Renal and Urology Flashcards
(103 cards)
<p>Define benign prostatic hyperplasia.</p>
<p>BPH is multifactorial and involves smooth muscle hyperplasia, prostatic enlargement, and bladder dysfunction, as well as input from the central nervous system.<br></br>Presents with both storage symptoms (frequency, urgency, nocturia, and incontinence) and voiding symptoms (weak stream, dribbling, dysuria, straining).</p>
<p>Explain the aetiology/risk factors of benign prostatic hyperplasia.</p>
<p>Age over 50 years<br></br>Family history<br></br>Non-Asian race<br></br>Cigarette smoking</p>
<p>Summarise the epidemiology of benign prostatic hyperplasia.</p>
<p>The prevalence of histological BPH increases with age, affecting approximately 42% of men between the ages of 51 and 60 years and 82% of men between the ages of 71 and 80 years.</p>
<p>Recognise the presenting symptoms of benign prostatic hyperplasia. Recognise the signs of benign prostatic hyperplasia on physical examination.</p>
<p>Storage symptoms<br></br>Voiding symptoms<br></br>Fever with dysuria<br></br>Urinary retention</p>
<p>Identify appropriate investigations for benign prostatic hyperplasia and interpret the results.</p>
<p>Urinalysis<br></br>PSA<br></br>International Prostate Symptom Score<br></br>Global bother score<br></br>Volume charting</p>
<p>Generate a management plan for benign prostatic hyperplasia.</p>
<p>Alpha blockers e.g. tamsulosin<br></br>5-alpha-reductase inhibitor e.g. finasteride<br></br>Surgical intervention e.g. TURP, laser</p>
<p>Identify the possible complications of benign prostatic hyperplasia and its management.</p>
<p>BPH progression<br></br>Urinary tract infection (UTI)<br></br>Renal insufficiency<br></br>Bladder stones<br></br>Haematuria<br></br>Sexual dysfunction<br></br>Acute urinary retention<br></br>Overactive bladder</p>
<p>Summarise the prognosis for patients with benign prostatic hyperplasia.</p>
<p>The majority of patients with BPH can expect at least moderate improvement of their symptoms with a decreased bother score and improved quality of life.</p>
<p>Define bladder cancer.</p>
<p>Cancer of the bladder. Over 90% of cancers of the urinary bladder are urothelial carcinoma (previously termed transitional cell carcinoma).</p>
<p>Explain the aetiology/risk factors of bladder cancer.</p>
<p>Tobacco exposure<br></br>Exposure to chemical carcinogens e.g. naphthylamine<br></br>Age >55 years<br></br>Pelvic radiation<br></br>Systemic chemotherapy<br></br>Schistosoma infection<br></br>Male sex<br></br>Chronic bladder inflammation<br></br>Positive FHx</p>
<p>Summarise the epidemiology of bladder cancer.</p>
<p>Bladder cancer ranks ninth in worldwide cancer incidence. It is the seventh most common cancer in men and the 17th most common cancer in women. Globally, the incidence of bladder cancer varies significantly, with Egypt, Western Europe, and North America having the highest incidence rates and Asian countries the lowest rates.</p>
<p>Recognise the presenting symptoms of bladder cancer. Recognise the signs of bladder cancer on physical examination.</p>
<p>Haematuria (gross or microscopic)<br></br>Dysuria<br></br>Urinary frequency</p>
<p>Identify appropriate investigations for bladder cancer and interpret the results.</p>
<p>Urinalysis</p>
<p>Define chronic kidney disease (CKD).</p>
<p>Chronic kidney disease (CKD), also known as chronic renal failure, is defined by either a pathological abnormality of the kidney, such as haematuria and/or proteinuria, or a reduction in GFR to <60 mL/minute/1.73 m² for ≥3 months' duration.</p>
<p>Explain the aetiology/risk factors of chronic kidney disease (CKD).</p>
<p>Explain the aetiology/risk factors of chronic kidney disease (CKD).</p>
<p>Summarise the epidemiology of chronic kidney disease (CKD).</p>
<p>This is a common condition that is often unrecognised until the most advanced stages. It is estimated that 11% of the adult population worldwide has CKD.</p>
