection of the renal parenchyma, calices and pelvis. Acute, recurrent or chronic.

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25
Who is commonly affected by Pyelonephritis
Younger women, pregnant women, men and older people
26
Bacteria causing of Pyelonephritis
E.coli Proteus mirabilis Klebsiella
27
Risk factors for Pyelonephritis
Frequent sexual intercourse, UTI, Diabetes mellitus, stress incontinence, anatomical urinary abnormality, immunosuppressed, pregnancy
28
Symptoms and signs of Pyelonephritis
Fever, nausea and vominting, dysuria, frequency, urgency, flank tenderness
29
Investigations for Pyelonephritis
Urinalysis ( raised WBCs), Gram Stain, Urine Culture (>100,000 bacteria), FBC, blood culture
30
Differentials for Pyelonephritis
Chronic Pyelonephritis , Pelvic Inflammatory Disease, Cystitis, Prostatitis, Lower lobe pneumonia
31
Treatment for Pyelonephritis
Cefixime or Ciprofloxacin
32
Complications of Pyelonephritis
``` Need for catherisation Renal failure Antibiotic failure Sepsis Renal Abscess formation ```
33
Chronic Pyelonephritis
Inflammation and renal scarring of the kidneys due to reflux of urine into the kidney's pelvis. Scarring and atrophy leading to loss of tubular function. Damage is irreversible.
34
Who is most affected by Chronic Pyelonephritis
Children Caucasians Females
35
Risk factors for Chronic Pyelonephritis
``` Acute Pyelonephritis Vesicoureteral reflux in children Obstruction Renal Calculi Diabetes ```
36
Signs and symptoms for Chronic Pyelonephritis
Nausea | Hypertension
37
Investigations for Chronic Pyelonephritis
Urinalysis, U&E, Urine culture, FBC, Renal USS, KUB scan, Abdomen CT, Voiding Cystourethography (VCUG)
38
Voiding Cystourethogram (VCUG)
Minimally invasive test that uses fluoroscopy to visualise a child's urinary tract and bladder
39
Differentials for Chronic Pyelonephritis
Acute pyelonephritis, renal calculi, renal cancer
40
Xanthogranulomatous Pyelonephritis
Prolonged obstructive uropathy in adults
41
Emphysematous Pyelonephritis
Infection by gas-producing bacteria in adults
42
Treatment for Xanthogranulomatous Pyelonephritis
Nephrectomy and Antibiotics
43
Treatment for Emphysematous Pyelonephritis
Percutaneous drainage and Antibiotics
44
Complications of Chronic Pyelonephritis
AKI, hyperparathyroidism (hypocalcaemia, hyperphosphataemia), CKD
45
Hydronephrosis
When the kidneys become stretched and swollen due to build up of urine. The rise in urethral pressure leads to changes in filtration, function and blood flow
46
Who is most affected by Hydronephrosis
Antenatal hydronephrosis: 1 in 100 unborn babies during pre-natal scans Women 20-60yo Men over 60yo
47
Causes of Hydronephrosis
``` Antenatal Hydronephrosis Kidney stones Pregnancy Benign Prostatic Hyperplasia (BPH) Ureteric Stenosis Cancer ```
48
Risk Factors for Hydronephrosis
Kidney Stones, congenital blockage, blood clot, scarring, tumour, enlarged prostate, pregnancy, UTi
49
Signs and Symptoms for Hydronephrosis
Flank pain, distended bladder, blood in urine, UTI symptoms
50
Investigations for Hydronephrosis
Renal Ultrasound, Cytoscopy, FBC, U&E, PR exam
51
Differentials for Hydronephrosis
Renal SinusCysts
52
Treatment for Hydronephrosis
Drain urine with urethral catheter or nephrostomy
53
Complications of Hydronephrosis
UTI | CKD
54
Acute Kidney Injury
An decline in renal function leading to a rise in creatinine and fall in urine output
55
Pre-renal AKI
Reduction in blood flow to the kidney. Pre-renal azotemia, hypovolaemia, haemorrhage, sepsis, pancreatitis, overdiuresis, heart failure
56
Azotemia
High levels of nitrogen-containing compounds and creatinine levels. The decreases renal flow stimulates salt and water retention to restore volume and pressure.
