why is there no screening for prostate cancer
wilson- junger criteria not met
what is a surgical stem (nature)
infection inflammation neoplasia hereditary degenerative iatrogenic/ trauma neurological
what is the management of acidosis
bicarbonate
what is a urothelial cancer
malignant tumour of the lining transitional cell epithelium (uroethmelium)
anywhere from renal calyces to tip of urethra
are urinary tract obstructions painful
acute - yes
chronic - no
what are risk factors for developing prostate cancer
age
race/ ethnicity - afro-caribbean men
geography - north europe/ america
family - 1st degree relative 2x risk
how is multiple myelomas treated
hydration
bisphosphonates for hypercalcaemia
glucocorticoids
what are metastatic disease symptoms of prostate cacner
back pain paraplegia (off legs) lymph node enlargement acute urinary retention loin pain weight loss, fatigue, fever
what does pathology of focal and segmental glomerulonephritis show
focal and segmental sclerosis with distinctive patterns eg. tip lesions, collapsing
what is the commonest cause of nephrotic syndrome in adults (25%)
membranous nephropathy
what drug reduces proteinuria
ACEi/ ARB
what is the treatment for UTI
identify organisms and give antibiotics - amoxicillin, cephalosporin, trimethoprim
what percentage of Type 1 and 2 diabetics will have nephropathy
1 - 4% in 10 years, 25% in 25 years
2 - 10% by 5 years, 30% by 20 years
what area is bladder pain felt
suprapubic
what are the measures to slow the rate of decline of CKD
BP control
control proteinuria
reverse contributing factors
control lifestyle
what are problems with using creatinine to measure kidney function
muscle mass
age -
ethnicity - african americans higher
gender - women lower
what percentage of ESRD is glomerulonephritis responsible for
30%
what is the 2nd most common haematological malignancy
multiple myeloma
how does infective endocarditis lead to glomerulonephritis
immune complex formation in glomeruli
does non proliferative glomerulonephritis present with nephrotic or nephritic syndrome
nephrotic
what is nocturnal polyuria
nocturnal urine output >1/3 of total day urine output
what is the filtration barrier of the kidney formed from
podocytes, glomerular basement membrane and endothelial cells
what are the 4 steps in the clinical approach to treating CKD
1) dieted aetiology
2) slow rate of renal decline
3) assessment of complications related to reduced GFR
4) prepare for renal replacement therapy
what are complications of urinary tract obstructions
decompression haematuria
post obstructive diuresis
where is the urinary tract sterile
everywhere but terminal urethra
what lymph nodes drain he testicles
para-aortic
why will a urinated specimen always be contaminated
terminal urethra houses skin (perineal) and gut (rectal) flora
how does minimal change nephrotic syndrome normally present
in children - sudden onset oedema (days)
what are AKI risk events
sepsis
toxins - avoid radio contrast, gentamicin, NSAIDs
hypotension
hypovolaemia - haemorrhage , Diarrhoea , vomiting
major surgery
what is myeloma kidney
cast nephropahty causes tubular nephropahty
what should you do if the bacterial count for a UTI is 10^3- 10^4
treat if symptomatic
what is stage 1 of AKI
creatinine - 1.5-1.9x baseline or >26.5umol/l increase
urine - < 0.5 ml/kg/ h for <6-12 hours
what are the initial stage of the treatment for localised prostate cancer
watchful waiting
active surveillance
which organisms are most likely to cause a UTI
bowel organsisms - E.coli, staph aureus, klebsiella, enterococcus
what are complications of chronic urinary retention
UTI
post - decompression haematuria
pathological diuresis
electrolyte abnormalities - metabolic acidosis, low Na, high K
what is the most common type of adult renal malignancy
renal adenocarcinoma in proximal tubules
what is the triad of nephrotic syndrome
oedema
proteinuria >3.5 g/ day
hypoalbuminaemia <25 g/L
(also hyperlipidaemia)
will a unilateral ureter obstruction present with renal failure
no - only bilateral or if on single functioning kidney
why does diagnosis of urothelial tumours need more that one mode of imaging
can easily be missed in IVU, USS, flexible cystoscope
what is the prognosis for localised prostate cancer
80-90% 5 year survival
what is chronic urinary retention defined as
painless, palpable and permissible bladder after voiding
what are the blood pressure aims in CKD
125/ 75 with proteinuria
130/80 if no proteinuria
list some transplant causes of CKD
1- recurrence
2 - rejection, calcineurin toxicity
