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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
Q

Who is commonly affected by Pyelonephritis

A

Younger women, pregnant women, men and older people

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26
Q

Bacteria causing of Pyelonephritis

A

E.coli
Proteus mirabilis
Klebsiella

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27
Q

Risk factors for Pyelonephritis

A

Frequent sexual intercourse, UTI, Diabetes mellitus, stress incontinence, anatomical urinary abnormality, immunosuppressed, pregnancy

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28
Q

Symptoms and signs of Pyelonephritis

A

Fever, nausea and vominting, dysuria, frequency, urgency, flank tenderness

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29
Q

Investigations for Pyelonephritis

A

Urinalysis ( raised WBCs), Gram Stain, Urine Culture (>100,000 bacteria), FBC, blood culture

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30
Q

Differentials for Pyelonephritis

A

Chronic Pyelonephritis , Pelvic Inflammatory Disease, Cystitis, Prostatitis, Lower lobe pneumonia

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31
Q

Treatment for Pyelonephritis

A

Cefixime or Ciprofloxacin

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32
Q

Complications of Pyelonephritis

A 
Need for catherisation 
Renal failure
Antibiotic failure
Sepsis
Renal Abscess formation
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33
Q

Chronic Pyelonephritis

A

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.

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34
Q

Who is most affected by Chronic Pyelonephritis

A

Children
Caucasians
Females

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35
Q

Risk factors for Chronic Pyelonephritis

A 
Acute Pyelonephritis
Vesicoureteral reflux in children 
Obstruction 
Renal Calculi
Diabetes
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36
Q

Signs and symptoms for Chronic Pyelonephritis

A

Nausea

Hypertension

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37
Q

Investigations for Chronic Pyelonephritis

A

Urinalysis, U&E, Urine culture, FBC, Renal USS, KUB scan, Abdomen CT, Voiding Cystourethography (VCUG)

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38
Q

Voiding Cystourethogram (VCUG)

A

Minimally invasive test that uses fluoroscopy to visualise a child’s urinary tract and bladder

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39
Q

Differentials for Chronic Pyelonephritis

A

Acute pyelonephritis, renal calculi, renal cancer

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40
Q

Xanthogranulomatous Pyelonephritis

A

Prolonged obstructive uropathy in adults

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41
Q

Emphysematous Pyelonephritis

A

Infection by gas-producing bacteria in adults

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42
Q

Treatment for Xanthogranulomatous Pyelonephritis

A

Nephrectomy and Antibiotics

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43
Q

Treatment for Emphysematous Pyelonephritis

A

Percutaneous drainage and Antibiotics

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44
Q

Complications of Chronic Pyelonephritis

A

AKI, hyperparathyroidism (hypocalcaemia, hyperphosphataemia), CKD

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45
Q

Hydronephrosis

A

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

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46
Q

Who is most affected by Hydronephrosis

A

Antenatal hydronephrosis: 1 in 100 unborn babies during pre-natal scans
Women 20-60yo
Men over 60yo

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47
Q

Causes of Hydronephrosis

A 
Antenatal Hydronephrosis
Kidney stones
Pregnancy
Benign Prostatic Hyperplasia (BPH)
Ureteric Stenosis
Cancer
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48
Q

Risk Factors for Hydronephrosis

A

Kidney Stones, congenital blockage, blood clot, scarring, tumour, enlarged prostate, pregnancy, UTi

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49
Q

Signs and Symptoms for Hydronephrosis

A

Flank pain, distended bladder, blood in urine, UTI symptoms

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50
Q

Investigations for Hydronephrosis

A

Renal Ultrasound, Cytoscopy, FBC, U&E, PR exam

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51
Q

Differentials for Hydronephrosis

A

Renal SinusCysts

52
Q

Treatment for Hydronephrosis

A

Drain urine with urethral catheter or nephrostomy

53
Q

Complications of Hydronephrosis

A

UTI

CKD

54
Q

Acute Kidney Injury

A

An decline in renal function leading to a rise in creatinine and fall in urine output

55
Q

Pre-renal AKI

A

Reduction in blood flow to the kidney. Pre-renal azotemia, hypovolaemia, haemorrhage, sepsis, pancreatitis, overdiuresis, heart failure

56
Q

Azotemia

A

High levels of nitrogen-containing compounds and creatinine levels. The decreases renal flow stimulates salt and water retention to restore volume and pressure.

