Renal GU FCM Flashcards
(120 cards)
1
Q
what is the most common form of bladder cancer
A
transitional cell carcinoma
others include squamous cell and adenocarcinoma
2
Q
How does bladder cancer present?
A
haematuria dysuria urinary frequency lower back, pelvic or lower abdominal pain weight loss/fatigue
3
Q
How can bladder cancer be investigated?
A
Cytoscopy - look inside bladder (+take a biospy).
urinanalysis and CT scans can also be useful
4
Q
What does management of bladder cancer involve?
A
dependent on stage of bladder cancer
low grade - surgical removal may be favoured if it hasn’t metastasised.
IV or systemic chemotherapy
other options include radiotherapy, immunotherapy or targeted therapy
5
Q
what are most prostate cancers?
A
adenocarcinomas
6
Q
How can prostate cancer/carcinoma present?
A
unexplained. ..
- lower back pain
- lethargy
- erectile dysfunction
- hematuria
Weight loss and also lower urinary tract symptoms - hesitancy, frequency, urgency, terminal dribbling and/or overactive bladder.
7
Q
What examinations/investigations are done when prostate cancer is suspected?
A
DRE (physical rectal exam)
PSA testing
Transrectal US + biopsy
(additional MRI imaging)
8
Q
How is prostate cancer managed?
A
dependent on the prognostic risk accounting for the clinical staging, PSA test and Gleason score.
TNM Stage
1 = watchful waiting/active surveillance
2 = radical treatment - radical prostectomy, external beam radiotherapy and brachytherapy
3 = adjunctive & palliative treatment - chemo & hormonal therapy
things to consider = pt age & preference, co-morbidities,
9
Q
Where does renal cell carcinomas originate?
A
in the lining of the proximal convoluted tubule
commonest type of kidney cancer in adults
10
Q
What does renal cell carcinoma present with?
A
hematuria persistent back or flank pain loss of appetite/unexplained weight loss tiredness & possibly fevers excessive hair growth in women lump in the abdomen and flank.
11
Q
How is renal cell carcinoma investigated?
A
CT scan
abdominal or kidney US + biopsy
Urine examination
FBC, LDH, LFTs
12
Q
How is renal cell carcinoma managed?
A
Dependent on the stage
Earlier stages may indicate surgical intervention - removing tumour via partial/full nephrectomy alongside some adjunctive therapy
cryoablation and radio-frequency ablation
Targeted therapy/immunotherapy or radiation therapy
13
Q
What is key about Wilm’s tumour?
A
a kidney cancer which primarily affects children
14
Q
How does Wilm’s tumour present?
A
constipation abdo pain/discomfort or abdo swelling nausea & vomiting weakness, fatigue and loss of appetite fever and SOB hematuria, HTN palpable abdominal mass
15
Q
How is wilm’s tumour investigated?
A
Abdo X-ray/ US + biopsy
blood and urine tests
16
Q
How is Wilm’s managed?
A
in non-metastatic cases the main treatments include
- surgery (nephrectomy)
- chemotherapy
- radiation therapy
17
Q
What are the 2 types of testicular cancer?
A
Seminoma = older age/gradual onset Non-seminoma = younger age/ more agressive/acute onset
18
Q
How will testicular cancer present?
A
testicular pain or discomfort /dull ache
testicular swelling
lower abdo/back pain
enlargement of breast tissue - gynaecomastia
lump/enlargement within either testes
heaviness in scrotum
sudden collection of fluid in scrotum
19
Q
How is testicular cancer investigated?
A
male genitalia examination
US to examine internal structure of testes
Blood tests - B-chorionic gonadotropin and a-fetoprotein (usually elevated)
20
Q
What does management of testicular cancer involve?
A
surgery to remove the testicles and sometimes the nearby lymph nodes
radiation therapy/chemotherapy used either prior ot in adjunct to surgery
21
Q
How does benign prostatic hyperplasia (BPH) present?
