Renal and GU Flashcards
(60 cards)
What is renal colic?
Renal colic is a SYMPTOM:
- Acute, unilateral pain
- ‘Loin to groin’ distribution
What is the main cause of renal colic?
Kidney stones (renal calculi)
What are the three most common sites for kidney stones to get stuck?
- Pelviureteric junction
- Pelvic brim
- Vesicoureteric junction
What is a kidney stone likely to be composed of?
Calcium oxalate (75% of stones)
What causes kidney stones?
Supersaturation of urine with salt/minerals
Describe the symptoms of kidney stones
- Acute unilateral pain with a ‘loin to groin’ distribution (renal colic)
- Problems associated with passing urine: dysuria, urinary retention, haematuria
- Nausea and vomiting
What investigations are required in a case of suspected renal colic?
- Bloods/urinalysis
- Diagnostic: CT abdomen (picks up 99% of stones)
Describe the management of renal colic.
- Pain relief
- Stones <5mm in diameter = pass spontaneously
- Stones >5mm in diameter = require medical intervention - either extracorporeal shock wave lithotripsy (ESWL) or percutaneous nephrolithotomy (PCNL)
How are future kidney stones prevented?
Drink plenty of water!
Nephrotic syndrome: causes, pathology and clinical presentation
Causes:
- Minimal change glomerular disease
- Membranous nephropathy
- Focal segmental glomerulosclerosis
Pathology:
-Glomerular damage without inflammation
Clinical presentation:
- Proteinuria
- Hypoalbuminaemia
- Oedema
Nephritic syndrome: causes, pathology and clinical presentation
Causes:
- Post-streptococcal glomerulonephritis/IgA nephropathy (presents days/weeks after URTI)
- Autoimmune glomerulonephritis (EITHER anti-glomerular basement membrane disease (which with lung involvement is called Goodpasture’s syndrome) OR anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis
Pathology:
-Glomerular damage WITH INFLAMMATION
Clinical presentation:
- Haematuria
- Proteinuria
- Hypertension
- Low urine volume
Describe the pathophysiology of ADPKD.
- Caused by mutations in PKD1/PKD2 gene
- This results in alterations in polycystin 1/2 respectively (protein)
- Polycystins regulate tubular and vascular development in the kidney as well as other organs (e.g liver, heart)… This leads to cyst development
- As cysts grow, there is renal enlargement and progressive decline in renal function due to destruction of healthy tissue
Describe the symptoms and signs of ADPKD
Symptoms:
- Acute loin pain (caused by cyst haemorrhage/infection and renal calculi)
Signs:
- Decline in renal function
- Hypertension
- Hepatomegaly
What is the diagnostic investigation for ADPKD?
Abdominal US
Describe the management of ADPKD.
- No cure
- Patient/family counselling
- Frequent monitoring to check disease progression
- Treat complications, e.g. hypertension
- Dialysis for end stage renal failure
What is benign prostatic hyperplasia?
Benign proliferation of the musculofibrous/glandular tissue of the transitional (inner) zone of the prostate due to the effect of dihydrotestosterone
Describe the clinical presentation of BPH.
LUTS!! - separated into ‘storage’ and ‘voiding’ symptoms
What are the ‘storage’ LUTS?
- Urgency
- Frequency
- Nocturia
What are the ‘voiding’ LUTS?
- Urinary retention
- Hesitancy
- Poor stream
- Post-micturition dribbling
- Overflow incontinence
Which investigations are carried out in a case of suspected BPH?
- DRE = smooth and enlarged
- PSA test +/- TRUSS (trans-rectal ultrasound scan) to exclude malignancy
Describe the conservative management of BPH.
Reduce alcohol/caffeine intake
Describe the pharmacological management of BPH.
- 1st line = alpha blocker, e.g. Tamsulosin
- 2nd line = 5-alpha reductase inhibitor, e.g. finasteride
Describe the interventional management of BPH.
- Catheterisation (if urinary retention/overflow incontinence)
- TURP (trans-urethral resection of prostate)
What are the red flag symptoms which may indicate prostate cancer rather than BPH?
- Haematuria
- Bone pain
