Urinary Flashcards
How do you define nephrotic syndrome?
Presence of proteinuria (>3.5 g/24 hours), hypoalbuminaemia (<30 g/L)
and peripheral oedema
Key differentiating feature of nephrotic syndrome induced oedema? What simple test can give you an idea?
Facial as can lay flat, simply measure urine for protein as this is not high in CCF or Liver disease
Most common idiopathic type of nephrotic syndrome?
If primary how treated?
Focal segmental glomerulosclerosis 30-50%
Primary responds to immunosuppresion
Most common cause of CKD?
Diabetes and HTN is second
How is CKD stage 1 and 2 defined?
stage 1 Egfr >90 but evidence of kidney damage such as proteinuria/haematuria or other evidence
Stage 2 the same but from 60-89 Egfr
Note: without evidence these are normal Egfrs
45-60 Egfr stage ckd?
Stage 3a regardless of damage or not (moderate)
Stage 3b CKD?
30-44ml Egfr
Severe CKD?
Egfr 15-29
End stage renal failure Egfr?
<15ml
Presentation of CKD?
Fatigue due to reduced epo and anaemia
Nausea due to increased urea
Pruritis due to urea
Foamy urine - protein
Management of HTN in CKD?
If ACR >30 offer ACEi or ARB
If ACR <30 manage under normal guidelines
ACR of >70mg what to offer?
ACEi or ARB regardless of BP
For people with hypertension and CKD and an ACR of 70 mg/mmol or more and 70 or less, ideally aim for BP?
130/80 and 140/90
When to offer statin in CKD?
If egfr <60 or ACR>3 use 20mg atorvostatin
CKD diagnosed when what is persistent how long?
egfr <60 for 3 months or persistent proteinuria (ACR>3mg for 3 months
Older adults with nephrotic syndrome most common cause?
Membranous nephropathy
Focal segmental nephropathy 1 and 2 both benefit from?
ACEi
IgA nephropathy?
Recurrent visible haematuria after URTI or Gastoenteritis
painless haematuria, but may have loin pain, can get an AKI usually 20-30 years old
What must be done in IgA nephropathy?
Renal biopsy
Management of IgA nephropathy?
If BP high acei, if good BP control but proteinuria >1g day can have steroids
Haematuria, sub-nephrotic protein urea and HTN?
Nephritic syndrome
When does IgA nephropathy occur?
few days post infection
Post strep nephropathy occurs?
1-2 weeks after
30% of men undergoing a TURP do so for what?
Obstructive prostatic retention
Worsening LUTS and then retention?
Acute prostatic urinary retention
Confusion, Hyponatraemia, fatigue, nausea after Prostate surgery?
TURP syndrome
Pain relief of choice in renal colic? What is this is not suitable?
Diclofenac 75mg IM
Can use morphine if contraindicated
Other than pain relief offer what in renal colic?
Metoclopramide 10mg IM (reduce doses in renal impairment)
Or Cyclizine 50mg IM
Investigation of choice in Renal/Ureteric colic?
CT-Non contrast, initially a urine dipstick to support diagnosis
Symptoms of renal/ureteric colic?
Pain lasts minutes to hours and occurs in spasms, with intervals of no pain or dull ache.
Is often accompanied by nausea, vomiting, and haematuria.
Some of worst pain experienced
Cannot lie still
Management of pre-renal AKI?
Fluids Normal saline,. Vasopressors if hypotensive
Renal replacement- uraemia, K++ or Acidotic
Intrinsic AKI management?
Fluids, underlying cause, stop drugs
Post renal AKI treatments?
Catheter for prostatic obstruction
Nephrostomy
Lithotripsy/stenting if strictures
Most important causative factor for bladder cancer?
Smoking
Primary presenting complaint of bladder cancer?
Painless gross haematuria, dysuria/UTI accompanied
Which sided varicocele can indicated a renal cancer?
Right sided
RTA then urinary retention what could be the cause?
Urethral damage - can be blood at meatus
Triad for renal cancer?
classical triad: haematuria, loin pain, abdominal mass
Other features of renal cancer other then the triad?
Pyrexia of unknown origin, Right sided varicocele, polycythaemia
Shcistosomiasis is a risk for what?
Squamous cell bladder
unexplained visible haematuria without urinary tract infection, or
visible haematuria that persists or recurs after successful treatment of urinary tract infection Age >45
Urgent referral (i.e. within 2 weeks)
Aged >= 60 years AND have unexplained nonvisible haematuria and either dysuria or a raised white cell count on a blood test
Urgent referral (i.e. within 2 weeks)
Non urgent urology referal for who and what problem?
Aged 60 >= 60 years with recurrent or persistent unexplained urinary tract infection
Glomerulonephritis induces what renal syndrome type?
Nephritic
Define AKI? numbers etc not stages just beginning
a rise in serum creatinine of 26 micromol/litre or greater within 48 hours
a 50% or greater rise in serum creatinine known or presumed to have occurred within the past 7 days
a fall in urine output to less than 0.5 ml/kg/hour for more than 6 hours in adults
investigation of choice for reflux nephropathy?
micturating cystogram/graphy
Non muscle invasive bladder cancer treatment?
Transurethral resection/intravesical chemo
Muscle invasive bladder cancer treatment?
Partial/complete cystectomy and lymph nodes
Stress incontinence treatment initially?
Training of bladder
Stress vs urge incontinence?
Stress is when you laugh or cough, urge need it cant get there in time
Urge incontinence treatments?
Antimuscarinics and bladder retraining
Macroscopic haematuria investigation by urologist?
Cystoscopy
Gold standard imaging for haematuria?
CT Urography (CTU)
What to rule out in haematuria?
Is it Just transient?
Microscopic haematuria investigation?
US +/- cystoscopy
Type of cancer prostate?
Adenocarcinoma
Which score used for prostate cancer?
Gleason
Signs and symptoms of prostate cancer?
Erectile dysfunction, back pain, bone pain, haematuria, weight loss, LUTS(hesitancy dribbling overactive)
When can PSA be raised?
Cancer, BPH, prostatitis, riding a bike, ejaculating, biopsy, DRE
What to do in low risk prostate cancer?
Active surveillance, MRi and then PSA every few months
Anything more than low risk prostate cancer what to do?
Radical prostatectomy radiotherapy and androgen deprivation
Bilateral hydronephrosis causes?
Urethra stenosis, prostatic problems, bladder tumour, retroperitoneal fibrosis
1st line investigation for hydronephrosis?
USS, can do CT KUB if stones suspected
Most common kidney stone?
Calcium oxalate ++ calcium in urine
Stones associated with proteus and pseudomonas/klebsiella?
Triple phosphate(struvite)
Size of stone to think about percutaneous nephrolithotomy?
> 15mm
Which stones not seen on xray?
Urate
Subtype of renal cell most common?
Clear cell
Definitive test for renal cell cancer?
Contrast enhanced CT Abdo and pelvis
Which stage Renal cell is not with curative intent?
Stage 4
Most common inheritance pattern for polycystic kidney disease?
Autosomal dominant
Presentation of polycistic disease?
Anurysms, SAH, HTN young age, Murmurs, hepatomegaly and cysts there.
ADPKD imaging?
USS
USS diagnostic for polycystic?
Positive family history <30 and 2 cysts uni or bilat
>30-59 two cysts in both
>60 4 cysts in both
Urethral stricture risk factors?
BPH, STIs and trans-urethral resections