A
urinary urgency or frequency nocturia difficulty initiating urination weak stream - intermittence terminal dribbling inability to completely empty bladder associated with UTIs or hematuria
22
Q
how is BPH examined and investigated?
A
PR Exam - check prostate enlargement
Urine test - rule out infections
Blood tests - U&E to check renal function
PSA blood test - usually raised in BPH
23
Q
How is BPH managed?
A
usually started on alpha-blockers which makes urinating easier 5-alpha reductase inhibitors prevent hormone changes or Tadalafil (PDE5 inhibitor)
minimally invasive/surgical therapy or laser therapies
- prostatic urethral lift
- embolisation
24
Q
How does acute Glomerulonephritis present?
A
puffiness in face urinating less often hematuria/dark coloured urine fluid in lungs - presents as a cough high BP
25
How does chronic Glomerulonephritis present?
```
swelling in face and ankles
frequent nocturia
abdominal pain
frequent epistaxis
bubbly/foamy urine
```
26
How do we investigate glomerulonephritis?
- urine tests
- blood -creatinine and Blood urea nitrogen (BUN)
- imaging tests
- biopsy - determine cause & confirm diagnosis
27
How do we manage glomerulonephritis?
dependent on the extent of GN and the underlying cause
antibiotics in infective cases
Control HTN using ACEi or ARBs
chronic GN may involve dietary changes and taking diuretics to reduce oedema
corticosteroid given to suppress and autoimmune attacks
28
What can cause glomerulonephritis?
Infections
Immune diseases
Scarring due to HTN, DM or focal segmental glomerulosclerosis
Vasculitis
29
What are the 2 main characteristic of an AKI (/acute renal failure)?
Abnormal increase in creatinine
| Drop in urine output
30
What are the causes of AKI divided into? what do each involve?
Pre-renal - reduced perfusion to the kidneys causing GFR to drop. examples include Hypovolemia, lower CO and antihypertensives
Renal - toxins & drugs, vascular conditions, abnormalities in glomerulus, tubular problems or interstitial problems
Post-renal - mainly due to obstruction. examples include stones, blocked catheter or enlarged prostate.
31
How does AKI present?
- decreased urine output
- fluid retention = swelling of legs, ankles and feet
- SOB, chest pain/pressure
- nausea or coma in severe cases
- creatinine rise of 26mmol/L within 48hrs
32
How do we investigate an AKI?
measure urine output - monitor over 24hrs
urine tests/ urinalysis
Blood tests - rapidly rising levels of urea & creatinine
imaging - US or CT to look for any structural abnormalities
Biopsy - guides/confirms diagnosis as well as aiding staging of AKI
33
How is AKI managed?
based upon cause - start by managing any of the underlying causes
offer supportive tx on maintaining hydration
consider stopping any nephrotoxic medication
close monitoring of creatinine
diuretics to reduce swelling,
34
what is classified as chronic renal failure/kidney disease?
reduction in renal function, structural damage or both presenting fro 3 months with associated health implications
35
what are some causes of CKD?
```
Type 1 &2 diabetes
HTN
Glomerulonephritis
Polycystic kidney disease
Prolonged obstruction
vesicoureteral reflux
recurrent UTI
```
36
How does CKD present?
```
nausea & vomiting
loss of appetite
fatigue & weakness
persistent itching
sleep problems/insomnia
swelling in feet/ankles
changes to urine output
decreased mental 'sharpness'
SOB, chest pain
muscle twitching
```
37
How is CKD investigated?
Blood test - U&Es
urine tests
Imaging tests
Biospy
38
How is CKD managed?
identify and treat underlying cause
monitoring of renal function - creatinine, eGFR, ACR
dialysis
renal replacement therapy - definitive
39
What characterises nephritic syndrome?
| what causes it?
nephritic syndrome is characterised by hematuria
also has mild proteinuria and very high BP (malignant HTN)
cause = endothelial wall damage mediated by immune-complex formation (IgA nephropathy)
post infection, lupus, infective endocarditis
40
what characterises nephrotic syndrome?
| what causes it?
involves heavy proteinuria (>3.5g/day)
hypoalbuminaemia and fluid overload
causes = structural damage to slit diaphragm, foot processes and depleting in podocyte numbers
41
How does nephritic syndrome present?