what is vasculitis
inflammatory reaction in the wall of any blood vessel
what is more expensive dialysis or transplant
transplant - 20,000 + ~6,500 on drugs
dialysis - £35,000 per annum per patient
what is differential diagnosis of an upper tract TCC
stone, tumour, fungal ball
in scotland, what are the most common causes of CKD in order
diabetes glomerulonephritis unknown pyelonephritis polycystic kidney disease hypertension
list some tubulointerstitial causes of CKD
1- UTI, stones, pyelonephritis
2 - drugs, toxins, sarcoid, prostatic disease, metazoic cancer,
which people are urinary tract infections common in
young, sexually active young women
what is the medical therapy for uncomplicated BPO
alpha blockers (main) 5 alpha reductase inhibitors
how may a spinal cord/ brain injury lead to a urinary infection
decreased sensation so don’t know when to micturate or when fully micturated leads to stasis of urine
how are most upper tract TCC treated
nephro-uterectomy (total removal)
what are histological subtypes of renal cell carcinoma
clear cell (85%)
papillary (10%)
chromophobe (4%)
bellini type ductal carcinoma (1%)
what are tumour markers for testicular cancer
alpha fetoprotein
BHCH - human chorionic gonadotrophin
LDH - lactate dehydrogenase
what is the treatment of renal cancer
radical nephrectomy - laparoscopic
chemo and radio resistant
what drug can be given to treat acute urinary retention
alpha blocker
what can be seen in paraneoplastic syndrome in renal cancer
anorexia, cachexia, pyrexia
hypertension, hypercalcaemia
anemia, raised ESR
how does acute pyelonephritis present
pyrexia, poor localisation, loin tenderness, signs of dehydration, turbid urine
how is anaemia treated in CKD
EPO and iron
treat if <10 g/ dl or symptomatic
what are advantages of haemodialysis
rapid solute/ fluid removal
rapid correction of electrolyte disturbances
what is anti- GBM disease
caused by circulating anti GBM - autoantibodies to type 4 collagen present in glomerular and alveolar membrane
what are disadvantages of haemofiltration
need continuous anticoagulation
may delay mobilisation
may not have adequate clearance
what is the 5 year survival by stage of renal cancer
T1 - 95% T2 - 90 T3 - 60% T4 - 20% N - 20% M - median 12-18 months
what studies are done on a renal biopsy to diagnose glomerulonephritis
light & electron microscopy
immunofluorescent studies
what is the main risk factor for acute urinary retention
and others
benign prostatic obstruction
UTI, urethral stricture, alcohol excess, post surgery)
what is the definition of acute kidney injury
syndrome of decreased renal function, measured by serum creatinine or urine output occurring over hours/ days
what investigation is done to grade urothelial tumours
flexible cystoscopy
what is the 4th stage of staging for prostate cancer
hormone refractory stage - stop responding to suppression of testosterone
what is microscopic haematuria classed as
5 RBC per high power field
what things don’t cross the glomerular basement membrane and shouldn’t be in the urine
RBC, WBC
HMW proteins - albumin, globulins
what is the immediate treatment of acute urinary retention
catheterisation - urethral or suprapubic
what is polyuria
urine output > 3L/ 24 hours
what is the lifetime risk of getting a kidney stone in males
1 in 8
how is MSSU collected (mid stream specimen urine)
void and stop midstream, discard urine, and then collect next volume of urine
list some voiding LUTS
hesitancy, poor flow, intermittency, terminal dribbling
due to underachieve bladder
what are the 4 most common presentations of glomerulonephritis
haematuria
heavy proteinuria
slowly increasing proteinuria
acute renal failure
what does of a diagnosis of UTI require
microbiological evidence AND symptoms signs;
fever, loin/flank/ suprapubic pain or tenderness, urinary frequency or urgency
what are 3 disposing factors to a urine infection
stasis of urine - obstruction, loss of feeling
pushing bacteria up urethra - sexual activity, catheterisation
generalised predisposition - diabetes
what are mesangial cells
tree like group of cells which support the capillaries
what is treatment of complicated BPO
cyctolitholapaxy and TURP
what is the prognosis for castrate resistant prostate cancer
median survival 18-22 months
what are the statistic for death in each stage of AKI
1 - 8%
2- 25%
3- 33%
how is reflux nephropathy investigated
micturating cystogram
what are common causes of obstruction in men, women and both
men - BPH
women - uterine prolapse
both - tumours, calculi
