Renal & Urology Flashcards

Question

Define testicular torsion.

Answer 1

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.

Answer 2

Risk Factors: - Age under 25 years - Neonate - Bell clapper deformity - Trauma / exercise - Intermittent testicular pain - Undescended testicle - Cold weather

Answer 3

Testicular torsion is a well known emergency in urology and can occur at any age. Our study shows that the incidence was 2.9 cases per 100,000 person years of males <25 yr of age and 1.1 cases per 100,000 person years at all ages. Most common at ages 11-30 years.

Answer 4

- Sudden onset of pain in one testis - Intermittent or acute on-and-off pain - No pain relief upon elevation of scrotum - Walking uncomfortable - Abdominal pain - Nausea - Vomiting - Fever - Increased urinary frequency

Answer 5

- Scrotal swelling or oedema - Inflammation of one testis - very tender, hot and swollen - Testis may lie high and tranversely NB: With intermittent torsion, the pain may have passed on presentation, but if it was severe, and the lie is horizontal, prophylactic fixing may be wise.

Answer 6

- Doppler US - may demonstrate lack of blood flow to the testis - Only perform US if diagnosis equivocal - do not delay surgical exploration - Urinalysis, FBC, CRP - check for infection

Answer 7

- Ask consent for possible orchidectomy + bilateral fixation (orchidopexy) - At surgery exposure and untwist the testis - If colour looks good, return the testis to the scrotum and fix both testes to the scrotum

Answer 8

- Infection - Infertility - Gangrene - Cosmetic deformity - Atrophy - Testicular death

Answer 9

If testicular torsion is treated right away—at best within six hours—the testicle may be saved. But if blood flow is cut off for more than six hours, the testicle may lose its ability to function

Answer 10

An acute decline in kidney function, leading to a rise in serum creatinine and/or a fall in urine output. Spectrum - mild to severe

Answer 11

Impaired clearance and regulation of metabolic homeostasis, altered acid / base and electrolyte regulation and impaired volume regulation. Caused by: - Impaired kidney perfusion - Exposure to nephrotoxins - e.g. aminoglycosides, vancomycin + piperacilliin-tazobactam, cancer therapies, NSAIDs, ACE inhibitors - Outflow obstruction - Intrinsic kidney disease Risk Factors: - Advanced age - Underlying kidney disease - DM - Sepsis - Iodinated contrast - Exposure to nephrotoxins - Excessive fluid loss - Sugrery - Haemorrhage - Recent vascular intervention - Cardiac arrest - Pancreatitis - Trauma - Malignant hypertension - Myeloproliferative disorders - e.g. multiple myeloma - Connective tissue disease - Sodium-retaining states - e.g. congestive heart failure, cirrhosis, nephrotic syndrome - Drug overdose - Nephrolithiasis Staging on the basis of Creatinine: Stage 1 - rise of>26micromol/L within 48 hours or 1.5-1.9x baseline Stage 2 - rise to 2-2.9x baseline Stage 3 - rise to >3x baseline or >354 micromol/L or initiated on RRT (irrespective of staging)

Answer 12

10,400 per million Seen in 10-20% of people admitted to hospital as emergencies Inpatient mortality >20% ICU incidence - 20-50%, mortality >50%

Answer 13

- Hypotension - Risk factors - Kidney insults - Reduced urine production - Lower urinary tract symptoms - e.g. urgency, frequency, hesitancy - Symptoms of volume overload or pulmonary oedema - e.g. orthopnoea, swollen ankles, crackles on auscultation of lungs, tachypnoea - N&V - Fever - Rash - Arthralgia - Haematuria - visible or non-visible - Palpable bladder and/or enlarged prostate and/or abdominal distension

Answer 14

- Hypotension - Risk factors - Kidney insults - Reduced urine production - Lower urinary tract symptoms - e.g. urgency, frequency, hesitancy - Symptoms of volume overload or pulmonary oedema - e.g. orthopnoea, swollen ankles, crackles on auscultation of lungs, tachypnoea - N&V - Fever - Rash - Arthralgia - Haematuria - visible or non-visible - Palpable bladder and/or enlarged prostate and/or abdominal distension

