Urology and Renal Medicine Flashcards
List the functions of the renal system
Excretion Acid-base balance Bone metabolism - activates Vit D RBC production - erythropoeitin Regulate BP
How many renal disease present on investigations?
Urinalysis - haematuria, proteinuria
U&Es - increase creatinine & urea, hyperkalaemia, reduced eGFR
LFTs - hypoalbuminaemia (also is -ve inflam marker!)
The “Act conditions” are UTI, acute cysitis, acute pyelo, prostatic acute urinary retention, severe hyperkalaemia.
Which one puts you at risk of arrythmias?
Hyperkalaemia
Hyperkalaemia is defined as K+ levels > ______?
- Management for K+ 5-5.9?
- What level requires ECG to look for changes?
- At what level do you just treat?
Hyperkalaemia = K+ >5
- Monitor, look at drug chart, check fluids
- 6-6.5
- > 6.5
State the treatment for hyperkalaemia.
10mls Calcium gluconate over 10 mins
10U Actrarapid + 50mls 50% Dextrose
+/- Salbutamol neb 5mg
If doesnt work –> Calcium resonium
The ECG changes of hyperkalaemia arebased on stringe thoery. As the T-waves move up it flatterns other waves.
What are the ECG changes?
- Tall-tented T waves
- Widened QRS
- Flattened P waves
- Often tachycardic +/- arrythmia
–> Sinusoidal
A 56 y/o man has BPH and recurrent UTIs.
The current UTI has give him a high urea and creatinine on U&Es.
How would you manage his condition?
What tests do you do to prevent complications?
STOP AKI Screen for sepsis Stop nephrotoxic drugs Fluids Urinalysis
VBG - K+, metabolic acidosis
+/- CXR - pulmonary oedema
Symptoms of hyperkalaemia?
Arrthymias - palpitations, chest pain, light-headed, SOB
Cardiac arrest - Collapse, unresponsive
A patient with CKD gets an AKI from vomitting after an episode of infective GE.
They become acutely SOB, in resp distress and have diffuse bilateral crackles.
How would you manage this complication?
Acute pulmonary oedema - ABCDE + PODMAN
- Position upright
- Oxygen
- Diuretic - IV Furosemide 40-80mg
- Morphine - IV Diamorphine 2.5mg
- Anti-emetic
- Nitrate - GTN spray
Causes of pulmonary oedema include….
- PUMP FAILURE
- TOO MUCH FLUID
Acute renal failure - AKI
Heart failure
Fluid overload - IV fluids, blood transfusion
A 25 y/o female presents to GP with dysuria. haematuria, frequency and urgency.
The most common organism resonsible is ________
Risk factors are: ______
E.Coli (80%)
Other: Staph Saprophyticus, Proetus mirabilis
Female, sexually active, obstruction: preg, fibroids, constipation, BPH, PC, stones. Structural ab: VUR. Catheters. Fistula
What results on urinalysis suggest UTI?
Once confirmed you send a urine MCS to lab
+ve leu +ve nitrites
-ve leu +ve nitrites
In what cases do you refer a UTI to Urology?
Paeds - recurrent, atypical, <1yr..
Male
Unresponsive to rx
Persistent haematuria
What other infection can cause LUTS?
STI!
Always ask sexual hx
Which abx is contraindicated in pregnancy for UTI?
Trimethoprim
- esp 1st trimester as folate anatgonist in bacterial cell
Complications of UTI are:
Ascend –> Pyelonephritis –> Sepsis
AKI
Hydronephritis
If preg –> still birth, developmental delay
Acute pyelonephritis is an acute kidney infection by organisms from ___________ or _________-
Blood
Bladder
Esp 15-29yr Females >Infant boys > Elderly
The risk factors for pyelo are the same as for UTI
True or False
True
Symptoms of pyelonephritis?
Loin/back/suprapubic pain
LUTS - dysuria haematuria, urgency, freq, smelly urine
Sysetmic: Fever/rigors/night sweats. N/V
You suspect pyelonephirits in 21 y/o female.
You order bloods: standard + blood cultures. You do urinalysis + urine MCS and organise a renal USS
What is the management?
Conservative: analgesia, anti-emetics, IV fluids
Medical: IV Abx for 10-14days
Acute urinary retention is a common cause of abdo pain.
What is the surgical sieve for the causes?
I - AKI
T - spinal or bladder trauma
M - constipation, diabetic neuropathy, alcohol
I - Post-op*, meds: anti-cholinrergics
N - tumour. Other obstructions: BPH, stricture, preg, fibroids
Examinations you do for anyone with urinary retention?
Abdo + PR
Neuro
Symptoms of acute urinary retention?
Anuria/Oliguria - incl dribbling, urgency
Spurapubic tenderness/ fullness
Delirium
A 69 y/o has BPH and has not urinated for the past 12hrs.
What tests do you order?
Bedside: bladder scan, Urinalysis
Labs: FBC, U&Es, PSA, +/- MCS
Imaging: Renal-USS +/- whole-spine MRI
