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FCM Matrix > Renal > Flashcards

Renal Flashcards

1
Q

sx of BPH

A
  • weak/intermittent urine flow
  • hesitancy
  • terminal dribbling
  • incomplete emptying
  • urgency
  • frequency
  • nocturia
  • urgency incontinence
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2
Q

Investigations of BPH

A
  • urine dip
  • PSA
  • U&E
  • IPSS
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3
Q

What is the IPSS

A

International Prostate Symptom Score (IPSS): classifying the severity of lower urinary tract symptoms and assessing the impact on quality of life

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4
Q

Management of BPH

A

1ST LINE: alpha-1 antagonists e.g. tamsulosin, alfuzosin

  1. 5 alpha-reductase inhibitors e.g. finasteride

Surgery : transurethral resection of prostate (TURP)

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5
Q

What is cystitis

A

inflammation of the bladder

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6
Q

Sx of cystitis

A
  • urinary urgency
  • dysuria
  • polyuria
  • haematuria
  • suprapubic pain
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7
Q

Cystitis investigations

A
  • urinalysis
  • urine culture
  • cystoscopy if underlying cause is suspected
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8
Q

Cystitis management

A

Nitrofurantoin/Trimethoprim

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9
Q

What is balanitis?

A

inflammation of the glans penis

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10
Q

Management of cystitis in pregnancy

A

Nitrafurantoin (trimethoprim contraindicated)

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11
Q

How is balanitis diagnosed?

A

clinical diagnosis

  • swabs taken if suspected infective cause
  • extensive skin change and doubt about cause = biopsy
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12
Q

Management of balanitis if ?candidiasis

A

topical clotrimazole

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13
Q

Bacterial balanitis management

A

oral flucloxacillin or clarithromycin (penicillin allergic)

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14
Q

Anaerobic balanitis management

A

saline washing and metronidazole if not settling

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15
Q

Management of dermatitis balanitis

A

topical corticosteroids

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16
Q

Lichen sclerosus balanitis management

A

high potency topical steroids or circumcision

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17
Q

Most common causes of balanitis

A

infective (bacterial and candidal)

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18
Q

Sx of balanitis

A
  • penile soreness and itch

- urinary sx (dysuria, dypareunia)

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19
Q

Clinical signs of balanitis

A
  • redness and swelling of glans penis
  • tightening of foreskin/ unable to retract (phimosis)
  • meatal stenosis (often in Lichen Sclerosus)
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20
Q

Most common pathogen associated with prostatitis

A

E.coli

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21
Q

Clinical features of prostatitis

A
  • pain maybe be referred to perineum, penis, rectum, back
  • obstructive voiding sx
  • fever
  • tender, boggy prostate gland
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22
Q

Investigation in suspected acute prostatitis

A
  • MSU (urine dip, culture, sensitivity)
  • blood culture
  • FBC
  • DRE
  • consider STI screen
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23
Q

Management of acute prostatitis

A

14 day course quinolone - ciprofloxacin

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24
Q

Management of chronic prostatitis

A
  • analgesia (paracetemol/NSAIDs)
  • alpha blocker - doxazosin
  • abx (trimethoprim/doxycyline)
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25
Q

What is urethritis?

A

inflammation of the urethra

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26
Q

How is urethritis categorised

A

gonococcal and non-gonococcal urethritis (NGU)

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27
Q

Investigations for urethritis

A

urethral swab

NAAT

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28
Q

Management of urethritis

A

7/7 doxycline / single dose azithromycin

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29
Q

What is pyelonephritis?

A

a type of UTI where one or both kidneys become infected

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30
Q

Common symptoms of acute pyelonephritis

A
  • fever
  • flank pain (usually unilateral)
  • N&V
  • UTI sx (urinary urgency, frequency, dysuria)
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31
Q

Investigation in suspected pyelonephritis

A
  • MSU
  • urine culture BEFORE starting empirical abx
  • urine dip
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32
Q

Management of pyelonephritis

A

Cefalexin / Co-amox / Trimethoprim /Ciprofloxacin

change according to sensitivities

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33
Q

When should you admit a patient with pyelonephritis to hospital

A

Severe sx = ?sepsis

  • tachy
  • hypotension, - breathless
  • confusion
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34
Q

Management of acute pyelonephritis in pregnant women

A

Cefalexin

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35
Q

What is epididymitis?

