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Urinary System > Summary > Flashcards

Summary Flashcards

1
Q

Describe a UTI

A

Can have pyelonephritis, cystitis, prostatitis, and epididymis/ testis
In children can cause CRF
Usually bowel organisms like E. coli, proteus, klebsiella, and enterococcus

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2
Q

What are the symptoms of UTI in children?

A

Diarrhoea, excessive crying, fever, nausea, vomiting and not eating

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3
Q

What are the symptoms of a UTI in adults?

A

Flank pain, dysuria, cloudy offensive urine, urgency, chills, strangury and confusion in elderly
Acute pyelonephritis - pyrexia, poor localisation, loin tenderness signs of dehydration and turbid pain

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4
Q

What are the investigations for a UTI?

A

Urinalysis - blood, leucocytes and nitrates
Microbiology - bacteriuria >10^5
If man or child then consider US or IVU

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5
Q

What is the treatment for UTIs?

A

Fluids and antibiotics - amoxicillin, cephalosporin, and trimethoprim
Severe - IV antibiotics

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6
Q

Describe reflux nephropathy

A

Kidney damage or scarring caused from urine flowing backwards from bladder into kidneys - reflux and infection
UTIs in children

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7
Q

What is the treatment for reflux nephropathy?

A

Surgery

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8
Q

Describe minimal change disease

A

Type of non-proliferative glomerulonephritis - inflammation of glomerulus
Commonest form in children
Prognosis is favourable and underlying cause is unknown

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9
Q

What are the symptoms and signs of minimal change disease?

A

Sudden onset oedema in days
Nephrotic syndrome - oedema, nephrotic range proteinuria >3.5g or 350mg creatinine, hypoalbuminemia <35g/l, and dyslipidaemia
Haematuria, hypertension and proteinuria

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10
Q

What is the treatment for minimal change disease?

A

Prednisolone for 16 weeks
Once remission achieved then slow taper for 6 months
Initial relapse treated by steroids then further are with cyclophosphamide, cyclosporine, tacrolimus and others

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11
Q

Describe focal and segmental glomerulosclerosis

A

Type of non-proliferative glomerulonephritis
Is a syndrome of multiple disease
High chance progression to ESRD

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12
Q

What are the symptoms and signs of focal and segmental glomerulosclerosis?

A

Nephrotic syndrome - oedema, proteinuria >3.5g or 350mg of creatinine, hypoalbuminemia <35, and dyslipidaemia
Haematuria, proteinuria, and hypertension

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13
Q

What is the treatment of focal or segmental glomerulosclerosis?

A

Generally steroid resistant
Trial steroids for positive response
Alternative - cyclopsorin, cyclophosphamide and rituximab

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14
Q

Describe membranous nephropathy

A

Type of non-proliferative glomerulonephritis and commonest cause of nephrotic syndrome in adults
Majority of cases are idiopathic

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15
Q

What are the investigations for membranous nephropathy?

A

Serology markers - anti-phospholipase A2 receptor antibody and thrombospondin type 1
Renal biopsy - thickened glomerular basement membrane
Immunofluorescence - diffuse IgG uptake

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16
Q

What is the treatment for membranous nephropathy?

A

General measure for 6 months
Immuno-suppression if symptomatic - rising proteinuria and deteriorating renal function
Cyclophosphamide and steroids for 6 months
Tacrolimus and Rituximab

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17
Q

Describe IgA nephropathy

A

Type of proliferative glomerulonephritis - characterised by IgA deposition
Most common in 20-30s years

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18
Q

What is the symptoms of IgA nephropathy?

A

Microscopic haematuria, proteinuria, nephritic syndrome and IgA crescent glomerulonephritis
Nephritic - haematuria, dysmorphic RBCs, and cellular casts
Hypertension

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19
Q

What is the treatment for IgA nephropathy?

A

High dose prednisolone and other immunosuppression drugs

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20
Q

Describe post infectious glomerulonephritis

A

Type of proliferative glomerulonephritis - immunological mediated glomerular injury
Follows 10-21 days after infection

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21
Q

What is the treatment for post infectious glomerulonephritis?