Answer 15

- Basic metabolic profile - includes urea, creatinine (HIGH), LFTs (hepatorenal syndrome) - K+ serum - HIGH - >6mmol/L or ECG changes = urgent treatment - FBC - leukocytosis (sepsis), low platelets (haemolytic uraemic syndrome, thrombotic thrombocytopenic purpura, cryoglobulinaemia), anaemia (haemolytic uraemic syndrome, myeloma, vasculitis) - Bicarbonate - LOW = acidosis - CRP - HIGH (sepsis, infection, vasculitis) - Blood culture - bacterial pathogen causing sepsis - Urinalysis - RBCs, WBCs, celllular casts, proteinuria, positive nitrile, leukocyte esterase - Urine culture - bacterial growth with antibiotic sensitivity - Urine output monitoring - hourly if catheterised, 4-hourly if not - <0.5ml/kg/hour for 6 hours at least - Fluid challenge - kidney function improves rapidly - Venous blood gases (metabolic acidosis) - anion gap acidosis - CXR - infection, pulmonary oedema, haemorrhage, cardiomegaly - ECG - peaked T waves, increased PR interval, widened QRS, atrial arrest, deterioration to a sine wave pattern = hyperkalaemia Measure serum creatinine to check for AKI if - compare to baseline over 3 months (if none, repeat within 12 hours): - >65 years - History - CKD, heart failure, liver disease, diabetes, dementia - Previous AKI - Exposure to iodinated contrast agent, nephrotoxins, RAS modifying agent, diuretic - History of urological obstruction - Sepsis - Hypovolaemia (with/without hypotension) - Hypotenison (SBP <90mmHg or a fall of >40mmHg from baseline BP) - Oliguria - urine output <0.5ml/kg/hour - Acute rise in NEWS >5 CKD Features (doesn't exclude): - Rise in serum creatinine over a long period of time - Hypocalcaemia - Hyperphosphataemia - Anaemia - Small kidneys on ultrasound, sometimes scarred NB: CKD is a risk factor for AKI. Check for: - Recent use of trimethoprim - false positive rise - Creatinine falls during pregnancy, so a rise in creatinine after recent delivery - false positive rise Serum K+ 5.5 to 5.9 mmol/L indicates mild hyperkalaemia 6.0 to 6.4 mmol/L indicates moderate hyperkalaemia ≥6.5 mmol/L indicates severe hyperkalaemia To catheterise or not to catheterise? - Benefits - sustained fall in urine output suggests AKI, difficult to measure without, diagnostic and therapeutic for bladder neck obstruction, assessment of response to treatment, urinalysis performed on samples - Risks - infection, trauma, falls risk