A

inflammation of the epididymis

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36
Q

Sx of epididymitis

A
  • pain in 1 or both testicles
  • tenderness
  • swollen, red, warm scrotum
  • discharge from penis
  • blood in semen
  • pain in suprapubic region
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37
Q

Which investigations should be ordered for suspected epididymitis?

A
  • urine dipstick

- urine culture

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38
Q

Common causes of epididymitis

A

STI (gonorrhoea or chalmydia)
Enteric organisms
Amiadorone

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39
Q

Tx of epididymitis STINA CROSS CHECK ANSWER PLS THX BBS

A

Gonorrhoea/chlamydia suspected:
Ceftriaxone and doxycyline

Enteric organisms suspected
Levofloxacin

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40
Q

What causes AKI

A

PRERENAL: ischaemia

  • poor cardiac output
  • hypovolaemia (diarrhoea and vomiting)
  • renal artery stenosis

INTRINSIC: intrinsic damage by toxins or immune-mediated

  • glomerulonephritis
  • rhabdomyolysis
  • acute tubular necrosis

POSTRENAL: obstruction causing ‘backing up’ of urine

  • kidney stone in ureter/bladder
  • BPH
  • external compression of ureter (tumours)
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41
Q

Define oliguria

A

urine output less than 0.5 ml/kg/hour

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42
Q

Which drugs can cause AKI

A

NSAIDs, aminoglycosides, ACEi, ARBs, diuretics

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43
Q

Clinical signs of AKI

A
  • Reduced urine output
  • pulmonary and peripheral oedema
  • arrhythmias
  • uraemia = encephelopathy or pericarditis
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44
Q

Which criteria are recommended by NICE to diagnose an AKI

A

a rise in serum creatinine of 26 micromol/litre or greater within 48 hours

a 50% or greater rise in serum creatinine known or presumed to have occurred within the past 7 days

a fall in urine output to less than 0.5 ml/kg/hour for more than 6 hours in adults

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45
Q

Investigations for suspected AKI

A
  • U&E
  • urinalysis
  • renal ultrasound
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46
Q

How should a patient with an AKI be investigated if there is no identifiable cause or the patient is at risk of a urinary tract obstruction

A

renal ultrasound within 24 hours of assessment

prompt review by urologist

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47
Q

AKI Management

A

largely supportive

  • fluid balance
  • medication review
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48
Q

Which complication of an AKI needs prompt treatment

A

Hyperkalaemia

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49
Q

When is renal replacement therapy used (e.g haemodialysis)?

A

when a patient is not responding to medical treatment of complications (e.g hyperkalaemia, oedema, acidosis, uraemia)

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50
Q

How to differentiate between AKI and CKD

A

Renal US - CKD = Bilayeral small kidneys

Hypocalcaemia in CKD due to lack of vitD

51
Q

Common causes of CKD

A
  • diabetic nephropathy
  • chronic glomerulonephritis
  • chronic pyelonephritis
  • hypertension
  • adult polycystic kidney disease
52
Q

Aetiology of bladder cancer

A
  1. Transitional cell = smoking

2. Squamous cell = chronic infection, schistosomiasis

53
Q

Symptoms of bladder cancer

A
  1. Haematuria: Can be NVH (asymptomatic) or VH
    - Rose/merlot/ ribena - urine
  2. Irritative LUTS: dysuria, urinary frequency
  3. associated clots
54
Q

Investigations for bladder cancer

A
  1. Cystoscopy with biopsy– gold standard for bladder cancer.
  2. White light cystoscopy current standard for diagnosis and follow up
55
Q

Management of bladder cancer

A
  1. Chemotherapy

2. Surgery - cystectomy

56
Q

Referral criteria for bladder cancer

A

Refer people for 2WWR:

  1. < 45 y/o and have:
    a) Unexplained visible haematuria without urinary tract infection, or
    b) Visible haematuria that persists or recurs after successful treatment of urinary tract infection, or
  2. > 60 y/o and have:
    a) unexplained non-visible haematuria and either dysuria or a raised white cell count on a blood test.

• non-urgent referral = > 60 years with recurrent or persistent unexplained urinary tract infection.