```
Haemturia
oedema
reduced urine output
uraemic symptoms - fatigue and tiredness
HTN, Oliguria
```
42
how does Nephrotic syndrome present?
```
oedema
frothy urine
fatigue
poor appetite
recurrent infections
SOB
```
43
How is nephritic syndrome investigated?
urine dipstick - leukocytes,protein and blood
urine ACR
acute renal screen
*Acute renal screen = tests measure the amounts of various substances, including several minerals, electrolytes, proteins, and glucose (sugar), in the blood to determine the current status of the kidneys*
44
How is nephrotic syndrome investigated?
urine ACR
| Acute renal screen
45
How is nephritic syndrome managed?
urgent renal referral
BP control +/- diuresis
treat underlying cause once confirmed on biopsy
46
How is nephrotic syndrome managed?
```
dependent on the underlying cause
often
- BP management
- diuresis
- prophylaxis against VTE
```
aim to reduce proteinuria
47
What is balanitis?
inflammation of the glans penis which can result from infection, trauma or be premalignant as well as from some form of dermatitis/psoriasis
48
how does balanitis present?
penile soreness/itch
dysuria and dyspareunia
redness and swelling of glans penis
inability to retract/ lightening foreskin
meatal stensis - suggests lichens sclerosis
bleeding from foreskin/ odour
49
How is balanitis investigated?
male genitalia exam
consider STI screen
HbA1c to assess diabetes or underlying HIV
can perform sub-preputial swab
50
How is balanitis managed?
dependent on cause
- if dermatitis = give topical hydrocortisone
- if candidal = imidazole cream
- if bacterial = oral flucloxacilin - clarithromycin if contraindicated
- anaerobic causes = metronidazole
51
How does prostatitis present?
```
UTI like symptoms = dysuria, frequency & urgency
lower back pain
pain on ejaculation
fever
tachycardia
perineal, penile or rectal pain
```
52
How is prostatitis investigated?
abdo/genitalia and rectal examination
MSU sample for dipstick to check for infection
Bloods - FBC (PSA)
Consider STI screen
53
How is prostatitis managed?
oral ciprofloxacin for 14days or Levofloxacin
advise analgesia for pain and fevers
advise adequate hydration
follow up after 48hrs and review in 14 days
emergency admission if...
- unable to take oral Abx
- severe symptoms or septic signs
- Diabetic or have a serious urological condition
54
What does epididymitis present with?
```
swollen, red or warm scrotum
testicular pain and tenderness
dysuria, urgency and frequency
penile discharge
lower abdo/pelvic pain
blood in semen
```
55
How would epididymitis be investigated?
abdo and genitalia examinations
Bloods - FBC, CRP, ESR
consider STI screen
US to rule out testicular torsion
56
How is epididymitis managed?
unknown organism = ceftriaxone 1g IM plus oral doxycycline BD 10-14days OR oral orfloxacin BD 14/7
Chlamydia organism = oral Doxycyline BD for 10-14/7
or oral orfloxacin BD 14days
Enteric organism (E.Coli) = Orfloxacin BD 14/7 OR levofloxacin PO BD 10 days
advise - bedrest, scrotal elevation, cold packs, analgesia, supportive underwear
57
What does urethritis present like in men?
mucopurulent & purulent urethral discharge
itching/burning sensation near the opening of the penis
presence of blood in semen
penile irritation/ discomfort
58
What does urethritis present like in women?
frequent discomfort and burning sensation
| abnormal discharge
59
What investigations should be done for suspected urethritis?
genitalia/abdominal examinations
urine samples or swabs may be taken
blood tests for infection/screen for UTI
60
How is urethritis managed?
usually antibiotics including doxycycline, azithromycin or orfloxacin
analgesia
STI notification and contact tracing - sexual abstinence
61
What does pylonephritis ?
main triad:
unilateral flank/loin pain
nausea and vomiting
fever
other presentations
- new myalgia/flu-like symptoms
- tenderness in ribs/flanks
62
How can we investigate pylonephritis?