what are the general measures in the treatment of non -proliferative glomerulonephritis
treat oedema - NaCl/ fluid restriction, loop diuretic
treat hypertension - ACEi
reduce risk of infection - vaccine
treat dyslipidaemia - statins
reduce risk of thrombosis - heparin, warfarin
how is post streptococcal glomerulonephritis treated
antibiotics for infection
loop diuretics for oedema
vasodilator for hypertension
where do ureteric calculi normally get lodged
pelvi- ureteric junction
cross of iliac vessels
vesicle- ureteric junction
what should you consider when differentiating between a complicated and uncomplicated UTI
age, sexual activity, gender, predisposing factors, foreign body
in glomerulonephritis, what is the microscopic finding of RBS
dysmorphic RBS (mickey mouse)
how may an upper tract TCC present
frank haematuria
flank/ loin pain
unilateral steric obstruction
metastatic symptoms
what form of glomerulonephritis is most common in children
minimal change glomerulonephritis
what are the 4 stages of testicular cancer
I - disease confined to testes
II - infra diaphragmatic nodes involved
III - supra diaphragmatic nodes involved
IV - extra lymphatic disease
which type of urinary infections should be investigated
complicated - men, children
what are presentations of late stage CKD
pruritus
nausea / vomiting
pericarditis
neuropathy
how may you investigate a UTI in the lower tract
flow studies, residual bladder scan, cystoscopy
what is the most common cause of ESRF leading to need for dialysis
diabetic nephropathy
what pathology does proteinuria occur from
podocyte pathology
how is the diagnosis of amyloid made (extracellular proteins)
biopsy - congo red staining
light microscopy - apple green biofrongens
what are methods of estimating GFR
creatinine Inulin clearance isotope GFR 24 hour urine collection + blood GFR estimating equations
what is the treatment of hyperkalaemia
calcium gluconate (stabilise myocardium)
salbutamol, insulin - shift K back to cell
diuresis - remove K
what is the treatment of anti GBM disease
corticosteroids, plasma exchange, cytotoxic B cell therapy , complement inhibitors
how may a child present with a UTI
diarrhoea (systemic response to infection)
excessive crying - pain
fever, nausea/ vomiting, loss of appetite
failure to thrive
how are high grade bladder tumours treated
radical surgery - can be very complicated
what may be a problem when interpreting a MSSU
bacterial species not normally present in terminal urethra may be pathogenic at low colony numbers
what is the differential diagnosis of nephrotic syndrome
congestive heart failure (high JVP, normal albumin, minimal proteinuria) hepatic disease (abnormal LFTs, no proteinuria)
what is the classic triad of renal cancer symptoms
flank pain, mass and haematuria
50% are asymptomatic
how does a flow rate study tell if BOO is present
if Qmax < 10 ml/s - 90% chance of BOO
what are the complications of CKD (related to a worsening GFR)
A - acidosis/ anaemia B - bone disease C - cardiovascular D - death and dialysis E - electrolyte imbalance F - fluid overload/ oedeama G - gout H - hypertesion I- iatrogenic
what are complications of a TURP
bleeding, infection, retrograde ejaculation (goes back into bladder)
stress urinary incontinence
what is the percentage of recurrence of uteric stones in 10 years
50%
what is the peak age for urolithiasis in men and women
men - 30
women - 35 or 55
what is the most common cause of AKI
poor perfusion - failure of circulation to provide sufficient plasma flow (loss of volume/ pressure)
does focal and segmental glomerulonephritis respond well to steroids
no - trial anyway
cyclosporine, rituximab, cyclophosphamide alternatives
what is the scoring system for benign prostatic hyperplasia
IPSS - international prostate symptomatic score sheet 7 domains + QOL mild = 0-7 moderate = 8-19 severe = >20
describe CKD classification by albuminuria in terms of albumin excretion in mg/hr an A:CR
A1 - <30, ratio <3
A2 - 30-300, ratio 3-30
A3 - >300, ratio >30
what is the diagnostic triad for prostate cancer
PSA
digital rectal examination
what is a CIS bladder tumour
non muscle invasive but very aggressive
precursor of muscle invasive
what surgical intervention is used for BPO
TURP - transurethral resection of prostate
what hormonal therapy can be given to treat prostate cancer
chemical castration - LHRH analogue, negative feedback on androgen receptors
anti - androgens
oestrogen (3rd line)
what is stage 3 of AKI
creatinine - 3x baseline or >354umol increase
