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MY REVISION - ALL TO DO 2 > RENAL AND UROGENITAL > Flashcards

RENAL AND UROGENITAL Flashcards

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1
Q

BPH
Describe the treatment for BPH

A

1st line = Alpha-1-antagonists (A-blockers) e.g. tamulosin
- relaxes smooth muscle in bladder neck & prostate

2nd line = 5-alpha-reductase inhibitors e.g. finasteride
- blocks conversion of testosterone to dihydrotestosterone -> decreases prostate size

TURP = gold standard

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2
Q

BPH
What are the indications in someone with BPH to do a TURP?

A

RUSHES

  • Retention
  • UTI’s
  • Stones (in bladder)
  • Haematuria (refractory to medical therapy)
  • Elevated creatinine
  • Symptom deterioration (despite maximal medical therapy)
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3
Q

TESTICULAR CANCER
what are the risk factors for testicular cancer?

A
  1. Cryptorchidism (undescended testes)
  2. Family history
  3. previous testicular cancer
  4. HIV
  5. age 20-45
  6. Caucasian
  7. infant hernia
  8. intersex conditions e.g. kleinfelters syndrome
  9. mumps orchitis
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4
Q

TESTICULAR CANCER
what are the clinical features of testicular cancer?

A

SYMPTOMS
- painless testicular lump
- hyperthyroidism
- gynaecomastia
- bone pain (indicates metastasis)
- breathlessness (indicates lung metastasis)

SIGNS
- firm, non-tender testicular mass (does not transluminate, hydrocele may be present)
- supraclavicular lymphadenopathy

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5
Q

HYDROCELE
Name 3 causes of secondary hydrocele

A
  1. Testicular tumours
  2. Infection
  3. Testicular torsion
  4. TB
  5. trauma - is rarer and present in older boys and men
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6
Q

CKD
How is CKD diagnosed?

A
  • eGFR < 60mL/min/1.73m2,
    or:
  • eGFR < 90mL/min/1.73m2 + signs of renal damage,
    or:
  • Albuminuria > 30mg/24hrs (Albumin:Creatinine > 3mg/mmol)
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7
Q

DIURETICS
On which part of the nephron do thiazides act?

A

The distal tubule Act on NCC channels

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8
Q

DIURETICS
On which part of the nephron do aldosterone antagonists act on?

A

Collecting ducts

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9
Q

AKI
What is the diagnostic criteria for AKI?

A

1/3 = diagnostic

  1. Rise in creatinine >26 mmol/L in 48 hours
  2. Rise in creatinine >1.5 x in last 7 days
  3. Urine output fall to < 0.5 ml/kg/h for more than 6 hours
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10
Q

UTI
What is the first line treatment for an uncomplicated UTI?

A

NON-PREGNANT FEMALE
- 1st line = NITROFURANTOIN (if eGFR>45) or TRIMETHOPRIM for 3 days
- 2nd line = NITROFURANTOIN (if not used 1st line + eGFR>45) or PIVIMECILLINAM or FOSFOMYCIN for 3 days

PREGNANT FEMALE
- 1st line = NITROFURANTOIN (if eGFR>45 + avoid near term) for 7 days
- 2nd line = AMOXICILLIN (only if culture-sensitive) or CEFALEXIN for 7 days

CATHETERISED FEMALE
- 1st line = NITROFURANTOIN or TRIMETHOPRIM for 7 days

MALE
- 1st line = TRIMETHOPRIM or NITROFURANTOIN for 7 days
- 2nd line = AMOXICILLIN (only if culture sensitive) or CEFALEXIN for 7 days

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11
Q

CYSTITIS
What is the treatment for cystitis?

A

1st line = Trimethoprim or nitrofurantoin (avoid trimethoprim in pregnancy -> teratogenic)

2nd line = ciprofloxacin or Co-amoxiclav

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12
Q

PROSTATITIS
How would you treat prostatitis?

A

1st line
- fluoroquinolone antibiotic (CIPROFLOXACIN), alternatives are trimethoprim + ofloxacin
- acute = 2-4 weeks
- chronic = 12 weeks

other treatment
- alpha blockers (TAMSULOSIN)
- NSAIDs
- stool softeners

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13
Q

URETHRITIS
what is the treatment for urethritis?

A

oral doxycycline for 7 days of single dose of azithromycin

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14
Q

PYELONEPHRITIS
Describe the treatment for pyelonephritis

A

MILD DISEASE - ORAL ANTIBIOTICS
- oral cefalexin - 500mg BD or TDS for 7-10 days
- oral ciprofloxacin - 500mg BD for 7 days

SEVERE DISEASE - IV ANTIBIOTICS
- IV gentamicin (dosage based of body weight + renal function)
- IV ciprofloxacin 400mg TDS

ADJUNCT THERAPY
- hydration = oral or IV
- analgesia = PR DICLOFENAC

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15
Q

HYDROCELE
what is communicating hydrocele?

