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Year 3 core conditions > renal tract > Flashcards

renal tract Flashcards

1
Q

what is UTI and what are the different types?

A

bacteria in urine

asymptomatic or symptomatic

lower UTI - bladder = cystitis, prostate = prostatitis

upper UTI - renal pelvis/kidney = pyelonephritis

complicated = abnormal renal/GU tract, voiding, difficulty/obstruction or uncomplicated = normal renal tract and function

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2
Q

causes of complicated UTI

A

stones, obstruction, polycystic kidneys, vesicoureteric reflux

or associated disease - diabetes mellitus, sickle cell disease, analgesic abuse

= risk of kidney damage and septicaemia

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3
Q

who gets UTIs

A

more common women
>65 women, 20% have asymptomatic bacteriuria

new born males -GU abnormalities
teenage women - sexual activity
men when older = prostate problems
women post menopause = hormones

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4
Q

most common organism causing UTI

A 
e.coli
proteus mirabilis
staphylococcus saprophyticus or epidermis
enterococcus faecalis
klebsiella aerogenes
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5
Q

recurrent UTI definition

and what can cause

A

same bacteria within 7 days of completion of antibacterial treatment

think stones, scarred kidneys, polycystic disease, bacterial prostatitis

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6
Q

reinfection UTI definition and what can cause

A

bacteriuria absent after treatment for 14 days, followed by reccurance of infection with same or different organism

implies reinvasion of susceptible tract with organism

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7
Q

risk factors of UTI

A

increased bacterial unoculation - sexual activity, urinary incontinence, faecal incontinence, constipation, female

increased binding of uropathogenic bacteria - spermicide, decreased oestrogen

decreased urine flow - dehydration, obstructed urinary tract

increased bacterial growth - DM, immunosuppression, obstruction, stones, catheter, renal tract malformation, pregnancy

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8
Q

presentation of cystitis

A 
frequency
dysuria
urgency
suprapubic pain
polyuria
haematuria
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9
Q

presentation of prostatitis

A 
pain - perineum, rectum, scrotum, penis, bladder, lower back 
fever
malaise
urinary symptoms
swollen or tender prostate on PR
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10
Q

examination signs of UTI

A 
pyrexial 
abdo/loin tenderness
foul-smelling urine
distended bladder
enlarged prostate
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11
Q

investigations for UTI

A

urine dipstick
urine MC+S - if symptomatic, dipstick positive, male, child, pregnant, immunosuppressed
blood tests - FBC, UEs, CRP and blood cultures if systemically unwell
imaging - utrasound, CTKUB, cystoscopy, MRI

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12
Q

treatment of UTI

A

drink plenty of fluids
urinate often
treat empirically with antibiotics until MC+S = trimethoprim or nitrofurantoin

prevention: drinking plenty, cranberry juice/tablets, antibiotic prophylaxis (continuous or post intercourse, self treatment when symptoms start)

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13
Q

how long to take antibiotics for UTI

A

non pregnant women = 3 days or 5-10 days if complicated infection

7 days for men

7 days in pregnant women

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14
Q

causes of pyelonephritis

A

bacteria ascending from lower UTI

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15
Q

risk factors for pyelonephritis

A

female
pregnant women
urinary tract blockage - kidney stones, enlarged prostate
weakened immune system - diabetes, HIV, certain meds
damage to nerves around bladder
urinary catheter
vesicoureteral reflux

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16
Q

presentation of pyelonephritis

A

proven UTI who has loin pain and/or fever

symptoms - fever, chills, flank or groin pain, abdo pain, freq, urg, dysuria, N+V, haematuria, foul smelling urine, rigors, septic shock

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17
Q

signs on examination of pyelonephritis

A

no clinical features that distinguish from cystitis

complications - kdiney scarring, septicaemia, pregnancy complications

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18
Q

investigations of pyelonephritis

A

MSU for culture and sensitivity

dipstick test

USS, CT scan or xray voiding cystourethrogram

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19
Q

treatment of pyelonephritis

A

prevention: fluids, urinate as soon as need to, wee after intercourse, wipe front to back, avoid feminine products

treatment:
- antibiotics for kidney infections - amoxicillin until sensitivity testing.
IV antibiotics and fluids if hospitalised

recurrent - may be due to misshapen urinary tract = need surgery to repair structural abnormality