57
Intrinsic AKI
``` Direct damage to the kidneys causes a sudden loss in kidney function. Acute Tubular necrosis Glomerulonephritis Acute Interstitial nephritis Vascular diseases ```
58
Post-renal AKI
Obstruction in the urinary tract below the kidneys causes waste to build up in the kidney. Lymphoma, tumour, BPH, strictures, renal calculi
59
Risk factors for AKI
Age, malignant HTN, diabetes, myeloproliferative disorders, connective tissue disease, nephrotic syndrome, haemorrhage, sepsis, pancreatitis, drug overdose, surgery, excessive fluid loss
60
Symptoms and signs of AKI
Reduced urine production, nausea and vomiting, dizziness, orthopnoea, PND, Pulmonary oedema, hypotension, tachycardia, orthostatic hypotension, HTN, peripheral oedema
61
Investigations for AKI
``` U&E: serum creatinine, hyperkalaemia, metabolic acidosis Urinalysis Urine culture FBC VBG Renal USS Chest Xray ECG ```
62
Differentials for AKI
CKD | Increased muscle mass
63
Treatment for Pre-renal AKI
Volume expansion and RBC transfusion Vasopressor Diuretic Renal replacement therapy
64
Treatment for Intrinsic AKI
Diuretic Volume expansion Renal Replacement Therapy
65
Treatment for Post-renal AKI
Catherisation Diuretic Renal replacement therapy
66
Complications of AKI
``` Hyperphosphataemia Oedema Uraemia Hyperkalaemia Metabolic Acidosis Chronic Kidney Disease ESRD ```
67
Symptoms of Azotemia
Oliguria, Fatigue, Asterixis (flapping tremor), Decreased alertness, Confusion, Pale skin, Oedema, thirst
68
Chronic Kidney Disease
Proteinuria or haematuria and a reduction in the GFR for more than 3 months duration
69
6 Stages of CKD
``` S1: GFR >90 S2: GFR 60-89 S3a: GFR 45-59 S3b: GFR 30-44 S4: GFR 15-29 S5: GFR <15 ```
70
How is most affected by CKD
Black and South Asians | Men > women
71
Prognosis of CKD
Progressive and will eventually lead to ESRD and will need RRT
72
Cause of CKD
Diabetes and Hypertension most common caused
73
Risk Factors for CKD
``` Diabetes Mellitus HTN Age >50 years Childhood Kidney Disease Smoking and obesity Autoimmune disorders ```
74
Signs and symptoms of CKD
Fatigue, oedema, nausea and vomiting, pruritis, anorexia, cloudy urine
75
Investigations for CKD
``` Elevated Serum Creatinine Haematuria Proteinuria Urine Microalbumin Small kidney size eFGR <60ml/min ```
76
Differentials for CKD
``` Diabetic Kidney disease Hypertensive nephrosclerosis Ischaemic nephropathy Obstructive uropathy Nephrotic Syndrome Glomerulonephritis ```
77
Treating CKD
``` Ace inhibitor or ARB Statin CCB Education about Renal Replacement Therapy Erythropoietin stimulating agent Dialysis ```
78
Complications of CKD
``` Anaemia Renal Osteodystrophy Cardiovascular disease Protein malnutrition Metabolic acidosis Hyperkalaemia Pulmonary Oedema ```
79
Renal Osteodystrophy
Alteration of bone morphology in patients with CKD. Due to elevation in parathyroid hormone as a result of phosphorus retention and hypocalcaemia from Vit D deficiency as GFR declines
80
Benign Prostatic Hyperplasia (BPH)
Lower urinary tract symptoms caused by bladder outlet obstruction.
81
Difference between Dynamic and Static component of BPH
Static: increase in benign epithelial prostatic tissue narrowing urethral lumen Dynamic: increase in prostatic smooth muscle tone mediated by alpha-adrenergic receptors
82
How common is BPH
Men 70-80 yo | Prevalence increases with age
83
Risk factors for BPH
Age >50years Less common in Asians Smoking
84
Symptoms of BPH
Storage symptoms: frequency, urgency and nocturia | Voiding symptoms: weak stream, hesitancy, straining, incomplete emptying and post-void dribbling
85
Investigations of BPH
``` PR exam Palpable bladder Reduced urine flow <15ml/s Prostate Specific Antigen (PSA) test on blood Cystoscopy ```
86
Cystoscopy
Procedure examining the lining of the bladder and urethra
87
Pathophysiology of BPH
Both glandular epithelial cells, muscle fibres and stromal cells undergo hyperplasia. Most growth happens in the transitional zone (TZ) and also posterior urethral glands.
