GU Flashcards
(205 cards)
1
Q
What is nephrolithiasis?
A
Kidney stones (renal calculi or urolithiasis)
2
Q
What are the 5 types of kidney stone?
A
Most common
* Calcium oxalate
* Calcium phosphate
Less common below
* Uric acid
* Struvite
* Cystine
3
Q
Which kidney stone is not visible on X-ray?
A
Uric acid stones
4
Q
What causes struvite stones to form?
A
Produced by bacteria (so during a renal infection)
5
Q
What causes cystine stones?
A
Autosomal recessive condition causes amino acids to join together
6
Q
What is it called when a calculus form in the shape of a renal pelvis?
A
Staghorn calculus
7
Q
When do staghorn calculus often form?
A
Recurrent UTIs causes bacteria to hydrolyse urea to ammonia forming a struvite stone to form
8
Q
What are some risk factors for kidney stones (5)?
A
- Chronic dehydration
- Kidney diseases (e.g. PKD)
- Hyperparathyroidism
- UTIs
- History of stones
9
Q
What are the signs/ symptoms of renal stones (4)?
A
- Renal colic
- Haematuria
- N+V
- Low urine output
10
Q
What is renal colic?
A
Pain felt with renal stones that is unilateral colicky (due to stones moving and settling) loin to groin pain
11
Q
How are kidney stones investigated (4)?
A
- Urine dipstick
- Abdominal X-ray = first line
- CT KUB (kidney, ureter, bladder) = gold
- Ultrasound (if pregnant)
12
Q
How are kidney stones treated (4)?
A
- Hydration
- NSAIDs
- Abx for UTIs
- Surgery
13
Q
What is the name of a strong NSAID used for kidney stones?
A
Diclofenac (IM)
14
Q
What procedures are done for kidney stones (3)?
A
- Extracorporeal shock wave lithotripsy (ESWL)
- Percutaneous nephrolithotomy (keyhole retrieval)
- Ureteroscopy (catheter with a LAZER on it basically)
15
Q
How can recurrent stone be prevented (2)?
A
- Hydration
- Avoid carbonated drinks
16
Q
What size kidney stones usually pass on their own?
A
< 5mm
17
Q
What is an example of an antiemetic?
A
Cyclizine
18
Q
What is acute kidney injury (AKI)?
A
An acute drop in renal function
19
Q
What are NICE criteria for AKI (3)?
A
- Rise in creatinine of >26 micromol/ L within 48 hours
- Rise in creatinine of >50% in 7 days
- Urine output of < 0.5 ml/kg/hour for 6 hours
20
Q
What is normal urine output?
A
0.5-1.5 ml/kg/hour
21
Q
What are the 3 types of AKI?
A
- Pre-renal
- Renal
- Post-renal
22
Q
What causes pre renal AKI (5)?
A
- Dehydration
- Hypotension
- Heart failure
- NSAIDS
- Renal artery stenosis/ blockage
23
Q
What causes renal AKI (4)?
A
- Glomerulonephritis
- Interstitial nephritis
- Acute tubular necrosis
- Sepsis (toxins)
Intrinsic kidney disease –> reduced filtration of blood
24
Q
What causes post renal AKI (4)?
A
- Stones
- Cancer
- Large prostate
- Unsafe bladder
Blocked urine outflow
25
What important substances does AKI lead to the build up of (4)?
* K+
* Urea
* Fluid
* H+
26
AKI signs/ symptoms (4)?
* N+V
* Reduced urine output
* Abdo pain
* Confusion
27
How is AKI investigated (4)?
Establish cause:
* Urinalysis
* Bloods
* Kidney biopsy (for intra renal)
* Ultrasound (for post renal)
28
How is AKI managed (3)?
* Correct complications (electrolytes)
* Treat underlying cause
* Dialysis/ transplant if severe
29
What are some complications of AKI (4)?