57
Q

Mots common type of prostate cancer

A

Adenocarcinoma

58
Q

Symptoms of prostate cancer

A
  1. LUTs overlapping with BPH:
  2. Nocturia, urinary frequency, hesitancy, urinary retention
  3. Haematuria can occur and erectile dysfunction
  4. Pain: back, perineal or testicular / bone pain
59
Q

Where does prostate cancer commonly metastasise to?

A

Bone

60
Q

Investigations for prostate cancer

A
  1. DRE- palpable
    - -> asymmetrical, hard, nodular enlargement with loss of median sulcus
  2. PSA
  3. Biopsy for definitive diagnosis
61
Q

Management for prostate cancer

A
  1. Watch and wait
  2. Radiotherapy
  3. Radical prostatectomy
  4. Hormonal therapy
62
Q

Referral for prostate cancer

A
  1. 2WWR for prostate cancer if their prostate feels malignant on digital rectal examination.
  2. Consider a prostate-specific antigen (PSA) test and DRE to assess for prostate cancer in men with:
    - -> Any lower urinary tract symptoms, such as nocturia, urinary frequency, hesitancy, urgency or retention, or
    - -> Erectile dysfunction, or
    - -> Visible haematuria.
  3. 2WWR for prostate cancer if their PSA levels are above the age-specific reference range.
63
Q

Symptoms of renal cell carcinoma

A

Classic triad:

  1. Haematuria
  2. Loin pain
  3. Mass in the flanks (abdominal mass)
  • Pyrexia of unknown origin, left varicocele (due to occlusion of left testicular vein)
  • Polycythaemia
64
Q

Investigation for renal cell carcinoma

A
  1. USS of kidneys

2. Definitive diagnosis - histology

65
Q

Management of renal cell carcinoma

A
  1. Partial or total nephrectomy (resection due to resistance to chemo and radiation)
  2. Alpha-interferon and interleukin-2 to reduce tumour size
  3. Receptor tyrosine kinase inhibitors (sorafenib, sunitinib)
66
Q

Referral for renal cell carcinoma

A

2WWR for renal cancer if they are >45 y/o and have:

  1. Unexplained visible haematuria without urinary tract infection

or

  1. Visible haematuria that persists or recurs after successful treatment of urinary tract infection.
67
Q

Most common type of testicular cancer

A

germ-cell tumours:

  1. seminomas
  2. non-seminomas
68
Q

Features of testicular cancer

A
  1. a painless lump
  2. pain
  3. hydrocele
  4. gynaecomastia
69
Q

Diagnosis of testicular cancer

A

1st line = USS

70
Q

Management of testicular cancer

A
  1. treatment depends on whether the tumour is a seminoma or a non-seminoma
  2. orchidectomy
  3. chemotherapy and radiotherapy may be given depending on staging and tumour type
71
Q

Features of Wilm’s Tumour

A
  1. abdominal mass (most common presenting feature- flank mass)
    - large, palpable, unilateral
  2. painless haematuria
  3. flank pain
  4. other: anorexia, fever, hypertension
72
Q

Most common metastatic location for Wilm’s tumour

A

lungs

73
Q

Investigation for Wilm’s tumour

A
  • Bloods
  • USS and/or IV pyelogram
  • Renal angiography
74
Q

Management of Wilm’s tumour

A
  • dependent on the extent of metastasis
  • nephrectomy + chemotherapy
  • radiotherapy if advanced disease
75
Q

Referral for Wilm’s tumour

A

children with an unexplained enlarged abdominal mass in children - possible Wilm’s tumour - arrange paediatric review with 48 hours

76
Q

Define urinary incontinence

A

Involuntary leakage of urine

77
Q

Types of urinary incontinence

A
  1. Functional incontinence – unable to reach toilet in time
  2. Stress incontinence – on effort or exertion
  3. Urge incontinence – sudden desire to urinate
  4. Mixed incontinence
  5. Overflow incontinence – due to bladder outlet obstruction, e.g. due to prostate enlargement
  6. overactive bladder (OAB)/urge incontinence: due to detrusor overactivity
78
Q

Investigations for urinary incontinence

A
  1. bladder diaries should be completed for a minimum of 3 days
  2. vaginal examination to exclude pelvic organ prolapse and ability to initiate voluntary contraction of pelvic floor muscles (‘Kegel’ exercises)
  3. urine dipstick and culture
  4. urodynamic studies
79
Q

Management of urinary incontinence

A
  1. Bladder retraining
  2. Bladder stabilising drugs
    - Antimuscarinics is 1st line = oxybutynin (avoid in frail older women)
  3. Mirabegron (beta-3 agonist)

Stress incontinence:
1. Pelvic floor muscle training

  1. Surgical procedure (retropubic mid-urethral)
  2. Duloxetine – combine noradrenaline an SSRI
80
Q

Define cryptorchidism

A

A congenital undescended testis is one that has failed to reach the bottom of the scrotum by 3 months of age.