Answer 16

Treat sepsis, optimization of volume status, correction of acidaemia or electrolyte complications, avoidance of nephrotoxins and relief of any obstruction. STOP AKI S = Sepsis - implement Sepsis Six within 1 hour, source and treat infection T = Toxins - stop nephrotoxins O = Optimise volume status /BP - assess and give IV fluids, hold antihypertensives and diuretics, consider vasopressors if not responding P = Prevent harm - treat complications and cause If HYPOVOLAEMIC - e.g. sepsis, fluid loss, reduced fluid intake(pre-kidney): - Mild hyperkalaemia (5.5-5.9) - fluid resus (500mL bolus over 15mins, wide bore cannula, crystalloid, reassess) , review meds, stop nephrotoxins (e.g. aminoglycoside antibiotics, NSAIDs, iodinated contrast agents, ACEi, ARB, diuretics), treat cause, vasoactive drug (e.g. noradrenaline, vasopressin, dobutamine), blood transfusion, specialist referral, cation-exchange resin (e.g. calcium polystyrene sulfonate to remove K+ from body) - Moderate hyperkalaemia (6.0-6.4) and no ECG changes - fluid resus, review meds, stop nephrotoxins, identify and treat cause, vasoactive drug, blood transfusion, specialist referral, insulin / glucose (to push potassium intracellularly, give over 15 mins, acts within 10-20 mins, lasts 4-6 hours) , salbutamol (to push potassium intracellularly) - Moderate (6.0-6.4) or Severe hyperkalaemia (>6.5) and associated ECG changes - fluid resus, review meds, stop nephrotoxins, identify and treat cause, vasoactive drug, blood transfusion, specialist referral, calcium chloride or gluconate (IV over 5-10 mins for cardiac protection vs arrhythmias), insulin/glucose, salbutamol - Metabolic acidosis - fluid resus, review medications, stop nephrotoxins, identify and treat cause, vasoactive drug, blood transfusion, specialist referral, sodium bicarbonate (if pH <7.2, refer to ICU possibly?, venous bicarb <16mmol/L with no volume overload) - Uraemia, refractory severe hyperkalaemia etc - fluid resus, review meds, stop nephrotoxins, identify and treat cause, vasoactive drug, blood transfusion, specialist referral, renal replacement therapy (if end-organ complications of uraemia, severe hyperkalaemia, refractory acidosis that is not responding - give intermittent haemodialysis [4hrs, fast removal of toxins] or continuous RRT [24-72hours, slower blood flow] or peritoneal dialysis) If HYPERVOLAEMIC - e.g. obstruction to urinary flow (post-renal): - Pulmoary oedema - loop diuretic (furosemide), sodium restriction, treat cause, renal replacement therapy (on basis of condition, not urea or creatinine value - intermittent haemodialysis, CRRT, peritoneal dialysis), upright positioning, high-flow oxygen (15L/min via resevoir mask, CPAP), glyceryl trinitrate IV (aim for SBP >95mmHg) - Mild hyperkalaemia (5.5-5.9) - loop diuretic (furosemide), sodium restriction, treat cause (review meds, restrict dietary intake, monitor K+ and glucose), renal replacement, cation-exchange resin (calcium polystyrene sulfonate - remove K+ from the body) - Moderate hyperkalaemia (6.0-6.4) and no ECG changes - loop diuretic (furosemide), sodium restriction, RRT, treat cause, insulin & glucose (push potassium intracellularly, give over 15 mins, acts within 10-20 mins, lasts 4-6 hours) , salbutamol (drive potassium intracellularly) - Severe hyperkalaemia (>6.5) or moderate hyperkalaemia (6.0-6.4) and associated ECG changes - loop diuretic (furosemide), sodium restriction, RRT, treat cause, calcium (for cardiac protection vs arrhythmias- can be calcium chloride or calcium gluconate), insulin & glucose, salbutamol - Metabolic acidosis - loop diuretic, sodium restriction, treat cause, RRT, specialist advice (once obstruction relieved, diuresis progressing, renal team decides whether to use sodium bicarbonate)

Answer 17

- Renal replacement therapy if do not respond to medical management - Hyperkalaemia - Acidaemia - Uraemic encephalopathy - Pericarditis - Pulmonary oedema - Volume overload - Electrolyte and acid-base disturbances - Hyponatraemia - Metabolic acidosis - Nutritional and gastrointestinal disturbances - Anaemia - Bleeding diathesis - Infection - Sepsis - Death - Multi-organ failure - Arrythmias - Muscle weakness

Answer 18

Prompt recognition and treatment is important. AKI occurs in 10% to 20% of emergency admissions and has an inpatient mortality >20%. Important to monitor: - Review haemodynamic status, including postural BP - Weight monitroing - Fluid input / out put chart - Urea and electrolytes - ECG changes - Dietary intake - avoid K+ rich foods

Answer 19

Resuscitation fluid therapy is aimed at re-establishing haemodynamic stability by restoring intravascular volume. Replacement fluid therapy provides daily maintenance water and electrolyte requirements and replaces any ongoing abnormal fluid losses. Maintenance fluid therapy must provide daily ongoing water and electrolyte requirements (i.e., sodium 1 mmol/kg, potassium 1 mmol/kg, and water 25-35 mL/kg) Never give maintenance fluids at a rate of >100 mL/hour.

Answer 20

A flexible tube used to empty the bladder and collect urine in a drainage bag. Urethral or suprapubic (small opening in tummy).

