Summary Flashcards
Describe a UTI
Can have pyelonephritis, cystitis, prostatitis, and epididymis/ testis
In children can cause CRF
Usually bowel organisms like E. coli, proteus, klebsiella, and enterococcus
What are the symptoms of UTI in children?
Diarrhoea, excessive crying, fever, nausea, vomiting and not eating
What are the symptoms of a UTI in adults?
Flank pain, dysuria, cloudy offensive urine, urgency, chills, strangury and confusion in elderly
Acute pyelonephritis - pyrexia, poor localisation, loin tenderness signs of dehydration and turbid pain
What are the investigations for a UTI?
Urinalysis - blood, leucocytes and nitrates
Microbiology - bacteriuria >10^5
If man or child then consider US or IVU
What is the treatment for UTIs?
Fluids and antibiotics - amoxicillin, cephalosporin, and trimethoprim
Severe - IV antibiotics
Describe reflux nephropathy
Kidney damage or scarring caused from urine flowing backwards from bladder into kidneys - reflux and infection
UTIs in children
What is the treatment for reflux nephropathy?
Surgery
Describe minimal change disease
Type of non-proliferative glomerulonephritis - inflammation of glomerulus
Commonest form in children
Prognosis is favourable and underlying cause is unknown
What are the symptoms and signs of minimal change disease?
Sudden onset oedema in days
Nephrotic syndrome - oedema, nephrotic range proteinuria >3.5g or 350mg creatinine, hypoalbuminemia <35g/l, and dyslipidaemia
Haematuria, hypertension and proteinuria
What is the treatment for minimal change disease?
Prednisolone for 16 weeks
Once remission achieved then slow taper for 6 months
Initial relapse treated by steroids then further are with cyclophosphamide, cyclosporine, tacrolimus and others
Describe focal and segmental glomerulosclerosis
Type of non-proliferative glomerulonephritis
Is a syndrome of multiple disease
High chance progression to ESRD
What are the symptoms and signs of focal and segmental glomerulosclerosis?
Nephrotic syndrome - oedema, proteinuria >3.5g or 350mg of creatinine, hypoalbuminemia <35, and dyslipidaemia
Haematuria, proteinuria, and hypertension
What is the treatment of focal or segmental glomerulosclerosis?
Generally steroid resistant
Trial steroids for positive response
Alternative - cyclopsorin, cyclophosphamide and rituximab
Describe membranous nephropathy
Type of non-proliferative glomerulonephritis and commonest cause of nephrotic syndrome in adults
Majority of cases are idiopathic
What are the investigations for membranous nephropathy?
Serology markers - anti-phospholipase A2 receptor antibody and thrombospondin type 1
Renal biopsy - thickened glomerular basement membrane
Immunofluorescence - diffuse IgG uptake
What is the treatment for membranous nephropathy?
General measure for 6 months
Immuno-suppression if symptomatic - rising proteinuria and deteriorating renal function
Cyclophosphamide and steroids for 6 months
Tacrolimus and Rituximab
Describe IgA nephropathy
Type of proliferative glomerulonephritis - characterised by IgA deposition
Most common in 20-30s years
What is the symptoms of IgA nephropathy?
Microscopic haematuria, proteinuria, nephritic syndrome and IgA crescent glomerulonephritis
Nephritic - haematuria, dysmorphic RBCs, and cellular casts
Hypertension
What is the treatment for IgA nephropathy?
High dose prednisolone and other immunosuppression drugs
Describe post infectious glomerulonephritis
Type of proliferative glomerulonephritis - immunological mediated glomerular injury
Follows 10-21 days after infection
What is the treatment for post infectious glomerulonephritis?
Antibiotics given for infection and supportive measures with control of fluids
Loop diuretics and anti-hypertensives
Describe anti-GBM disease
Type of proliferative glomerulonephritis - immune mediates pathology involving antibodies against GBM antigens
Possible lung haemorrhage
What is the investigations for Anti-GBM glomerulonephritis?
Anti-GBM antibodies in serum and kidney
IgG deposits on kidney biopsy
What is the treatment for anti-GBM glomerulonephritis?
Aggressive immunosuppression - steroids, steroids, plasma exchange and cyclophosphamide
Describe acute kidney injury (AKI)
Rapid deterioration of kidney function
Increases in serum creatinine by >26.5umol/l within 48hrs or >1.5x baseline which has occurred in prior 7 days
Or urine volume is <0.5ml/kg/hr for 6 hrs
Describe chronic kidney disease (CKD)
Defined by either presence of kidney damage from abnormal blood, urine, or x-ray, or GFR<60 that is present for more than 3 months
What are the symptoms of chronic kidney disease?
Include anaemia, hypertension, SOB, itch + cramps, cognitive changes, GI symptoms, haematuria, change in urine output, proteinuria, and peripheral oedema
What is the treatment and management for CKD?
BP is most important
Control proteinuria by ACE inhibitor
Treat underlying cause
Preparation for RRT - dialysis or renal transplant
Describe urolithiasis
Kidney stones are hard deposits of minerals and salts from inside the kidney
Can be calcium oxalate, phosphate, calcium phosphate, uric acid and cystine
What are the symptoms of urolithiasis?
Renal pain (fixed to loin), ureteric colic (radiating to groin), dysuria, haematuria, urinary infection, loin tenderness, pyrexia, and testicular/ vulvar pain
What is the treatment for urolithiasis?