urine - anuria for >12 hours or <0.3 ml/ kg/ h for over 24 hours
what are the indications for dialysis in AKI
A - low bicarb E - high K I - aspirin, metformin, lithium, methanol, theophylline, ethylene glycol o - pulmonary oedema u - pericarditis
what are some intrinsic causes of a urinary tract obstruction
stone uteric tumour (TCC) blood clot fungal ball scar tissue
why doe CKD increase CV disease
increased BP vascular stiffness inflammation oxidative stress abnormal endothelial function
is PSA cancer or prostate specific
prostate specific but not cancer
high flash positive from infection/ inflammation
is haematuria nephritic or nephrotic
nephritic
what % of prostate cancers occur in the peripheral zone
80
what things can elevate PSA levels (give false positive test result)
UTO chronic prostatitis catheterisation/ recent urological procedures ejaculation BPH prostate cancer
how does myeloma lead to renal failure
cast nephropathy
light chain nephropahthy
what does diagnosis of glomerulonephritis depend on
biopsy
what advice would you give to prevent UTIs
fluid intake
void every 2-3 hours, before bed and before/ after intercourse
what is nocturia
waking up at night on 1 or more occasions to micturate
what signs will be present if there is obstruction at the level of the ureter
upper urethral and bladder dilation bilateral hydroureter (water expansion of ureter)
what is active surveillance when treating prostate cancer
deferring treatment until absolutely necessary to avoid unnecessary side effects
do PSa, rectal examination, MRI regularly
why is PSA test repeated again in 3 weeks
half life is 2.2 days
what are advantages of haemofiltration
greater haemodynamic stability
control over volume status
why does benign prostate hyperplasia present with LUTS
in transitional zone - compresses urethra
describe the ECG changes seen in hyperkalaemia
1) tall tented T eaves
2) PR interval increases
3) P wave widens and flattens till it eventually disappears
4) prolonged/ widened QRS
how is the diagnosis of post streptococcal glomerulonephritis made
evidence of infection - high ASOT, anti-DNase B, low C3
how may you investigate a painless lump in the testes
MSSU
ultrasound
tumour markers
what is the most common cause of glomerulonephritis worldwide
IgA nephropathy
what is the most common cancer amongst young men
testicular cancer - peak incidence 3rd decade
what are the 3 classes of neurological causes of LUTS
- supra-pontine - stroke, alzheimers, parkinsons
- infra- pontine supra sacral - spinal cord injury, disc prolapse, spina bifida
- infra- sacral - MS, diabetes, cauda equina
what is stage 2 of AKI
creatinine - 2-2.9x baseline
urine - <0.5 ml/kg/h for >12 hours
what scoring system is used to grade prostate cancer
Gleason pathological grading system
what is the difference in solute removal in haemodialysis and heamofiltration
haemodialysis - by diffusion in intermittent therapy
haemofiltration - by convection in continuous therapy
how may a stone in the urinary tract present
renal pain uteric colic dysuria haematuria UTI
what is the management of oedema in CKD
salt ad fluid restriction , loop diuretics
what is the peak age incidence of prostate cancer
65-75 years
75% > 65
1 %< 50
(45% <70 - treat if no comorbidities)
what is SLE
systemic autoimmune disease with antibodies against nuclear components e.g double stranded (ds)DNA
deposition of antibody complexes causes inflammation and tissue damage
what is the management of CV disease in CKD
BP, aspirin, cholesterol, exercise
how may an iatrogenic complication of CKD occur
build up urea - uraemia pericarditis
drug toxin
list some glomerular causes of CKD
1- glomerulonephritis
2- diabetes, amyloid, myeloma
what are techniques to remove kidney/ ureteric stones
open surgery
endoscopic surgery
ESWL - extracorpeal shockwave lithotripsy
PCNL - percutaneous nephrolithotomy
why may you do an USS for CKD
check size, symmetry, anatomy, exclude obstruction
is proteinuria nephritic or nephrotic
nephrotic
what is normal range of PSA
0-4 ug/mL <50 - 2.5 is upper limit 50-60 - 3.5 is upper limit 60-70 - 4.5 is upper limit >70 - 6.5 is upper limit
what imaging procedure can be done to investigate frank haematuria
cystourethroscopy
what may membranous nephropathy occur secondary to
majority are primary (in isolation)
malignancy - lung, breast, prostate, GI
infection - hep B/C, streptococcus, malaria
immune - SLE, rheumatoid arthritis, sarcoidosis
drugs - gold, NSAIDs, penicillamine
what is the most common type of bladder cancer
transitional cell carcinoma