* Fluid overload (heart failure)
* Hyperkalaemia
* Metabolic acidosis
* Uraemia (high urea)
30
What can uraemia cause (2)?
* Encephalitis
* Pericarditis
31
What is chronic kidney disease?
A chronic reduction in kidney function (usually permanent and progressive)
32
What are the two main causes of CKD?
* Hypertension
* Diabetes
33
What other things can cause CKD (3)?
Any kidney disease:
* PKD
* Glomerulonephritis
* Nephrotoxic drugs (e.g. NSAIDs)
34
How do NSAIDs damage the kidneys?
Inhibit the production of prostaglandins, which regulate vasodilation in the kidneys
35
How does the kidney compensate for CKD?
Release renin --> higher BP --> higher GFR
36
What effect does a compensatory release of renin have on the kidneys?
Increase BP --> increase transglomerular pressure --> high shearing force --> loss of BM selective permeability
37
How does diabetes damage the kidneys?
Glucose sticks to proteins in the walls of the efferent vessels (stiffening them), and making it hard for blood to leave the glomerular
38
What are the signs/ symptoms of CKD (6)?
Early stages = asymptomatic
* Oedema
* N+V
* Hypertension
* Loss if appetite
* Muscle cramps
* Pruritus (itching)
39
What are some complications of CKD?
* Anaemia (low EPO)
* Renal bone disease (low activated vit D)
* Neuropathy + encephalopathy (uraemia)
* CVD
40
How is CKD investigated (3)?
* FBC = anaemia
* Urine dip
* U+Es
41
What does a urine dipstick look for in CKD (2)?
* Proteinuria
* Haematuria
42
How is proteinuria quantified and what value is significant?
UACR (Urine albumin:creatinine ratio) > 3 mg/ mmol
43
What is eGFR?
Estimated glomerular filtration rate?
44
What information does eGFR use to calculate?
* Creatinine
* Age
* Gender
* Ethnicity
45
What is a normal eGFR?
>90 ml/min/1.73m^2
46
What are the stages of CKD?
47
What are renal signs in stage 1 and 2 CKD?
Significant proteinuria
48
How is CKD treated?
Treat underlying cause and manage complications
49
How are the complications managed of CKD?
* Anaemia = EPO + Fe
* Renal bone disease = active vit D
* Oedema = diuretics
50
What is classed as end stage renal failure?
CKD stage 5 (eGFR <15)
51
How is end stage renal failure treated?
Dialysis / transplant
52
What is benign prostatic hyperplasia?
Increase in the number of cells (hyperplasia) and enlargement of the prostate
53
What are 2 risk factors for BPH?
* Older age
* Afro-carribean (higher testosterone)
54
Which part of the prostate proliferates and narrows urethra ?
Transitional zone (inner part)
55
What are the three types of LUTSs?
* Storage
* Voiding
* Post micturition
56
What are some examples of storage LUTSs (4)?
* Increased frequency
* Nocturia
* Increased urgency
* Incontinence
57
What are some examples of voiding LUTSs (4)?
* Poor stream
* Terminal dribbling
* Incomplete emptying
* Straining/ hesitancy
58
What are some examples of post micturition LUTSs?
* Post micturition dribbling
* *Incomplete emptying - usually considered voiding symptom*
59
Which type of LUTSs do patients with BPH usually present with?
Voiding (as urethra obstructed)
60
How is BPH diagnosed?
Rectal exam = smooth + enlarged prostate
61
What other test may be carried out for patients with enlarged prostates (depending on their wishes)?
PSA test (more commonly raised in those with prostate cancer)
62
What does a cancerous prostate feel like?
Irregular, central sulcus disrupted
63
How is BPH treated (4)?
* Lifestyle (decrease caffeine)
* Medications
* Self catheterisation
* Surgery
64
What medications are used to treat BPH (2)?
* Alpha blockers (tamsulosin)
* 5 alpha reductase inhibitors (finasteride)
65
What is a side effect of tamsulosin?