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20
Q

what is hydronephrosis

A

swelling of one or both kidneys when urine cannot drain

occurs due to blockage of ureters or anatomical defects

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21
Q

causes of hydronephrosis

A

most common: prostatic obstruction, gynaecological cancer, calculi

split into intralumenal obstruction or obstruction within the wall (congenital abnormalities of urinary tract, stricture, neuropathic bladder)

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22
Q

presentation of hydronephrosis

A

loin pain that radiates to lower abdo or groin

dysuria, urgency, frequency

nausea and vomiting

fever

failure to thrive in infants

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23
Q

signs on examination of hydronephrosis

A

depends on sight of obstruction

enlarged bladder or hydronephrotic kidney felt on exmamination

pelvic and rectal examination to determine cause of obstruction

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24
Q

investigations for hydronephrosis

A

imaging - USS, excretion urography

radionuclide studies - differentiated long standing obstruction

bloods - creatinine and function of kidneys

urine dipstick/MCS - identify stones/infection which may be cause of blockage

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25
Q

treatment of hydronephrosis

A

mild to mod = wait and see approach, preventative antibiotic therapy to lower risk of UTI

severe - surgery if affects kidney function to fix blockage or correct reflux

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26
Q

types of acute kidney injury

A

pre renal
renal
post renal

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27
Q

causes of pre renal acute kidney injury

A

hypovolaemia
hypotension
impaired cardiac pump efficiency
vascular disease limiting renal blood flow

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28
Q

risk factors for acute kidney injury

A

> 65
history of AKI
chronic kidney disease eGFR<60
symptoms of urological obstruction or conditons which may lead to this
chronic conditions - liver, heart, diabetes
neurological or cognitive impairment or disability
sepsis
hypovolaemia
oliguria
nephrotoxic drug use within last week
exposure to iodinated contrast agents within last week

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29
Q

signs on examination of AKI

A

nausea, vomiting, drowsiness, breathlessness (pulomnary oedema or metaoblic acidosis)

arrhythmias

hyperkalaemia
metabolic acidosis
hyponatraemia
hypoglycaemia (reduced vit D) and hyperphsophataemia (phosphate retention)

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30
Q

investigations of pre renal AKI

A

tests to differentiate between pre renal and intrinsic causes

  • urine specific gravity and urine osmalarity
  • urine sodium
  • fractional excretion of sdium
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31
Q

treatment of pre renal AKI

A

prompt fluid replacement (blood in case of haemorrhagic shock or crystalloid in vomiting, diarrhoea, polyuria)

treat underlying cause e.g. if related to cardiac pump insifficiency or occlusion of renal vasculature

32
Q

intrinsic AKI causes

A

acute tubular necrosis as result of renal ischaemia or direct renal toxins

disease affecting the interstitium, renal vasculature, acute glomerulonephritis

33
Q

causes of acute tubular necrosis

A 
haemorrhage
burns
diarrhoea and vomiting
fluid loss from fistula
acute pancreatitis
diuretics
MI
congestive cardiac failure
endotoxic shock
myoglobinaemia
haemoglobinaemia
hepatorenal syndrome
radiological contrast agents
drugs - aminoglycosides, NSAIDs, ACEi, platinum derivatives, abruptio placentae 
pre-eclampsia, eclampsia
34
Q

presentation of AKI

A

risk facotrs, urological symptoms, multi system disease affecting kidneys

alteration of urine volume

biochemical abnormalities

35
Q

investigations of intrinsic AKI

A

blood count
urine and blood cultures
urine dipstick testing and microscopy
histological investigations

36
Q

treatment of intrinsic AKI

A

fluid correction
sodium and potassium restricted
stop nephrotoxic drug and adjust doses of others

