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3rd Year > Renal tract conditions > Flashcards

Renal tract conditions Flashcards

1
Q

What is bacteriuria?

A

The presence of bacteria in the urine

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2
Q

Define UTI

A

The presence of characteristic symptoms and significant bacteriuria from kidneys to bladder

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3
Q

What is the laboratory threshold for diagnosing significant bacteriuria?

A

10 to the power of 5 colony-forming units per millilitre (cfu/ml)

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4
Q

What is infection of the bladder called?

A

Cystitis

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5
Q

What is an uncomplicated urinary tract infection?

A

An infection of the urinary tract by a usual pathogen in a person with a normal urinary tract and with normal kidney function

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6
Q

What is a complicated UTI?

A

This occurs where anatomical, functional or pharmacological factors predispose the person to persistent infection

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7
Q

What are the three most common microorganisms to cause UTI?

A

Escherichia coli (75-95% in the community)
Staphylococcus saprophyticus
Proteus mirabilis

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8
Q

Are UTIs more common in men or women?

A

women

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9
Q

Risk factors associated with UTI are?

A 
Recent sexual activity
New sexual partner
Use of spermicide
Diabetes
Presence of catheter
Institutionalisation
Pregnancy
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10
Q

How does acute pyelonephritis present?

A 
High fevers
rigors
vomiting
loin pain and tenderness
oliguria
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11
Q

What is oliguria?

A

Passing a reduced amount of urine (less than 400mL/day in adults)

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12
Q

What are the symptoms of cystitis?

A 
Frequency
dysuria
urgency
haematuria
suprapubic pain
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13
Q

What are the symptoms of prostatitis?

A

Flu-like symptoms
Low backache
Few urinary symptoms
Swollen or tender prostate on PR

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14
Q

What is dysuria?

A

Painful urination

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15
Q

What are the sings of UTI?

A 
Fever
Abdominal or loin Tenderness
Foul smelling urine
Distended bladder
Enlarged prostate
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16
Q

Investigations for UTI?

A

Urine dipstick test (check for nitrites and/or leukocytes)

MSU

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17
Q

What is an MSU?

A

Midstream specimen of urine

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18
Q

What is sterile pyuria?

A

The presence of elevated numbers of white cells in urine which appears sterile

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19
Q

When should MSU be asked for?

A 
If symptomatic but dipstick is -ve
Or if:
Male
a child
pregnant
immuno-compromised
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20
Q

When should patients be referred for imaging or cytoscopy?

A

Patients who:
have persistently not responded to treatment
have a history of renal tract disease or anomaly
have haematuria
women with >3 confirmed infection in the last year
men with >2 confirmed infections in the last year

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21
Q

What is the drug of first choice for the empirical treatment of uncomplicated UTI?

A

Trimethoprim or nitrofurantroin

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22
Q

Causes of sterile pyuria?

A 
TB
Inadequately treated UTI
Appendicitis
Calculi; prostatitis
Bladder tumour
Polycystic kidney
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23
Q

Prevention of UTI?

A

Drink more water
Antibiotic prophylaxis (continuously or post coital)
Cranberry juice

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24
Q

What is the management for UTI?

A

Drink plenty of fluids
Urinate often
Emperical antibiotic treatment

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25
Q

What are the risk factors for pyelonephritis?

A 
Structural renal abnormalities
Calculi and urinary tract catheterisation
Stents or drainage procedures
Pregnancy
Diabetes
Primary biliary cirrhosis
Immunocompromised patients
Neuropathic bladder
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26
Q

How does pyelonephritis present?

A 
Rapid onset (appears over a day or two)
Unilateral/ bilateral loin pain, suprapubic or back pain
Fever (variable)
Malaise
Nausea
Vomiting
Anorexia
Diarrhoea (occasionally)
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27
Q

What investigations could be undertaken for pyelonephritis?

A 
Urinalysis
Inflammatory markers
FBC
Blood cultures
Imaging
Renal biopsy
Fairley test
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28
Q

What will urinalysis show in pyelonephritis?

A

Urine is often cloudy with an offensive smell

May be positive for blood, protein, leukocyte esterase and nitrite

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29
Q

What is the fairley test?