Postural hypotension (as alpha 1 receptors relax BV walls)
66
How do 5 alpha reductase inhibitors reduce prostate size?
Prevent conversion of testosterone to dihydrotestosterone (more potent androgen)
67
What surgery is offered for BPH (2)?
* Transurethral resection of the prostate (TURP)
* Prostatectomy
68
What is a complication of TURP?
Retrograde ejaculation (into bladder)
69
What is a complication of BPH?
Anuria --> hydronephritis
70
What is the most common renal cancer?
Renal cell carcinoma
71
What is the most common type of renal cancer?
Renal cell carcinoma
72
What are some risk factors for RCC (3)?
* Smoking
* Haemodialysis (due to the kidney disease)
* Family history
73
What is a auto dom hereditary condition that increases risk of RCC?
Von Hippel-Lindau syndrome
74
What are the symptoms of an RCC?
* Flank pain
* Haematuria
* Abdo mass
* Swollen left testicle
75
How is RCC investigated?
* Ultra-sound = 1st line
* CT = gold
76
What is Wilms tumour?
Renal tumour (starts in mesenchymal cells)
77
What is Wilm tumour also known as?
Nephroblastoma
78
What is a blastoma?
Cancer of developing cells
79
What is the most common type of bladder cancer?
Transitional cell carcinoma (TCC)
80
What are some risk factors for bladder cancer (3)?
* Exposure to dyes/ paints/ rubber
* Smoking
* Age (old)
81
What is the main symptoms of bladder cancer?
Haematuria
82
How is bladder cancer diagnosed?
Cystoscopy + biopsy
83
What surgery is used to treat bladder cancer (2)?
* Transurethral resection of bladder tumour (TURBT)
* Cystectomy
84
What is the most common type of cancer in the prostate gland?
Adenocarcinoma
85
What part of the prostate gland does cancer usually form?
Outer, peripheral zone
86
What are 3 risk factors for prostate cancer?
* Genetics/ family history
* Higher age
* Afro Caribbean
87
What 2 genes have been linked to the development of prostate cancer?
* BRCA2
* HOXB13
88
What are the symptoms of prostate cancer (4)?
* LUTSs (mainly voiding)
* Haematuria
* Erectile dysfunction
* Systemic symtoms - if metastasised (e.g. fatigue, weight loss)
89
Where does prostate cancer most commonly metastasise to (2)?
* Bone (sclerotic lesions)
* Lymph nodes
90
How is prostate cancer investigated (4)?
* Digital rectal exam
* PSA test
* Transrectal US / MRI
* Biopsy
91
What score is prostate cancer graded with by biopsy?
Gleason score
92
How is prostate cancer treated (3)?
* Prostatectomy
* Hormone therapy
* Chemo/ radio therapy
93
What are the hormone therapies used to treat prostate cancer?
* Bilateral orchidectomy (male castration)
* GnRH agonists (initially increase testosterone, then receptor down-regulation)
94
How do GnRH agonists work?
Reduce the levels of testosterone produced, results in suppression of the HPG axis. (initially increase testosterone levels, then receptor down-regulation)
95
What is an example of a GnRH agonist?
Goserelin
96
What are the 2 most common types of testicular cancer?
* >90% = germ cell cancer
* <10% = non germ cell cancer
97
What are the two types of germ cell cancer?
* Seminomas
* Teratomas
98
What are 3 types of non-germ cell testicular tumour?
* Sertoli
* Leydig
* Sarcoma
99
What are testicular cancer risk factors (3)?
* Cryptorchidism (undescended testes)
* Infertility
* Family history
100
Symptoms of testicular cancer (2)?
* Painless lump in testicle (does not transiluminate - light does not shine through)
* Gynaecomastia (leydig cell tumour)
101
How is testicular cancer diagnosed?
Scrotal ultrasound
102
What are testicular cancer markers in the blood (2)?