37
Q

causes of post renal AKI

A

occurs when both urine outflow tracts are obstructed or when tract is obstructed in paitent with a single functioning kidney

quickly reversed if obstruction releived

38
Q

investigations of post renal AKI

A

renal ultrasonohraphy for hydronephrosis and dilated ureters

bladder outflow obstructed ruled out by flushing of existing catheter or insertion of urethral catheter - removed unless larged vol of urine obtained

39
Q

treatment of post renal AKI

A

temporary measures to relieve fluid build up - urethral/suprapubic catheterisation or percutaneous nephrostomy until definitive treatment of obstructing lesion can be undertaken

40
Q

what is chronic renal failure

A

abnormal kidney structure or function present for >3 months with implications for health

classification is based on GFR category, presence of albuminuria as a marker of kidney damage and the cause of kidney disease

41
Q

who gets chronic renal failure

A

older ppl

more in females

42
Q

causes of chronic renal failure

A

intrinsic kidney disease - associated conditons: hypertension, DM

nephrotoxic drugs - lithium, ciclosporin, calcinuerin inhibitors, aminoglycosides, mesalazine

obstructive kidney disease - assoicated conditions: neurogenic bladder, BPH, urinary division surgery, recurrent urinary stones

Multisystem disease: SLE, vascultitis, myeloma, AD polycystic kidney disease, alports disease, familial glomerulonephritis, DM, polycystic kidney disease

acute renal failure

43
Q

risk factors of chronic kidney disease

A 
AKI
CVD
hypertension or proteinuria
diabetes
smoking
NSAIDs - chronic use
nephrotoxic drugs
untreated urinary outflow obstruction
SLE
44
Q

presentation of chronic kidney disease

A

anaemia
platelet abnormalities
skin pigmentation pruritis
GI - anorexia, nausea, vomiting, diarrhoea
endocrine/gonads - ammennhoria, erectile dysfunction, infertility
polyneuropathy
CNS- coma, confusion
CVS - uraemic pericarditis, hypertension, peripheral vascular disease, heart failure
renal - nocturia, poluria, salt and water retention, oedema
renal osteodystrophy - osteomalacia, muscle weakness, bone pain, hyperparathyroidism, osteosclerosis, dynamic bone disease

45
Q

investigations for chronic kidney disease

A 
serum creatinine
urine electrolytes
blood count
urine and blood cultures
urine dipstick and microscopy
histological investigations
46
Q

who gets BPH

A

elderly men >60

47
Q

causes of BPH

A

hyperplasia of both glandular and connective tissue elements

aetiology unknown

48
Q

risk factors of BPH

A

age,

metabolic syndrome,

49
Q

presentation of BPH

A

increased frequency of micturition
nocturia
delay in initiation of micturition and post void dribbling

acute urinary retention or retention with overflow incontinence also occurs

50
Q

signs on examination of BPH

A

enlarged smooth prostate

51
Q

investigations of BPH

A

serum electrolytes and renal ultrasonography to exclude renal damage resulting from obstruction

prostate cancer present with similar symptoms

serum PSA elevated in benign disease but elevated value is usually an indication for specialist referral and prostate biopsy

52
Q

treatment of BPH

A

if mild symptoms - watchful waiting

selective a1-adrenoreceptor antagonists such as tamsulosin = relax smooth muscle in bladder neck and prostate producing increase in urinary flow rate and improvement in obstructive symptoms

5a reductase inhbiitor finasteride = prevents further enlargement

acute retention or retention with overflow = urethral catheterisation or if not possible suprapubic catheter drainage

prostatectomy or permanent catheter as later treatment options

53
Q

who gets prostate cancer

A

most common cancer in men

malignant change within prostate increasingly common with age

54
Q

causes of prostate cancer

A

ethical
familial and genetic risk factors

  • genetic mutations of androgen receptors of prostatic cells = hormone treatment effective
55
Q

risk factors for prostate cancer

A

increasing age
ethnicity - black African or black Carribean
family history
BRACA gene mutation