what blood tests would you do to investigate AKI
FBC, U&E, bicarb LFT (hepatorenal disease) clotting - in case biopsy blood gas ANCA (vasculitis), Ig (myeloma), C3/4 dsDNA (lupus)
what is the commonest cancer diagnosed in men
prostate
what investigation is used to asses the size of the prostate
digital rectal
what is the treatment for renal bone disease in CKD
diet and phosphate binders
give active vit D3
parathyroidectomy
in high pressure chronic urinary retention what 2 type of diuresis may occur
physiological - <200ml/ hour
pathological - >200 ml/ hour +/- postural hypotension
what are complications of acute urinary retention
UTI post - decompression haematuria pathological diuresis renal failure electrolyte abnormalities
when does anti GBM disease normally present
two peaks - 3rd decade and 6th decade
what tests can diagnose proteinuria
24 hour urine collection
urine protein creatinine ratio
what is the treatment for minimal change nephrotic syndrome
prednisolone
relapses treated with immunosuppression
what should you always do before performing a renal biopsy
check clotting factors
what are indications for surgical treatment of ureteric stones
obstruction of urinary tract
recurrent haematuria, pain and infection
progressive loss of kidney function
patient occupation
how do 5a reductase inhibitors help BPO
reduce prostate size and reduce LUTs
what are some clinical features of multiple myeloma (excess immunoglobulins and light chains)
raised ESR anaemia weight loss fractures back pain
what closes off the ureter and stops reflux
increased pressure in the bladder as it fills
how does IgA nephropathy usually present
asymptomatic
microscopic haematuria
what are presentations of early stage CKD
asymptomatic fatigue anaemia hypertension oedema bone pain to renal disease
how are the majority of prostate cancers diagnosed
opportunistic PSA testing
what are risk factors for testicular cancer
caucasians
family history
previous cancer in contralateral tests
what should you do if a child presents with a urinary obstruction
send to paediatric surgeon
how do you treat uncomplicated BPO
watchful waiting
which form of glomerulonephritis does not leas to kidney failure
minimal change disease
what is anuria
absolute - no urine output
relative - <100ml/ 24 hours
what are complications of nephrotic syndrome
thromboembolism -
infection - urinary loss of immune mediators
hypelipidaemia-
what must be kept constant in glomerular capillaries to keep filtration working
pressure
what does pathology of focal and segmental glomerulonephritis show
focal and segmental sclerosis with distinctive patterns eg. tip lesions, collapsing
what is the most common presentation of bladder cancer
painless frank haematuria
what are symptoms and signs of a urinary tract obstruction
pain, frank haematuria, palpable mass, signs of complication
what are emergencies related to UTIs
acute kidney injury acute urinary retention sepsis sever heamaturia causing haemorrhage stroke testicular torsion paraphimosis/ priapism
what is the prognosis for localised prostate cancer
> 90% 15 year survival
how may an iatrogenic CKD be prevented
ask about drug medication
when should someone be counselled for RRT
when risk of failure is 10-20% in 1 year
why are females more susceptible to urine infections
shorter urethra lack of prostatic bacteriostatic secretion closeness of urethra to rectum sexual activity pregnancy (pressure on ureter/ kidney)
what is oliguria
urine output < 0.5ml/ kg/ hour
how can you investigate haematuria
flexible cystoscopy
why is anaemia a complication of CKD
reduced erythropoietin and red cell survival
what is the gold standard investigation for a UTI
MSSU with microbiology (bacteria > 10^5)
describe the glomerular filtration rate classification of GFR
G1 - >90 G2 - 60-89 G3a - 45-59 G3b - 30-44 G4 - 15 - 29 G5 - <15
how are low grade bladder tumours treated
endoscopic resection and chemo
what are the immediately dangerous consequences of AKI
A - acidosis E - electrolyte (high K) I - intoxication - toxins in blood O - oedema (pulmonary) U - uraemia complications
how does anti- GBM disease manifest in the kidneys and lungs
renal - oliguria/anuria, haematuria, AKI, renal failure
lung- SOB, haemoptysis (pulmonary haemorrhage in 50-90%)
what urinalysis would you look at in a UTI
blood, leucocytes, protein, nitrates
what are 2 main causes of squamous cell carcinoma in the bladder
schistosomiasis
chronic cystitis
what signs will be present if there is obstruction at the level of the renal pelvis
