Renal & Urology Flashcards
How is CKD classified?
Stage 1: >90 eGFR Stage 2: 60-89 Stage 3a (moderately impaired): 45-59 -Stage 3b (moderately impaired): 30-44 -Stage 4 (severely impaired): 15-29 -Stage 5 (advanced/on dialysis): <15
How is kidney disease investigated?
- FBC, U&Es, LFTs, CK and coag
- eGFR
- Urinalysis (blood or protein)
- Urine PCR/ACR
- Histology
- Imaging (USS
Name some of the causes of CKD
- Diabetes
- Glomerulonephritis
- Hypertension
- Renovascular disease
- Polycystic kidney disease
How can CKD present?
- Anaemia
- Hypertension
- SOB (fluid overload, cardiomyopathies etc.)
- Cognitive impairment
- Anorexia
- Nausea and vomiting
- Oliguria
- Nocturia
- Haematuria/proteinuria
- Peripheral oedema
- Itches and cramps
How can CKD be managed?
- Treatment of underlying disease
- Slowing the rate of renal decline
- Prevention and treatment of complications
- Preparation for renal replacement therapy
Name some of the complications of CKD
- Acidosis
- Anaemia
- Bone disease
- CV risk
- Electrolytes
- Fluid overload
- Gout
- Hypertension
- Iatrogenic issues
Name the risk factors for prostate cancer
- Age
- Race/ethnicity (Afro-Caribbean
- Family history
How does prostate cancer present?
- Mostly asymptomatic (diagnosed through opportunistic PSA testing)
- Urinary symptoms: weak stream, hesitancy, incomplete emptying, frequency, urgency, urge incontinence, UTI, haematuria
- Perineal/suprapubic/loin pain
- Renal failure
- Haemospermia
- Tenesmus
- Impotence
How is prostate cancer diagnosed?
- PSA
- PR exam
- TRUS guided prostate biopsies
How can localised prostate cancer be managed?
- Watchful waiting
- Radiotherapy
- Radical prostatectomy
How can locally advance prostate cancer be managed?
Hormone therapy +/- surgery or radiotherapy
Name the types of hormonal therapy for prostate cancer
- Surgical castration
- Chemical castration
- Anti-androgens
- Oestrogens
How does testicular present?
- Painless lump
- Tender inflammed swelling
- History of trauma
Name the tumour markers used for testicular cancer
- AFP (teratoma)
- HCG (seminoma)
- LDH (tumour burden)
How can testicular cancer be diagnosed?
- MSSU
- USS
- CXR
- Tumour markers
How can testicular cancer be managed?
-Radical orchidectomy
What is the most common type of testicular cancer?
Germ cell tumour
Name the antibiotics of choice for lower UTIs in women
- Trimethroprim 3 days
- Nitrofurantoin
Name the antibiotics of choice for lower UTIs in men
- 7 days of trimethroprim or nitrifurantoin
- 14 days of a quinolone (e.g. ciprofloxacin) if possible prostatitis
Which antibiotics can be used for UTIs in pregnancy?
- Nitrofurantoin (not at term)
- Cephalexin
Describe the stages of AKI
Stage 1: 1.5-2x baseline creatinine
- Stage 2: 2-3x baseline creatinine
- Stage 3: 3x baseline
How should AKIs be managed?
- S: suspect sepsis
- H: hypovolaemia
- O: obstruction (bladder scan)
- U: urinalysis
- T: toxins (med review and avoid nephrotoxics)
How can hyperkalaemia be managed?
- Calcium gluconate
- Salbutamol or insulin-dextrose
- Dialysis or diuresis
Describe the presentation of a nephritic state
- Urine sediment
- Haematuria
- Dysmorphic RBCs
- Cellular casts
- Hypertension
- Renal impairment
How does nephrotic syndrome present?
- Oedema
- Proteinuria
- Hypoalbuminaemia
- Hyperlipidaemia
Name the nephrotic type glomerulonephritis
- Minimal change disease
- Membranous nephropathy
Name the nephritic type glomerulonephritis
- Diffuse proliferative
- Post-infective
- Crescentic GN
How can post-infective GN be managed?
- Loop diuretis
- Vasodilators (amlodipine)
How can crescentic GN be managed?
- Steroids
- Plasma exchange
- Cytotoxics
- B cell therapy
- Complement inhibitors
How can nephrotic syndrome be managed?
- Salt and fluid restriction
- Loop diuretics
- ACEIs
- Heparin or warfarin
- Statins
How can minimal change disease be managed?
- Prednisolone
- Relapses: cyclosporin, tacrolimus etc.
How can acute urinary retention be managed?
- Catheterisation
- Alpha blocker e.g. alfuzosin
How do urinary tract stones present?
- Renal pain
- Ureteric colic (radiates to the groin)
- Dysuria
- Haematuria
- Testicular or vulval pain
- UTI
- Loin tenderness
- Pyrexia
How can urinary tract stones be managed?
- NSAIDs
- Paracetamol or opiods
- Alpha blockers
How can benign prostatic obstruction be managed?
- Watchful waiting
- Alpha blockers
- 5 alpha reductase inhibitors
- TURP or other resective surgery
What is the most common type of bladder cancer?
Transitional cell carcinoma
How does bladder cancer present?
- Painless visible haematuria
- Recurrent UTI
- Dysuria, frequency, nocturia, urgency and urge incontinence
- Bladder pain
How can bladder cancer be investigated?
- Urine culture
- Cystourethroscopy
- CT urogram or USS
- Cytology
- BP and U&Es
How can bladder cancers be managed?
- Endoscopic or radical resection
- Chemotherapy
- BCG therapy
- Radiotherapy
How do upper tract urothelial cancers present?
- Frank haematuria
- Unilateral ureteric obstruction
- Flank or loin pain
How can upper tract urothelial cancers be managed?
- Nephro-ureterectomy
- Endoscopic treatment
- Surveillance cystoscopy
How do renal adenocarcinoma present?
- Asymptomatic
- Flank pain, mass and haematuria
- Paraneoplastic syndrome (anorexia cachexia, pyrexia, hypertension, hypercalcaemia, abnormal LFTs, anaemia, polycythaemia and raised ESR
- Metastatic disease
How can renal adenocarcinoma be managed?
- Radical nephrectomy
- RCC is radioresistant and chemoresistant
- Tyrosine kinase inhibitors
- Immunotherapy
