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Conditions + definitions > Urinary 2 > Flashcards

Urinary 2 Flashcards

1
Q

What are the indications for renal imaging?

A 
Renal colic and renal stone disease
>Diagnosis and follow up
Haematuria
Suspected renal mass
UTIs
Hypertension
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2
Q

What imaging is used for kidneys?

A

Plain X-ray
USS
CT

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3
Q

What are the clinical features of nephrourolithiasis?

A 
Renal pain (fixed in loin)
Ureteric colic (radiating to groin)
Dysuria / haematuria / testicular or vulval pain
Urinary infection
Loin tenderness
Pyrexia
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4
Q

How do you investigate kidney stones?

A

Bloods, Urine analysis
Parathyroid hormone
Radiology

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5
Q

What are the indications for surgery and renal stones?

A 
Obstruction
	Recurrent gross haematuria
	Recurrent pain + infection
	Progressive loss of kidney function
	Patient occupation
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6
Q

What are the indications for PCNL?

A 
Large stone burden (risk of Steinstrasse)
		Associated PUJ stenosis.
		Infundibular stricture.
		Calyceal diverticulum.
		Morbid obesity or skeletal deformity.
		ESWL resistant stones e.g. Cystine.
Lack of availability of ESWL.
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7
Q

What are the complications of PCNL (surgery)?

A

Uncorrected coagulopathy.
Active Urinary Tract Infection.
Obesity or unusual body habitus unsuitable for X-ray tables.
Relative contraindications include small kidneys and severe perirenal fibrosis.

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8
Q

What is ESWL, when is it used?

A

Extracorporeal wave lithotripsy
Not used as first line with stones greater than 2cms
Not as effective after 2 treatments

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9
Q

What are the indications for ESWL?

A

Severe obstruction, uncontrollable pain, persistent haematuria, lack of progression, failed ESWL and patient occupation

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10
Q

What are the complications of uteroscopy?

A

Minor complications: 0-30%
>Haematuria, fever, small ureteric perforation, minor vesico-ureteric reflux.
Major complications:
>Major ureteric perforation, ureteric avulsion, ureteral necrosis and stricture formation.

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11
Q

What is the clinical presentation of bladder stones?

A 
Suprapubic / groin / penile pain
Dysuria, frequency, haematuria
Urinary infection (persistent)
Sudden interruption of urinary stream
Usually secondary to outflow obstruction
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12
Q

How do you treat bladder stones?

A

Endoscopically

Large stones with open excision

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13
Q

What systemic diseaes affect the kidneys?

A 
Diabetes mellitus
Cardiovascular disease
>Cardiac failure
>Atheroembolism
>Hypertension
>Atheroscelrosis
Infection
Inflammation in blood vessels
Myeloma
Amyloidosis
Drugs
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14
Q

What drugs affect the kidneys?

A 
Aminoglycosides
	ACEI
	Penicillamine
	NSAIDs
Radiocontrast
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15
Q

What are the types of vascalitis?

A 
Aorta/large artery
>Takayasu arteritis
>Giant cell arteritis
Medium artery
>Polyarteritis nodosa
>Kawasaki disease
Small vessel
>Wegener’s granulomatosis
>Microscopic polyarteritis
Churg-Strauss syndrome
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16
Q

What is wegners granulomatosis?

A

Granulomatous inflammation in respiratory tract
Focal necroitising glomerulonephritis with crescents
Affects all age groups

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17
Q

What is the clinical presentation of vasculitis?

A 
Upper respiratory tract
>Epistaxis, sinusitis
>Cough, dyspnoea, haemoptysis
>Pulmonary haemorrhage
Kidney 
>- glomerulonephritis
Joints
> arthralgia, myalgia
Eyes
> scleritis
Heart
>pericarditis
Systemic	
> fever, weight loss, vasculitic skin rash
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18
Q

How do you diagnose vasculitis?

A 
Yrine blood/protein
Raised urea
Low albumin, 
Raised Alk P
Anaemia
Hyperglobulinaemia
Positive ANCA
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19
Q

How do you diagnose multiple myeloma?

A

bone marrow aspirate
Serum para protein
urinnary Bence Jones protein
skeletal survey

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20
Q

What are the complications of multiple myeloma?

A 
cast nephropathy
	light chain nephropathy
	amyloidosis
	hypercalcaemia
	hyperuricaemia
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21
Q

How do you diagnose multiple myeloma?