* Alpha- fetoprotein (in teratomas)
* Beta hCG (in seminomas)
103
What is a general tumour marker?
Lactate dehydrogenase (general tumour marker, released when tumour destroy healthy cells)
104
How is testicular cancer treated?
Surgery (radical orchidectomy) + chemo/ radiotherapy for metastasise
105
What is offered to people with testicular cancer?
Sperm storage
106
What is obstructive uropathy?
Blockage of urine flow anywhere along the urinary tract
107
Where would a blockage have to occur to obstruct both kidneys?
Urethra
108
Give some causes of obstructive uropathy (5)?
* BPH
* Stones
* Strictures (due to scar tissue)
* Cancers
* Neurogenic bladder
109
What can obstructive uropathy cause within the kidney?
Hydronephrosis (backlog of urine into the renal pelvis)
110
What can hydronephrosis result in (2)?
* AKI / CKD
* Infection (stagnant urine)
111
What are the symptoms/ signs of obstructive uropathy (4)?
* Loin to groin pain
* Reduced urine output
* N + V
* Kidney damage blood markers (e.g. creatinine)
*May be asymptomatic if only 1 kidney down*
112
How is obstructive uropathy treated?
* Ureteric catheterisation (through back)
* Ureteric stent
113
What are the two types of UTI by location?
* Upper
* Lower
114
What organ is affected in upper UTI and what is its inflammation called?
Kidney --> pyelonephritis
115
What inflammation can occur in lower UTIs (4)?
* Cystitis
* Urethritis
* Prostatitis
* Epididymo orchitis
116
What is the most common infective organism in UTIs?
E. coli
117
What percentage of UTIs are E. coli?
80%
118
What are some other infective organisms in UTIs (4)?
* **K**lebsiella
* **E**. coli
* **E**nterococci
* **P**. aeruginosa
* **S**. saprophiticus
119
What fungi can commonly cause UTI?
Candida albicans
120
Which gender is more commonly affected by UTIs and why?
Women - have shorter urethra so bacteria enter bladder more easily
121
What are some signs/ symptoms of lower UTI (3)?
* Dysuria
* LUTSs
* Confusion (especially in older patients)
122
When would pyelonephritis be suspected (3)?
* Fever
* Back pain/ tenderness
* Pyuria (pus in urine)
*More systemic symptoms + general feeling of unwellness*
123
How are UTIs investigated?
* Urine dip stick
* Midstream urine (culture + sensitivity testing)
124
What is present in urine dipstick in those with UTIs?
* Nitrites (most important)
* Leukocytes
* Haematuria (less common)
125
Why are nitrites present in UTIs?
Bacteria break down nitrates to nitrites
126
What are the most common/ first line antibiotics in the community for UTIs (2)?
* Trimethoprim
* Nitrofurantoin
127
What is a contraindication for the use of trimethoprim and nitrofurantoin?
Pregnancy:
* Nitrofurantoin - not used in 3rd trimester due to haemolytic anaemia of newborn risk
* Trimethoprim - not used 1st trimester as anti-folate
128
What is a risk factor for UTIs and complicates the treatment of UTIs?
The presence of a catheter
129
What is considered a non complicated UTI?
UTI in a non pregnant woman
130
What antibiotics are used for the treatment of pyelonephritis (2)?
* Ciprofloxacin
* Co-amoxiclav
131
What is the most common way urethritis is picked up?
Sexually transmitted infection
132
What are the two types of infective urethritis?
* Gonococcal
* Non-gonococcal
133
What causes gonococcal urethritis?
N. Gonorrhoeae (gonorrhoea)
134
What is the most common cause of non-gonococcal urethritis?
Chlamydia trachomatis
135
Which type of urethritis is more common?
Non-gonococcal
136
How are gonorrhoea and chlamydia detected?
Nucleic acid amplification test (of urine sample)
137
How is neisseria gonorrhoeae treated?
