URINARY SYSTEM Flashcards
** UTI
Lower called?
Upper called?
Main organism?
RF?
CF?
IVX?
TX
non-pregnancy
pregnanct
Lower UTI: Urethritis, cystitis and prostatitis
Upper UTI: Pyleonephritis
E.COLI Main organism
RF: abnormality of renal tract, incomplete bladder emptying, Female, Sex, menopause
CF: Increased Frequency, pain on weeing, blood in wee, urgency, foul smelling, loin/abdo tenderness, confusion and fevers
IVX: Dipstick, MSU, FBC. U+E, CRP, blood cultures, USS or cystoscopy
Tx: Fluids and wee often
Non-pregnant women: Trimethoprim or Nitrofurantoin
Pregnant: Get expert help
Men: Take seriously and refer if upper UTI/ recurrent
Consider PSA in men
** Acute Cystitis
CF
IVX
Management
- Inflammation or infection of bladder
RF: Female, DM. pregnancy
CF: frequency, dysuria, urgenecy, suprapubic pain
IVX: Urine dipstick, MSU
Management: 3-5 day trimethoprim
Analgesia and hydration
** Acute Pyelonephritis
Causative organism
RF
CF
Ivx
Tx
which antibiotic?
- Infection within renal pelvis often ascending
Cause: E.coli, klebsiella
RF: Vesicoureteric reflux, catheters or stents, pregnancy
CF: High fever, Rigors, Vomiting, Loin pain and tenderness, Malaise +/- LUTI syx
IVX: urinalysis, MSU, inflammation markers, FBC, USS
Management: Rest, fluid, analgesia
Start epirical abx awaiting cultures –> Ciprofloxacin
** Prostatic acute urinary obstruction
Drug treatment
- Benign Prostatic Hypertrophy
RF: ageing and afro-caribbean
CF: Nocturia, frequency, post-micturation dribbling, poor stream, hesitancy, urgency, incomplete emptying
IVX: MSU, bloods, USS, rule out cancer with PSA, PR
Management: Avoid caffeine and alcohol, relax
Transurethreal resection or incision of prostate
Drugs: Tamsulosin a blocker or Finasteride 5 alpha reductase (decreases testosterone)
** Severe Hyperkalaemia
Severe level?
Cause:
CF
Ivx
Management:
Mild = >5.5, Severe >6.5 - over 7 URGENT
Cause: Decreased excretion e.g AKI, CKD, ACE inhibitors, NSAIDS,
CF: SOB, fatigue, weakness, bradycardia, arrhythmias
Ivx: FBC, ECG tall tented t waves, ABG, Urine output
Management:
- 10 ml 10% Calcium Gluconate
- 10 units Insulin Act Rapid with 50ml 50% Glucose
- 10mg Neb Salbutamol back to back
Chronic Kidney Disease
EGFR under..
when go to nephrologist?
Signs?
DAMN?
Treatment
- Damage over 3 months
EGFR <60ml/L
Cause: increased BP, DM, glomerulonephritis, renovascular disease, infective, obstructive, renal stones
CF: N+V, Weight loss, fatigue, lethargy, insomnia, muscle cramps, nocturia, sexual dysfunction
Sings: increased pigmentation, HTN, restless leg, peripheral oedema
IVX: blood, U+E, Ca, ERR, FBC, MSU, renal USS, renal biopsy
Management: Refer to nephrologist if GFR< 30 or sustained decrease in eGFR –> DIALYSIS or transplant
Review meds: DAMN for acute AKI Diuretics Antibiotics and Ace inhibitors + ARB Methotrexate + metformin careful in CKD Nsaids
Lower BP target
- Statin and aspirin to all CKD !!!!!
- Folic acid and B vitamins, restrict dietary phosphate
- Bisphosphonates
- Prepare for dialysis
Acute Kidney Injury
Rise in…
CF:
Signs
Ivx
Rise in serum creatinine >26 in 48 hours or 1.5X baseline in 1 week or urine output <0.5ml/kg for 6 consecutive hours
Pre-renal, intrinsic and post renal
CF: Oligouria, N+V, Dehydration, confusion
signs: HTN, large painless bladder, dehydration with postural HTN, Pallor, rash, Signs of vasculitis
IVX: Bloods, U+E, CK, ABG, Blood cultures, hepatitis, urine dip, CXR? pulmonary oedema, ECG. renal ultrasound
Management: identify and correct pre and post renal factors
consider transfer to HDU
Pulse BP UO hourly, match input loss, correct fluid depletion, Rx if sepsis
Incontinence
3 diff types
med for tx of stress incontiencence??
