Renal & Urology Flashcards
What are the most common symptoms of a UTI? (6)
Dysuria
Increased frequency
Urgency
Foul smelling urine
Suprapubic pain
+/- haematuria
What condition would the following indicate:
A patient presents with a 2 day history of haemoptysis. Blood results show a raised urea & creatinine.
Goodpasture Syndrome (anti-glomerular basement membrane disease)
~ glomerulonephritis (AKI)
~ pulmonary haemorrhage (haemoptysis)
Explain urge incontinence:
• state the commonest cause
What are the treatments of urge incontinence?
• Non-pharmacolgical
• Pharmacological
The sudden need to urinate without warning
• overactive/ irritated bladder (detrusor muscle is over stimulated!)
- *Non-pharmacolgical:** Bladder retraining
- *Pharmacological:** Antimuscarinics** (eg Oxybutinin)
Antimuscarinics act to block activation of the detrusor muscle
List some extrinsic causes of urinary incontinence: (5)
- Immobility issues - unable to get to toilet
- Diuretics - increase volume of urine
- Constipation
- Confusion - may be unaware of needing toilet
- Painkillers - can cause constipation
Is a ductal carcinoma in-situ (DCIS) an invasive/non-invasive form or breast cancer?
Non-invasive
Explain urinary retention with overflow:
• state the commonest cause in males!
What are the treatments of overflow incontinence?
• Non-pharmacolgical
• Pharmacological
• Surgical
Stenosed urethra causing blockage of urinary flow
• benign prostatic hyperplasia
- *Nonpharmacolgical**-: suprapubic catheterisation (last resort)
- *Pharmacological**: Alpha blockers or anti-androgens
- *Surgical**: TURP (trans-urethral resection of prostate)
What is priapism?
What is the biggest risk factor for it?
A painful erection that lasts for longer than 2 hours.
Sickle cell disease
On average, how long is the urethra in:
- Males
- Females
Males: 18-21cm
Females: 4-8cm
List some risk factors for transitional cell carcinoma of the bladder (3)
Smoking
Aromatic amines (rubber, dyes and chemicals)
Cyclophosphamide (chemo drug)
A testicle that has a ‘bag of worms’ texture indicates what?
What is the underlying cause of this?
If this occurs on the left side (testicle), what should you be suspicous about?
Varicocele
Enlargement/dilation of the testicular veins
Renal cell carcinoma - causing compression of the left renal/ left testicular vein
What are the 2, 1st line investigations of prostate cancer?
What blood test can also be requested?
What imaging is best initially?
Digital rectal examination to examine the prostate
Urine dip
Prostate specific antigen (PSA)
MRI
Name structures A - D that compose the glomerulus:
A - podocyte
B - mesangial cells
C - glomerular basement membrane
D - endothelial cells
Explain neuropathic bladder (aka underactive bladder):
• state the commonest cause
• what type of incontinence can it result in?
What is the treatment of a neuropathic bladder?
Underactive bladder: bladder no longer detects when it contains urine (detrusor muscle doesn’t contract)
• commonest cause = long term catheterisation
• results in overflow incontinence
Treatment: catheterisation!
What is the gold standard treatment of non-muscle invasive bladder cancer?
What is the gold standard treatment of muscle invasive bladder cancer?
TURBT (transurethral resection of bladder cancer) + mitomycin C (chemo)
Cystectomy with urinary diversion (bladder is removed & the ureters are diverted)
A 16y boy presents with central abdominal pain & haematuria for 1 week. He also complains of pain in both knees. Examination reveals a non-blanching purpuric rash on his legs & buttocks. Urine dip shows blood ++ & protein +, kidney function is abnormal.
What is the most likely diagnosis? - what is this?
List the 4 common presenting features of this condition:
What is the management of this condition?
