Kidney/Urology Flashcards
(46 cards)
AKI - definition
Serum creatinine rise of ≥26 μmol/L within 48 hours.
≥50% rise in serum creatinine known or presumed to have occurred within the past 7 days.
A fall in UO to <0.5 mL/kg/hour for >6 hours in adults or >8 hours in children and young people. 25% or greater fall in eGFR in children and young people within the past 7 days.
AKI Management
Urinalysis +/- urg. USS
RV. nephrotoxic drugs -ACEi, ARB, Metformin, Diuretics, NSAIDs
What is CKD?
ACR ≥3 (any eGFR)
eGFR <60
Repeat test in 2 weeks to exclude AKI
Repeat test in 3 months to confirm diagnosis
When should ACR be done, and what needs to be avoided?
ACR - 1st urine of the day
Avoid meat 12hr pre-test
When is CKD progressive?
Change in CKD category/12 months or ↓eGFR 25% or 15 mL/min/1.73 m2/year.1
What other investigations should be done in CKD?
FBC (?Anaemia) and if eGFR <30, calcium, phosphate, PTH and vitamin D.
Urine dip for haematuria. Use ACR (not dipstick) for protein measurement.
Renal USS if eGFR <30, progressive CKD, haematuria, FH PCKD or obstruction or may require a renal biopsy.
What is the management of CKD?
Offer Statin as primary prevention
BP <140/90 in diabetics <130/80 (SBP >120)
Consider starting ACEi - for renal protection: if ACR (mg/mmol): ≥70 or ≥ 30 + HTN or ≥3 + DM and K <5 mmol/L. Stop if change of eGFR ↓25% or creatinine ↑30% or K ≥6 mmol/L.
When to refer CKD
-eGFR<30
-ACR >70
-ACR >30 + haematuria.
-Progressive CKD
-Suspected renal artery stenosis
-≥4 antihypertensives.
When to check PSA
- Associated LUTS.1
- Visible haematuria.1
- Erectile dysfunction.1
- Unexplained symptoms (such as lower back ache, weight loss and bone pain) – might be due to
secondaries. - Men aged >50 afer counselling (even if asymptomatic*).
PSA counselling points
- Prostate cancer is not the only cause of a raised PSA.
- PSA cannot distinguish between aggressive and slow-growing cancers that would never have caused a
problem. - 15% of men with prostate cancer will have normal PSA.
- Prostate biopsies are negative in three out of four men with raised PSA.
- Prostate biopsy may cause infection and bleeding.
- Treatment of prostate cancer includes surgery, radiotherapy, hormones with side efects of incontinence,
ED and fertility loss. - NOT having test will avoid side efects of treatment–but may mean that early treatable cancers are
missed
When should a 2WW referral be sent for prostate
- Abnormal PSA levels. Normal is 0–4 but the PSA test is not diagnostic and the upper level varies accord- ing to race and age. NICE recommends 2WW referral for any man with PSA > age-specifc range.1
- Suspicious prostate on DRE.1
Signifcant rise in PSA whilst taking a 5-alpha reductase inhibitor.3
When could a PSA be artificially raised
PSA rises in cancer, BPH, UTI, exercise (e.g. cycling), ejaculation, urinary retention or surgical intervention, e.g. fexible cystoscopy.
Acute prostatitis
-What are 3 sx
Febrile illness, urinary symptoms + perineal/suprapubic pain.
Acute prostatitis:
-What is found on exam?
-What investigations are needed?
Exquisitely tender prostate, leucocytes on urine dipstick.
MSU and STI screening. Blood cultures.
Chronic prostatitis:
-What are the two types?
- Chronic bacterial prostatitis (10%).
- Chronic prostatitis/chronic pelvic pain syndrome (CPPS = 90%).
What are 3 different areas of symptoms that can be found in chronic prostatitis?
How is symptom severity assessed?
Pain: Perineum, inguinal, suprapubic, penis, scrotum, testes, rectum, lower back or abdomen.
LUTS: Hesitancy, urgency, poor stream, terminal dribbling, frequency, nocturia or dysuria.
Sexual: ED, painful ejaculation, premature ejaculation or decreased libido.
National Institute of Health Chronic Prostatitis Symptom Index or IPSS.
What investigations are indicated in chronic prostatitis?
-Urine dip and MSU (try sending MSU afer DRE to increase microbiology yield). -Consider full STI screen (esp. if <35 years or new partner).
-Bloods: Consider PSA testing and routine bloods, e.g. FBC, U&E and CRP.
NB: MSU may be negative in chronic bacterial prostatitis so look for old MSUs.
what is the mgt of chronic prostatitis?
4–6 weeks antibiotic (check local guidance).
NICE – ciprofoxacin, ofoxacin or trimethoprim if quinolones not tolerated/allergy. Trial alpha-blocker if LUTS present.
Paracetamol ± NSAID, laxatives if constipation also present.
Describe the conservative mgt of overactive bladder/storage LUTS?
- Bladder training.
- Avoid cafeine and alcohol. Carbonated sof drinks and fruit juice may aggravate symptoms.
- Avoidance of dehydration (concentrated urine can exacerbate the problem).
- Weight loss may help.
- Pelvic foor exercises may help men, especially if history of stress incontinence as well.
- Ofer containment devices, e.g. pads or external sheaths to help whilst problem is being investigated.
Describe 1st line pharmacological mgt of overactive bladder
Ofer antimuscarinic (anticholinergic) – oxybutynin (immediate release), tolterodine (immediate release), or darifenacin (once daily preparation) can be used frst line. If frst line fails, ofer alternative.
What are common sid effects of antimuscarinics?
Common side efects of antimuscarinics: dizziness, drowsiness, dry mouth, blurred vision, constipation, headache, indigestion and abdominal pain. Do not ofer oxybutynin (immediate release) to frail older men due to the risk of impairment of daily functioning, chronic confusion, or acute delirium (less common).
Describe 2nd line pharmacological mgt of overactive bladder?
Second line (if antimuscarinic contraindicated or inefective): mirabegron.
When to refer to urology for UTI?
UTI fails to respond to antibiotics.1
Recurrent UTI – two or more in a 3-month period and no haematuria.
‘Even if >60 years – NICE advise this is a non-urgent referral.’
Genitourinary history suggests a cause or risk factor: e.g. stones, operations, bladder outfow obstruction.1 Persistent microscopic haematuria and normal renal function.1
If renal function impaired or proteinuria – refer to renal.