A

processus vaginalis fails to close, allowing peritoneal fluid to communicate with the scrotal portion

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16
Q

POLYCYSTIC KIDNEY
what are the causes of autosomal dominant polycystic kidney disease?

A
  • mutations in PKD1 gene on chromosome 16 = 85%

- mutations in PKD2 gene on chromosome 4

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17
Q

CKD
what is stage 1 CKD?

A

eGFR > 90ml/min

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18
Q

CKD
what is stage 2 CKD?

A

eGFR 60-89ml/min

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19
Q

CKD
what is stage 3a CKD?

A

eGFR 45-59ml/min

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20
Q

CKD
what is stage 4 CKD?

A

eGFR 29-15ml/min

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21
Q

CKD
what is stage 5 CKD?

A

eGFR < 15ml/min

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22
Q

GOODPASTURES
what is the management for goodpasture’s disease?

A

plasma exchange
steroids
cyclophosphamide (for immune suppression)

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23
Q

RENAL PHYSIOLOGY
which part of the loop of henle is permeable to water?

A

descending limb

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24
Q

RENAL PHYSIOLOGY
what is the innervation of the external urinary sphincter?

A

pudendal nerve S2-S4

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25
RENAL PHYSIOLOGY what is the innervation of internal urinary sphincter?
pelvic splanchnic nerve S2-S4
26
RENAL PHYSIOLOGY what is the innervation of the bladder?
``` sympathetic = sympathetic chain T11-L2 parasympathetic = pelvic splanchnic S2-S4 ```
27
CKD what is stage 3b CKD?
eGFR 30-44ml/min
28
DIALYSIS what is the most common causative organism of peritonitis secondary to peritoneal dialysis?
staphylococcus epidermidis s.aureus is another common cause
29
DIALYSIS what is the management of peritonitis secondary to peritoneal dialysis?
vancomycin + ceftazidime added to dialysis fluid OR vancomycin added to dialysis fluid + oral ciprofloxacin
30
EPIDIDYMO-ORCHITIS what is the management?
ANTIBIOTICS - STI related = ceftriaxone 500mg-1g IM single dose + doxycycine 100mg BD for 10-14 days - UTI related = oflaxacin 200mg BD for 14 days or levofoxacin 500mg OD for 10 days SUPPORTIVE CARE - analgesia (paracetamol + NSAIDS) - safety net - referral
31
BLADDER CANCER what are the 2WW referral criteria?
>45 + unexplained visible haematuria without UTI >45 + visible haematuria that persists/recurs after successful treatment of UTI >60 + unexplained microscopic haematuria + dysuria or raised WCC
32
AKI what are the different stages of AKI?
STAGE 1 - Cr rise to 1.5-1.9 x baseline - Cr rise by 26umol/L - fall in urine to <0.5ml/kg/hr for >6hrs STAGE 2 - Cr rise to 2.0-2.9 x baseline - fall in urine output to 0.5ml/kg/hr for >12 hrs STAGE 3 - Cr rise to >3.0 x baseline - Cr rise to >353.6umol/L - fall in urine to <0.3ml/kg/hr for >24hrs - in patients <18yr, fall in eGFR to <35ml/min/1.73m2
33
RENAL CELL CARCINOMA what are the endocrine associations?
EPO = polycythaemia PTH hormone-related peptide (PTHrP) = hypercalcaemia ACTH = cushings syndrome renin
34
URINARY STONES what are the risk factors?
- dehydration - previous kidney stones - stone-forming foods (chocolate, rhubarb, spinach, tea, most nuts) - genetic - crohns disease - hypercalcaemia - hyperparathyroidism - kidney related disease (polycystic kidney) - drugs (loop diuretics, acetazolamide, protease inhibitors) - gout
35
NEPHRITIC SYNDROME what are the findings for IgA nephropathy?
Blood = high IgA titres, normal complement Biopsy = mesangial deposits of IgA complexes
36
NEPHRITIC SYNDROME what are the features of alport's syndrome?
comprises of triad of ophthalmological issues, auditory issues and nephritic syndrome x-linked dominant inheritance
37
NEPHRITIC SYNDROME what are the findings for Alport's syndrome?
- renal biopsy = gold standard (basket-weave appearance under electron microscope) - genetic testing = mutation in alpha chain of type IV collagen
38
NEPHRITIC SYNDROME what are the findings for lupus nephritis?
- loop wire appearance
39
NEPHROTIC SYNDROME what is the classic triad for nephrotic syndrome?
- proteinuria (>3.5g/day) - hypoalbuminaemia (<30g/L) - leads to severe oedema - hyperlipidaemia
40
NEPHROTIC SYNDROME what are the causes?
- minimal change disease (most common in children) - focal segmental glomerulosclerosis - membranous nephropathy - membranoproliferative GN - diabetes - amyloidosis
41
NEPHROTIC SYNDROME what are the findings for minimal change disease?
- light microscopy = normal glomeruli - electron microscopy = effacement of foot processes