What monitoring needs to be done? (2)
Henoch-Schonlein Purpura - A type of IgA vasculitis
- Purpura (rash on legs → buttocks)
- Joint pain (commonly knee’s & ankles)
- Abdominal pain
- Renal impairment
Management: supportive (analgesia, rest, hydration)
~ most usually resolve within 4-6 weeks.
Monitoring: needed whilst the disease is still active:
• urine dipstick (to monitor renal impairment)
• blood pressure (to monitor for hypertension)
What is the classic triad that suggests a renal cell carcinoma?
Flank pain
Haematuria
Mass in the flank area
List the distinguishing features that differentiate IgA nephropathy from post-streptococcal glomerulonephritis: (2)
IgA Nephropathy:
~ 1-2 days post URTI
~ Renal biopsy: IgA immune complex deposits in the glomerulus
Post-strep GN:
~ 1-3 weeks post URTI (usually strep throat)
~ Renal biopsy: IgG immune complex deposits in the glomerulus
What investigations are done initially if bladder cancer is suspected? (3)
Urine culture (to rule out UTI)
CT urogram (contrast CT of the urinary tract)
Flexible cytoscopy
What grading system is used in prostate cancer?
The gleason score
What are the signs of hypercalcaemia?
“Stones, bones, abdominal moans & psychiatric groans”
Renal stones
Painful bones
GI: nausea, vomiting, constipation, indigestion
Neuro: fatigue, memory loss, depression, psychosis
What is epididymo-orchitis?
What are the 2 commonest causes of it developing?
Inflammation of the epididymus & testis
STI’s (commonly chlamydia & gonorrhoea) & UTI’s (commonly E.coli)
What investigation(s) are done for a UTI in: 1. Young women
- Children/ men/ women that are pregnant/ with recurrent infections
- Urine dip only
- MSSU sent for MC&S
If a UTI is suspected in older, hospitalised patients, what test should be done to confirm the UTI?
~ Explain why this is done
Urine sample should be sent for analysis - DO NOT DO URINE DIP
Most older people have asymptomatic bacteriurea which will indicate infection on a urine dip so need to send the sample for analysis!
How do you diagnose a UTI in older people (65y +) in hospital?
Why do we do this?
Urine sample → lab analysis of urine culture (NOT URINE DIP)
Older people commonly have asymptomatic bacteriuria which would show as a false positive for infection on a urine dip
List the distinguishing features that differentiate IgA nephropathy from post-streptococcal glomerulonephritis: (2)
IgA Nephropathy:
~ 1-2 days post URTI
~ Renal biopsy: IgA immune complex deposits in the glomerulus
Post-strep GN:
~ 1-3 weeks post URTI (usually strep throat)
~ Renal biopsy: IgG immune complex deposits in the glomerulus
What are the 2 antibiotics used to treat UTI’s?
Which one is more favourable in pregnancy?
Nitrofurantoin - used in pregnancy
Trimethoprim
What is haemolytic uraemic syndrome (HUS)?
What disease does HUS usually follow from?
What is the commonest organism that causes HUS & what investigation is used to identify it’s presence?
What are the characteristic triad of features seen with HUS?
→ What invstigations would be done for each feature to identify them?
HUS occurs when there is thrombosis in small blood vessels throughout the body
Gastroenteritis
E.coli - stool sample will identify it
1) Haemolytic anaemia → FBC, blood film
2) AKI → U&E’s to measure serum urea
3) Thrombocytopenia → FBC
What is the gold standard investigation for suspected vesico-uteric reflux in children?
What investigation is used to look for any kidney scarring/ function of the kidney?
What investigation is used to look at the structure (size & shape) of the kidney?
MCUG (micturicting urogram)
DMSA
US KUB
List 3 clinical features of bladder cancer:
Painless, frank haematuria
Recurrent UTIs
Hydronephrosis
Explain stress incontinence:
What are the treatments of stress incontinence?
