Urinary Problems Flashcards
Criteria for definition of an AKI?
Rise in creatinine - >1.5 x from baseline within 7 days
OR - >26 micromol/L within 48hrs
AND Urine output <0.5mL/Kg for >6 hours
Pre-renal causes of AKI?
Generally due to hypoperfusion - secondary to..
Hypovolaemia - burns, D+V, major haemorrhage
Shock and reduced CO - sepsis, cardiac failure
Renal and post-renal causes of AKI?
Renal - Glomerular (tubular necrosis), interstitial (infection), vessels (vasculitis, HUS)
Post-renal - stones, stricture, malignancy, clots
Management principles of someone with AKI?
Treat underlying cause
Stop nephrotoxic meds - NSAIDs, ACEi, ARB, aminoglycoside
Optimise drug dosages for renal impairment
Treat hyperkalaemia - IV Insulin + glucose
Correct acidosis - IV sodium bicarbonate
Causes of acute urinary retention (AUR)
Men - BPH, prostate cancer, meatal stenosis
Women - prolapse, pelvic mass
Both - calculi, malignancy, stricture, faecal impaction
Investigations in AUR?
Abdo + genitourinary exam
PR - check anal tone, exclude impaction
Urine dipstick, renal USS
Serum Urea and creatinine
Management of AUR?
Bladder decompression - catheter / Supra-pubic
consider alpha blockers - Tamsulosin
Which investigations to order in renal colic?
Exclude infection - urinalysis and MSU
Bloods - U&Es, Calcium, phosphate, urate
KUB Xray
Management of renal colic
IV opioid analgesia +/- NSAID
PCNL - percutaneous nephrolithotomy
95% <5mm stones will pass spontaneously
>5mm - extracorporeal shockwave lithotripsy
Presentation and clinical features of testicular torsion
Sudden onset, severe testicular pain +/- abdo pain, N+V
High lying, horizontal testicle
Absent cremasteric reflex
no pain relief on elevating testicle (Epididymo-orchitis)
Investigations in testicular torsion
should really be a clinical diagnosis
Grey-scale ultrasound - whirlpool sign
Doppler USS of testicular blood flow
Management of Testicular torsion
Urgent surgical exploration and bilateral fixation of both testicles
If <6hrs - salvage rate 90-100%. If >24hrs, rate 0-10%
Investigations in UTI?
Dipstick –> +ve nitrites, leukocytes
Urine microscopy, culture and sensitivity if indicated
If pyelonephritis suspected, USS of upper UT
Indications for referral in UTI?
unresponsive to treatment
Hx of renal disease/anomaly
Recurrence in women despite preventative measures
Recurrence in men - 2+ episodes in 3 months
Haematuria
Which UTI medication is safe to take in pregnancy and when?
Trimethoprim: Safe in 3rd trimester/term - due to action as folate inhibitor unsafe in 1st/2nd trimester
–> do not take with methotrexate –> bone marrow suppression
Nitrofurantoin: Safe in 1st/2nd trimester, unsafe at term
