Renal & Urology Flashcards
Renal | Investigations
USS kidney; dilatation, PKD, masses, stones
CT KUB; *GS stones, bladder/prostate Ca
Renal biopsy; glomerulopathies
Urine dipstick
24hr urinary protein
A:Cr or P:Cr
Nephrotic syndrome | Features
Primary
Secondary
Oedema Proteinuria Hypoalbuminaemia Hyperlipidaemia Hypercoagulable state Sepsis; loss of Ig
May be primary or secondary (to malignancy, infection, autoimmune disease, drugs)
Nephrotic syndrome
Minimal change disease | Epidemiology, Clinical features
Most common in children, boys
Facial oedema
NO haematuria
Does not cause renal failure!
Inv; urinalysis, 24hr urinary protein, A:Cr, serum albumin
[Management] Oral prednisolone 60mg for 6/52 Fluid restriction, low-salt diet (Furosemide, albumin) CYClophosphamide for relapses
Nephrotic syndrome
FSGS & Membranous nephropathy
Asymptomatic proteinuria
(Microscopic haematuria)
HTN, renal impairment
May progress to CKD/ESRF
[Management]
ACEi/ARB
Oral prednisolone for 6/12
Ciclosporin for maintenance
SLE | Lupus nephritis
ANA sensitive
Anti-dsDNA specific
Low C3 C4
Rash, photosensitivity, arthritis, CNS effects
Nephritis or general nephrosis
[Management]
High dose corticosteroids
CYC or MMF
Acute GN | Features
Haematuria; red cell casts (under microscope)
Proteinuria, inflammation causes leaky capillaries
HTN, kidneys cannot remove waste/extra fluid from blood so retention causes HTN
Oedema, salt and water retention in tissues
(Oliguria/uraemia)
Nephritic GN
Post-streptococcal GN | Epidemiology & Management
Child preceding strep infection 1-3/52 prior
Strep throat, otitis media, cellulitis/impetigo
[Management]
AntiHTN, diuretics
Salt and fluid restrict
Dialysis
Nephritic GN
IgA nephropathy | Epidemiology & Management
Children, young males
Preceding URTI or viral gastroenteritis
Haematuria
[Management]
ACEi/ARB
Steroids
Nephritic GN
Anti-GBM
Rapidly progressive GN; any aggressive GN progressing to renal failure over days-weeks
Goodpasture’s; GN with lung haemorrhage
AKI, haematuria, oliguria, renal failure, haemoptysis, SOB
Alport’s; GN with sensorineural deafness
[Management]
Plasma exchange; to remove antibodies
Corticosteroids
CYClophosphamide
Henoch-Schonlein purpura (HSP)
Haemolytic uraemic syndrome (HUS)
[HSP]
Small vessel vasculitis
Variant of IgA nephropathy
Purpuric rash on extensor surfaces, legs
Flitting polyarthritis
Abdominal pain, GI bleeding
Nephritis
Tx as IgA; ACEi/ARB, steroids
(IgA kidney only)
[HUS] Preceding gastroenteritis (E.coli O157) diarrhoea + fever
Haemolysis
Thrombocytopenia
AKI
UTI | Types Complicated Pregnancy Catheter-associated Urinary sepsis
Complicated; stones, DM, abnormal anatomy, VUR, PKD, obstruction, sickle cell
Pregnancy Tx; PO nitrofurantoin, amoxicillin (asx)
Catheter-associated sx Tx; IV gentamicin, do not Tx if asymptomatic bacteriuria
Urinary sepsis Tx; IV gentamicin
Pyelonephritis | Investigations & Management
USS kidney; calculi, obstruction, hydronephrosis
CT KUB; tissue damage
[Management]
IV co-amoxiclav OR
IV gentamicin
Nephrolithiasis | Aetiology, Types & Management
Dehydration, hypercalcaemia, infection
Renal tubular acidosis
Calcium oxalate; opaque
Uric acid
Cystine; semi-opaque
Struvite; staghorn calculus
USS kidney; dilatation of renal pelvis, hydronephrosis
CT KUB; stones
[Management]
Conservative; diclofenac
Medical; tamsulosin
Surgical; ESWL, stent, keyhole removal (PCNL)
Prostatitis | Clinical features & Management
Perineal pain, scrotal pain
Frequency, dysuria, lower back pain, suprapubic pain
Fever, nausea, malaise
Swollen/tender prostate on PR
Inv; STI screening
Tx; ciprofloxacin
AKI | Clinical features & Aetiology
Stage 1-3
Serum Cr vs. urine output
Prerenal; hypotension, hypovolaemia, hypoperfusion (ischaemia)
Intrarenal; GN, ATN, AIN, inflammation, infection, autoimmune disease, drugs, trauma, vascular