81
Q

Diagnosis for cryptorchidism

A

physical examination

82
Q

Treatment for Cryptorchidism

A
  1. Orchidopexy at 6- 18 months of age.
  2. Intra-abdominal testis should be evaluated laparoscopically and mobilised.
  3. Orchidectomy after 2 years
83
Q

Complications of Cryptorchidism

A

untreated can lead to testicular cancer

84
Q

Definition of hydrocele

A

Accumulation of fluid within the tunica vaginalis.

85
Q

Features of hydrocele

A
  • Onset can be acute or chronic.
  • Painless and non-tender
  • soft, non-tender swelling of the hemi-scrotum.
  • Will transilluminate with a pen torch
86
Q

Diagnosis of hydrocele

A

May be clinical

USS if doubt

87
Q

Management of hydrocele

A
  1. Infantile hydroceles are generally repaired if they do not resolve spontaneously by the age of 1-2 years
  2. in adults a conservative approach may be taken depending on the severity of the presentation.
  3. Further investigation (e.g. ultrasound) is usually warranted however to exclude any underlying cause such as a tumour
88
Q

Define varicocele

A

abnormal enlargement of the testicular veins.

89
Q

Features of varicocele

A
  • classically described as a ‘bag of worms’
  • Onset is chronic
  • Painless and non-tender but maybe dull, dragging discomfort
90
Q

Diagnosis of varicocele

A

USS with Doppler studies

91
Q

Management of varicocele

A
  • Conservative

- Surgery – if patient is trouble by pain

92
Q

Define Nephrolithiasis + Urolithiasis

A 
Nephrolithiasis = kidney stones 
Urolithiasis = stone in the urinary tract
93
Q

Features of Nephrolithiasis/ Urolithiasis

A

Classic triad:

  1. Acute flank pain
  2. Fever
  3. Nausea/Vomiting
  • Urinary frequency / urgency
  • Haematuria
94
Q

Imaging of choice for Nephrolithiasis/ Urolithiasis

A

Non-enhanced CT-Scan

95
Q

Other investigations for renal stones

A
  1. FBC, CRP
  2. Urinalysis
  3. 24h urine levels – calcium, phosphate, oxalate, urate
  4. X-ray
  5. USS
96
Q

Type of renal stones

A

Radio-opaque:

  1. Calcium oxalate
  2. Mixed calcium oxalate/phosphate stones
  3. Triple phosphate stones*
  4. Calcium phosphate

Radio-lucent:

  1. Urate stones
  2. Cystine stones : Semi-opaque, ‘ground-glass’ appearance
  3. Xanthine stones
97
Q

Management of renal stones

A
  1. Analgesia – NSAID (diclofenac IM)
  2. Anti-emetic
  3. IV Fluids
  4. Most small stone pass naturally (<5mm)
  5. Surgery – depends on location and size
98
Q

Define Phimosis + Paraphimosis

A

Phimosis = non-retractile foreskin at birth (does not retract before the age of 2 years):
–> Not a problem until difficulties – urinary obstruction, haematuria or local pain

Paraphimosis = tight prepuce is retracted and unable to be replace as the glans swells.

99
Q

Management of Paraphimosis

A

Gentle compression with saline-soaked swab followed by reduction of the prepuce over the glans

100
Q

Define testicular torsion

A

Twist of the spermatic cord resulting in testicular ischaemia and necrosis.

