Uro/Endo week: core conditions (UTI, acute kidney injury, CKD, prostate disorders)

Question 1

Define acute kidney injury

Answer 1

Abrupt sustained rise in serum urea and creatinine (1.5x)

Usually (not always) reversible or self-limiting

Question 2

Causes of pre-renal AKI

Answer 2

Prolonged hypovolemia leading to fall in GFR

• V n D
• burns
• sepsis
• heart failure
• liver cirrhosis
• drugs that impair renal autoregulation (ACE inhibitors, NSAIDs)

Question 3

Causes of renal AKI

Answer 3

• Intrinsic renal disease

- Drugs (nephrotic eg aminoglycoside a/b - gentamycin, IV contrast, ACE i, NSAIDs, diuretics)

Question 4

Causes of post-renal AKI

Answer 4

-urinary tract obstruction (both tracts)

• Liminal - stones, clots
• Mural - malignancy, bph, stricture
• Extrinsic compression = malignancy around pelvis

Question 5

Symptoms of AKI

Answer 5

• Fatigue
• Nausea
• Confusion
• Dehydration
• Reduced urine output

Question 6

2 definitions of chronic kidney disease

Answer 6

1. Impaired renal function for >3 months due to abnormal kidney structure/damage
2. eGFR <60 for 3 months with or without kidney disease/damage

Question 7

Evidence of impaired renal function

Answer 7

• proteinuria
• haematuria
• anatomical abnormality

Question 8

Pathology of CKD

Answer 8

Fibrosis of remaining tubules, glomeruli, small blood vessels.

Leads to progressive renal scarring, loss of renal function

Question 9

Causes of CKD

Answer 9

• Hypertension/ atherosclerotic reno-vascular disease
• Diabetes
• Intrinsic renal disease
• Schistosomiasis (due to ureterovesical stricture causing urinary tract obstruction)

Question 10

Most common overall cause of UTI

Answer 10

E Coli

Question 11

UTI bacteria that promotes kidney stone growth

Answer 11

Proteus mirabilis

Question 12

Most common cause of UTI in young sexually active females

Answer 12

Staph saprophyticus

Question 13

Most common bacterial cause of haematogenous pyelonephritis

Answer 13

Staph aureus

Question 14

Predisposing factors that cause UTI

Answer 14

• urine flow obstruction (calculi/ urethral stricture)
• vesico-ureteral reflux (congenital abnormality, bladder overdistension)
• female
• sex
• diabetes
• elderly, immunocompromised

Question 15

Symptoms of urethritis

Answer 15

Burning with urination

Question 16

Symptoms of cystitis

Answer 16

• Pelvic pressure
• Urge incontinence
• Lower abdomen discomfort
• Frequent urination
• Painful urination (dysuria)
• Blood in urine

Question 17

Symptoms of acute pyelonephritis

Answer 17

• Upper back and side (flank) pain
• High fever
• Shaking and chills
• Nausea
• Vomiting

Question 18

Who should be treated for cystitis?

For how long?

Answer 18

• all symptomatic patients (duration differs)
• asymptomatic pregnant women (1-2 weeks)
• children (1-2 weeks)
• non pregnant women (3 days)

Question 19

Who should not be treated for asymptomatic cystitis

Answer 19

Elderly

Question 20

Antibiotics for UTI

Which must be cautioned in pregnancy

Answer 20

• trimethoprim
• nitrofurantoin
• ciprofloxacin
• amoxicillin
• cefuroxime
• gentamycin

Cautioned in pregnancy

• ciprofloxacin (avoid in all trimester)
• trimethoprim (avoid 1st trim)
• nitrofurantoin (avoid 3rd trim)

Question 21

Which components of urine dipstick test, when positive, point to UTI

Which is more sensitive?

Answer 21

• nitrite (more sensitive)

- leukocyte esterase

Question 22

What in a midstream urine sample indicates a UTI

Answer 22

Positive nitrites and leucocyte esterase