MSU/CSU - determine infecting organism
dipstick - nitrites and leukocytes
abdo examination
63
How is pylonephritis managed?
offer antibiotics - cefalexin first line
others include co-amoxiclav, trimethoprim or ciprofloxacin (based on sensitivities)
analgesia
avoid dehydration & advise keeping hydrated
reassess in 48hrs for effectiveness of antibiotics
septic signs - hospital admission
64
How does urinary incontinence present?
```
occasional, minor leaks of urine
usually when doing some form of activity
sudden urge to urinate
strain to pass, intermittent stream
feeling incomplete passing of urine
```
65
How is urinary incontinence investigated?
perform a general examination - check weight, gait, neurological disease
pelvic examination - check for any prolapse and check pelvic muscle tone bimanually
urinalysis - check for any infection
post-voidal residue - catheter or US used to check how much urine retained in bladder after voiding
66
How is urinary incontinence managed?
1. lifestyle advice - reducing caffeine, fluid intake, weight loss and smoking cessation
2. behavioural techniques - bladder training (delaying urge) and scheduling toilet trips
3. offer referral for 3 months of supervise pelvic floor muscle training
5. consider Absorbent containment products, hand-held urinals, and toileting aids
4. conservative Tx fails = refer to special urologist, urogynaecologist
5. offer duloxetine as 2nd line (anti-depressant)
for UUI - offer oxybutynin, tolterodine/darifenacin as 1st line OR mirabegron if other contraindicated
67
What does cryptorchidism presented with?
testicular asymmetry
| scrotal hyperplasia or asymmetry
68
How is cryptorchidism investigated/examined?
usually diagnosed with clinical examination
| sometimes US used if clinician is unsure
69
How is cryptorchidism managed?
suspected undescended testes in dependent on the location & presence of testes
specialist management - includes surgical Tx/hormonal Tx
70
What does the varicocele present?
painless swelling - usually on left side
feels like a 'bag of worms'
sometimes scrotal groin pain
ages in 12yrs +
Disappears on lying and reappears on standing.
71
What does the hydrocele present?
fluctuant, ovoid swelling enveloping the testis
may experience some discomfort/heaviness
common in neonates
72
How are varicoceles investigated/examined?
usually clinical diagnosis
US with colour flow
Doppler semen analysis
73
How are hydroceles investigated?
blood urine tests
US
transillumination
74
How is varicocele managed?
Subclinical or grade I varicocele - no Tx necessary
Grade II/III and asymmetrical testes - Observe with annual examinations
offer semen analysis if fertility is a concern
Grade II/III or symptomatic varicocele and abnormal semen parameters - refer to urologist for possible surgery
75
How does Urothialiasis present?
```
pain in lower abdomen or groin
pain in testicles for males
high temperature
severe pain that comes and goes and sweating
nausea and vomiting
haematuria
```
76
How is urolithiasis investigated?
blood tests - calcium/uric acid
urine testing
imaging CT, abdo, x-rays US
analysis of passed stones
77
What does management of urolithiasis involve?
Conservative - watchful waiting to see if there is spontaneous passing of stones
medical management - alpha-blockers (tamsulosin) & NSAIDs for pain
Surgical management - shockwave lithotripsy - to break stone down into fragments making it easier to pass
78
What does paraphimosis involve?
A condition affecting males who are uncircumcised - foreskin which can no longer be pulled forward - becomes stuck and swollen
79
How does paraphimosis present?
inability to return the foreskin back to its normal position
foreskin has become swollen and painful
tip of penis may become discoloured = (dark red/blue) due to lack of blood flow
80
How is the paraphimosis managed?
treatment varies depending on age or severity
1. treat/reduce the swelling by applying ice packs, bandaging tightly around the area
2. needles to drain any pus/blood
3. inject hyaluronidase
4. analgesia for pain - may give anaesthetic/nerve block or oral narcotic
severe cases require complete circumcision
81
What is testicular torsion?
