Renal/ Urology Flashcards
What are the lower urinary tract symptoms?
STORAGE:
- frequency
- urgency
- nocturne
- incontinence
VOIDING:
- poor flow
- intermittency
- straining
- terminal dribbling
- hesitancy
POST MICTURITION:
- sense of incomplete voiding
- post-micturition dribbling
Why do people typically get lower urinary tract storage symptoms?
overactive bladder
improper emptying
What is the difference between terminal dribbling and post-micturition dribbling?
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
What is an atonic bladder?
bladder doesn’t contract and relax
What are the types of incontinence?
stress
urge
mixed
Who typically gets stress incontinence? Why?
pregnant women after vaginal delivery
due to damage of pelvic floor muscles
What is urge incontinence?
when you get the sudden urge to urinate and cannot get to the toilet in time
What are the risk factors for renal cell carcinoma?
smoking
obesity
genetic
hypertension
dialysis
What are two genetic syndromes that cause kidney cancer?
von hippel lindau
tuberous sclerosis
Why do you try and preserve a kidney with a tumour instead of removing it?
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
Why would a tumour cause a varicocele?
- 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
What is a varicocele?
a mass of varicose veins in the scrotum
What is the gold standard treatment for kidney cancer?
partial nephrectomy
open or robotic
What are the noncancerous causes of haematuria?
stones
infections
prostate- cancer or benign enlargement
nephrological causes
no cause found
What is GFR?
glomerular filtration rate
What is the normal range for GFR?
90 to 120 mL/min/1.73 m2
How does GFR change with age?
GFR decreased with age
What is CKD?
chronic kidney disease
abnormalities of kidney structure or function which lasts longer than 3 months and has implications on health
What is classed as CKD in terms of GFR?
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
What are the causes of CKD?
diabetes
hypertension
glomerulonephritis
congenital causes
persistant pyelonephritis
obstruction
nephrotoxic drugs
Which drugs are nephrotoxic?
NSAIDS
ACEIs
antidepressants
many antibiotics
How do we categorise UTIs
lower tract
upper tract
OR
asymptomatic bacteriruia
complicated
uncomplicated
What is pyuria?
white cells/ leukocytes in urine
What is bacteriuria?
bacteria in the urine
What is an uncomplicated UTI?
UTI in non pregnant woman
What is a complicated UTI?
Any UTI except for those in non pregnant women
What is a way to make UTIs less likely for a man?
circumcision
What is the main cause of UTI?
E. coli
>50% of cases
What pathogens can cause UTI?
e.coli
proteus
klebsiella
enterococci
staph. saprophyticus
s.aureus
pseudomonas aeruginosa
What type of UTI is most associated with catheterisation?
klebsiella
What type of patient is associated with proteus UTI?
patients with renal stones
What type of patients get staph.saprophyticus UTIs?
young women
What are the causes of UTI?
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
What are the symptoms of a lower UTI?
dysuria (painful urination)
increased frequency
What are the symptoms of an upper UTI?
haematuria
fever
patients more systemically unwell in an upper UTI
How do we diagnose a UTI?
urine dipstick with microscopy and culture
What does a urine dipstick measure?
leukocytes
nitrates
blood
protein
pH
glucose
ketones
What will the urine dipstick show in a UTI?
will show leukocytes and nitrates plus other substances depending on cause of UTI
What is an early morning urine sample used for?
used to look for TB, allows bacilli to build up overnight
What does urine microscopy pick up?
WBCs
RBCs
casts
bacteria
epithelium cells
What does epithelial cells on urine microscopy mean?
indicates a poorly taken sample
How do we treat asymptomatic bacteriuria?
if >65 then do not treat
they don’t cause harm and is exposure to antibiotics for no reason
How does treatment for uncomplicated and complicated UTIs differ?
uncomplicated: 3 days course of antibiotics
complicated: always send sample for culture
longer antibiotic course of 7 days
What antibiotics are used to treat UTIs?
avoid broad spectrum antibiotics
NITROFURANTOIN
trimethoprim
pivemcillinam
fosfomycin
cefalexin
amoxicillin
Why can we not prescribe nitrofurantoin to pregnant women in their 3rd trimester?
can cause fetal jaundice
In which people should we treat asymptomatic bacteriuria? Why?
pregnant women
because 20-40% of pregnant women with untreated asymptomatic bacteriuria will develop pyelonephritis
What are the symptoms of pyelonephritis?
loin pain
fever
pyuria
What is pyelonephritis?
kidney infection
Where in the urinary tract do you typically get stones?
renal, ureteric, bladder
What are kidney stones made from?
can be:
calcium oxalate/ phosphate (80%)
uric acid
struvite (infection stones)
cystine (congenital)
How can we prevent kidney stones?
overhydration
low salt diet
normal dairy intake
healthy protein intake
reduce BMI
active lifestyle
What are the symptoms of kidney stones?
loin pain
renal colic
UTI symptoms
recurrent UTIs
haematuria
What is a KUBXR?
kidney ureter bladder x-ray
What is the target 24 hour urine output be for a 70kg adult patient?
840-2520ml
What is the target urine output for an adult?
0.5-1.5ml/kg/hr
What time of renal injury does naproxen cause?
naproxen is an NSAID
interstitial renal injury
How does NSAIDS damage the kidney?
NSAIDS decrease prostaglandins which results in unopposed constriction of afferent arterioles
Which zone of the prostate is most commonly affected by cancer?
peripheral zone
What is the most common site of metastases for prostate cancer?
bone
What cellular changes occur in BPH?
hyperproliferation of epithelial and stromal cells in the transition zone of the prostate gland
Describe the venous drainage of the left testicle.
pampiniform plexus
lest testicular vein
left renal vein
IVC
Which organism is associated with both UTI and renal stones?
proteus
What are the typical findings on urinalysis with nephrotic syndrome?
proteinuria and frothy appearance
What is the most common cause of nephrotic syndrome in children in the UK?
minimal change disease
How does minimal change disease present in children?
oedema everywhere
Which ion do loop diuretics inhibit and by what mechanism?
sodium
by inhibiting the Na2ClK symporter in the thick ascending loop of henle