A

Antibiotics given for infection and supportive measures with control of fluids
Loop diuretics and anti-hypertensives

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22
Q

Describe anti-GBM disease

A

Type of proliferative glomerulonephritis - immune mediates pathology involving antibodies against GBM antigens
Possible lung haemorrhage

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23
Q

What is the investigations for Anti-GBM glomerulonephritis?

A

Anti-GBM antibodies in serum and kidney
IgG deposits on kidney biopsy

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24
Q

What is the treatment for anti-GBM glomerulonephritis?

A

Aggressive immunosuppression - steroids, steroids, plasma exchange and cyclophosphamide

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25
Q

Describe acute kidney injury (AKI)

A

Rapid deterioration of kidney function
Increases in serum creatinine by >26.5umol/l within 48hrs or >1.5x baseline which has occurred in prior 7 days
Or urine volume is <0.5ml/kg/hr for 6 hrs

26
Q

Describe chronic kidney disease (CKD)

A

Defined by either presence of kidney damage from abnormal blood, urine, or x-ray, or GFR<60 that is present for more than 3 months

27
Q

What are the symptoms of chronic kidney disease?

A

Include anaemia, hypertension, SOB, itch + cramps, cognitive changes, GI symptoms, haematuria, change in urine output, proteinuria, and peripheral oedema

28
Q

What is the treatment and management for CKD?

A

BP is most important
Control proteinuria by ACE inhibitor
Treat underlying cause
Preparation for RRT - dialysis or renal transplant

29
Q

Describe urolithiasis

A

Kidney stones are hard deposits of minerals and salts from inside the kidney
Can be calcium oxalate, phosphate, calcium phosphate, uric acid and cystine

30
Q

What are the symptoms of urolithiasis?

A

Renal pain (fixed to loin), ureteric colic (radiating to groin), dysuria, haematuria, urinary infection, loin tenderness, pyrexia, and testicular/ vulvar pain

31
Q

What is the treatment for urolithiasis?

A

Surgery - open, endoscopic, and ESWL. PCNL - percutaneous nephrolithotomy
Small stones - NSAIDs, fluids and alpha blockers

32
Q

Describe benign prostatic hyperplasia

A

Benign enlargement of the prostate characterised by fibromuscular and glandular hyperplasia
50% of men at age of 60

33
Q

What is the symptoms of BPH?

A

Moderate to severe LUTS
Hesitancy, poor stream, terminal dribbling, incomplete, emptying, frequency, nocturia and urgency

34
Q

What can BPH result in?

A

BPO - benign prostatic obstruction or bladder outflow obstruction (BOO)

35
Q

Describe upper tract obstruction

A

Includes PUJ, ureter and VUJ
Complications include infection, sepsis, and renal failure if bilateral

36
Q

What are the causes of upper tract obstruction?

A

Stone, ureteric tumour, blood clot, fungal ball scar tissue, LNs, prostatic cancer, abdominal mass, and iatrogenic

37
Q

What are the symptoms of upper tract obstruction?

A

Pain, frank, haematuria, and symptoms of complication
Palpable mass and microscopic haematuria

38
Q

What investigations are used for upper tract obstruction?

A

Abdominal renal US - hydro nephrosis and hydroureter
CT-KUB - investigation of urinary renal stones and obstruction in emergency setting
IVU, CT urogram and MAG-3 renogram

39
Q

What is the treatment for upper tract obstruction?

A

Percutaneous nephrostomy insertion or retrograde stent insertion
Treat underlying problem - stones by ureteroscopy and ureteric tumour by radical nephron-urethrectomy

40
Q

Describe lower tract obstruction

A

Bladder outflow obstruction
Includes bladder neck in men, prostate, urethra, foreskin, and urethral meatus

41
Q

What are the symptoms of lower tract obstruction?

A

LUTS - voiding, storage and urinary incontinence
Acute/ chronic urinary retention, sepsis, recurrent UTIs, frank haematuria, renal failure, and PV bleeding

42
Q

What is the treatment for lower tract obstruction?