57
Q

Intrinsic AKI

A 
Direct damage to the kidneys causes a sudden loss in kidney function. 
Acute Tubular necrosis
Glomerulonephritis
Acute Interstitial nephritis 
Vascular diseases
58
Q

Post-renal AKI

A

Obstruction in the urinary tract below the kidneys causes waste to build up in the kidney.
Lymphoma, tumour, BPH, strictures, renal calculi

59
Q

Risk factors for AKI

A

Age, malignant HTN, diabetes, myeloproliferative disorders, connective tissue disease, nephrotic syndrome, haemorrhage, sepsis, pancreatitis, drug overdose, surgery, excessive fluid loss

60
Q

Symptoms and signs of AKI

A

Reduced urine production, nausea and vomiting, dizziness, orthopnoea, PND, Pulmonary oedema, hypotension, tachycardia, orthostatic hypotension, HTN, peripheral oedema

61
Q

Investigations for AKI

A 
U&E: serum creatinine, hyperkalaemia, metabolic acidosis
Urinalysis
Urine culture
FBC
VBG
Renal USS
Chest Xray
ECG
62
Q

Differentials for AKI

A

CKD

Increased muscle mass

63
Q

Treatment for Pre-renal AKI

A

Volume expansion and RBC transfusion
Vasopressor
Diuretic
Renal replacement therapy

64
Q

Treatment for Intrinsic AKI

A

Diuretic
Volume expansion
Renal Replacement Therapy

65
Q

Treatment for Post-renal AKI

A

Catherisation
Diuretic
Renal replacement therapy

66
Q

Complications of AKI

A 
Hyperphosphataemia
Oedema
Uraemia
Hyperkalaemia
Metabolic Acidosis
Chronic Kidney Disease
ESRD
67
Q

Symptoms of Azotemia

A

Oliguria, Fatigue, Asterixis (flapping tremor), Decreased alertness, Confusion, Pale skin, Oedema, thirst

68
Q

Chronic Kidney Disease

A

Proteinuria or haematuria and a reduction in the GFR for more than 3 months duration

69
Q

6 Stages of CKD

A 
S1: GFR >90
S2: GFR 60-89
S3a: GFR 45-59
S3b: GFR 30-44
S4: GFR 15-29
S5: GFR <15
70
Q

How is most affected by CKD

A

Black and South Asians

Men > women

71
Q

Prognosis of CKD

A

Progressive and will eventually lead to ESRD and will need RRT

72
Q

Cause of CKD

A

Diabetes and Hypertension most common caused

73
Q

Risk Factors for CKD

A 
Diabetes Mellitus
HTN
Age >50 years
Childhood Kidney Disease
Smoking and obesity
Autoimmune disorders
74
Q

Signs and symptoms of CKD

A

Fatigue, oedema, nausea and vomiting, pruritis, anorexia, cloudy urine

75
Q

Investigations for CKD

A 
Elevated Serum Creatinine
Haematuria 
Proteinuria
Urine Microalbumin 
Small kidney size
eFGR <60ml/min
76
Q

Differentials for CKD

A 
Diabetic Kidney disease
Hypertensive nephrosclerosis
Ischaemic nephropathy
Obstructive uropathy
Nephrotic Syndrome 
Glomerulonephritis
77
Q

Treating CKD

A 
Ace inhibitor or ARB
Statin
CCB
Education about Renal Replacement Therapy
Erythropoietin stimulating agent
Dialysis
78
Q

Complications of CKD

A 
Anaemia
Renal Osteodystrophy
Cardiovascular disease
Protein malnutrition 
Metabolic acidosis
Hyperkalaemia
Pulmonary Oedema
79
Q

Renal Osteodystrophy

A

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
Q

Benign Prostatic Hyperplasia (BPH)

A

Lower urinary tract symptoms caused by bladder outlet obstruction.

81
Q

Difference between Dynamic and Static component of BPH

A

Static: increase in benign epithelial prostatic tissue narrowing urethral lumen
Dynamic: increase in prostatic smooth muscle tone mediated by alpha-adrenergic receptors

82
Q

How common is BPH

A

Men 70-80 yo

Prevalence increases with age

83
Q

Risk factors for BPH

A

Age >50years
Less common in Asians
Smoking

84
Q

Symptoms of BPH

A

Storage symptoms: frequency, urgency and nocturia

Voiding symptoms: weak stream, hesitancy, straining, incomplete emptying and post-void dribbling

85
Q

Investigations of BPH

A 
PR exam
Palpable bladder
Reduced urine flow <15ml/s
Prostate Specific Antigen (PSA) test on blood 
Cystoscopy
86
Q

Cystoscopy

A

Procedure examining the lining of the bladder and urethra

87
Q

Pathophysiology of BPH

A

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
Q

International Prostate Symptoms Score

A

Eight-question written screening tool used to screen for suggest management of the symptoms of BPH

89
Q

Differentials for BPH

A 
Prostate CAncer
UTI
Urinary Tract stones
Detrusor muscle weakness
Prostatits
90
Q

Treatment for BPH

A

Alpha Blocker
5-alpha reductase inhibitor
Phosphodiesterase-5 Inhibitor
Surgery

91
Q

Alpha-blockers for TURP

A

Tamsulosin, Alfuzosin, Doxazosin, Terazosin

92
Q

5-alpha reductase inhibitor

A

Finasteride

93
Q

Surgical options for BPH

A

Transurethral Resection of Prostate (TURP)
Transurethal Incision of the Prostate (TUIP)
Retropubic Prostatectomy
Transurethral Laser-induced Prostatectomy (TULIP)