Answer 21

- Acute urinary retention - e.g. BPH, blood clots - Chronic obstruction that causes hydronephrosis - Initiation of continuous bladder irrigation - Intermittent decompression for neurogenic bladder - Hygienic care of bedridden patients

Answer 22

- Allergy or sensitivity to latex - Bladder stones - Blood infections (septicaemia) - Blood in urine (haematuria) - Kidney damage (long-term) - Urethral injury - Urinary tract or kidney infections

Answer 23

Heterogenous group of diseases characterized by extracellular deposition of amyloid fibrils. Can be systemic or localised - e.g. pancreatic islets of Langerhans, cerebral cortex, cerebral blood vessels, bones and joints Pancreatic Islets of Langerhans - T2DM Cerebral Cortex - Alzheimer's Cerebral Blood Vessels - amyloid angiopathy Bones & Joints - long-term dialysis caused by B2 microglobulin

Answer 24

Amyloid fibrils are polymers comprising low-molecular-weight subunit proteins. Amyloid fibril subunits are derived from proteins that undergo conformational changes to adopt anti-parallel B-pleated sheet configuration. Amyloid fibril subunits associated with GAGs and serum amyloid P-component (SAP), and their sdeposition progressively disrupts the structure and function of nromal tissue. Classification: - AA - serum amyloid A protein - e.g. Chronic inflammatory (RA, seronegative arthritides, Crohn's, familial Mediterranean fever), chronic infections (TB, bronchiectasis, osteomyelitis), malignancy (Hodgkin's disease, renal cancer) - AL - monoclonal immunoglobulin light chains fibril protein - e.g. subtle monoclonal plasma cell dyscrasias, multiple myeloma, Waldenstrom's macroglobulinaemia, B-cell lymphoma - ATTR (familiar amyloid polyneuropath) - genetic-variant transthyretin - autosomal dominantly transmitted muttaions in the gene for transthyretin (TTR), variable penetrance Risk factors: - Monoclonal gammopathy of undetermined significance (MGUS) - Inflammatory polyarthropathy - Chronic infections - IBD

Answer 25

AA = 1-5% incidence among patients with chronic inflammatory disease AL = estimated annual incidence of about 3,000 cases in US, 300-600 cases in UK Hereditary - 5% of patients with systemic amyloidosis

Answer 26

Renal - Proteinuria - Nephrotic syndrome - Renal failure Cardiac - Restrictive cardiomyopathy - Heart failure - Arrythmia - Angina - due to accumulation of amyloid in coronary arteries GI - Macroglossia - characteristic of AL - Hepatomegaly - Splenomegaly - Gut dysmotility - Malabsorption - Bleeding Neurological - Sensory and motor neuropathy - Autonomic neuropathy - symptoms of bowel or bladder dysfunction, postural hypotension - Carpal tunnel syndrome Skin - Waxy skin - Easy brusing - Purpura around the eyes - characteristic of AL - Plaques - Nodules Joints - Painful asymmetrical large joint - Shoulder pad sign - enlargement of the anterior shoulder Haematological - Bleeding diathesis - factor X deficiency due to binding on amyloid fibrils primarily in the liver and spleen and reduce synthesis of coagulation factors in patients with advanced liver disease

Answer 27

Renal - Proteinuria - Nephrotic syndrome - Renal failure Cardiac - Restrictive cardiomyopathy - Heart failure - Arrythmia - Angina - due to accumulation of amyloid in coronary arteries GI - Macroglossia - characteristic of AL - Hepatomegaly - Splenomegaly - Gut dysmotility - Malabsorption - Bleeding Neurological - Sensory and motor neuropathy - Autonomic neuropathy - symptoms of bowel or bladder dysfunction, postural hypotension - Carpal tunnel syndrome Skin - Waxy skin - Easy brusing - Purpura around the eyes - characteristic of AL - Plaques - Nodules Joints - Painful asymmetrical large joint - Shoulder pad sign - enlargement of the anterior shoulder Haematological - Bleeding diathesis - factor X deficiency due to binding on amyloid fibrils primarily in the liver and spleen and reduce synthesis of coagulation factors in patients with advanced liver disease

Answer 28

1. Tissue biopsy - congo red stain, immunohistochemistry (diagnose amyloidosis, identify amyloid fibril protein) 2. Urine (proteinuria, free immunoglobi light chains in AL) 3. Blood (CRP, ESR, RF, Ig levels, serum protein electrophoresis, LFTs, U&E, SAA levels) 4. 123I-SAP Scan - radiolabeled SAP localizes to the deposits enabling quantitative imaging of amyloidotic organs throughout the body

Answer 29

Characterised by presence of >100,000 of colony-forming units per milllitre of urine. May affect bladder (cystitis), kidney (pyelonephritis) or prostate (prostatitis).