<p>Recognise the presenting symptoms of chronic kidney disease (CKD). Recognise the signs of chronic kidney disease (CKD) on physical examination.</p>
<p>Presence of risk factors<br></br>Fatigue<br></br>Oedema<br></br>Nausea with/without vomiting<br></br>Pruritus<br></br>Anorexia<br></br>Arthralgia<br></br>Enlarged prostate gland</p>
<p>Identify appropriate investigations for chronic kidney disease (CKD) and interpret the results.</p>
<p>Serum creatinine<br></br>Urinalysis<br></br>Urine microalbumin<br></br>Renal ultrasound<br></br>Estimation of GFR</p>
<p>Define epididymitis.</p>
<p>Epididymitis is an inflammation of the epididymis characterised by scrotal pain and swelling of less than 6 weeks' duration. It may be associated with irritative lower urinary tract symptoms, urethral discharge, and fever. It is usually unilateral.</p>
<p>Explain the aetiology/risk factors of epididymitis.</p>
<p>Unprotected sexual intercourse<br></br>Bladder outflow obstruction<br></br>Instrumentation of urinary tract</p>
<p>Summarise the epidemiology of epididymitis.</p>
<p>The most common cause of acute scrotal pain is epididymitis. In the UK, the reported incidence was 2.45 cases per 1000 men between 2003 and 2008.</p>
<p>Recognise the presenting symptoms of epididymitis. Recognise the signs of epididymitis on physical examination.</p>
<p>Presence of risk factors<br></br>Age >19 years<br></br>Unilateral scrotal pain and swelling of gradual onset<br></br>Symptoms <6 weeks' duration<br></br>Tenderness<br></br>Hot, erythematous, swollen hemiscrotum</p>
<p>Identify appropriate investigations for epididymitis and interpret the results.</p>
<p>Gram stain of urethral secretions<br></br>Urine dipstick test<br></br>Urine microscopy<br></br>Urine culture<br></br>Nucleic acid amplification test (NAAT) of urethral secretions or first-void urine for Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium<br></br>Culture of urethral secretions</p>
<p>Generate a management plan for epididymitis.</p>
<p>Antibiotic therapy</p>
Identify the possible complications of epididymitis and its management.
Abscess formation
Testicular ischaemia/infarction
Epididymal obstruction
Chronic pain following epididymitis
Male factor infertility
Summarise the prognosis for patients with epididymitis.
In men with infectious acute epididymitis, symptoms usually resolve rapidly following the initiation of appropriate antibiotic therapy. Inadequately treated infectious epididymitis, particularly sexually transmitted infection, can in rare cases lead to epididymal obstruction or testicular atrophy and subsequent infertility problems.
Define glomerulonephritis.
Glomerulonephritis (GN) denotes glomerular injury and applies to a group of diseases that are generally, but not always, characterised by inflammatory changes in the glomerular capillaries and the glomerular basement membrane (GBM).
Explain the aetiology/risk factors of glomerulonephritis.
Group A beta-haemolytic Streptococcus
Respiratory infections
Gastrointestinal infections
Hepatitis B
Hepatitis C
Infective endocarditis
HIV
Systemic lupus erythematosus (SLE)
Systemic vasculitis
Hodgkin's lymphoma
Lung cancer
Colorectal cancer
Non-Hodgkin's lymphoma
Leukaemia
Thymoma
Haemolytic uraemic syndrome
Drugs
Summarise the epidemiology of glomerulonephritis.
For every patient with clinically apparent GN, approximately 5 to 10 patients have undiagnosed subclinical disease. In the US and Europe, GN is the third commonest cause of end-stage renal disease (ESRD), after diabetes and hypertension.
Recognise the presenting symptoms of glomerulonephritis. Recognise the signs of glomerulonephritis on physical examination.
Haematuria
Oedema
Hypertension
Oliguria
Anorexia
Nausea
Malaise
Weight loss
Fever
Skin rash
Arthralgia
Haemoptysis
Abdominal pain
Sore throat
Identify appropriate investigations for glomerulonephritis and interpret the results.