42
NEPHROTIC SYNDROME what are the findings for focal segmental glomerulonephritis?
- light microscopy = focal + segmental glomerular sclerosis - electron microscopy = effacement of foot processes
43
NEPHROTIC SYNDROME what are the findings in membranous nephropathy?
- light microsopy = thick glomerular basement membrane - electron microscopy = subepithelial immune complex deposition (spike + dome pattern)
44
NEPHROTIC SYNDROME what are the findings for amyloidosis?
- apple-green birefringence under polarise microscopy with congo red stain
45
RENAL TUBULAR ACIDOSIS what is the blood results for renal tubular acidosis?
hyperchloraemic metabolic acidosis with normal anion gap
46
RENAL TUBULAR ACIDOSIS what is type I RTA?
- defective H+ secretion in distal tubule - causes hypokalaemia
47
RENAL TUBULAR ACIDOSIS what are the causes of type I RTA?
- idiopathic - RA - SLE - Sjogren's - amphotericin B toxicity - analgesic nephropathy
48
RENAL TUBULAR ACIDOSIS what are the complications of type I RTA?
nephrocalcinosis renal stones
49
RENAL TUBULAR ACIDOSIS what is type II RTA?
- decreased HCO3- reabsorption in proximal tubule - causes hypokalaemia
50
RENAL TUBULAR ACIDOSIS what are the causes of type II RTA?
- idiopathic - fanconi syndrome - wilson's disease - cystinosis - outdated tetracyclines - carbonic anhydrase inhibitors (acetazolamide, topiramate)
51
RENAL TUBULAR ACIDOSIS what is type IV RTA?
- reduction in aldosterone leads in turn to reduction in proximal tubular ammonium excretion
52
RENAL TUBULAR ACIDOSIS what are the causes of type IV RTA?
- hyperaldosteronism - diabetes
53
RENAL TUBULAR ACIDOSIS what is the management?
- stop causative medications - treat electrolyte imbalance - Type 1 + 2 = bicarbonate (or potassium citrate) - type 4 = lifelong mineralocorticoid + glucocorticoid replacement
54
ACUTE INTERSTITIAL NEPHRITIS what are the investigations?
URINE - microscopy = pyuria + white cell casts - culture = negative (sterile pyuria) BLOODS - FBC = eosinophilia - U&Es - autoimmune screen IMAGING - renal USS
55
ACUTE INTERSTITIAL NEPHRITIS what is the management?
CONSERVATIVE - stop any causative medications - supportive fluid management - refer to specialist renal services MEDICAL - if autoimmune = steroids - fluid overload = furosemide
56
ACUTE TUBULAR NECROSIS/INJURY what are the investigations?
URINE - dipstick = may be false positive for blood - microscopy = muddy brown granular casts and renal tubular epithelial cells - osmolality = low - urinary sodium = high BLOODs - blood gas - U&Es - urea:creatinine ratio - FBC IMAGING - ECG - USS KUB
57
ACUTE TUBULAR NECROSIS/INJURY what is the management?
CONSERVATIVE - identify + treat cause - avoid nephrotoxic meds - fluid balance monitoring MEDICAL - IV fluids - blood if haemorrhage
58
URINARY STONES what is the management of renal stones?
- < 5mm + asymptomatic = watchful wait - 5-10mm = shockwave lithotripsy - 10-20mm = shockwave lithotripsy or ureteroscopy - >20mm = percutaneous nephrolithotomy
59
URINARY STONES what is the management of uretic stones?
- <10mm = shockwave lithotripsy (+/- alpha blockers) - 10-20mm = ureteroscopy
60
CKD how would you manage proteinuria in CKD?
1. ACEi 2. SGLT-2
61
CKD what change in eGFR and creatinine is acceptable when starting ACEi?
- decrease in eGFR up to 25% - rise in creatinine up to 30%
62
CKD what level of albumin-creatinine ratio (ACR) would you begin treatment for proteinuria?
if ACR > 30mg/mol + HTN if ACR>70mg/mol even without HTN
63
NEPHRITIC SYNDROME what is the management of IgA nephropathy?
no proteinuria = no treatment required proteinuria 0.5-1g/day = ACEi failure to respond to treatment = corticosteroids
64
AKI what are the indications for renal replacement therapy?
AEIOU - acidosis (refractory) - electrolyte imbalance (refractory) - ingestion of toxins - oedema/overload - uraemia (refractory)
65
LUTS what screening tool is used to evaluate LUTS + give a symptom score?
International Prostate Symptom Score
66
PROSTATE CANCER which zone of the prostate is primarily affected?
peripheral zone
67
PROSTATE CANCER what is the 1st line investigation?
multiparametric MRI
68
PROSTATE CANCER how is the Gleason score calculated?
- two most common tumour patterns across all samples are graded based on differentiation - the sum of the two grades is the Gleason score
69
POLYCYSTIC KIDNEY what is the most common inheritance pattern?
autosomal dominant
70
POLYCYSTIC KIDNEYS what is the role of tolvaptan in the treatment of this condition?
- reduce the growth rate of the cysts

MY REVISION - ALL TO DO 2 (24 decks)

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