Answer 30

Transurethral ascent of normal colonic organisms. Escherichia coli Proteus mirabilis Klebsiella Enterococci (hospitals)

Answer 31

30% of women experience UTI at some point in their lives. 5% of pregnant women, 2% of non-pregnant women, 20% elderly living at home, 50% institutionalized elderly. Rare in children and young men (if present, suspect an underlying cause).

Answer 32

- Silent - asymptomatic bacteruria Cystitis: - Frequency - Urgency - Dysuria - pain on micturition - Haematuria - Suprapubic pain - Smelly urine Pyelonephritis (acute): - Feber - Malaise - Rigors - Loin / flank pain Prostatitis: - Fever - Low back / perineal pain - Irritative and obstructive symptoms - e.g. hesitancy, urgency, intermittency, poor stream, dribbling Elderly: - Malaise - Nocturia - Incontinence - Confusion Up to 30% of women with UTI symptoms may not have bacteruria.

Answer 33

May be asymptomatic. Cystitis: - Fever - Abdominal / suprapubic / loin tenderness - Bladder distension Pyelonephritis - Fever - Loin / flank tenderness Prostatitis: - Tender - Swollen prostate

Answer 34

MSU - Dipstick test - blood, protein, leucocytes, nitrites - Microscopy, culture and sensitivity - >10^5 colonies/mL indicates significant bacteriuria, but with UTI symptoms threshold becomes lower = women (>10^2/mL), men (>10^5/mL) - If there is sterile pyuria (pus cells with no organisms), consider if this may be partially treated UTI, tuberculosis stones, tumour, interstitial nephritis, renal papillary necrosis Imaging - Renal USS or IV urogram if women with frequent UTI and children/men

Answer 35

Cystitis: - Local microbiological polices - Commonly used: oral co-trimoxazole, trimethoprim, nitrofurantoin, amoxicilliin, ciprofloxacin (males) Pyelonephritis: - IV gentamicin, cefuroxime, ciprofloxacin Catheterized patients: - Obtain culture - Change catheter - Do not treat unless patient is symptomatic Prophylaxis: - High fluid intake - Regular micturation to keep bladder empty - Cranberry-based products reduced frequency of recurrence - Low-dose long-term (6-12 months) antibiotics if frequently having UTIs Surgical: - Rarely necessary - May be necessary for relief of any obstruction and removal of any renal calculi

Answer 36

- Renal papillary necrosis - in those with underlying renal disease - e.g. DM, stones - Renal / perinephric abscess - seen on renal USS - Pyonephritis - pus in palvicalyceal system - Gram-negative septicaemia

Answer 37

Mostly resolve with treatment. Among pregnant women, 20% develop acute pyelonephritis if not treated, however there is a high relapse rate.

Answer 38

Epididymitis - inflammation of the epididymis Orchitis - inflammation of one or both testicles Acute epididymitis - inflammation of the epididymis characterized by scrotal pain and swelling of less than 6 weeks' duration. Acute Epididymo-orchitis - if concurrent inflammation of the testis is present.

Answer 39

Sexually active men - most commonly caused by: - Chlamydia trachomatis - Neisseria gonorrhoea - Mycoplasma genitalium Older men - most commonly caused by enteric pathogens: - Bladder outlet obstruction - Recent instrumentation of the urinary tract - Systemic illness RISK FACTORS: - Unprotected sexual intercourse - Bladder outflow obstruction - Instrumentation of urinary tract - Immunosuppression - Vasculitis - Amiodarone - Mumps - Exposure to TB

Answer 40

Usually unilateral.