• Non-pharmacolgical
• Pharmacological
• Surgical
Stress incontinence occurs when abdominal pressure is increased, eg coughing/ jumping
- *Non-pharmacolgical:** physiotherapy (pelvic floor exercises)
- *Pharmacological:** oestrogen pessary/ duloxetine (SSRI)
- *Surgical**: Colposuspension
A bacterial growth of what suggests a UTI?
105
List some features of nephrotic syndrome: (4)
List some features of nephritis syndrome: (3)
Nephrotic syndrome:
• proteinuria (+++)
• oedema
• hypoalbuminaemia
• hyperlipidaemia
Nephritic syndrome:
• haematuria
• hypertension
• proteinuira (+)
A patient with a latex allergy is needing to be temporarily catheterised. What type of catheter is suitable?
How long can this type of catheter remain insitu for?
PVC (plastic catheter)
14 days
List some risk factors for squamous cell carcinoma of the bladder (2)
Schistosomiasis infection
Long term catheterisation (10+ years)
What is the 1st line analgesic for renal colic?
IM diclofenac
What examination would you do to differentiate between epididymo-orchitis and testicular torsion?
What result would indicate each pathology?
Raise the testis and see whether this relieves the pain (Prehn’s sign)
Testicular torsion: pain is still present in testis on elevation
Epididymo-orchitis: pain is relieved when testis is elevated
What is the commonest causative organism of prostatitis?
What else do you have to consider in younger men?
UTI’s, eg E. Coli
STI’s, eg Gonorrhoea & Chlamydia
A 22-year-male presents to the emergency department complaining of testicular pain. The pain is localised in the right testicle and has come up gradually over the last 24 hours.
On examination, he looks distressed. His heart rate is 24/min, blood pressure 120/96 mmHg, respiratory rate 16/min and temperature 38.2 ºC. The right testicle is erythematous and swollen. Elevation of the scrotal skin eases the pain. He denies any discharge.
What is the most likely diagnosis & what is the most appropriate next step?
~ most likely causative organism?
If the patient was 60 years old instead, what would be your next investigation?
~ most likely causative organism?
Epididymo-orchitis (inflammation of the epididymus & testes)
Investigations if (**young**)/ **high risk STI**: send a urine first void sample for nuclear acid amplification tests (**NAATs**) ~ gonorrhoea, chlamydia
Investigations if (older)/ lower risk of STI:
send a mid-stream urine (MSU) for microscopy and culture
~ E.coli (urinary infection)
A 56-year-old man presents to the urology clinic. He has suffered from recurrent episodes of renal colic. CT scans have shown multiple stones and 24-hour urine collection reveals high urinary calcium.
What medication is used to lower his calcium and thus reduce stone formation?
Thiazide diuretics
What is the 1st line (only…) treatment option for renal cell carcinoma?
~ why?
Radical nephrectomy (removal of kidney)
Most RCC’s are resistant to chemotherapy & radiotherapy
A 65-year-old man presents to the GP after noticing blood in his urine. He has no past medical history and denies any unexplained weight loss, dysuria, or urinary hesitancy. He has smoked 30 cigarettes daily for the last 40 years.
On examination, he is obese and slight gynaecomastia is present. A right-sided testicular lump is noted that is similar in feeling to a bag of worms. When lying down it does not disappear.
He has no family history.
What is the most likely diagnosis?
In this diagnosis, what causes the varicocele?
Renal cell carcinoma
In RCC, varicocele’s are caused by a tumour compressing the venous drainage of the testis.
What does the left testicular vein drain into?
What does the right testicular vein drain into?
Left testicular vein → left renal vein
Right testicular vein→ IVC
What effect does Finasteride have on PSA levels?
It lowers the PSA level.. be cautious when interpreting PSA if you suspect a prostatic carcinoma!!
If you suspect a patient has prostate cancer, what investigations should you do? (3)
PSA (and other usual bloods)
DRE
Refer for multiparametric MRI
Which 2 tumour markers may be raised in a testicular cancer?
hCG, AFP (alpha fetoprotein)
What are the 3 triad of symptoms classically seen in renal cancer?