Urinalysis
Comprehensive metabolic profile
Glomerular filtration rate (GFR)
Full blood count
Lipid profile
Spot urine albumin:creatinine ratio (ACR)
Ultrasound of kidneys
Define hydrocoele.
A hydrocele is a collection of serous fluid between the layers of the membrane (tunica vaginalis) that surrounds the testis or along the spermatic cord.
Explain the aetiology/risk factors of hydrocoele.
Male sex
Prematurity and low birth weight
Infants <6 months of age
Infants whose testes descend relatively late
Increased intraperitoneal fluid or pressure
Inflammation or injury within the scrotum
Testicular cancer
Connective tissue disorders
Summarise the epidemiology of hydrocoele.
Hydroceles predominantly occur in males and are rare in females. They are common in male infants and children and in many cases are associated with an indirect inguinal hernia.
Recognise the presenting symptoms of hydrocoele. Recognise the signs of hydrocoele on physical examination.
Presence of risk factors
Scrotal mass
Transillumination
Enlargement of scrotal mass following activity
Variation in scrotal mass during the day
Identify appropriate investigations for hydrocoele and interpret the results.
Clinical diagnosis
Ultrasound
Define nephrotic syndrome.
Nephrotic syndrome is defined as the presence of proteinuria (>3.5 g/24 hours), hypoalbuminemia (<30 g/L), and peripheral oedema.
Explain the aetiology/risk factors of nephrotic syndrome.
Diabetes
Lupus
Amyloidosis
Other kidney diseases.
NSAID use
HIV
Hepatitis B/C
Malaria
Summarise the epidemiology of nephrotic syndrome.
Nephrotic syndrome is one of the most common chronic renal diseases in children. It has an incidence of 2 to 7 per 100,000 population and a prevalence of 16 per 100,000 population, well above the 1 per 1 million incidence of chronic renal failure in children.
Recognise the presenting symptoms of nephrotic syndrome. Recognise the signs of nephrotic syndrome on physical examination.
Oedema
Foamy urine
Proteinuria
Weight gain due to excess fluid retention
Fatigue
Loss of appetite
Xanthelasma
Xanthomata
Hypertension
Hepatomegaly
Identify appropriate investigations for nephrotic syndrome and interpret the results.
Urine dipstick
Blood microscopy
FBC
U+Es
LFT
ESR
CRP
24 hour urine collection
Renal USS
Define polycystic kidney disease.
Polycystic kidney disease (PKD) is part of a heterogeneous group of disorders characterised by renal cysts and numerous systemic and extrarenal manifestations. There are 2 types: autosomal-dominant PKD (ADPKD) and autosomal-recessive PKD (ARPKD). This monograph concentrates on ADPKD, the more common form.
Explain the aetiology/risk factors of polycystic kidney disease.
Family history of autosomal-dominant PKD (ADPKD)
Family history of cerebrovascular event
Summarise the epidemiology of polycystic kidney disease.
Autosomal-dominant PKD (ADPKD) occurs worldwide and in all races. Prevalence in the US is estimated to be between 1 in 400 (including observed and estimated autopsy cases) and 1 in 1000 (clinically diagnosed cases only).
Recognise the presenting symptoms of polycystic kidney disease. Recognise the signs of polycystic kidney disease on physical examination.
Family history of autosomal-dominant PKD (ADPKD) or end-stage renal disease (ESRD)
Family history of cerebrovascular event
Renal cysts
Hypertension
Abdominal/flank pain
Haematuria
Palpable kidneys/abdominal mass
Headaches
Dysuria, urgency, suprapubic pain, fever
Cardiac murmur
Abdominal hernia or rectus abdominis diastasis
Hepatomegaly
Identify appropriate investigations for polycystic kidney disease and interpret the results.
Renal ultrasound
CT scan of abdomen/pelvis
MRI of abdomen/pelvis
Urinalysis/Gram stain and urine culture
Serum electrolytes, urea, creatinine
Fasting lipid profile
ECG
CT scan of brain
Define prostate cancer.
A malignant tumour of glandular origin, situated in the prostate. It is most commonly seen in older men; between 2011 and 2015 the median age at diagnosis in the US was 66 years.
