Treatments Flashcards
Renal colic/nephrolithiasis - Acute
Acute
NSAIDs for pain
Antiemetics for vomiting and nausea
Allow stones <5mm to pass spontaneously
Renal colic/nephrolithiasis - surgical interventions
Percutaneous nephrostomy
Extracorporeal shock wave lithotripsy
AKI
Treat hyperkalaemia risk for arrhythmia
Fluid rehydration - if pre-renal
Stop nephrotoxic medications
Relieve obstruction
CKD - Reduce risk of complications
Oral NaHO3 to treat metabolic acidosis Iron supplementation and erythropoietin to treat anaemia Vit D to treat renal bone disease Dialysis in the end stage renal failure Renal transplant in end stage failure
Prostate cancer
- External beam radiotherapy directed at the prostate
- Brachytherapy
- Hormone therapy
- Bilateral orchiectomy - to remove testicles (rarely used)
Surgery - Removal of the prostate gland
Prostate procedure side affects
ED and urinary incontinence
Benign prostate hyperplasia - Mid/manageable
Behavioural management e.g. avoiding caffeine/alcohol
Medical options
1st - Alpha blockers e.g. tamsulosin
5-alpha reductase inhibitors e.g. finasteride
Mechanism of action Tamsulosin and Finasteride
Tamsulosin - relaxes smooth muscle
Finasteride - reduces size of the prostate
BPH - Most common surgical management
Transurethral resection
Urethritis - Gonorrhoea
Single IM dose of ceftriaxone if sensitivities unknown
Single does of oral ciprofloxacin if sensitivities are known
Urethritis - Chlamydia
Single 1g dose of azithromycin
Plus 7 days doxycycline
Varicocele
Uncomplicated can be managed conservatively - reassurance/observation
If testicular pain, atrophy or infertility risk then surgery may be indicated
Testicular Torsion
Surgical emergency
Orchiopexy - correcting the position of the tesicles by fixing them in place
Orchidectomy - removal if surgery is delayed or there is necrosis
SLE - mild disease
1st - Hydroxychloroquine - DMARD
Corticosteroids
NSAIDs
Sun cream and sun avoidance
SLE - severe disease
Rituximab - MCAB that targets CH20 protein on B cells
Belimumab - MCAB that targets B-cell activating factor
Minimal change disease
1st line - High dose corticosteroids Plus Fluid restriction/low salt diet Albumin infusion may be required in severe hypoalbuminemia Furosemide - diuretic to treat oedema
MCD - Steroid Resistance
ACE inhibitors and immunosuppressants e.g. cyclosporine, tacrolimus and rituximab
Bladder cancer - Surgical options
Transurethral resection of bladder tumour (TURBT)
Intravesical chemotherapy
Intravesical Bacillus Calmette-Guerin (BCG)
Radical cystectomy - removal of entire bladder
Pyelonephritis
Cefalexin 7-10 days
Trimethoprim (E.coli) or amoxicillin if sensitive
Prostatitis - Acute
Oral ABs - trimethoprim (E.coli)
Analgesia
Laxatives
Prostatitis - Chronic
Alpha blockers e.g. tamsulosin Analgesia NSAIDs or paracetamol Psychological treatment e.g. CBT or ADs ABs Laxatives
Epididymitis
ABx- Ofloxacin Alternatively Levofloxacin, doxycycline or Co-amoxiclav Analgesia Supportive underwear Reduce physical activity Abstain from intercourse
IgA nephropathy (Berger’s disease)
Moderate: Observation Severe: - Supportive treatment for renal failure - ACE-I - benazepril/ramipril - Immunosuppressant medications
Post-strep glomerulonephritis
Usually resolves spontaneously
Focal segmental glomerulosclerosis -
Asymptomatic or proteinuria <3g/24h
ACE-i e.g. ramipril
Angiotensin-2 receptor antagonist e.g. irbesartan
Plus dietary modification
Adjunct: statin
Focal segmental glomerulosclerosis -
Symptomatic or proteinuria 3g or more per 24h
Corticosteroid therapy
Plus ACE-I (ramipril) or A2RA (irbesartan)
Membranous nephropathy
1st - Low-salt and low protein diet
Plus: ACE-I (ramipril) /A2RA (irbesartan) - for hypertension
Plus: Statin - For hyperlipidemia
Plus: Furosemide +/- hydrochlorothiazide - if risk of progression to end stage to renal failure
Polycystic kidney disease - Dominant
Vasopressin receptor antagonist e.g. can slow the development of the cysts and the progression to renal failure
ACE-I/BB for hypertension e.g. ramipril/propranolol
ABxs for infection
Drainage of cysts
Dialysis/transplant
Genetic counselling
Avoid contact sports to avoid cyst rupture
Cystitis
ABx 3 days of trimethoprim or nitrofurantoin
UTI - uncomplicated
Trimethoprim or nitrofurantoin
UTI - Pregnancy
1st Nitrofurantoin
2nd Cephalexin or amoxicillin
Chlamydia
Single 1g dose of azithromycin
Plus 7 days doxycycline
Gonorrhoea
Single dose Ceftriaxone IM dose
Syphilis
IM benzathine benzylpenicillin (penicillin)