101
Q

Features of testicular torsion

A
  1. pain is usually severe and of sudden onset
    - may be referred to the lower abdomen
  2. nausea and vomiting may be present

O/E:
1. swollen, tender testis retracted upwards. The skin may be reddened

  1. cremasteric reflex is lost
  2. elevation of the testis does not ease the pain (Prehn’s sign)
102
Q

Management of testicular torsion

A
  1. Admit immediately
  2. treatment is with urgent surgical exploration
    - Reduction and orchidopexy
    - if a torted testis is identified then both testis should be fixed as the condition of bell clapper testis is often bilateral.
103
Q

Types of haematuria

A

Microscopic haematuria = non-visible blood

Macroscopic haematuria = visible blood

104
Q

Investigating haematuria

A
  1. urine dipstick
  2. persistent non-visible haematuria: blood being present in 2 out of 3 samples tested 2-3 weeks apart
  3. renal function, albumin: creatinine (ACR) or protein:creatinine ratio (PCR) and blood pressure should also be checked
  4. urine microscopy may be used but time to analysis significantly affects the number of red blood cells detected
105
Q

Urgent referral criteria for haematuria

A

Urgent (2WWR)
Aged >= 45 years AND:
1. unexplained visible haematuria without urinary tract infection, or

  1. visible haematuria that persists or recurs after successful treatment of urinary tract infection

Aged >= 60 years AND:
- have unexplained non-visible haematuria and either dysuria or a raised white cell count on a blood test

106
Q

Non-urgent referral criteria for haematuria

A

Aged >= 60 years with recurrent or persistent unexplained urinary tract infection

patients < 40 years with normal renal function, no proteinuria and who are normotensive do not need to be referred and may be managed in primary care

107
Q

Define acute urinary retention

A

Acute urinary retention is when a person suddenly (over a period of hours or less) becomes unable to voluntarily pass urine.

108
Q

Symptoms of acute urinary retention

A
  1. Inability to pass urine
  2. Lower abdominal discomfort
  3. Considerable pain or distress
  4. an acute confusional state may also be present in elderly patients
109
Q

Signs of acute urinary retention

A
  1. Palpable distended urinary bladder either on an abdominal or rectal exam
  2. Lower abdominal tenderness
  3. All men and women should have a rectal and neurological examination to assess for the likely causes above. Women should also have a pelvic examination.
110
Q

Investigations for acute urinary retention

A
  1. Urine sample – urinalysis + culture
    - Urinary catheterisation
  2. Serum U + E’s, Creatinine: assess AKI
  3. FBC + CRP: look for infection
  4. USS – confirm diagnosis – a volume of >300 cc
111
Q

Management of acute urinary retention

A

1st episode = admission, catheterize and investigate cause

  • Recurrent = admission, urethral catheter
  • -> Treatment to prevent or manage recurrent retention:
  • -> Alpha-blocker (alfuzosin 10 mg a dat)
  • -> Intermittent urethral catheterization
  • -> Long-term indwelling catheter
112
Q

Define Chronic Urinary retention

A

Gradual (over months or years) development of the inability to empty the bladder completely.

113
Q

Symptoms of Chronic Urinary retention

A

Painless and insidious

114
Q

Management of Chronic Urinary retention

A
  1. Exclude non-obstructive causes of reduced urine flow (such as chronic heart failure).
  2. Check serum creatinine to assess renal function.
  3. Refer the man for specialist assessment.
    - Consider seeking specialist for imaging of the upper urinary tract and kidneys
  4. Advise the man about management options in secondary care, including:
    - No catheterization, but follow up with regular monitoring of renal function, volume of urinary retention, and any changes in imaging of upper renal tract.
    - Intermittent urethral catheterization (performed by the man or his carer).
    - A permanent indwelling catheter.
    - Surgery to divert the urine externally (urostomy).
115
Q

What is orchitis

A

inflammation of one or both testicles

116
Q

investigations for orchitis

A
  • STI screen
  • urine test
  • US
117
Q

management of orchitis

A

treat cause

118
Q

nephrotic syndrome triad

A
  1. proteinuria
  2. Hypoalbuminaemia
  3. oedema
119
Q

sx of nephrotic syndrome

A
  • hypertension
  • frothy urine
  • swelling of feet, hand and around eyes
  • weight gain
120
Q

diagnosis of nephrotic syndrome

A
  • urinalysis
  • FBC, U&E
  • kidney biopsy
121
Q

What is nephrotic syndrome

A

a kidney disorder that causes your body to pass too much protein in your urine

122
Q

management of nephrotic syndrome

A

sodium and fluid restriction
high-doe diuretics
refer to nephrology

123
Q

What is nephrotic syndrome associated with

A

hyperlipidaemia and hypercoagulability

FCM Matrix (17 decks)

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