Explain the aetiology/risk factors of prostate cancer.
Age >50 years
Black ethnicity
North American or northwest European descent
Family history of prostate cancer
High levels of dietary fat
Summarise the epidemiology of prostate cancer.
Between 2011 and 2015, the median age at diagnosis of prostate cancer was 66 years. The age-adjusted incidence rate during the same period was 112.6 per 100,000 men per year.
Recognise the presenting symptoms of prostate cancer. Recognise the signs of prostate cancer on physical examination.
Elevated prostate-specific antigen (PSA)
Nocturia
Urinary frequency
Urinary hesitancy
Dysuria
Abnormal digital rectal examination
Identify appropriate investigations for prostate cancer and interpret the results.
Serum prostate-specific antigen (PSA)
Testosterone
LFTs
FBC
Renal function
Prostate biopsy
Define renal artery stenosis.
Renal artery stenosis (RAS) is a narrowing of the renal artery lumen. It is considered angiographically significant if more than a 50% reduction in vessel diameter is present.
Explain the aetiology/risk factors of renal artery stenosis.
Dyslipidaemia
Smoking
Diabetes
Summarise the epidemiology of renal artery stenosis.
RAS has a prevalence of 0.2% to 5% in all hypertensive patients. Atherosclerotic RAS accounts for 90% of all RAS. Prevalence is as high as 25% in patients with CAD undergoing cardiac catheterisation. Two percent of end-stage renal disease (ESRD) is due to ischaemic nephropathy.
Recognise the presenting symptoms of renal artery stenosis. Recognise the signs of renal artery stenosis on physical examination.
Onset of hypertension age >55 years
History of accelerated, malignant, or resistant hypertension
History of unexplained kidney dysfunction
History of multi-vessel coronary artery disease
History of other peripheral vascular disease
Abdominal bruit
Sudden or unexplained recurrent pulmonary oedema
Identify appropriate investigations for renal artery stenosis and interpret the results.
Serum creatinine
Serum potassium
Urinalysis and sediment evaluation
Aldosterone-to-renin ratio
Duplex ultrasound
CT angiography
Define renal calculi.
Renal calculi refers to the presence of crystalline stones within the urinary system (kidneys and ureter).
Explain the aetiology/risk factors of renal calculi.
High protein intake
High salt intake
White ancestry
Male sex
Dehydration
Obesity
Crystalluria
Summarise the epidemiology of renal calculi.
The lifetime prevalence of renal calculi is estimated to be between 5% and 12%, with the probability of having a stone varying according to age, gender, race, and geographical location. Renal calculi typically affects adult men more commonly than adult women, with a male to female ratio of 2 or 3:1.
Recognise the presenting symptoms of renal calculi. Recognise the signs of renal calculi on physical examination.
Acute, severe flank pain
Previous episodes of nephrolithiasis
Nausea and vomiting
Urinary frequency/urgency
Haematuria
Testicular pain
Obesity
Identify appropriate investigations for renal calculi and interpret the results.
Low radiation CT KUB
Pelvic USS
Urinalysis
FBC
Serum electrolytes, urea, and creatinine
Urine pregnancy test
Stone analysis
Generate a management plan for renal calculi.
Conservative management
Surgical decompression and management:
ESWL
PCNL
Laser
Identify the possible complications of renal calculi and its management.
Post PCNL bleeding
Post ESWL haematoma
Post-ESWL, PCNL, or ureteroscopy treatment urosepsis
Post-ESWL steinstrasse
Post-ESWL, PCNL, or ureteroscopy ureteric injury
Visceral organ injury
Pneumothorax
Ureteric stricture
Summarise the prognosis for patients with renal calculi.
The rate of recurrence of renal calculi in first-time stone formers is 50% at 5 years and 80% at 10 years. The patients at highest risk for recurrence are frequently those who are not compliant with medical therapy and dietary/lifestyle modifications, or where underlying metabolic abnormalities exist. Residual stone fragments from surgery will usually spontaneously pass as long as their size is <4 mm.
Define renal cell carcinoma.
Renal cell carcinoma (RCC) is renal malignancy arising from the renal parenchyma/cortex, and accounts for about 85% of renal cancers.
