Renal/Urology guidelines Flashcards
UTI management
- non pregnant women
- pregnancy woman
- man
- 3d nitrofurantoin/trimethoprim
- 7d nitrofurantoin (even if asymptomatic)
- 7d nitro/trimethoprim
Pyelonephritis Mx
cephalosporin 14d
Can also use quinolone (levofloaxin, ciprofloxacin)
Prostatitis Mx
Quinolone 14d (levofloxacin, ciprofloxacin)
UTI in children
<3m
>3m, lower UTI
>3m, upper UTI
<3m = admit if under 3m
>3m, lower UTI = treat as adult
>3m, upper UTI = admit for 10d cephalosporin
timeline for needing CTKUB for renal stones
within 14 hours
Mx of renal stone based on size
<0.5cm = expectant with alpha blocker (tamsulosin) or CCB (nifedipine)
<2cm = lithotripsy (uretoscopy if pregnant)
>2cm (or complex like staghorn) = percutaneous nephrolithotomy
Any size + infection/hydrocephalus
2 main drugs for BPH and SE
tamsulosin (a2 blocker) - post hypotension, dizziness
finasteride (5a reductase inhibitor) - libido, erections, retrograde ejaculation, gynaecomastia
do you need to do a biopsy for renal cancer
no, not if a nephrectomy is planned
CTCAP is good enough
Mx of renal cancer T1 T2+ chemotherapy if is a transitional cancer of renal pelvis
T1 (<7cm in one kidney) = partial nephrectomy
T2+ = radical nephrectomy (without adrenals)
NO adjuvant chemo needed
If TCC, need to disconnect ureter at the bladder and remove it.
when do you refer for prostate cancer
if craggy if PSA above age specific range: 50-60 = 3 60-70 = 4 70+ = 5
1st line investigation once referred for prostate cancer and how this leads on to definitive investigation
Multiparametric MRI, reported using the 5 point Likert scale:
1-2 –> discuss pros and cons of biopsy
3+ –> perform trans rectal biopsy TRUS and then grade using gleason score
When can you do conservative treatment for prostate cancer and what does this entail
T1/T2 stage (local) AND
elderly + comorbid + 3/3 Gleason score (low).
This group needs active surveillance including re-biopsy
Mx of prostate cancer
- T3/4 (advanced to local structures)
surgery + radiotherapy +/- hormone therapy
Mx of prostate cancer
- Metastatic
Goserelin (GnRH agonist) + covering antiandrogen cytoperotone acetate
1st line for testicular cancer
USS
Mx of testicular cancer
always
seminoma
non-seminoma
Always = orchidectomy via inguinal approach Seminoma = radiotherapy Non-seminoma = chemotherapy
Approaches to hydrocele operation if adult or child
adult has scrotal approach (Lords or Jaboulay)
child (if persisting beyond 2yrs) has inguinal approach
Ix of varicocele
when do you operate
Ix = doppler studies Mx = usually conservative. if pain or fertility issues, operate
CKD management
- high phosphate
- low vit D
- anaemia
- hypertension
- tertiary hyperPTH
- use calcium based phosphate binders. Unless CKD bone disease is present in which case use Sevelamer (nonCabased)
- give activated vit D calcitriol/alfacalcidol
- IV iron or EPO
- ACEi is good (allowed a 30% rise in creatinine or 25% reduction in eGFR)
- parathyroidectomy of offending gland
Stress incontinence Mx
C = pelvic floor exercises, 8r, 3x/day 3 weeks M = duloxetine (SNRI) S = retropubic tabe
Urge incontinence Mx
C = bladder retraining M = oxybutninin (antimuscarinic), mirabegron (B3) for old ladies worried about falls S = botulinum toxin
definition of AKI and stages
Stage 1 = <0.5ml/kg/hr, 50% (or 26umol) increase in creatinine in 48 hours
Stage 2 = 2x increase in creatinine or above for 12 hours
Stage 3 = 3x increase
when do you do urine dip and renal USS for AKI
urine dip = always
renal USS = only if cause not known for AKI after 24 hours
do you fluid resuscitate in AKI
If pre-renal, yes, but if ATN no.
Pre-renal: urinary sodium <30
ATN: urinary sodium >30
What do you do FIRST if called to hyperkalaemia
do ECG and repeat VBG to check result
When do you manage hyperK
If >6.5 or if ECG changes
Mx and doses for hyper K
1st = 10ml 10% calcium gluconate Then = 10U actrapid in 50ml of 50% glucose over 10 mins Consider = salbutamol. rectal Resonium.
definition of nephrotic syndrome
> 3g/24hr protein
hypoalbuminaemia (<30)
Investigation findings for the following:
- MNCS
- FSGS
- membranous
- IgA
- Post-strep (proliferative)
- Rapid progressive
- MNCS = podocyte effacement on EM
- FSGS = focal sclerosis and hyalinosis on light microscopy
- membranous = subepithelial deposits ‘spike and dome’
- IgA = mesangial hypercellularity, +ve for IgA and C3
- Post-strep (proliferative) = low C3, high ASOT, endothelial proliferation and subepithelial humps
- Rapid progressive = epithelial crescents
AIN heptad
fever, eosinophilia, urinary white cell casts, rash
General nephrotic syndrome Mx
General nephritic syndrome Mx
steroids + immunosuppression
with membranous type also use ACEi/ARB
Nephritic are usually self limiting or are caused by something systemic like GwPA so have special treatments
Amyloidosis Ix (3)
Congo red stain shows apple green birefringence
Serum amyloid precursor scan (SAP scan)
Biopsy of rectal tissue
Amyloidosis general Mx
Myoablative chemotherapy (as problem is often within the bone marrow)
how do you screen for PCKD
USS
How do you diagnose PCKS based on USS
<30 = two cysts either kidney 30-60 = two cysts both kidneys 60+ = four cysts both kidneys
Mx of PCKD
tolvaptan (ADH receptor 2 antagonist) if CKD2/3 or rapidly progressing
Peyronie’s disease Ix and Mx
Ix = USS Mx = vitamin E and surgery