unilateral hydrometer unilateral hydronephrosis (back pressure to kidney)
list some cystic/ congenital causes of CKD
1- renal dysplasia
2- polycystic kidney disease, fabric disease
what is acute urinary retention defined as
painful inability to void with a palpable and percussible bladder
what is the difference between global and segmental glomerulonephritis
global - all glomerulus affect
segmental - part affected
what is the difference in the 5 year survival for low and high grade bladder TCC
low - 90%
high - 50%
what is the prognosis for metastatic prostate cancer
3-5 years
what is the essential treatment of testicular cancer
radical orchidectomy
+/ - radiotherapy and chemotherapy
what is the most common type of uteric stone
calcium oxalate
2nd - Ca oxalate and phosphate
what is henoch schonelein purpura (HSP)
a small vessel vasculitis and a systemic variant of IgA nephropathy with IgA deposition in skin, joints or gut in addition to the kidney
what should you do if a MSSU is too difficult to collect
suprpubic aspirate
what is chronic kidney disease
either the presence of kidney damage (abnormal blood, urine or X-ray findings) or GFR <60 ml/min/ 1.73m^2 that is present for > 3 months
what age group do seminomas and non seminomas mainly affect
seminomas - 30-40
non seminomas - 20-30
what is the relationship between the levels of PSA and cancer probability
0-1 - 5% 1-2.5 - 15% 2.5 - 4 - 25% 4-10 - 40% >10 - 70%
why do CKD patients get renal bone disease
high phosphate and lower Ca absorption lead to secondary hyperparathyroidism (PTH tries to correct imbalance)
low Ca as lack of activated vit D
what is the commonest cause of urological emergency admissions
colic
how does hyperglycaemia reduce GFR
increased growth factors
RAAS activation
oxidative stress
production of advanced glycolysation products
how is the diagnosis of minimal change nephrotic syndrome made
electron microscopy - effacement of podocyte processes
how does henoch schonelein purpura (HSP) present
purpuric rash on extensor surfaces (legs)
polyarthristis, abdominal pain, nephritis
how are bladder tumours classified
by grade 1-3 and stage TNM combination
what imaging test is mandatory in renal cancer
CT scan of abdomen and chest
what are symptoms of uraemia
nausea/ vomiting anorexia cramp fatigue pruritis drowsiness
what is a radio contrast nephropathy
AKI following administration of iodinated contrast agent
normally resolve after 72 hours
what are some extrinsic causes of a urinary tract obstruction
obstruction from crossing vessel Lymph nodes abdominal mass (tumour) iatrogenic prostate/ cervical cancer
where do renal cancers commonly metastasise to
lungs, bone, brain, liver
how may wegners granulomatosis present
URT- epistaxis, saddle nose, sinusitis LRT - cough, dyspnoea, haemoptysis glomerulonephritis pulmonary haemorrhage joints - arthritis, myalgia pericarditis vasculitic sin rash
what is membranoproliferative glomerulonephritis divided into
immune complex associated - increased/ abnormal immunoglobulin deposition in the kidney
C3 glomerulonephropathy - defect in complement pathway
how would you treat a post renal cause of AKI
catheter + nephrostomy
what does chronic urinary retention present as
LUTS or complications
what is dysuria
pain of micturition
when do complications of CKD usually manifest
when GFR <20mls/ min
when does post streptococcal glomerulonephritis typically present
10-21 days after infection typically of throat (2 weeks) or skin (3-6 weeks)
what is the usual route of infection
ascending
what is the difference between a complicated and uncomplicated UTI
uncomplicated - young sexually active females with clear reaction to sexual activity
complicated - due to structural/ functional abnormality, obstruction, stones, catheter, neurogenic bladder, renal transplant
what is the treatment for locally advanced prostate cancer
hormonal therapy and radiation
what is the treatment for wegners granulomatis
high dose glucocorticoids ply immunsuppresant
plasma exchange if renal failure/ pulmonary hameorrage
how is myeloma diagnosed
bone marrow aspirate
serum paraprotein
urinary bence-jones protein (BJP)
what are clinical features of myelomas
anaemia, back pain, fractures, infections, high ESR, high Ca
what are complications of BPO
progression of LUTS acute urinary retention chronic urinary retention (new bed wetting) urinary incontinence UTI renal failure from high back pressure
what is the emergency treatment of urinary obstruction
percutaneous nephrostomy insertion or retrograde stent insertion