- Flank pain
- Mass
- Haematuria
What is the most common type of prostate cancer?
Adenocarcinoma
What is the commonest type of renal stone?
Calcium oxalate
A recent proteus infection increases the risk of developing which type of renal stones?
Staghorn stones (struvite)
What is the commonest type of bladder cancer?
Urothelial carcinoma (also known as transitional cell carcinoma)
According to the guidelines, what is the 1st line analgesic for the acute management of renal colic?
IM Diclofenac
A 65-year-old man attends his GP with a 4-month history of frequency, urgency and weak stream. Urinalysis is positive for blood. A multiparametric MRI is arranged and confirms that the patient has prostate cancer. He is started on the GnRH agonist goserelin and the anti-androgen, cyproterone acetate. He is counselled on the importance of taking cyproterone acetate.
What is the purpose of cyproterone acetate?
Cyproterone acetate prevents tumour flares!
GnRH agonists can cause ‘tumour flare’ when started, resulting in temporary worsening of symptoms: bone pain, bladder obstruction etc
Creatinine, creatinine, urine output
What is the NICE criteria for an AKI?
- Rise in creatinine of >25micromol/L in 48h
- Rise in creatinine of >50% in 7 days
- Urine output of 0.5ml/kg/hour for more than 6 hours
What are the commonest drug classes that can cause/worsen an AKI? (5)
- ACEi
- ARBs
- NSAIDs
- Diuretics
- Aminoglycosides (eg Gentamicin!)
If a patient has worsening renal function and ‘muddy brown casts’, what condition does this indicate?
Acute tubular necrosis
What are the indications for dialysis? (AEIOU)
A - acidosis below 7.15 (if unresolved with medical input)
E - electrolyte imbalances (eg hyperkalaemia above 7)
I - intoxication (of medicine, eg lithim)
O - overloaded with fluids
U - uraemia with symptoms (eg pericarditis, encephalopathy)
List 3 risk factors for testicular cancer:
- infertility (increases risk by 3x)
- cryptorchidism (aka, undescended testes)
- FH
A 25y/o presents with 1 week of dark urine and swollen ankles. He had a sore throat and fever 2 weeks ago which resolved after a course of antibiotics. He has no significant PMH and takes no regular medications.
His urinalysis has blood 3+ and protein 3+
What is the most likely diagnosis?
If he had the sore throat 4 days ago, what would the most likely diagnosis be now?
Post-streptococcal glomerulonephritis
~ 1-2 weeks after URTI (strep cause)
IgA nephropathy
~ 2-4 days after URTI (strep cause)
A 25y/o woman presents to ED with persistent nausea and vomiting for the past 8 hours. She has felt generally unwell over the last 2 days, with poor oral intake. She last opened her bowels 3 days ago, which is unusual for her. She has dry mucous membranes with an otherwise unremarkable cardiovascular and respiratory examination. Abdominal examination reveals flank masses bilaterally. Her blood pressure is 162/91 mmHg and temperature 36.2 °C. Her eGFR is 56 mL/min/1.73m2.
What is the most likely diagnosis?
How is this condition causing her constipation?
Polycystic kidney disease
The cysts are so large that they’re starting to compress the bowel!
What part of the kidney does ADH (anti diuretic hormone) act on?
~ what effect does this have?
What consequently happens to the BP?
ADH acts on the collecting ducts to increase the resorption of water from urine → increasing BP
A 28y/o male is referred to the medical assessment unit by his GP following a 2-day history of visible haematuria and a productive cough. He has had no dysuria, abdominal pain, or urinary frequency. He admits to coughing up blood and experiencing nosebleeds for the past 5 days.
A urine dip shows protein ++, red blood cells ++ and is negative for nitrites and leukocytes.
What is the most likely diagnosis?
GOOD PASTURES SYNDROME (aka, anti-glomerular basement membrane disease)
Which electrolyte abnormality does spironolactone cause?
Hyperkalaemia