IM Ceftriaxone or Azithromycin
138
How is chlamydia trachomatis treated?
Azithromycin or doxycycline
139
What can also cause urethritis?
Reactive arthritis
140
What are the symptoms of reactive arthritis?
* Cant See (conjunctivitis)
* Cant Pee (urethritis)
* Cant climb a tree (arthritis)
141
What is epididymo orchitis?
Inflammation of epididymus (extending to testes)
142
What are the symptoms of epididymo orchitis?
Soctral pain + swelling (relived when elevated testicle)
143
What are nephr**O**tic and nephr**I**tic syndrome?
2 separate groups of symptoms that occur consistently together
144
What are the symptoms of nephrotic syndrome (3)?
* Proteinuria
* Hypoalbuminaemia
* Peripheral oedema
*+ other weird stuff: Hyperlipidaemia, thrombosis formations, immunodeficiency*
145
What are the symptoms of nephritic syndrome (4)?
* Proteinuria
* Haematuria
* Hypertension
* Oliguria (low urine production)
146
What can present as both nephrotic and nephritic syndrome?
* Diffuse proliferative glomerulonephritis
* Membrano-proliferative glomerulonephritis
147
What 3 conditions can cause intrinsic nephrotic syndrome?
* Minimal change disease
* Focal segmental glomerulosclerosis
* Membranous nephropathy
148
What is minimal change disease?
Podocyte foot process effacement (destruction) by unknown mechanisms
149
Why is it known as minimal change disease?
The histological changes can only be picked up by electron microscopy, not light microscopy
150
Who does minimal change disease occur in most often?
Young children 2-7 years old
151
What is focal segmental glomerulosclerosis?
Segmental sclerosis of glomeruli secondary to numerous causes (e.g. drugs, HIV, sickle cell)
152
What percent of glomeruli are affected in focal segmental glomerulosclerosis?
<50%
153
What is membranous nephropathy?
Thickening of glomerular basement membrane and sub epithelial immune complex deposition
154
What is the most common nephrotic syndrome in adults?
Focal segmental glomerulosclerosis
155
How are these intrinsic nephrotic syndromes treated?
Steroids
156
Which nephrotic syndromes respond best and which not so well to steroids?
* Best = minimal change
* Not so well = focal segmental glomerulosclerosis, membranous nephropathy
157
What other type of nephrotic syndrome is common and is secondary to an underlying illness?
Diabetic nephropathy
158
How does diabetes cause nephropathy?
The efferent arteries harden/ thicken due to glucose sticking to proteins (glycation) in the endothelium. This increase the pressure in the glomerulus, damaging it.
159
What 5 conditions cause nephritic syndrome?
* IgA nephropathy
* Post strep glomerulonephritis
* Goodpastures syndrome
* SLE nephropathy
* Haemolytic uraemic syndrome
160
What type of hypersensitivity are these nephritic syndromes?
All type 3, except goodpastures = type 2
161
What is IgA nephropathy also known as?
Bergers disease (NOT B**u**ergers - this is something else)
162
What is IgA nephropathy?
IgA immune complex deposition in the kidneys (usually after infection)
163
How is IgA nephropathy treated (2)?
* Steroids
* Reduce BP (e.g. ACE inhibitors)
164
What can IgA nephropathy frequently progress to?
End stage renal failure (30% of time)
165
What condition is related to IgA nephropathy?
Henoch schonlein purpura (IgA deposition in blood vessels - small cell vasculitis)
166
What is post strep glomerulonephritis?
Sub endothelial immune complex deposition in the glomeruli post strep A infection
167
What can often be found deposited in post strep glomerulonephritis (3)?
IgM, IgG, C3 (compliment component 3)
168
How does SLE cause nephritis?
ANA (anti-nuclear antibody) deposition in endothelium causing inflammation
169
How is SLE nephritis treated (2)?
* Prednisolone (steroid)
* Hydroxychloroquine (DMARD)
170
How does goodpastures cause glomerulonephritis?