Stress: involuntary leakage on exertion
Functional: poor mobility
Urge: Sudden compelling desire to wee / involuntary detrusor contraction
RF: pregnancy, vaginal delivery, stroke, enlarged prostate
IVX: digital assessment, DRE for prostate, urine dip and bladder scam / urodynamic stress
2 week if microscopic haematuria aged >50
Manage:
Urge: reduce caffiene
Stress: pelvic floor muscles, Duloxetine
Nephrotic syndrome
CF
treatment
- PROTEINURIA and Hypoalbuminaemia due to damaged basement membrane
Cause: Primary golmerular diseases e.g minimal change + secondary eg infection HIB
CF: Facial swelling and peripheral oedema, DVT or MI, frothy urine, tired, breathless due to pleural effusion
IVX: Urine Dip, MSU, Quantify Proteinuria
FBC and coag, renal function tests, LFT
tx: NA and fluid restriction
HIGH DOSE DIURETICS and STEROIDS!!!
Detrusor Instability
SYX
Drug treatment?
- Overactive bladder- associated with detrusor muscle over activity
CF: urgency, freq, nocturia, urge incontience
Ivx: Urine dip, MSU, urodynamic studies
Reduce caffiene, lower MI
Drugs = Oxybutynin to relax urinary smooth muscles
Bladder Cancer
90% are?
Refer when?
- 90% transitional cell carcinoma
RF: smoking, rubber industires, shcistsomiasis
CF: painless haematuria, recurrent UTI
IVX: urine microscopy
REFER over 45s + haematuria
Management: Intravesical chemo, cystectomy
Prostatic Cancer
RF?
Tx drug:
Most adenocarcinomas arising in the peripheral zone
RF: age, afro-caribbean, FHx, Testosterone
CF: asymptomatic, noctura, hesitancy, obstruction, impotence
IVX: PSA, transrectal USS and biopsy urinalysis, bone X ray
Grading = Gleason
TX: Goserelin and prostacetectomy
Hydronephrosis
- Dilatation of the renal pelvis
Caused: by obstruction eg calculus or blood clot or tumour inside, within wall or from outside
CF: pain in back or ribs
Treatment: Analgesia, Nephrostomy to drain urine
Renal Carcinoma
most common in kids?
Traid of?
in kids = wilms tumour
CF: Triad of Haematuria, Loin pain and abdo / loin mass
- anorexia, malaise, ankle swelling
IVX: Bp increased due to renin secretion, blood FBC and urine cytology, MRI
Adult Polycystic disease
age of detection?
drug management
- Dont get symptoms until 30-60 years old
- Inherited
SYX: high bp, back pain, headache, blood in urine
Management: Tolvaptan slows growth of cysts
“tolvaps” the cysts
Urethral stricture
- Scarring of urethra
SYX: Decreased urine stream.
Incomplete bladder emptying.
Spraying of the urine stream
Treatment: Streching or surgical methods eg remove scar
Vesico-Ureteric Reflux
syx
age at which needs surgery
Occurs when valve between ureters and bladder not working properly
Leads to urine flowing backwards through ureters sometimes as far as kidneys
Affects kids predominantly
- Syx: Repeated UTIs, burning, frequency, abdo pain, high temp, reduced appetite
IVX: Micturition Cystography, USS
Management: Low dose ABX until 2-3YRS old
If severe aged 5 = surgery
Glomerulonephritis
• Includes a range of immune-mediated disorders that cause inflammation within the glomerulus and other compartments of the kidney
E.g: minimal change, diffuse, focal and segmental
Cause: IgA nephropathy, SLe, nephritic, Henoch Schonlein purpura
Syx: Nephritic or nephrotic syx: protienuria, haematuria
TX: monitor haematuria and proteinuria + treat cause
Orthostatic Proteinuria
• Elevated protein excretion while in the upright position and normal protein excretion in a supine or recumbent position
IVX: 24 hr protein collection
AKI parameters
Rise in creatinine of ≥ 25 micromol/L in 48 hours
Rise in creatinine of ≥ 50% in 7 days
Urine output of < 0.5ml/kg/hour for > 6 hours
neprhotoxic drugs
Review meds: DAMN Diuretics Antibiotics and Ace inhibitors + ARB Methotrexate + metformin careful in CKD Nsaids
side effects of erythropeitin
Bone aches, flu-like symptoms and skin rashes
Renal colic treatment
Diclofenac 75mg PR
Renal Cell carcinoma pathonomic finding in CXR
Cannon ball mets
igA nephropothy
- Nephritic syndrome
- (also known as Berger disease)
- Occurs after GI or resp infection a few DAYS
- Gross haematuria, flank pain and red blood cells casts on microscopic examination of the urine
- no wcc in urine dip
Minimal change disease
NEPHROTIC
mainly affects children
treat with steroids
Post infectious Glomerulonephropathy disease progression
Has lag time of around 2 weeks before haematuria occurs and would be a less benign presentation if associated with visible haematuria
time for igA nephropathy vs post infectious for urine blood after infection
igA nephropathy = days
post infectious = weeks
DAMN
Diuretics
Ace inhibitors, ARBS + ABX (RIFAMPICIN)
Methotrexate + Metformin
NSAIDs
CKD levels
ckd 1 = <90 with deranged alb: creat
