Urinary Conditions Flashcards
Acute kidney injury (AKI) - crucial features
Increased creatinine
Decreased urine output
Duration - hours/days
What are the risk factors for AKI?
Any acute illness
Infection
Diabetes
What are the causes of AKI?
Pre-renal (most common, due to inadequate blood supply) - dehydration, hypotension, heart failure
Renal (intrinsic disease) - glomerulonephritis, interstitial nephritis, acute tubular acidosis
Post-renal (obstruction to the outflow of urine) - kidney stones, ureter/urethral strictures, enlarged prostate
What investigations would be done if AKI was suspected?
Bloods - FBC, U&Es, creatinine, CRP, LFTs
Urinalysis
Ultrasound
How is AKI managed?
Rehydration
Stop nephrotoxic medications
Relieve obstruction
What are the complications of AKI?
AEIOU: Acidosis (metabolic) Electrolyte imbalance - hyperkalaemia Intoxications Fluid overload Uraemic complications
Chronic kidney disease
3 months
What are the causes of CKD?
Diabetes Hypertension Age-related decline Glomerulonephritis Polycystic kidney disease
What are the symptoms of CKD?
Asymptomatic Pruritus Loss of appetite Nausea Oedema Pallor Hypertension
What are the stages of CKD?
1-5 (3 has a and b)
Stage 1 - GFR normal (90)
Stage 5 - GFR <15
Increases by 15 each time
How is CKD managed?
Aim to slow disease progression
Optimise control of condition
ACE inhibitor
Renal replacement therapy (if CKD stage 5) - dialysis (haemodialysis, peritoneal), transplantation
What are the complications of CKD?
Anaemia
Bone disease
CVS disease
Peripheral neuropathy
What is the pathology of polycystic kidney disease?
Fluid filled cysts in the kidney
What is the cause of polycystic kidney disease?
Autosomal dominant
Presents in early adult life
PKD-1 on chromosome 16
(is a recessive one too on different chromosome)
What are the symptoms of polycystic kidney disease?
Dysuria Loin pain Haematuria Polyuria Increased BP
How is polycystic kidney disease treated?
Symptomatic
Transplant
What are the complications with polycystic kidney disease?
Liver/pancreatic cysts
Cerebral artery berry aneurysm
What are predisposing factors for a urinary tract infection?
Sex - female Stones Foreign bodies Congenital abnormalities Bladder outflow obstruction
Why are UTIs more common in females?
Shorter urethra
Moist environment
Close proximity to anus
What are common pathogens in UTIs?
E.coli
Pseudomonas
What are the symptoms of a UTI?
Cystitis - frequency, urgency, dysuria, suprapubic pain
Pyelonephritis - loin pain, nausea, fever, rigors
When do you investigate a UTI further?
Male Recurrent infections Children Pregnancy Urinalysis (nitrates and leukocytes show infection), MSU, USS, KUB
How are UTIs treated?
Trimethroprim
Pyelonephritis - amoxicillin
What causes urinary stones?
Idiopathic Infection Obstruction Hot climate Hyperparathyroidism
What are most stones made of?
Calcium oxalate
What are the symptoms of stones?
Severe loin pain (10/10)
Bladder/urethra - maybe haematuria
Ureter - radiates to groin
What investigations would be done if stones were suspected?
Urinalysis - microscopic haematuria
CT KUB - diagnostic
IV urogram
How are urinary stones treated?
Analgesia
Small stones normally pass on their own
Extracorporeal shock wave lithotripsy
Percutaneous nephrolithotomy
What are the complications of urinary stones?
Recurrence
What is the pathology of renal cell carcinoma?
Adenocarcinoma - clear cell
What are the symptoms of renal cell carcinoma?
Average age 70 Haematuria Loin pain Palpable mass Weight loss
Where does renal cell carcinoma commonly spread to?
Renal vein
IVC
How is renal cell carcinoma treated?
Nephrectomy
What are the risk factors for bladder cancer?
Smoking
Exposure to aromatic amines
What is the pathology of bladder cancer?
90% transitional cell carcinoma
The rest are squamous
What are the symptoms of bladder cancer?
Haematuria
Recurrent UTIs
What investigations would be done if bladder cancer was suspected?
Flexible cystography
CT
How is bladder cancer managed?
Superficial - endoscopic resection
Invasive - radical cystectomy
Benign prostatic hyperplasia
Affects men over 50
What are the symptoms of benign prostatic hyperplasia?
Hesitancy Poor stream Terminal dribbling Incomplete emptying Frequency Nocturia Urgency
How is benign prostatic hyperplasia investigated?
Digital rectal examination - enlarged prostate MSU Urinary flow rate Post-void residual volume PSA
How is benign prostatic hyperplasia treated?
Conservative - avoid caffeine, evening fluids
Alpha blocker - tamsulon
Surgery - transurethral removal of the prostate
What are the complications of benign prostatic hyperplasia?
Acute urinary retention
Overflow incontinence
ALI
Bladder stones
What are the risk factors for prostate cancer?
Ageing
Family history - prostate, BRCA1, BRCA2
What are the symptoms of prostate cancer?
Storage and voiding problems
Haematuria
Hard nodular prostate on examination
Can present with advanced disease - AKI, bone pain, spinal cord compression
What investigations would be done if prostate cancer was suspected?
PSA
Trans-rectal ultrasound guided prostatic biopsy
MRI
How is prostate cancer treated?
Active surveillance
Radiotherapy
If advanced - hormone manipulation (eg GnRH agonist goserelin)
What are the risk factors for testicular cancer?
Testicular maldescent
Infertility
Atrophic testes
Previous cancer in contralateral testes
What is the pathology of testicular cancer?
Germ cell tumour
What are the symptoms of testicular cancer?
Painless lump
Potential tenderness, inflammation
What investigations would be done if testicular cancer was suspected?
MSU
Testicular ultrasound
How is testicular cancer managed?
Radical orchidectomy
Where does testicular cancer commonly metastasise to?
Lung
Bone
Liver