Autoimmune condition whereby anti-glomerular basement membrane (anti-GBM) antibodies are produced
171
How is goodpastures treated (2)?
* Steroids
* Plasma exchange
172
What is haemolytic uraemic syndrome?
Bacterial toxins damage blood vessels in kidneys and clots form causing inflammation
173
What is polycystic kidney disease?
Formation of cysts thought kidneys
174
What are the two types of PKD?
* Autosomal dominant
* Autosomal recessive
175
What genes are affected and which gene is affected more in dominant PKD?
* PKD 1 gene (85%)
* PKD 2 gene (15%)
176
How is recessive PKD inherited?
Requires mutation on both copies of polycyctic kidney hepatic disease 1 gene (PKHD1)
177
How do the gene mutations in PKD cause cyst formation?
PKD 1 and 2 code for polycystin which is a Ca 2+ channel --> Ca 2+ prevents cells from multiplying --> lack of Ca 2+ = cilia overgrowth --> over absorption of water = cyst formation
178
Which type of PKD is more serious and presents in childhood and which is less serious and presents in adulthood?
Recessive = severe childhood illness
Dominant = less severe adult illness
179
What are the sign/ symptoms of PKD (4)?
* Bilateral flank/ abdo pain
* Hypertension
* Haematuria
* Oedema
180
What are 3 extra renal manifestations of PKD?
* Berry aneurysm
* Hepatic cysts
* Aortic root dilatation
181
How is PKD diagnosed?
* Kidney US
* Family history + genetic testing
182
How is PKD treated?
* Manage symptoms (e.g. ace inhibitors)
* Renal transplant
* Tolvaptan (ADH antagonist)
183
Name some scrotal diseases (4)?
* Epididymal cyst
* Hydrocele
* Varicele
* Testicular torsion
184
What is an epididymal cyst (where does it form)?
Extratesticular cyst, above and behind testes
185
How can an epididymal cyst be diagnosed?
Scrotal US
186
Where does a hydrocele form?
Between the visceral and parietal layers of tunica vaginalis
187
How is a hydrocele diagnosed?
Scrotal US
188
What causes a varicocele?
Pampinform distension due to high left renal vein pressure
189
Why is a varicocele usually on the left?
The right testicular vein directly joins IVC therefore it would require high IVC pressure to back up there blood
190
What does a varicocele resemble/ feel like?
Bag of worms
191
What is a complication of varicocele?
Infertility
192
What can a varicocele sometimes be an indication of?
Retroperitoneal tumours (e.g. renal cell carcinoma)
193
How is a varicocele diagnosed?
Clinical examination (can be confirmed with an ultrasound)
194
What is testicular torsion?
Spermatic cord twists on itself, occluding the testicular artery
195
What is a risk factor for testicular torsion?
Bell clapper deformity - horizontal lying testicle
196
What are some symptoms of testicular torsion (4)?
* Severe unitesticular pain
* Abdominal pain
* N+V
* Cremasteric reflex lost
197
What is a cremasteric reflex?
Stroke inner thigh --> testicle should elevate
198
How is testicular torsion diagnosed?
If clinical suspicion --> immediate explorative surgery
199
What is performed surgically to reduce the risk of further testicular torsions?
Orchiplexy = fixing of testicles to scrotum
200
What is a testicular appendage torsion?
Twisting of a small piece of tissue attached to the upper testicle
201
What are the 4 types of urinary incontinence?
* Urge
* Stress
* Overflow
* Functional
202
What is urge incontinence?
Overactivity of detrusor muscle --> suddenly need to micturate
203
What is stress incontinence?
Week sphincter --> high intra abdominal pressure overcomes sphincter strength
204
What is overflow incontinence?
Bladder does not empty fully --> urine frequency dribbles out (due to overfilling)
205
What is functional incontinence?
Physical/ mental impairment prevents you reaching toilet in time (e.g. arthritis)
