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Phase 2a > Renal/ Urology > Flashcards

Renal/ Urology Flashcards

1
Q

What are the lower urinary tract symptoms?

A

STORAGE:
- frequency
- urgency
- nocturne
- incontinence

VOIDING:
- poor flow
- intermittency
- straining
- terminal dribbling
- hesitancy

POST MICTURITION:
- sense of incomplete voiding
- post-micturition dribbling

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2
Q

Why do people typically get lower urinary tract storage symptoms?

A

overactive bladder
improper emptying

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3
Q

What is the difference between terminal dribbling and post-micturition dribbling?

A

terminal dribbling occurs while still on toilet when patient thinks they are done, post-micturition is usually having urinated in underwear after patient left bathroom

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4
Q

What is an atonic bladder?

A

bladder doesn’t contract and relax

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5
Q

What are the types of incontinence?

A

stress
urge
mixed

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6
Q

Who typically gets stress incontinence? Why?

A

pregnant women after vaginal delivery
due to damage of pelvic floor muscles

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7
Q

What is urge incontinence?

A

when you get the sudden urge to urinate and cannot get to the toilet in time

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8
Q

What are the risk factors for renal cell carcinoma?

A

smoking
obesity
genetic

hypertension
dialysis

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9
Q

What are two genetic syndromes that cause kidney cancer?

A

von hippel lindau
tuberous sclerosis

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10
Q

Why do you try and preserve a kidney with a tumour instead of removing it?

A

Patients with cancer on the kidney are much more likely to also get cancer in the other kidney, so if you remove the first kidney then you only have one left which could also become cancerous

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11
Q

Why would a tumour cause a varicocele?

A
  • right testicular vein drains into vena cava
  • left testicular vein drains into left renal vein
  • testicular vein occluded by tumour leads to a varicocele- usually in the left testicle
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12
Q

What is a varicocele?

A

a mass of varicose veins in the scrotum

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13
Q

What is the gold standard treatment for kidney cancer?

A

partial nephrectomy
open or robotic

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14
Q

What are the noncancerous causes of haematuria?

A

stones
infections
prostate- cancer or benign enlargement
nephrological causes
no cause found

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15
Q

What is GFR?

A

glomerular filtration rate

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16
Q

What is the normal range for GFR?

A

90 to 120 mL/min/1.73 m2

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17
Q

How does GFR change with age?

A

GFR decreased with age

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18
Q

What is CKD?

A

chronic kidney disease

abnormalities of kidney structure or function which lasts longer than 3 months and has implications on health

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19
Q

What is classed as CKD in terms of GFR?

A

either:

  • GFR < 60ml/min/1.73m2

OR

  • GFR < 90ml/min/1.73m2 + one of:
    albuminurea/ proteinurea
    urine sediment abnormalities (e.g. haematuria)
    electrolyte abnormalities due to tubular disorders
    abnormalities detected by histology
    structural abnormalities detected by imaging
    history of kidney transplantation
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20
Q

What are the causes of CKD?

A

diabetes
hypertension
glomerulonephritis
congenital causes
persistant pyelonephritis
obstruction
nephrotoxic drugs

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21
Q

Which drugs are nephrotoxic?

A

NSAIDS
ACEIs
antidepressants
many antibiotics

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22
Q

How do we categorise UTIs

A

lower tract
upper tract

OR

asymptomatic bacteriruia
complicated
uncomplicated

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23
Q

What is pyuria?

A

white cells/ leukocytes in urine

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24
Q

What is bacteriuria?

A

bacteria in the urine

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25
Q

What is an uncomplicated UTI?

A

UTI in non pregnant woman

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26
Q

What is a complicated UTI?

A

Any UTI except for those in non pregnant women

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27
Q

What is a way to make UTIs less likely for a man?

A

circumcision

28
Q

What is the main cause of UTI?

A

E. coli
>50% of cases

29
Q

What pathogens can cause UTI?

A

e.coli
proteus
klebsiella
enterococci
staph. saprophyticus
s.aureus
pseudomonas aeruginosa

30
Q

What type of UTI is most associated with catheterisation?

A

klebsiella

31
Q

What type of patient is associated with proteus UTI?

A

patients with renal stones

32
Q

What type of patients get staph.saprophyticus UTIs?