Answer 41

- Irritative lower urinary tract symptoms - Urethral discharge (purulent) - Fever Common - Presence of risk factors - Age >19 years - Gradual onset - Symptoms <6 weeks' duration - Frequent and painful micturition

Answer 42

Common - Unilateral scrotal pain - Tenderness - Hot - Erythematous - Swollen hemiscrotum Uncommon - Pyrexia - Fluctuant swelling or induration of scrotal tissue - Enlarged or tender prostate

Answer 43

1st line: - Gram stain of urethral secretions - >5 WBC per oil immersion field, intracellular gram-negative diplococci - Urine dipstick test - positive leukocyte esterase tests shown as colour change on the reagent strip - Urine microscopy - >10 WBC per high-power field - Urine culture - Isolate of causative organism - NAAT (nucleic acid amplification test) of urethral secretions or first-void urine - Chalmydia trachomatis, Neisseria gonorrhoea, Mycoplasma genitalium DNA / RNA detected - Culture of urethral secretions - positive culture for N.gonorrhoea Consider: - Colour duplex US - epididymis is enlarged, hyperaemic, low-resistance monophasic arterial waveform pattern, good for localising areas of inflammation - Surgical exploration - oedematous epididymis with vascular congestion and evidence of surrounding inflammatory reaction, with no evidence of testicular torsion - 3 early morning urine samples for acid-fast bacilli staining, culture and NAAT - may be positive - HIV test - may be positive - Syphilis test - may be positive

Answer 44

BACTERIAL INFECTION - Abx - Supportive measures - paracetamol or naproxen or ibuprofen NB: Abx Gonorrhoea / Chlamydia suspected - ceftriaxone and doxycycline Gonorrhoea / Chlamydia suspected, Gonorrhoea likely - ceftriaxone, doxycycline and azithromycin Gonorrhoea / Chlamydia / Enteric organisms suspected - ceftriaxone, ofloxacin / levofloxacin Enteric organisms suspected - ofloxacin or levofloxacin M Genitalium suspected - moxifloxacin AMIODARONE-INDUCED - Discontinuation or dose reduction - Supportive measures - paracetamol or naproxen or ibuprofen UNDERLYING VASCULITIS - Specialist referral to rheumatologist - can be due to Behcet's Syndrome or Henoch-Schonlein purpura - Supportive measures - paracetamol or naproxen or ibuprofen IDIOPATHIC OR VIRAL - Supportive measures - paracetamol or naproxen or ibuprofen TB - Anti-TB antibiotics - guidelines! - Specialist referral - Supportive measures - paracetamol or naproxen or ibuprofen

Answer 45

- Scrotal abscess and pyocele - Testicular infarction - Fertility problems - Testicular atrophy - Cutaneous fistulization from rupture of abscess through tunica vaginalis - Recurrence, chronic epididymitis and orchialgia

Answer 46

Most epididymitis cases clear up within 3 months. However, more invasive treatment may be needed in some cases. If an abscess has formed on the testicles, your doctor can drain the pus using a needle or with surgery. Surgery is another option if no other treatments have been successful.

Answer 47

The abnormal dilation of the internal speratic veins and pampiniform plexus that drain blood from the testis.

Answer 48

Caused by defective valves in the veins within the scrotum, just above the testicles. May impede adolescent testicular growth and affect adult sperm parameters and testosterone production. Risk factors: - Somatometric parameters - e.g. tall, low BMI - Family history of varicocele

Answer 49

15% of adolescent boys and adult men. 90% cases left side. 10% bilateral. 40% of men being evaluated in a male fertility clinic will have a varicocele.