A

Rarely used today
A bladder washout is performed.
Urine cultures are taken immediately and at 10, 20 and 30 mins
Isolated bladder infection: bacteriuria take time
Kidney infection: bacteriuria returns rapidly

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30
Q

What supportive management is there for pyelonephritis?

A

Rest
Adequate fluid intake
Analgesia

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31
Q

What is the first line empirical antibiotic treatment for pyelonephritis?

A

Ciprofloxacin

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32
Q

Which patients are more at risk of pyelonephritis complications?

A 
Diabetes mellitus
Chronic renal failure
sickle cell disease
Renal transplant
AIDs (and other immunocompromised states)
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33
Q

What are the potential complications of pyelonephritis?

A 
Septicaemia
Perinephric abscess
Renal abscess
Acute papillary necrosis
Pregnancy (risk of premature labour)
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34
Q

Risk factors for chronic pyelonephritis?

A

Structural renal tract anomolies, obstruction or calculi
Children with vesicoureteral reflux
Intrarenal reflux in neonates
Genetic predisposition
Any factors predisposing to recurrent urinary infection

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35
Q

How does chronic pyelonephritis present?

A 
Fever
Malaise
Loin pain
Nausea
Vomiting
Dysuria
Hypertension
Failure to thrive
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36
Q

Management of chronic pyelonephritis?

A

Blood pressure control (ACE-i)
Surgical re-implantation of the ureters may be needed in severe cases
Renal failure may eventually require renal transplantation

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37
Q

What should all patients with chronic kidney disease be monitored for?

A

Hyperlipidaemia
Hypertension
Diabetes
Deteriorating renal function

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38
Q

What is acute kidney injury?

A

A rapid deterioration of renal function as measured by serum urea and creatinine, resulting in inability to maintain fluid, electrolyte and acid-base balance

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39
Q

What are 3 criteria for diagnosing AKI?

A

Rise in creatinine >26umol/L in 48 hours
Rise in creatinine >1.5x baseline
Urine output 6 consecutive hours

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40
Q

In how many hospital patients does AKI occur?

A

18%

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41
Q

Risk factors for AKI?

A 
Age >75
Chronic kidney disease
Cardiac failure
Peripheral vascular disease
Chronic liver disease
Diabetes
Drugs
Sepsis
Poor fluid intake/increased losses
History of urinary symptoms
42
Q

What are the most common causes of AKI?

A

Ischaemia
Sepsis
Nephrotoxins
Prostatic disease

43
Q

What are the pre-renal causes of AKI?

A 
(40-70%) renal hypoperfusion eg
hypotension
hypovolaemia
sepsis
renal artery stenosis
44
Q

What medications can cause renal hypoperfusion?

A

NSAIDS
selective COX-2 inhibitors
ACE inhibitors
ARBs

45
Q

What are the causes of Intrinsic renal problems?

A

Glomerular disease
Tubular injury
Acute interstitial nephritis due to drugs, infection or autoimmune diseases
Vascular disease

46
Q

What are the post-renal causes of AKI?

A

(10-25%) caused by urinary tract obstruction
Luminal (stones, clots, sloughed papillae)
Mural (malignancy, BPH, Strictures)
Extrinsic compression (malignancy, retroperitoneal fibrosis)

47
Q

Hows does AKI present?

A

Present differently depending on the underlying cause and severity of AKI.

48
Q

If symptomatic what are the symptoms of AKI?

A 
Oliguria/anuria
Nausea
Vomiting
Dehydration
Confusion
49
Q

Signs of AKI?

A

Hypertension
Large painless bladder
Dehydration with postural hypotension and no oedema
Fluid overload (raised JVP, pulmonary and peripheral oedema)
Pallor, rash, bruising (may suggest inflammatory or vascular disease, emboli or disseminated intravascular coagulation)
Pericardial rub

50
Q

Assessment of AKI?

A

Make sure you know all the renal effects of all drugs being taken
All assessment should include basic ABCDE approach

51
Q

When assessing ABCDE for AKI what parts of C are important to remember?

A

Assess volume status (BP, JVP, skin turgor, cap refill, urine output)
Check an urgent K+ on a venous blood specimen and check ECG for life threatening hyperkalaemia

52
Q

What blood tests should be undertaken for acute kidney injury?

A 
U&E
FBC
LFT
clotting
ESR
CRP
consider ABG
53
Q

What should be looked for in a AKI urinalysis?