A 
Urine protein, microscopic blood
Elevated urea, creatinine + CRP
Anaemia
Raised alk P
ANCA
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22
Q

What are the clinical features of multiple myeloma?

A 
Hands
>splinter haemorrhages, purpura
face
>scleritis, uveitis, nasal cartilage deformity, retinal vasculitis, hypertensive retinopathy
Skin
>Vasculitic rash, scleroderma
CVS
>Hypertension, murmur
Chest
>Crepitations, haemoptysis
Locomotor
>Joint swelling, tenderness
CNS
>Stroke, encephalopathy
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23
Q

What are the common sites of urinary tumours?

A

Epithelial lining

Bladder

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24
Q

What is the pathology of bladder cancer?

A

Most often transitional cell carcinoma

If schistomosomiasis is endemic, squamous cell carcinoma

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25
Q

What are the risk factors for transitional cell carcinoma?

A

smoking (accounts for 40% of cases)
aromatic amines
non-hereditary genetic abnormalities (e.g. TSG incl. p53 and Rb)

26
Q

What are the risk factors for squamous cell carcinoma?

A

Schistosomiasis (S. haematobium only)
chronic cystitis
cyclophosphamide therapy
pelvic radiotherapy

27
Q

What are the symptoms of bladder cancer?

A

Visible often painless haematuria
Occasionaly symptoms due to invasive or metastatic disease
Recurrent UTI
Storage bladder symptoms

28
Q

How do you investigate haematuria?

A

Urine culture
Cystourethroscopy
Upper tract imaging
>Intravenous urogram/US

29
Q

How do you diagnose urothelial tumours?

A

IVU will miss some renal cell tumours

USS alone will miss urothelial tumours of upper tracts

30
Q

What are the different stages of bladder cancer?

A

G1 = Well diff. - commonly non-invasive
G2 = Mod. diff. - often non-invasive
G3 = Poorly diff. - often invasive
Carcinoma in situ (CIS) – non-muscle invasive but VERY aggressive (hence treated differently)

31
Q

How do you treat low grade bladder cancer (no muscle involvement)?

A

endoscopic resection followed by single installation of intravesical chemotherapy (mitomycin C) within 24 hours
prolonged endoscopic follow up for moderate grade tumours
consider prolonged course of intravesical chemotherapy (6 weeks to 6 months) for repeated recurrences

32
Q

How do you treat invasive bladder cancer?

A

Chemo + radio

Or chemo + surgery

33
Q

What are the symptoms of upper tract urothelial cancer?

A

Frank haematuria
Unilateral ureteric obstruction
Flank or loin pain
Symptoms of nodal or metastatic disease

34
Q

What is UTUC?

A

Renal pelvis or collecting system most commonly, sometimes ureter
High grade multifocal unilateral
Endoscopic treatment

35
Q

What are the renal tumours?

A

Benign : oncocytoma, angiomyolipoma

Malignant : renal adenocarcinoma
	commonest adult renal malignancy
36
Q

What are the histological subtypes of renal adenocarcinoma?

A

clear cell (85%)
papillary (10%)
chromophobe (4%)
Bellini type ductal carcinoma (1%)

37
Q

What are the risk factors of renal adenocarcinoma?

A 
Family history (autosomal dominant e.g. vHL, familial clear cell RCC, hereditary papillary RCC; can be bilateral and/or multifocal)
Smoking
Anti-hypertensive medication
Obesity
End-stage renal failure
Acquired renal cystic disease
38
Q

What is the presentation of renal adenocarcinoma?

A

Asymptomatic (i.e. incidentally noted on imaging for unrelated symptoms) : 50%

‘Classic triad’ of flank pain, mass and haematuria : 10%

Paraneoplastic syndrome : 30%
anorexia, cachexia and pyrexia
hypertension, hypercalcaemia and abnormal LFTs 
anaemia, polycythaemia and raised ESR
Metastatic disease : 30%
>bone, brain, lungs, liver
39
Q

How do you investigate renal adenocarcinoma?

A

CT scan
Bloods
US, IVU, DMSA

40
Q

How do you treat renal adenocarcinoma?

A

Surgical
Radio/chemoresistant (mets difficult to treat)
Immunotherapy

41
Q

What are the predisposing factors to UTIs?

A 
Immunosuppression
Steroids
Malnutrition
Diabetes
Female
Sexual intercouse
Congenital abnormalities
Stasis of urine
Foreign bodies (catheters, stones)
Oestrogen deficiency
Fistula between bladder and bowel
42
Q

What organisms generally cause a UTI?