A

young women

33
Q

What are the causes of UTI?

A

bladder stones/ tumour
ureteric stones
obstruction from BPH
catheterisation
bowel flora (in women, shower urethra)
e.coli from bladder colonisation
stasis in ureter during pregnancy

34
Q

What are the symptoms of a lower UTI?

A

dysuria (painful urination)
increased frequency

35
Q

What are the symptoms of an upper UTI?

A

haematuria
fever

patients more systemically unwell in an upper UTI

36
Q

How do we diagnose a UTI?

A

urine dipstick with microscopy and culture

37
Q

What does a urine dipstick measure?

A

leukocytes
nitrates
blood
protein
pH
glucose
ketones

38
Q

What will the urine dipstick show in a UTI?

A

will show leukocytes and nitrates plus other substances depending on cause of UTI

39
Q

What is an early morning urine sample used for?

A

used to look for TB, allows bacilli to build up overnight

40
Q

What does urine microscopy pick up?

A

WBCs
RBCs
casts
bacteria
epithelium cells

41
Q

What does epithelial cells on urine microscopy mean?

A

indicates a poorly taken sample

42
Q

How do we treat asymptomatic bacteriuria?

A

if >65 then do not treat
they don’t cause harm and is exposure to antibiotics for no reason

43
Q

How does treatment for uncomplicated and complicated UTIs differ?

A

uncomplicated: 3 days course of antibiotics

complicated: always send sample for culture
longer antibiotic course of 7 days

44
Q

What antibiotics are used to treat UTIs?

A

avoid broad spectrum antibiotics

NITROFURANTOIN
trimethoprim
pivemcillinam
fosfomycin
cefalexin
amoxicillin

45
Q

Why can we not prescribe nitrofurantoin to pregnant women in their 3rd trimester?

A

can cause fetal jaundice

46
Q

In which people should we treat asymptomatic bacteriuria? Why?

A

pregnant women
because 20-40% of pregnant women with untreated asymptomatic bacteriuria will develop pyelonephritis

47
Q

What are the symptoms of pyelonephritis?

A

loin pain
fever
pyuria

48
Q

What is pyelonephritis?

A

kidney infection

49
Q

Where in the urinary tract do you typically get stones?

A

renal, ureteric, bladder

50
Q

What are kidney stones made from?

A

can be:
calcium oxalate/ phosphate (80%)
uric acid
struvite (infection stones)
cystine (congenital)

51
Q

How can we prevent kidney stones?

A

overhydration
low salt diet
normal dairy intake
healthy protein intake
reduce BMI
active lifestyle

52
Q

What are the symptoms of kidney stones?

A

loin pain
renal colic
UTI symptoms
recurrent UTIs
haematuria

53
Q

What is a KUBXR?

A

kidney ureter bladder x-ray

54
Q

What is the target 24 hour urine output be for a 70kg adult patient?

A

840-2520ml

55
Q

What is the target urine output for an adult?

A

0.5-1.5ml/kg/hr

56
Q

What time of renal injury does naproxen cause?

A

naproxen is an NSAID
interstitial renal injury

57
Q

How does NSAIDS damage the kidney?

A

NSAIDS decrease prostaglandins which results in unopposed constriction of afferent arterioles

58
Q

Which zone of the prostate is most commonly affected by cancer?

A

peripheral zone

59
Q

What is the most common site of metastases for prostate cancer?

A

bone

60
Q

What cellular changes occur in BPH?

A

hyperproliferation of epithelial and stromal cells in the transition zone of the prostate gland

61
Q

Describe the venous drainage of the left testicle.

A

pampiniform plexus
lest testicular vein
left renal vein
IVC

62
Q

Which organism is associated with both UTI and renal stones?

A

proteus

63
Q

What are the typical findings on urinalysis with nephrotic syndrome?

A

proteinuria and frothy appearance

64
Q

What is the most common cause of nephrotic syndrome in children in the UK?

A

minimal change disease

65
Q

How does minimal change disease present in children?

A

oedema everywhere

66
Q

Which ion do loop diuretics inhibit and by what mechanism?

A

sodium
by inhibiting the Na2ClK symporter in the thick ascending loop of henle

Phase 2a (18 decks)

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