A

Leukocytes and nitrites (infection)

Blood and protein (Glomerular disease)

54
Q

What can a renal USS be used to distinguish between in an AKI?

A

Obstruction and hydronephritis.

Also used to look for cysts, small kidneys, masses as well as assess corticomedullary differentiation

55
Q

When should chronic kidney disease be suspected?

A

Long duration of symptoms
Nocturia
Small kidneys (

56
Q

Is there a specific treatment for AKI?

A

No. AKI management is largely supportive. Consists of treating the cause where possible, monitoring fluid and electrolyte balance closely and optimising haemodynamic status.

57
Q

What are the general measures in AKI management?

A 
Assess volume status
Aim for euvolaemia
Stop nephrotoxic drugs
Monitoring
Identify and treat infection
Nutrition
58
Q

Which drugs should one consider withholding in AKI?

A 
CANDA
Contrast media
ACE inhibitors
NSAIDs
Diuretics
Angiotensin receptor blocker
59
Q

What are the acute complications of AKI?

A

Hyperkalaemia
Metabolic Acidosis
Pulmonary Oedema
Bleeding

60
Q

What are the ECG signs of hyperkalaemia?

A

Tall ‘tented’ T-waves
small or absent p wave
increased PR interval
Widening QRS complex

61
Q

What is the immediate treatment for hyperkalaemia?

A 
10mL 10% calcium gluconate IV (cardioprotective)
IV insulin and glucose (insulin stimulates intracellular uptake of K+)
Salbutamol nebulisers (work in the same way as insulin)
62
Q

When should the patient be referred for renal replacement therapy?

A 
If any of the following are not responding to medical management:
Hyperkalaemia
Metabolic acidosis
Fluid overload
Pulmonary oedema
Uraemia
63
Q

What is hydronephrosis?

A

Hydronephrosis is the swelling of a kidney due to a build-up of urine. It happens when urine cannot drain out from the kidney to the bladder from a blockage or obstruction. Hydronephrosis can occur in one or both kidneys.

64
Q

What are the causes/risk factors for hydronephrosis?

A 
Kidney stone
UTI
Congenital blockage
Blood clot
Scarring of tissue
Tumor or cancer
Enlarged prostate
Pregnancy
65
Q

What are the two mechanisms to cause hydronephrosis?

A

Obstruction of the outflow of urine

Reflux of urine into the renal pelvis

66
Q

How is hydronephrosis diagnosed?

A

Ultrasound

Cytoscopy

67
Q

What is the definition of Chronic kidney disease?

A

Impaired renal function for >3 months based on abnormal structure or function or GFR 3 months with or without evidence of kidney damage.

68
Q

At what stage of CKD do symptoms normally occur

A

stage 4 (GFR

69
Q

What is the definition of end stage renal failure? ESRF

A

GFR

70
Q

What are the 5 primary causes of CKD?

A 
Diabetes (20%)
Glomerulonephiritis
Unknown (20%)
Hypertension/renovascular disease
Pyelonephritis and reflux nephropathy
71
Q

What conditions is CKD often associated with?

A 
Old age
Diabetes
Hypertension
Obesity
CVD
72
Q

Risk factors for CKD?

A 
CVD
Proteinuria
AKI
Hypertension
Diabetes
Smoking
African, African-caribbean or asian family origin
Chronic use of NSAIDs
Untreated urinary outflow tract obstruction
73
Q

Symptoms of CKD?

A

Usually asymptomatic and often unrecognised because there are no specific symptoms
Specific symptoms usually develop only in severe CKD

74
Q

What are the symptoms of severe CKD?

A 
Anorexia
Nausea
Vomiting
Fatigue
Weakness
Pruritus
Lethargy
Peripheral oedema
Dyspnoea
Insomnia
Muscle cramps
Pulmonary oedema
Nocturia
Polyuria
Headache
Sexual dysfunction
75
Q

Signs of CKD?

A 
Increased skin pigmentation
Pallor
Hypertension
Postural hypotension
Peripheral oedema
Left ventricular hypertrophy
peripheral vascular disease
pleural effusion
peripheral neuropathy
restless legs syndrome
76
Q

What is assessment of CKD focused on?