A

Generally bowel oganisms

E coli mos common

43
Q

How do UTIs transfer into the urinary tract?

A 
Transurethral route
>Perurethral area contaminated
>>Recurrent UTIs, diaphragms, ? bubble baths
>Urethra to bladder
>>Intercourse, catheterisation
>Bladder (and up ureters)
Bloodstream
Lymphatics
44
Q

What are the clinical features of UTIs in children?

A 
Diarrhoea	
		Excessive crying
		Fever
		Nausea and vomiting
		Not eating
45
Q

What are the clinical features of UTIs in adults?

A 
Flank pain
		Dysuria (“like passing broken glass”)
		Cloudy offensive urine
		Urgency
		Chills
		Strangury
		Confusion (very old people)
46
Q

What are the clinical features of pyleonephritis?

A 
Pyrexia
	Poor localisation
	Loin tenderness (renal angle)
	Signs of dehydration
Turbid urine
47
Q

How do you investigate a UTI?

A

MSSU (midstream sample of urine)
Urinalysis
Microbiology

> Identify organism so you can treat

48
Q

How do you treat a UTI?

A 
Fluids
Antibiotics
> Trimethoprim - first line
>Amoxicillin (3-5 	day 	course or 	3g x 2), 	>cephalosporin
Severe infections
>Intravenous antibiotics
49
Q

What is reflux?

A

Urine going back to kidneys

Often happens in children

50
Q

How do you manage reflux?

A

Assess progression of reflux by USS

Surgery if needed

51
Q

What are the potential complications pf pyleonephritis?

A 
Radiological diagnosis
	Scarring & clubbing
	Hypertension / CRF
	Reflux
15% progress to renal failure
52
Q

What are the risk factors of prostate cancer?

A 
Age (old)
	Ethnicity 
	Family history
	Food?
Drugs
53
Q

What is the presentation of prostate cancer

A 
Mainly asymptomatic
If not, then often LUTS
	diagnosed through PSA testing
	>then digital rectal examination
	>and prostate biopsies
PSA prostate specific not cancer specific
54
Q

What is PSA?

A 
Prostate specific antigen
A Serine protease - liquifies semen
half of 2.2 days
normal range of 0 to 4 µg/mL
levels increase with age
55
Q

What can cause elevation of PSA?

A 
UTI
	chronic prostatitis 
	physiological
	recent urological procedure, insurance
	prostate cancer
	BPH
56
Q

How do you treat prostate cancer?

A

Immediate hormonal therapy is mainstay of treatment
Supportive treatment : e.g. palliative radiotherapy to bony metastases, colostomy, nephrostomy, zoledronic acid, palliative care support, etc.
Hormone refractory stage will be reached in 18-24 months of treatment
Oestrogen can be tried
Surgery possible

57
Q

How does testicular cancer present?

A 
Usually painless lump
Sometimes:
>Tender inflamed swelling
>history of trauma
>signs and symptoms for distant nodal metastases
58
Q

What are the tumour markers for testicular cancer?

A

AFP (alpha-fetoprotein) (teratoma)
Beta-HCG (Human Chorionic Gonadotrophin) (seminoma)
LDH (Lactate dehydrogenase) (non-specific marker of tumour burden)

59
Q

How do you diagnose testicular cancer?

A

ump in testes are testicular tumours until proven otherwise
look for tumour markers
perform testicular ultrasound and x-ray

60
Q

What are the differentials for testicular cancer?

A

differentials
>infection
>epididymal cyst
>Missed testicular torsion

61
Q

How do you treat testicular cancer?

A 
orchidectomy
further treatment dependent on type
Low stage, negative markers
>Surveillance; or
>Adjuvant radiotherapy (SGCT only); or
>Prophylactic chemotherapy
Nodal disease, persistent tumour markers, or relapse on surveillance
>Combination chemotherapy (BEP); or
> Lymph node dissection (NSGCT only)
Metastases
>First-line chemotherapy
>Second-line chemotherapy
62
Q

What is the pathology of testicular cancer?

A

Germ cell tumour (95%)
>Seminomatous GCT (classical, spermatocytic, or anaplastic) 30-40yrs
>Non-seminomatous GCT (teratoma, yolk sac, choriocarcinoma, mixed GCT) 20-30yrs

Non-GCT (sex cord/stromal):
>Leydig
>Sertoli
>Lymphoma rare

Conditions + definitions (68 decks)

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