The twisting of the spermatic cord which is responsible for blood supply to the scrotum
82
How does testicular torsion present?
```
Sudden, severe scrotal pain
swelling of the scrotum
abdo pain
nausea & vomiting
testicle positioned higher than normal/unusual angle
frequent urination
fever
```
83
what are the investigations for testicular torsion?
urine test
| scrotal US
84
How is testicular torsion managed?
if suspected admit immediately to urology or paediatric surgery
distortion is required within 4-8hours to avoid any ischemic damage
85
What is urinary retention and what causes it?
a condition where you cannot empty your bladder and so urine is retained
many causes usually categorised as obstructive/non-obstructive
- prostate cancer/BPH
- urethral stricture
- severe constipation
- pelvic tumour
- perineal pain
- drugs - antimuscarinics, opioid analgesics and anaesthetics
86
How is urinary retention investigated?
measure serum creatinine and eGFR
PSA testing if indicated
Abdominal examination may show abnormal palpation/percussion
87
How is acute urinary retention managed?
insert urethral catheter and discuss how the UR should be treated/managed
- alpha-blcokers - 65yrs+ which is started 24hrs prior to catheter removal and used until several hours of normal voiding is established
- intermittent urethral catheterization
- Long term indwelling catheter
88
How is chronic urinary retention managed?
1. exclude any non-obstructive causes of reduced urine flow
2. check serum creatinine
3. refer for specialist assessment - arrange imaging
management options
- no catheterization - regular monitoring of renal function, volume of retention & imaging
- intermittent catheterization
- permanent indwelling catheter
- surgery to divert urine externally
89
What is the most common form of Glomerulonephritis?
membranous glomerulonephritis - autoantibody damage to the GBM - increasing permeability and allowing leakage of protein
90
How does membranous Glomerulonephritis present?
Nephrotic syndrome - proteinuria, Hypoalbuminemia, oedema
91
Investigations for Membranous Glomerulonephritis
Electron microscopy - thickened GBM, 'spike & dome' appearance, effacement of foot processes
Immunofluorescence - granular appearance
92
Mx of membranous Glomerulonephritis?
treat underlying cause
All pts = ACEi/ARB
immunosuppression = steroids and cyclophosphamides
93
How does membranoproliferative glomerulonephritis?
Usually present as nephrotic - proteinuria, hypoalbuminemia and oedema
94
Ix of membranoproliferative glomerulonephritis?
light microscopy - tram-track appearance
immunofluorescence - granular appearance
electron microscopy of renal biopsy = 'dense deposits'
95
mx of membranoproliferative glomerulonephritis?
steroids are usually effective
96
What is rapidly progressive glomerulonephritis?
GBM breaks down as a result of proliferation and deposition of crescent shaped cells
97
how does rapidly progressive glomerulonephritis present?
nephritic syndrome
- haematuria
- oliguria
- azotemia
- HTN
- rapid loss renal function/GFR
98
Ix of Rapidly progressive glomerulonephritis?
light microscopy - crescent shaped cells in the glomeruli
immunofluorescence
type 1 - linear
type 2 - granular
type 3 - negative
99
mx of rapidly progressive glomerulonephritis?
immunosupressants - prednisolone & cyclophosphamide
plasmapheresis in some cases - goodpasture's
100
What is post-streptococcal glomerulonephritis?
inflammation resulting from a streptococcal infection - Group B haemolytic strep
typically in children - ~6weeks after skin infection/impetigo
1-2 weeks after pharyngitis
101
How does post-streptococcal glomerulonephritis present?
nephritic syndrome
- visible haematuria
- oliguria
- peripheral & periorbital oedema
- malaise and headaches
- HTN
102
Ix for post-streptococcal glomerulonephritis?