A

Assessment of renal function (stage of CKD) and identification of the underlying cause

77
Q

Define the GFR 5 stages of CKD

A 
Stage 1: GFR >90
Stage 2: GFR 60-89
Stage 3: GFR 45-59
Stage 4: GFR 15-29
Stage 5 GFR
78
Q

Signs of renal damage?

A

Proteinuria
Haematuria
Evidence of abnormal anatomy or systemic disease

79
Q

When should a patient with CKD be referred to a nephrologist?

A 
Stage 4 and 5 CKD
Moderate proteinuria
Proteunuria with haematuria
Rapidly falling GFR
Increasinh BP poorly controlled despite >4 antihypertensive drugs
Rare or genetic causes of CKD
Suspected renal artery stenosis
80
Q

Management of CKD patients is split into four main approaches. These are?

A

Investigation (identifying and treating reversible causes)
Limiting progression/complications
Symptom control
Preperation for renal replacement therapy

81
Q

What does limiting progression/complication of CKD involve?

A

BP
Renal bone disease
Cardiovascular modification
Diet

82
Q

What does symptom control of CKD involve?

A

Anaemia
Acidosis
Oedema
Restless leg/cramps

83
Q

For which drugs is is important to modify dosage in relation to GFR?

A 
Aminoglycosides (gentamicin)
Cephalosporins
Heparin
Lithium
Opiates
Digoxin
84
Q

What is benign prostatic Hyperplasia?

A

BPH is an increase in the size of the prostate gland without malignancy. Benign nodular or diffuse proliferation of musculofibrous and glandular layers of the prostate

85
Q

What is LUTS?

A

lower urinary tract symptoms

86
Q

How is the pathology of BPH different to that of prostate carcinoma?

A

In BPH the inner (transitional) zone enlarges in contrast to peripheral layer expansion seen in prostate carcinoma.

87
Q

How common is BPH?

A

24% if aged 40-64

40% if older

88
Q

How does BPH present?

A 
Nocturia
Frequency
Urgency
Post-micturition dribbling
Poor stream/flow
Hesitancy
Overflow incontinence
Haematuria
Bladder stones
UTI
89
Q

Tests/assessment of BPH

A

Assess severity of symptoms and impact on life
PR exam
MSU
U&E
Ultrasound
‘Rule out’ cancer: PSA, transrectal USS and biopsy

90
Q

What lifestyle changes should be recommended in BPH?

A

Avoid caffeine and alcohol (to reduce urgency and nocturia)
Relax when voiding
Void twice in a row to aid emptying
Train the bladder (holding on)

91
Q

What drug treatments are there for BPH?

A

Alpha blockers are first line (tamsulosin, alfuzosin). They decrease prostate and bladder smooth muscle tone
5alpha-reductase inhibitors (finasteride). Reduce testosterone

92
Q

What are the surgical options of BPH?

A

Transurethral resection of prostate
Transurethral incision of prostate
Retropubic prostatectomy
Transurethral laser-induced prostatectomy

93
Q

How common is prostate cancer?

A

Commonest male malignancy.

80% in men >80years

94
Q

What is the most common pathology of prostate cancer?

A

Most prostate cancers are adenocarcinomas arising in the peripheral zone of the prostate.

95
Q

Risk factors for Prostate carcinoma

A

Increasing age
Family history
High testosterone levels

96
Q

Symptoms of prostate cancer?

A 
Can be asymptomatic
Nocturia
Hesitancy
Poor stream
Terminal dribbling or obstruction
Weight loss and bone pain suggests metastates
97
Q

How would prostate cancer present in a DRE?

A 
A hard irregular gland.
Asymmetry
Nodule with one lobe
Induration
Lack of mobility
Palpable seminal vesicles
98
Q

Diagnosis of Prostate cancer?

A 
Increased PSA
Transrectal USS and biopsy
X rays
Bone scan
CT/MRI
99
Q

Treatment for prostate cancer confined to the prostate?

A

Radical prostatectomy
Radical radiotherapy
Hormone therapy
Active surveillance

100
Q

Treatment for metastatic prostate cancer?

A

Hormonal drugs (LHRH agonists) reduce testosterone. eg goserelin

101
Q

Side effects of Hormone therapy?

A 
Flare phenomenon
Sexual dysfunction
Hot flushes
Osteoporosis
Gynaecomastia
Fatigue

3rd Year (18 decks)

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