definitive treatment - treat cause
what are risk factors for developing renal cancer
family history
obesity, smoking
anti- hypertensive medication
end stage renal failure (cystic changes in kidney)
how is multiple myeloma diagnosed
bone marrow aspirate
urinary bence jones protein
serum free light chains in blood
how may a lower tract obstruction present
LUTS
incontinence
frank heamaturiea
urinary retention
what genes may increase the chance of developing prostate cancer
HPC 1
BRAC 1 &2 - breast cancer gene in females passed on to offspring
what is the treatment of membranous nephropathy
general measures
immunosuppression if symptomatic
how does Gleason score relate to risk of death from CAP
6 - 18-30% (ISUP 1)
7 - 42-70% (ISUP 2-3)
8-10 - 60-87%
what abnormalities in the renal tract may lead to a UTI
stones, renal outflow obstruction, BOO, horseshoe kidney, bladder tumour, fistula bladder / bowel
what is PSA
kallikrein serine protease (liquifies semen) produced by glands of the prostate
what causes post streptococcal glomerulonephritis
streptococci antigen deposits in glomerulus leading to immune complex formation and inflammation
what is the first line treatment for renal and ureteric calculi (<2cm)
ESWL
what are serological markers of membranous nephropathy
PLA2R antibody positive
THSD7A
diffusely thickened GBM due to sub epithelial deposits go IgG
list some proliferative glomerulonephritis
post infective nephrtitis (diffuse proliferative) IgA nephropathy (focal proliferative) Cresentric nephritis (focal necrotising)
what are patients with CKD most likely to die of
cardiovascular disease
what characterises IgA nephropathy
IgA deposition in the mesangium and mesangial proliferation
why is the kidney a target for systemic disease
- high blood flow
- glomeruli can trap proteins or immune complexes
- metabolises drugs which may be toxic
what percentage of men at 60 years and and 85 years will have benign prostatic hyperplasia
65 - 50%
85 - 90%
what is benign prostatic hyperplasia characterised by
fibromuscular and glandular hyperplasia in transitional zone
how may you investigate a UTI in the upper tract
USS kidneys, CT KUB/ IVU, MAG-3 venogram, DMSA scan
what uteric stones are infective
triple phosphate - Ca, Mg, NH3
what are the main presentations of UTI
dysuria, pain, increased frequency
cloudy offensive smelling urine
what are risk factors for AKI
pre- existing CKD
age
male
co-morbidities - DM, CV disease, malignancy, chronic liver disease
what are complications of a UTI
sepsis renal failure bladder malignancy (squamous cell carcinoma) acute urinary retention frank haematuria bacteriuria of pregnancy clubbing of calyces
what is the most common pathological class of testicular cancer
germ cell tumour (95%)
seminomatous / non seminomatous
how is IgA nephropathy managed
control BP (ACEi) prepare for RRT
what test can be done to assess split renal function
DMSA or MAG-3 renogram
what is the definitive treatment of localised prostate cancer
radical prostatectomy
what are pre renal causes of AKI
reduced circulation volume - dehydration, haemorrhage, D&V hypotension / shock congestive heart/ liver failure arterial occlusion NSAIDs
what is a urinary tract infection
infection affecting urinary tract - kidneys, ureter, bladder, urethra, prostate, epididymis, testis
how does hyperkalaemia occur in CKD
K is normally exchanged with Na in the distal tubule - reduced Na delivery as GFR falls
>7 = fatal cardiac arrythmia
what is the risk of developing bladder TCC if you have upper tract TCC
40% in 10 years - regular surveillance
what is a common cause of UTIs in children
reflux nephropathy - bladder contacts and expels urine back to kidney leading to infection
what are renal causes of AKI
acute tubular necrosis toxin related - drugs, radio contrast, snake acute interstitial nephritis acute glomerulonephritis myeloma
what are the 4 grades of bladder tumour
G1- well differentiated, non invasive
G2 - mod differentiated, non invasive
G3 - poorly differentiated, invasive
does proliferative glomerulonephritis present with nephrotic or nephritic syndrome
nephritic - blood on dipstick
extra cells in glomerulus
what urine investigations can be done to investigate glomerulonephritis
MC&S
A:CR/ P:CR
RBC casts
what are the T stages of renal cancer
T1 - <7cm confined within capsule
T2 - >7 cm confined in capsule
T3 - local extension outside capsule
T4 - beyond Gerotas fascia
what drugs are nephrotoxic
digoxin, diuretics
aminoglycosdies, ACEi/ ARB
metformin , morpheine (opiates)
NSAIDS