Explain the aetiology/risk factors of renal cell carcinoma.
Smoking
Male sex
Age 55 to 84 years
Residence in developed countries
Black/American-Indian ethnicity
Obesity
Hypertension
Positive family history (FHx) of RCC
History of hereditary syndromes
History of acquired renal cystic disease
Summarise the epidemiology of renal cell carcinoma.
The majority (85%) of renal malignancies are RCC (arising from the renal cortical parenchyma). RCC accounts for 2% to 3% of all new cancers globally, and, depending on geographic region and gender, is the 6th to 8th most common adult malignancy.
Recognise the presenting symptoms of renal cell carcinoma. Recognise the signs of renal cell carcinoma on physical examination.
Asymptomatic (incidental finding)
Haematuria
Flank pain
Palpable abdominal mass
Identify appropriate investigations for renal cell carcinoma and interpret the results.
FBC
LDH
Corrected calcium
Liver function tests (LFTs)
Coagulation profile
Creatinine
Urinalysis
Abdominal/pelvic ultrasound
CT abdomen/pelvis
MRI abdomen/pelvis
Define testicular cancer.
Cancer of the testicles. The most common malignancy in young adult men (20 to 34 years of age), and highly curable when diagnosed early.
Explain the aetiology/risk factors of testicular cancer.
Cryptorchidism
Gonadal dysgenesis
Family history of testicular cancer
Personal history of testicular cancer
Testicular atrophy
White ethnicity
HIV infection
Summarise the epidemiology of testicular cancer.
Incidence of testicular cancer varies with geography. Across Northern Europe, incidence rates vary from 7.8 per 100,000 in Denmark to 0.9 per 100,000 in Lithuania.
Recognise the presenting symptoms of testicular cancer. Recognise the signs of testicular cancer on physical examination.
Age 20 to 34 years
Testicular mass
Extratesticular manifestation
Identify appropriate investigations for testicular cancer and interpret the results.
Ultrasound (colour Doppler) of testis
CT scan (abdomen and pelvis)
Serum beta-human chorionic gonadotrophin (beta-hCG)
Serum alpha-fetoprotein (AFP)
Serum lactate dehydrogenase (LDH)
Define testicular torsion.
Testicular torsion is a urological emergency caused by the twisting of the testicle on the spermatic cord leading to constriction of the vascular supply and time-sensitive ischaemia and/or necrosis of testicular tissue.
Explain the aetiology/risk factors of testicular torsion.
Age under 25 years
Neonate
Bell clapper deformity
Trauma/exercise
Intermittent testicular pain
Undescended testicle
Cold weather
Summarise the epidemiology of testicular torsion.
In males <25 years of age, the annual incidence of torsion is 1 in 4000 in the US. Torsion can be seen at any age but it is not generally a disease affecting the elderly.
Recognise the presenting symptoms of testicular torsion. Recognise the signs of testicular torsion on physical examination.
Testicular pain
Intermittent or acute on-and-off pain
No pain relief upon elevation of scrotum
Scrotal swelling or oedema
Scrotal erythema
Reactive hydrocele
High-riding testicle
Horizontal lie
Nausea and vomiting
Abdominal pain
Identify appropriate investigations for testicular torsion and interpret the results.
Grey-scale ultrasound
Power Doppler ultrasound
Colour Doppler ultrasound
Generate a management plan for testicular torsion.
Manual de-torsion followed by surgical testicular exploration
Identify the possible complications of testicular torsion and its management.
Infarction of testicle/permanent testicular damage/loss of testicles
Infertility secondary to loss of testicle
Psychological implication of losing a testis
Cosmetic deformity
Recurrent torsion
Impaired pubertal development (significant or bilateral testicular loss)
Summarise the prognosis for patients with testicular torsion.
The adage 'time is testicle' applies to patients with testicular torsion because the longer it takes for diagnosis and definitive repair, the greater the likelihood that the patient will develop tissue necrosis, decreased tissue viability, decreased spermatogenesis, and possible infertility.
Define urinary tract infection in men.