A

Emergency - urethral or suprapubic catheterisation
Treat underlying cause - BPE by TURP, phimosis by circumcision and meatal stenosis by dilatation

43
Q

Describe acute urinary retention

A

Painful inability to void with palpable and precussable bladder
Residuals vary from 500ml to 1l

44
Q

What is the treatment for acute urinary retention?

A

Immediate treatment is catheterisation - urethral or suprapubic
Treat underlying cause - main risk is BPO

45
Q

Describe chronic urinary retention

A

Painless, palpable, and precussible bladder after voiding
Often able to void but with residuals of between 400 ml to 2l depending on stage of condition

46
Q

How does chronic urinary retention present?

A

Presents as LUTS
Also can have complication like UTIs, bladder stones, overflow incontinence or obstructive renal failure

47
Q

What is the treatment for chronic urinary retention?

A

Asymptomatic with low residuals - no need for treatment
With symptoms or complications - immediate catheterisation followed by CISC if appropriate
Subsequent treatment - long term catheter, CISC or TURP

48
Q

Describe prostate cancer

A

Most common cancer for men in the UK
75% of deaths occur in men over the age of 75
Diagnosed through PSA testing (check again after 3 weeks), RE, MRI and biopsy

49
Q

What are the symptoms and signs of prostate cancer?

A

Mostly asymptomatic and diagnosed by opportunistic PSA testing
Weak stream, haematuria, hesitancy, frequency, urgency, and UTI
Can metastasise to bone and LNs

50
Q

What is the management and treatment for prostate cancer?

A

Watchful waiting
RT
Radical prostatectomy
If locally advanced - hormone therapy followed by surgery. HT alone, or radiation after HT
Metastatic - hormone therapy plus docetaxel chemo

51
Q

Describe testicular cancer

A

One of the commonest cancers of young men
Testicular germ cell neoplasia in-situ is a precursor lesion
Peaks in 3rd decade

52
Q

What is the presentation of testicular cancer?

A

Usually painless lump, less often tender swelling, history of trauma, and symptoms of metastatic disease - bone, chest and para-aortic LNs

53
Q

Describe bladder cancer

A

Tumour type is most commonly transitional cell carcinoma (TCC) but there is also squamous cell
Risk factors for TCC - smoking, amines and non-hereditary genetics
RF for squamous - chronic cystitis, pelvic RT and cyclophosphamide therapy

54
Q

What are the symptoms for bladder cancer?

A

Painless visible haematuria - most common
Haematuria can be visible or microscopic
Have recurrent UTIs and storage bladder symptoms

55
Q

What is the treatment for bladder cancer?

A

Low grade non-muscle invasive - endoscopic resection with intravesical CT
High grade non-muscle invasive - endoscopic resection, BCG therapy, and surgery
Muscle invasive - neoadjuvant chemo, RT or radical surgery

56
Q

Describe upper tract TCC

A

Renal pelvis or colleting system is commonest
Tumours are often high grade and multifocal on one side
High risk of local recurrence

57
Q

What are the symptoms of upper tract TCC?

A

Frank haematuria, unilateral ureteric obstruction, flank/ loin pain and signs of metastatic disease

58
Q

What is the treatment for upper tract TCC?

A

Most are treated by nephroureterectomy
If unfit or bilateral then consider nephron sparing endoscopic treatment
If unifocal and low grade - endoscopic treatment

59
Q

Describe renal cancer

A

Malignant renal adenocarcinoma is commonest adult renal malignancy
Most arise from proximal tubules
Clear cell, papillary, chromophobe and bellini type ductal

60
Q

What is the presentation of renal cancer?

A

Can be asymptomatic
Classic triad is flank pain, mass and haematuria
Paraneoplastic symptoms - anorexia, cachexia, pyrexia and hypertension
Abnormal LFTs, anaemia and raised ESR

61
Q

What is the investigations for renal cancer?

A

CT scan of abdomen and chest is mandatory
Bloods - U+Es and FBS
Optional - US and MAG-3 renogram

62
Q

What is treatment for renal cancer?

A

Surgical - radical nephrectomy
Laparoscopic radial nephrectomy is standard
RCC is chemo and radio-resistant so receptor tyrosine kinase receptors and immunotherapy used

Urinary System (26 decks)

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