light microscopy - glomeruli appear enlarged and hypercellular
electron microscopy - deposits in the subepithelium appear as humps
Immunofluorescence - granular or 'starry sky' appearance
bloods - Anti-DNAse B, raised ASO titre and decreased complement levels
103
Mx for post-streptococcal glomerulonephritis?
usually supportive mx
104
complications of post-streptococcal glomerulonephritis
some children can go onto developing renal failure
| 1/4 of adults have rapidly progressive GN
105
What is focal segmental glomerulosclerosis?
FSGS typically develops in young adults causing nephrotic syndrome and kidney disease
106
How does FSGS present?
foamy urine - loss of albumin via urine
hypoalbuminaemia
oedema
decline in kidney function
hyperlipidemia and lipiduria
drop in RBC - anaemia
107
How is FSGS Investigated/diagnosed?
urinalysis - increased protein/lipid
blood test - drop in RBC, lipids and protein
kidney biopsy - scarring and 'glassy appearance'
light microscopy - segmental sclerosis and hyalinosis
108
Mx of FSGS?
dietary salt restrictions and diuretics (tx oedema)
steroids +/- immunosupressants
antihypertensives & statins & lifestyle changes
if secondary - tx of underlying cause
109
When Is renal replacement therapy considered?
CKD developing renal failure with GFR <15ml/min
110
What types of RRT are there and what do they involve?
1. HAEMODIALYSIS - most common, 3x week, 3-5hr sessions, arteriovenous fistula surgery required 8 weeks prior to starting
2. PERITONEAL DIALYSIS - dialysis solution (high dose dextrose) injected through permanent catheter
3. RENAL TRANSPLANTATION - average wait 3yrs, renal vessels connected to external iliac vessels, lifelong immunosuppression to prevent rejection
111
What is IgA nephropathy?
| Presentation?
commonest cause og Glomerulonephritis, presenting usually in childhood during a URTI/GI infection
young males, macroscopic haematuria,
hx of resp tract infection
rarer - proteinuria in nephrotic range, renal failure
* Henloch-schnolein purpura presents similarly but will manifest in the skin, connective tissue, joints and GI tract
112
Ix of IgA Nephropathy?
Light microscopy - mesangial proliferation
Electron microscopy - immune deposits of mesangium
Immunofluorescence - presence of immune complexes
113
Management of IgA nephropathy?
isolated haemturia/minimal proteinuria & normal GFR = no tx needed, Follow up and check renal function
Persistent haematuria & slight drop in GFR = ACEi
Active disease - declining GFR & unresponsive to ACEi = immunosupression with costicosteroids
114
What is Minimal change disease?
| Presentation?
most common cause of nephrotic syndrome in children
Presentation
- nephrotic syndrome - proteinuria
- normal renal function
- normal level of complement
- normotensive
115
Ix and finidngs for Minimal change disease?
Light micrscopy - normal glomeruli, 'minimal change'
Electron microscopy - fused podocytes and effacement of foot processes
Immunofluorescence = negative, change isn't due to immune complexes
116
Mx of minimal change disease?
usually steroids responsive
| if steroids resistant - cyclophosphamide
117
What is polycystic Kidney disease?
A commonly inherited kidney disease - cysts on kidneys
118
presentation of PKD?
```
most commonly presents with loin pain
HTN
bilateral kidney enlargement
gross haematuria following trauma
UTI/Pyelonephritis
intracranial (berry) aneurysms
```
119
How is PKD investiagted?
| Diagnosis?
Bloods - FBC, U&E, creatinine and eGFR, bone profile
Urinanalysis and urine MC&S
Imaging - US/CT
aged <30 - uni/bilateral 2 cysts
aged 30-59 - 2 cysts bilaterally
>60 - 4 cysts bilaterally
120
Management of PKD?
tolvaptan - slows progression of cyst development
monitoring RFs/exacerbations
supportive management