Postrenal; obstruction of urine outflow, BPH, calculi, bladder/prostate tumour
Decreased GFR, oliguria, raised U/Cr
Serum Cr OR urine output
Stage 1; 1.5-1.9x baseline
Stage 2; 2.0-2.9x baseline
Stage 3; >3.0x baseline
Urine output <0.5mL/kg/hr
Stage 1; for 6-12hrs
Stage 2; for >12hrs
Stage 3; for >24hrs
AKI | Complications & Management
[Complications]
Fluid overload; pulmonary oedema
Hyperkalaemia; ATN
Acidosis
[Management]
Sepsis 6
Stop nephrotoxic drugs; ACEi, ARB, gentamicin, NSAIDs, diuretics, metformin, antiHTN
Renal replacement therapy; haemodialysis, haemofiltration
Prerenal; Tx sepsis, fluid resuscitation, increase perfusion by circulatory support
Renal; renal biopsy
Postrenal; catheter, nephrostomy, urological surgery
CKD | Aetiology, Classification
Abnormal kidney structure/function for >3/12
GFR classifcation Stage 1; >90 + protein/haematuria, biopsy/imaging pathology Stage 2; 60-89 Stage 3a; 45-59 (Mild) Stage 3b; 30-44 (Moderate) Stage 4; 15-29 (Severe) Stage 5; <15 (Failure)
May be classified A1-3 by albuminuria, A:Cr
[Aetiology]
DM, HTN
SLE, RA, infection
CKD | Complications & Management
Monitoring
[Complications] Hyperkalaemia Hypocalcaemia; less vit D, hyperPTH Osteoporosis HTN; negative feedback from reduced GFR, increased renin Oedema Anaemia; reduced EPO
[Management] Target BP/proteinuria ACEi/ARB Manage CV risk; atorvastatin, antiplatelet, DM, smoking Renal drug modifications Specialist referral if GFR < 30
[Monitoring]
FBC, U&Es
Vit D, Ca, phosphate, PTH
PKD | Clinical features, Investigations & Management
Autosomal dominant commonly, PKD1 mutation
Loin pain, haematuria, HTN, progressive renal failure
[Extrarenal]
Liver cysts, ovarian cysts
Berry aneurysms causing SAH
Inv; USS kidney, genetic testing
[Management]
AntiHTNs
RRT and transplantation
Prognosis; ESRF by 50s
Bladder cancer | Clinical features
RFs
Age >55yrs
Painless haematuria
[RFs] Smoking Schistosomiasis Occupational exposure; painters, decorators, dye, rubber, roofers Pelvic radiation
Inv; cystoscopy, biopsy, CT urogram
[Management]
TURBT, radical cystectomy
Prostate cancer | Epidemiology & Management
BPH | Clinical features
Management
Age >50yrs
Nocturia, frequency, hesitancy, dysuria
Inv; abnormal PR, raised PSA
Gleason score, histological dx
Tx; tamsulosin, TURP, robotic prostatectomy
[BPH]
Age >50yrs
Storage sx; frequency, urgency, nocturia
Voiding sx; weak stream, hesitancy, dribbling, straining, incomplete emptying
Tx; tamsulosin/finasteride + behavioural
RCC | Epidemiology
Age >55yrs
Triad; haematuria, loin pain, palpable mass
RFs; smoking, HTN
Incontinence | Types
Stress
Urge
Mixed
Leaking, nocturnal enuresis, frequency, hesitancy, straining, intermittent stream, dribbling, incomplete emptying
[Stress]
Raised IAP; coughing, laughing
RFs; age, obesity, postnatal NVD, prolapse
Tx; pelvic floor exercises, duloxetine
[Urge] OAB
Running water, caffeine, obesity
RFs; stroke, dementia, Parkinson’s
Inv; USS bladder scan, urodynamics studies
Tx; bladder retraining, pelvic floor exercises, oxybutinin (anti-ACh)
[Management]
Conservative; smoking cessation, reduce caffeine, limit fluid intake before bedtime, avoid constipation, weight loss if high BMI
Surgical; bulking agents, slings, colposuspension
Scrotal masses | Types
Testicular torsion Epididymal cyst Hydrocele Epididymo-orchitis Variocele Testicular tumour Indirect inguinal hernia
Testicular torsion; severe sudden onset testicular pain, adolescents, not eased on elevation, loss of cremasteric reflex
Epididymal cyst; 40yrs, painless, above and behind
Hydrocele; soft fluctuant, get above it, transilluminate
Epididymo-orchitis; dysuria, urethral discharge, pain eased on elevating testis, Chlamydia
Variocele; left sided smaller swelling, ‘bag of worms’
Testicular tumours; young males, painless lump
Orchitis is associated with mumps
Indirect inguinal hernia; not possible to get above
