Renal + Urology Flashcards
First line Ix for renal colic
CT-KUB - gold standard
If pt <50, or pregnant - US KUB
Management steps for erectile dysfunction (4x2)
- Optimise modifiable RF
- Smoking, diet, exercise, etoh
- BP control, lipids - Treat reversible causes
- Medication induced
- Psychogenic -> referral to sexual therapist - PDE-5 inhibitor
- assess exercise tolerance first
- PRN sildenafil - Refer to Urologist for other
- Intracavernosal injections
- Vacuum erection device
PDE5 contra-indication
Concurrent nitrate use
Safety of Ural
Not established in UTI
Reduces effect of nitrofurantoin
Risk of crystalluria with quinolones
Treatment of chronic bacterial prostatitis
If symptomatic + culture proven
- ciprofloxacin 500mg BD for 4wks
Non pharma mx of ED (6)
Exercise (150min mod/week)
Psychologist or sexual counsellor
Diet (mediterrean)
physio for pelvic floor
consider of penile pump
If relevant - reduce smoking and etoh
Pharma treatment for premature ejaculation
Dapoxetine 30mg 1-3hrs prior to intercourse (or paroxetine)
2nd line - daily ssri (paroxetine)
Prostate screening - what age and how often (4 groups)
Always a discussion of risk v benefit
- general pop -> 2 yearly PSA from 50-69
- high risk (1x 1st deg relative) - can offer 2yrly from 45-69
- higher (3+ 1st deg relative) - can offer 2yrly from 40-69
- don’t offer >70
Decision to screen ASx pt for prostate Ca. PSA comes back at 4.0
What next
PSA >3 = rpt in 1-3 months with free-to-total ratio
- 3-5.5 -> Free-total <25% = refer to urology
- >5.5 refer to urology
CKD Clinical treatment goals (6)
- BP - <130/80
- Albuminuria - reduction >30% uACR
- Gylcaemic control - HbA1c <7%
- Potassium - K <6.0
- Immunisation - all inc flu, pneumococcal, covid, herpes zoster
- Lipids - no target, statin for CKD eGFR >15 + CVD risk 10%
Treat CKD with a BAG of PILs
Screening kidney check + cut-offs (just for CKD or not)
BP + uACR + eGFR
uACR >3mg/mmol
- rpt for 3 over 3 months, if 2/3 >3 = CKD
eGFR <60
- Rpt in 7 days, if >20% drop = AKI
- Rpt at 3 months, if 2/3 <60 = CKD
Risk factors for CKD (9 - 2,3,2,2)
- Age >60
- First Nations >18yo
- DM
- HTN
- Established CVD
- BMI >30
- Smoking (prev or current)
- Hx of AKI
- FHx of CKD
2 mates 18yo first nations Mr Long, and 60yo Mr Shot. Bond over the fact they both have HTN, obese, diabetes, established CVD. Both have had AKIs which is scary as they have a FHX of CKD. Positively they have both quit smoking
Indications for kidney screen + frequency. Essentially risk factors (combined into 4 groups)
Yearly - DM + HTN + First Nations >18
2yearly - CVD, FHx, Obesity, SMoking
AKI - yearly for 3, then 2yearly
Age >60 - once off, then as indicated
Screening CKD for First Nations
> 18 - yearly
<18 - screen for red flags and screen if concerns
Medications in CKD (5)
- ACE-I or ARB
- Statin +- Ezetimibe
- SGLT2 Inhibitor
- Non-steroidal MRA
- GLP-1 RA (dulaglutide)
KFP: DDx for renal colic (or some time of unilateral back/flank pain) (4)
Specific with answer
1. Ruptured AAA
2. X-side pyelonephritis
3. Acute pancreatitis
4. MSK strain
KFP: Strategies to prevent recurrence of renal colic (6)
- Maintain hydration aiming for clear urine
- Low sodium intake
- Low oxalate intake
- Low intake of animal protein
- Limit sugar-sweetened beverages
- Aim BMI 18-25
KFP: Dietary advice for CKD (6)
- Consume varied diet - Meditterean diet
- Limit salt to <2g sodium (6g salt)
- Consume ~1g/kg protein daily
- Ensure adequate hydration
- Limit intake of saturated fats
- Limits sugar-sweetend drinks
KFP: Hx to to acertain risk factors for urinary incontinence in older female? (6)
- Parity
- Truama to pelvic region
- Chronic cough
- Menopausal symptoms
- Constipation
- Caffeine intake
KFP: Non pharma options for preventing CKD (5)
- 30mins moderate exercise >5/7
- Mediterrean diet
- Aim BMI <25
- Limit salt <5g per day
- Smoking cessation
65yoM with frequent urine leaking after voiding, and going more often day + night.
Other than BPH, DDx
- Prostate Ca
- Over-active bladder
- AE of drug (diuretic)
KFP: Non pharma management of BPH (5)
- Reduce caffeine OR alcohol - grouped
- Limit fluid in evenings
- Pelvic floor exercises
- Advise double voiding
+- constipation treatment if relevant
1/2/3rd line Rx for UTI in non pregnant women
1st Oral trimethoprim OD 3/7
2nd Oral nitrofurantoin QID for 5/7
3rd (only if 2 above CI) - oral ceflex BD for 5/7
Sick Day meds for CKD (7)
SAD-MANS
S - Sulfyonureas
A - ACE-I
D - Diuretics
M - Metformin
A - ARB
N - NSAIDs
S - SGLT2-i
Managing HTN in CKD specifically - options + consideration
Options - ACE-I/ARB, Ca-channel blocker, Diuretic, B-blocker
Consideration - max dose of ACE-I then add 2nd agent (differing from standard HTN Rx)
KFP Causes of haematuria (5)
- Transient - trauma, intercourse, exercise induced
- Malignant - Urothelial, prostate, RCC
- Infectious - pyelo, UTI, Radiation cystitis
- Renal - IgA nephropathy
- Obstructive - urolithiasis, BPH
Risk factors/red flags for haematuria work-up (7)
-> Warrants imaging + urology referral for cystoscopy
1. Hx gross haematuria
2. Age >50
3. Smoking Hx
4. Irritative LUTS
5. Recurrent UTI
6. Previous pelvic RTx
7. Occuptional exposures
Pt with haematuria -> next step (1/1/2)
- UTI/transient benign cause -> Rpt micro 6wks
- Macroscopic haematuria -> Imaging (+- urine cytology) AND referral for cystoscopy
- Microscopic haematuria
- Low risk -> consider rpt in 6/12
- RF present -> imaging and referral