Urinary tract infection (UTI) is an inflammatory reaction of the urinary tract epithelium in response to pathogenic microorganisms, most commonly bacteria.
Explain the aetiology/risk factors of urinary tract infection in men.
Benign prostatic hypertrophy
Urinary tract stones
Urological surgery, instrumentation
Urethral strictures
Age >50
Previous UTI
Catheterisation
Summarise the epidemiology of urinary tract infection in men.
Combined data for men and women from all patient-care settings identify urinary tract infection (UTI) as the most common infection, and it is the second most common infection among non-institutionalised patients.
Recognise the presenting symptoms of urinary tract infection in men. Recognise the signs of urinary tract infection in men on physical examination.
Dysuria
Urgency
Frequency
Suprapubic pain
Hesitancy
Nocturia
Enlarged prostate
Identify appropriate investigations for urinary tract infection in men and interpret the results.
Dipstick urinalysis
Urine microscopy
Urine culture
Generate a management plan for urinary tract infection in men.
Antibiotics e.g. nitrofurantoin, trimethoprim, ceftriaxone, cefalexin
Identify the possible complications of urinary tract infection in men and its management.
Renal function impairment
Prostatitis
Pyelonephritis
Sepsis
Summarise the prognosis for patients with urinary tract infection in men.
Younger men with UTI less often have complicated infection. In the absence of a complicated UTI, antibiotic therapy is more effective and results in fewer failures. Younger men have a good prognosis.
Define urinary tract infection in women.
A urinary tract infection (UTI) is an infection of the kidneys, bladder, or urethra. Infectious cystitis is the most common type of UTI, which is caused by a bacterial infection of the bladder. E.Coli is the most common organism responsible.
Explain the aetiology/risk factors of urinary tract infection in women.
Sexual activity
Spermicide use
Post-menopause
Positive family history of UTIs
History of recurrent UTI
Presence of a foreign body
Summarise the epidemiology of urinary tract infection in women.
Ten percent of women aged older than 18 years report at least one suspected UTI every 12 months. Approximately 20% to 40% of women with an initial UTI develop recurrent UTI. UTIs are among the most common conditions encountered in primary care, hospitals, and extended care facilities.
Recognise the presenting symptoms of urinary tract infection in women. Recognise the signs of urinary tract infection in women on physical examination.
Dysuria
Polyuria
Fever
Haematuria
Back/flank pain
Costovertebral angle tenderness
Identify appropriate investigations for urinary tract infection in women and interpret the results.
Urine dipstick
Urine microscopy
Urine culture and sensitivity
Generate a management plan for urinary tract infection in women.
Course of antibiotics e.g. nitrofurantoin, trimethoprim, ceftriaxone, cephalexin
For recurrent UTIs, consider longer course of low dose antibiotics.
Hiprex, anti-bacterial
Lifestyle management
Identify the possible complications of urinary tract infection in women and its management.
Sepsis
Renal and perirenal abscess
Acute kidney injury
Emphysematous pyelonephritis
Xanthogranulomatous pyelonephritis (XGP)
Summarise the prognosis for patients with urinary tract infection in women.
Prognosis for UTIs in women is excellent. With appropriate antimicrobial treatment and resolution of symptoms, there is unlikely to be long-term sequelae.
Define varicocele.
A varicocele is the abnormal dilation of the internal spermatic veins and pampiniform plexus that drain blood from the testis.
Explain the aetiology/risk factors of varicocele.
Somatometric parameters (tall/low BMI)
FHx of varicocele
All of these risk factors are quite weak though.
Summarise the epidemiology of varicocele.
It has been estimated that between 10% and 15% of men and adolescent boys in the general population have varicocele. However, the true incidence of adolescent varicoceles may be under-reported, as most teens are not routinely examined in the upright position.
The majority (>80%) of adult varicoceles are not associated with infertility. Ninety percent of varicoceles are on the left side, while approximately 10% are bilateral.
Recognise the presenting symptoms of varicocele. Recognise the signs of varicocele on physical examination.
Painless scrotal mass
Left-sided signs/symptoms
Small testicle
Infertility
Identify appropriate investigations for varicocele and interpret the results.
Clinical diagnosis is usually sufficient.