94
Q

Complications of BPH

A 
UTI
Renal Insufficiency
Bladder stones
Sexual dysnfunction
Acute urinary retention
95
Q

Prostate carcinoma

A

High grade prostatic intra-epithelial neoplasia (PIN) is the precursor of invasive prostate cancer

96
Q

Genes involved in Prostate carcinoma

A

ZIP1
PTEN
KAI1

97
Q

Risk factors for Prostate Carcinoma

A 
Age
Breast Cancer in family
Ethnicity
Smoking 
Diet
98
Q

Symptoms of Prostate Carcinoma

A

LUTS
Erectile dysfunction
Painful ejaculation
Metastatic spread: back pain, bone pain, weight loss, anaemia, lymph node enlargement

99
Q

What to look out for in a PR exam

A 
Asymmetry
Nodules
Adhesion to surrounding tissue
Hard gland 
Palpable seminal vesicles
Obliteration of median sulcus
100
Q

Investigations for Prostatic Carcinoma

A 
Elevated PSA >4mcg/L
Testosterone
LFTs, FBC, U&amp;Es, 
Transrectal ultrasound-guided needle biopsy (TRUS)
Bone Scan 
Pelvic CT scan
101
Q

Differentials for Prostatic Carcinoma

A

BPH (smooth, enlarged prostate, no metastatic symptoms)
UTI/ Stone (dysuria, haematuria)
Chronic Prostatitis

102
Q

Treatment for Prostatic Carcinoma

A

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
Q

Symptoms of Bladder carcinoma

A

Painless Haematuria
Dyusuria
Urinary frequency

104
Q

Investigations for Bladder carcinoma

A 
Urinalysis 
Renal and Bladder USS
Cystoscopy
Urogram
FBC, U&amp;Es
105
Q

Differentials for Bladder Carcinoma

A 
BPH
Haemorrhagic Cystitis
Prostatitis
Nephrolithiasis
Renal cell/ urothelial carcinoma
Radiation cystitis
Diverticulitis
106
Q

Treatment for Bladder Carcinoma

A 
Transurethral resection 
Immediate post-op intreavesical chemo 
Delayed intravesical BCG immunotherapy 
Chemotherapy 
Immunotherapy
107
Q

What is BCG

A

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
Q

Complications of Bladder Carcinoma

A

Prostatic Urothelial carcinoma
Hydronephrosis
Urinary retention

109
Q

Renal Carcinoma

A

80% are renal cell adenocarcinomas of clear cell histology

110
Q

Role of VHL proteins in Renal Carcinoma

A

VHL protein functions to degrade hypoxia-inducible factor (HIF). Without VHL, HIF promotes VEGF, PDGF and EGFR

111
Q

Prognosis for Renal Cell Carcinoma

A

5-year survival of 64%

112
Q

Risk factors for Renal Cell Carcinoma

A

Smoking male, 50-80yo, resident in developed country,

113
Q

Symptoms for Renal Cell Carcinoma

A

Asymtomatic, haematuria, flank pain, palpale abdominal mass

114
Q

Differentials for Renal Cell Carcinoma

A 
Benign Renal Cyst
Ureteric Cancer
Bladder Cancer
Upper urinary tract urothelial tumour
Secondary metastases
Renal infection
115
Q

Treatment for Renal Cell Carcinoma

A

Surgery

Local ablation therapy

116
Q

Complications of Renal Cell Carcinoma

A

Anaemia, hypercalcaemia, erythrocytosi, SIADH, hepatic dysfunction

117
Q

Urinary Tract Stones

A

Calculi within the urinary system. Made of varying amounts of cyrstalloid and organic matter

118
Q

How common are Urinary tract stones

A

More in men, white people, 40-60s

119
Q

Types of Urinary Stones

A 
Calcium stones (80%)
Uric acid stones (10-20%)
Crystine stones (1%)
Struvite stones (5%)
120
Q

Cause of Urinary Stones

A

Increased levels of calcium, uric acid, oxalate and sodium
Decreased levels of citrate and magnesium
Low urinary volume

121
Q

Risk factors for Urinary Stones

A 
High protein and salt intake
White ancestry
Male
Dehydration
Obesity
Crystalluria
122
Q

Signs and symptoms for Urinary stones

A 
Acute sever flank pain. Radiates to ipsilateral groin
Previous episodes of nephrolithiasis
N&amp;V
Urinary frequency
Haematuria
Testicular pain
123
Q

Investigation for Urinary stones

A 
Urinalysis
Urine pregnancy test to exclude ectopic pregnancy
CT scan
Renal USS
IV Pyelogram
FBC, U&amp;E
124
Q

Differentials for Urinary stones

A

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
Q

Treatment for Urinary Stones

A

Hydration
Anti-emetics
Antibiotics if bacteriuria

126
Q

Complications of Urinary Stones

A

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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