what quantities of serum creatinine and urine volume are given for an AKI
increase in S creatinine >26.5 mol/l within 48 hours or >1.5 x baseline (from past 7 days)
or urine <0.5 ml/ kg/ h for 6 consecutive hours
what is the main symptom nephrotic syndrome
generalised pitting oedema
what is glomerulonephritis
group of inflammatory disorders of the kidney
how is an upper tract TCC investigated
CT IVU
uteroscopy and biopsy
what are risk factors for transition cell carcinoma
smoking (40%)
aromatic amines
genetic abnormalities
pelvic radiotherapy
what specific blood tests may you do to investigate CKD
C3/4 autoantibody ANCA - vasculitis anti GBM serum electrophoresis - myeloma
what is seen on urinalysis of the nephritic state
haematuria, dysmorphic RBCs, cellular casts
which lymph nodes drain the prostate gland
pelvic lymph nodes
what blood tests may you do to investigate CKD
U&E, FBC, HCO3 total protein albumin LFT creatinine kinase immunoglobulins coagulation screen
what blood tests would you request to investigate glomerulonephritis
FBC, U&E, LFT, CRP
immunoglobulins, complement C3/ 4
autoantibodies - ANCA, anti-dsDNA, anti-GBM
culture
what are secondary causes of nephrotic syndrome
DM,
amyloid
myeloma
lupus nephrtitis
what are the terms for the inflammation of; bladder, prostate, urethera, kidney, testis
cystitis, prostatitis, urethritis, pyelonephritis, orchitis
what are signs of circulatory volume depletion and overload
depletion - orthostatic BP, skin turgor/ temperature
overload - raised JVP, crepitations, ascites, oedema
how are patients prepared for RRT
education select modality planning access decide when to start multidisciplinary team
what imaging test would you do to investigate AKI
renal USS
what are the symptoms of locally invasive prostate cancer
haematuria
incontinence
perineal / suprapubic pain
haemospermia
how does the Gleason pathological grading system classify grades of cancer
score 3-5 in terms of how well differentiated
summated - number of most common cells + number of 2nd most common cells
(cancer is heterogenous)
min 6 max 10
what are disadvantage of haemodialysis
slower filtration
only fluid removal when treatment
how do alpha blockers help BPO
smooth muscle relaxation - prostate innervated by sympathetic alpha adrenergic nerves
(can be selective/ non selective/ highly selective)
what are post renal causes of AKI (seen on ultrasound)
obstruction - intraluminal, intramural, extramural
what are complications of ureteric calculi
haematuria, fever, perforation , reflux, stricture formation
why should you always sterilise a catheter before inserting
can move lower urethral flora up the tract
list some storage LUTS
frequency, nocturia, urgency, urge incontinence
what may focal and segmental glomerulonephritis be secondary to
HIV, heroin, lithium, lymphoma
at what % of GFR will creatinine levels begin to drop
60%
how would you investigate a stone in the urinary tract
CT KUB USS Urinalysis and culture bloods 24 hour urine collection (high Ca)
what is the differential diagnosis for a painless lump in testes
infection (epididymo-orchitis)
epidymal cyst
hydrocele
hernia - can’t get above lump
what is the prognosis of each stage of testicular cancer
good, 5 year survival:
1 - 99%
2/3 - 96%
4 - 73%
how may an obstruction in the urinary tract lead to an infection
slow urine flow can’t flush out the bacteria
or sediments form stone with cause more obstruction
what is the prognosis of membranous nephropathy
resolves spontaneously in 1/3
25% on dialysis on 10 years
good prognosis if proetinura resolves
what is the difference between primary and secondary glomerulonephritis
primary - only in glomerulus
secondary - other body systems affected (SLE, wagerers etc.)
what is the difference between diffuse and focal glomerulonephritis
diffuse - >50% glomeruli affected
focal - <50% glomeruli affected
list some blood flow/vessel causes of CKD
1 - renal vasculitis, renal artery stenosis
2 - heart failure, hypertension
what is the name of the zones used the describe locations in the prostate
McNeals
what is produced in excess in myeloma
light chains and immunoglobulins - by plasma cells
describe the 2 forms of T staging a bladder tumour
Tis-T1 - non invasive of detrusor muscle
T2-4 - invade the detrusor muscle
what is the microbiological evidence of a UTI
bacterial count of 10^5 cfg/ ml from MSSU specimen
is there is frank haematuria, what is the res of malignancy in >50s
25-35%
how does testicular cancer usually present
a painless lump (can be tender or inflammed)