Surgery - open, endoscopic, and ESWL. PCNL - percutaneous nephrolithotomy
Small stones - NSAIDs, fluids and alpha blockers
Describe benign prostatic hyperplasia
Benign enlargement of the prostate characterised by fibromuscular and glandular hyperplasia
50% of men at age of 60
What is the symptoms of BPH?
Moderate to severe LUTS
Hesitancy, poor stream, terminal dribbling, incomplete, emptying, frequency, nocturia and urgency
What can BPH result in?
BPO - benign prostatic obstruction or bladder outflow obstruction (BOO)
Describe upper tract obstruction
Includes PUJ, ureter and VUJ
Complications include infection, sepsis, and renal failure if bilateral
What are the causes of upper tract obstruction?
Stone, ureteric tumour, blood clot, fungal ball scar tissue, LNs, prostatic cancer, abdominal mass, and iatrogenic
What are the symptoms of upper tract obstruction?
Pain, frank, haematuria, and symptoms of complication
Palpable mass and microscopic haematuria
What investigations are used for upper tract obstruction?
Abdominal renal US - hydro nephrosis and hydroureter
CT-KUB - investigation of urinary renal stones and obstruction in emergency setting
IVU, CT urogram and MAG-3 renogram
What is the treatment for upper tract obstruction?
Percutaneous nephrostomy insertion or retrograde stent insertion
Treat underlying problem - stones by ureteroscopy and ureteric tumour by radical nephron-urethrectomy
Describe lower tract obstruction
Bladder outflow obstruction
Includes bladder neck in men, prostate, urethra, foreskin, and urethral meatus
What are the symptoms of lower tract obstruction?
LUTS - voiding, storage and urinary incontinence
Acute/ chronic urinary retention, sepsis, recurrent UTIs, frank haematuria, renal failure, and PV bleeding
What is the treatment for lower tract obstruction?
Emergency - urethral or suprapubic catheterisation
Treat underlying cause - BPE by TURP, phimosis by circumcision and meatal stenosis by dilatation
Describe acute urinary retention
Painful inability to void with palpable and precussable bladder
Residuals vary from 500ml to 1l
What is the treatment for acute urinary retention?
Immediate treatment is catheterisation - urethral or suprapubic
Treat underlying cause - main risk is BPO
Describe chronic urinary retention
Painless, palpable, and precussible bladder after voiding
Often able to void but with residuals of between 400 ml to 2l depending on stage of condition
How does chronic urinary retention present?
Presents as LUTS
Also can have complication like UTIs, bladder stones, overflow incontinence or obstructive renal failure
What is the treatment for chronic urinary retention?
Asymptomatic with low residuals - no need for treatment
With symptoms or complications - immediate catheterisation followed by CISC if appropriate
Subsequent treatment - long term catheter, CISC or TURP
Describe prostate cancer
Most common cancer for men in the UK
75% of deaths occur in men over the age of 75
Diagnosed through PSA testing (check again after 3 weeks), RE, MRI and biopsy
What are the symptoms and signs of prostate cancer?
Mostly asymptomatic and diagnosed by opportunistic PSA testing
Weak stream, haematuria, hesitancy, frequency, urgency, and UTI
Can metastasise to bone and LNs
What is the management and treatment for prostate cancer?
Watchful waiting
RT
Radical prostatectomy
If locally advanced - hormone therapy followed by surgery. HT alone, or radiation after HT
Metastatic - hormone therapy plus docetaxel chemo
Describe testicular cancer
One of the commonest cancers of young men
Testicular germ cell neoplasia in-situ is a precursor lesion
Peaks in 3rd decade
What is the presentation of testicular cancer?
Usually painless lump, less often tender swelling, history of trauma, and symptoms of metastatic disease - bone, chest and para-aortic LNs
Describe bladder cancer
Tumour type is most commonly transitional cell carcinoma (TCC) but there is also squamous cell
Risk factors for TCC - smoking, amines and non-hereditary genetics
RF for squamous - chronic cystitis, pelvic RT and cyclophosphamide therapy
What are the symptoms for bladder cancer?
Painless visible haematuria - most common
Haematuria can be visible or microscopic
Have recurrent UTIs and storage bladder symptoms
What is the treatment for bladder cancer?
Low grade non-muscle invasive - endoscopic resection with intravesical CT
High grade non-muscle invasive - endoscopic resection, BCG therapy, and surgery
Muscle invasive - neoadjuvant chemo, RT or radical surgery
Describe upper tract TCC
Renal pelvis or colleting system is commonest
Tumours are often high grade and multifocal on one side
High risk of local recurrence
What are the symptoms of upper tract TCC?
Frank haematuria, unilateral ureteric obstruction, flank/ loin pain and signs of metastatic disease
What is the treatment for upper tract TCC?
Most are treated by nephroureterectomy
If unfit or bilateral then consider nephron sparing endoscopic treatment
If unifocal and low grade - endoscopic treatment
Describe renal cancer
Malignant renal adenocarcinoma is commonest adult renal malignancy
Most arise from proximal tubules
Clear cell, papillary, chromophobe and bellini type ductal
What is the presentation of renal cancer?
Can be asymptomatic
Classic triad is flank pain, mass and haematuria
Paraneoplastic symptoms - anorexia, cachexia, pyrexia and hypertension
Abnormal LFTs, anaemia and raised ESR
What is the investigations for renal cancer?
CT scan of abdomen and chest is mandatory
Bloods - U+Es and FBS
Optional - US and MAG-3 renogram
What is treatment for renal cancer?
Surgical - radical nephrectomy
Laparoscopic radial nephrectomy is standard
RCC is chemo and radio-resistant so receptor tyrosine kinase receptors and immunotherapy used