56
Q

signs on examination of prostate cancer

A

hard irregular gland

57
Q

investigation of prostate cancer

A

transrectal US of prostate
elevated serum PSA
transrectal prostate biopsy
if mets are present, PSA usually markedly elevated
endorectal coil MRI used to locally stage tumour

58
Q

treatment of prostate cancer

A

microscopic tumour usually by watchful waiting

treatment of disease confined to gland is radical prostatectomy, radiotherapy = 80-90% 5 yr survival

treatment of metastatic disease depends on removing androgenic drive to the tumour - bilateral orchiectomy (testes) , synthetic luteinising hormone releasing hormone analogues

59
Q

who gets bladder carcinoma?

A

M:F 3:1

5th commonest cause of cancer deaths

60
Q

risk factors for bladder caricnoma

A

exposure to aromatic hydrocarbons - industrial workers, chimney sweep

smoking

61
Q

presentation of bladder carcinoma

A

painless haematuria
painless micturition
renal colic due tot blood clot, disturbance of urinary stream, retention of urine

62
Q

investigations of bladder carcinoma

A

urine cytology - malignant cells

cystoscopy also possible

63
Q

treatment of bladder caricnoma

A

transurethral resection
TCT an be completed by endoscopic resection
intravesical chemo reduces high risk of occurrence
may need radical cystectomy

64
Q

who gets renal carcinoma

A

M:F 3:1

65
Q

location of renal carcinoma

A

often small and can be multiple

local spread often includes spread via intravascular invasion to the renal vein and IVC

66
Q

risk factors for renal carcinoma

A

FHx

clinical evidence of neurological or ocular disease should raise possiblity of von hippel lindau disease

67
Q

presentation of renal carcinoma

A

may be asymptomatic

tumour detected during imaging of abdomen for unrelated conditon

painless haematuria, groin pain, awareness of mass arising from the flank, chest symptoms and bone pain present to these sites

68
Q

investigations for renal caricnoma

A

blood tests and ferritin to check for anaemia

electrolytes and creatinine to check overall renal function

raised corrected calcium and alkaline phosphatase suggest bony mets

diagnostic staging and diagnosis by CT with contrast

isotope bone scan if clinical or biochemical evidence of bony mets

69
Q

treatment of renal carcinoma

A

surgery - only curative treatment except in very elderly, extensive local invasion and mets - partial or radical nephrectomy depending on size

medical therapy - used for metastatic disease. biological therapy with immune modulators (interferons and interleukins). chemo not used as renal cancers arent usually sensitive
radiotherapy for palliative painful bone mets

70
Q

who gets urinary tract stones

A

males >females

20-50 yos

71
Q

causes of urinary tract stones

A

metabolic - hyperparathyroidism, idiopathic hyperclaciuria, disseminated malignancy, sarcoidosis, hypervitaminosis D

familial metabolic causes - cysturia, errors of purine metabolism

infection

impaired urinary drainage - medullary sponge kidney, pelvi-uteric junction obstruction, ureteric stricture, extrinsic obstruction

72
Q

risk factors for urinary tract stones

A

summer months

most are calcium stones

73
Q

presentation of urinary tract stones

A

ureteric/renal colic
severe intermittent stabbing pain radiating from loin to groin

microscopic or rarely, frank haematuria

systemic symptoms such as nausea, vomiting, tachycardia, pyrexia

loin or renal angle tenderness due to infection or inflammation

iliac fossa tenderness if passed to distal ureter

74
Q

investigations of urinary tract stones

A

raised WCC and CRP suggest infection and inflammation

raised Cr = renal impairment

stones often visible on plain abdo Xray. gold standard is non contrast CT

serum calcium, phosphate and uric acid

75
Q

treatment of urinary tract stones

A

acute presentation - analgesia, if <0.5cm then conservative treatment
percutaneous nephrostomy or uteric stent insertion if painful or obstruction persistent

elective presentation - extra-corpeal nephrolithotomy, endoscopic treatment or open nephrolithotomy

Year 3 core conditions (15 decks)

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