88
International Prostate Symptoms Score
Eight-question written screening tool used to screen for suggest management of the symptoms of BPH
89
Differentials for BPH
``` Prostate CAncer UTI Urinary Tract stones Detrusor muscle weakness Prostatits ```
90
Treatment for BPH
Alpha Blocker 5-alpha reductase inhibitor Phosphodiesterase-5 Inhibitor Surgery
91
Alpha-blockers for TURP
Tamsulosin, Alfuzosin, Doxazosin, Terazosin
92
5-alpha reductase inhibitor
Finasteride
93
Surgical options for BPH
Transurethral Resection of Prostate (TURP) Transurethal Incision of the Prostate (TUIP) Retropubic Prostatectomy Transurethral Laser-induced Prostatectomy (TULIP)
94
Complications of BPH
``` UTI Renal Insufficiency Bladder stones Sexual dysnfunction Acute urinary retention ```
95
Prostate carcinoma
High grade prostatic intra-epithelial neoplasia (PIN) is the precursor of invasive prostate cancer
96
Genes involved in Prostate carcinoma
ZIP1 PTEN KAI1
97
Risk factors for Prostate Carcinoma
``` Age Breast Cancer in family Ethnicity Smoking Diet ```
98
Symptoms of Prostate Carcinoma
LUTS Erectile dysfunction Painful ejaculation Metastatic spread: back pain, bone pain, weight loss, anaemia, lymph node enlargement
99
What to look out for in a PR exam
``` Asymmetry Nodules Adhesion to surrounding tissue Hard gland Palpable seminal vesicles Obliteration of median sulcus ```
100
Investigations for Prostatic Carcinoma
``` Elevated PSA >4mcg/L Testosterone LFTs, FBC, U&Es, Transrectal ultrasound-guided needle biopsy (TRUS) Bone Scan Pelvic CT scan ```
101
Differentials for Prostatic Carcinoma
BPH (smooth, enlarged prostate, no metastatic symptoms) UTI/ Stone (dysuria, haematuria) Chronic Prostatitis
102
Treatment for Prostatic Carcinoma
Observation Brachytherapy: transperineal implantation of radioactive seed into the prostate Cryotherapy: method of localized freezing temperatures to deaden an irritated nerve Radiotherapy Radical Prostatectomy Androgen-deprivation therapy
103
Symptoms of Bladder carcinoma
Painless Haematuria Dyusuria Urinary frequency
104
Investigations for Bladder carcinoma
``` Urinalysis Renal and Bladder USS Cystoscopy Urogram FBC, U&Es ```
105
Differentials for Bladder Carcinoma
``` BPH Haemorrhagic Cystitis Prostatitis Nephrolithiasis Renal cell/ urothelial carcinoma Radiation cystitis Diverticulitis ```
106
Treatment for Bladder Carcinoma
``` Transurethral resection Immediate post-op intreavesical chemo Delayed intravesical BCG immunotherapy Chemotherapy Immunotherapy ```
107
What is BCG
Bacillus Calmette-Guerin is the main intravesical immunotherapy for early stage bladder cancer. It’s made from a weakened strain of Mycobacterium bovis, a vaccine for tuberculosis. The BCG is inserted into the bladder through the urethra.
108
Complications of Bladder Carcinoma
Prostatic Urothelial carcinoma Hydronephrosis Urinary retention
109
Renal Carcinoma
80% are renal cell adenocarcinomas of clear cell histology
110
Role of VHL proteins in Renal Carcinoma
VHL protein functions to degrade hypoxia-inducible factor (HIF). Without VHL, HIF promotes VEGF, PDGF and EGFR
111
Prognosis for Renal Cell Carcinoma
5-year survival of 64%
112
Risk factors for Renal Cell Carcinoma
Smoking male, 50-80yo, resident in developed country,
113
Symptoms for Renal Cell Carcinoma
Asymtomatic, haematuria, flank pain, palpale abdominal mass
114
Differentials for Renal Cell Carcinoma
``` Benign Renal Cyst Ureteric Cancer Bladder Cancer Upper urinary tract urothelial tumour Secondary metastases Renal infection ```
115
Treatment for Renal Cell Carcinoma
Surgery | Local ablation therapy
116
Complications of Renal Cell Carcinoma
Anaemia, hypercalcaemia, erythrocytosi, SIADH, hepatic dysfunction
117
Urinary Tract Stones
Calculi within the urinary system. Made of varying amounts of cyrstalloid and organic matter
118
How common are Urinary tract stones
More in men, white people, 40-60s
119
Types of Urinary Stones
``` Calcium stones (80%) Uric acid stones (10-20%) Crystine stones (1%) Struvite stones (5%) ```
120
Cause of Urinary Stones
Increased levels of calcium, uric acid, oxalate and sodium Decreased levels of citrate and magnesium Low urinary volume
121
Risk factors for Urinary Stones
``` High protein and salt intake White ancestry Male Dehydration Obesity Crystalluria ```
122
Signs and symptoms for Urinary stones
``` Acute sever flank pain. Radiates to ipsilateral groin Previous episodes of nephrolithiasis N&V Urinary frequency Haematuria Testicular pain ```
123
Investigation for Urinary stones
``` Urinalysis Urine pregnancy test to exclude ectopic pregnancy CT scan Renal USS IV Pyelogram FBC, U&E ```
124
Differentials for Urinary stones
Appendicitis, ectopic pregnancy, ovarian cyst, diverticular disease, bowel obstruction, pancreatitis, peptic ulcer disease, gastroenteritis, AAA, pyelonephritis, testicular/ ovarian obstruction, MSK back pain, constipation, cholecystitis
125
Treatment for Urinary Stones
Hydration Anti-emetics Antibiotics if bacteriuria
126
Complications of Urinary Stones
Post Percutaneous nephrostolithotomy bleeding Post-extracorpeal shock wave lithotripsy haematoma Urosepsis Visceral organ injury Pneumothorax Ureteric stricture

Y3 Core Conditions (13 decks)

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