Answer 50

- Painless scrotal mass - Left-sided signs / symptoms - Small testicle - Infertility - Age > 12 years - Scrotal or groin pain

Answer 51

- Painless scrotal mass - Left-sided signs / symptoms - Small testicle - Infertility - Age > 12 years - Scrotal or groin pain (uncommon)

Answer 52

1st line: - Clinical diagnosis - inspection of spermatic cord above the testicle may reveal "bag of worms appearance", Valsalva manoeuvre to elicit small ones Consider: - Scrotal ultrasound with colour flow Doppler imaging - identification of sub-clinical varicocele - Semen analysis - reduced sperm count, impaired sperm motility - Serum FSH and GnRH stimulation - high (suggesting testicular dysfunction) - Serum testosterone - may be low - DNA fragmentation index (DFI) - high - CT abdomen / pelvis - exclude abdominal, pelvic or retroperitoneal mass - MRI abdomen / pelvis - exclude abdominal, pelvic or retroperitoneal mass - Retroperitoneal USS - exclude retroperitoneal mass

Answer 53

A collection of serous fluid between the layers of the membrane (tunica vaginalis) that surrounds the testis or along the spermatic cord. Similar collection in females along the canal of Nuck.

Answer 54

x2 Types: COMMUNICATING - Patent processus vaginalis connects peritoneum with tunica vaginalis - Allows peritoneal fluid to flow freely between both structures - Abdominal contents may enter the groin = inguinal hernia (direct or indirect) - Direct - hernial sac medial to inferior epigastric artery and deep inguinal ring - Indirect - hernial sac lateral to inferior epigastric artery NON-COMMUNICATING - Clossed processus vaginalis - More fluid is being produced by tunica vaginalis than is being absorbed Risk factors: - 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 - Varicocelectomy - Failariasis - Maternal exposure to polybrominated biphenyl

Answer 55

Common in male infants and the newborn. Most are congenital and resolve within the first year of life. May occur in adult men where they are found secondary to: - Minor trauma - Infection - Testicular torsion - Epididymitis - Varicocele operation - Testicular tumour

Answer 56

- Painless - Swollen scrotum - On one or both sides - Feels like a water-filled balloon - Transillumination - Enlargement of scrotal mass following activity - Variation in scrotal mass during the day

Answer 57

- Painless - Swollen scrotum - On one or both sides - Feels like a water-filled balloon - Transillumination - Enlargement of scrotal mass following activity - Variation in scrotal mass during the day

Answer 58

1st line: - Clinical diagnosis - features of hydrocele Consider: - Ultrasound - confirm prescence via scrotal or inguinal ultrasound

Answer 59

Lower urinary tract symptoms (LUTS) caused by bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (also known as BPE).

Answer 60

- Smooth muscle hyperplasia - Prostatic enlargement - Bladder dysfunction - Input from CNS 2 COMPONENTS: - Static component - increase in benign prostatic tissue narrowing urethral lumen - Dynamic component - increase in prostatic smooth muscle tone mediated by alpha-adrenergic receptors May also be due to bladder overactivity. Risk factors: - >50 years - Family history - Non-Asian race - Cigarette smoking - Male pattern baldness - Metabolic syndrome

Answer 61

Clinical benign prostatic hyperplasia (BPH) is one of the most common diseases in ageing men and the most common cause of lower urinary tract symptoms (LUTS). The prevalence of BPH increases after the age of 40 years, with a prevalence of 8%–60% at age 90 years.

Answer 62

LUTS STORAGE SYMPTOMS - Frequency - Urgency - Nocturia - Incontinence VOIDING SYMPTOMS - Weak stream - Dribbling - Dysuria - Straining Uncommon: - Fever with dysuria - Urinary retention

Answer 63

- Prostate volume > 30g - Nodules or tenderness suspicious of prostate cancer or prostatitis - Abdominal examination for palpable bladder - DRE - Neurological assessment

Answer 64

1st line: - Urinalysis - normal in BPH, haematuria in cancer, pyuria in UTI - PSA - elevation greater than age guideline - International Prostate Symptom Score - defines severity of symptoms - Global bother score - defines degree of bother to patient - Volume charting - diary of frequency and volume of voiding Consider: - USS - hydronephrosis, mass, urolithiasis, post-void residual - CT AP - mass, hydronephrosis, urolithiasis - Cystoscopy - mass, stone, stricture - Uroflowmetry - < 15ml/second - Urodynamic study - abnormal bladder pressure, abnormal bladder voiding

Answer 65

- Acute urinary retention - Long-term chronic urinary retention - UTI - Renal damage - Renal stones

Answer 66

The outlook for benign prostatic hyperplasia is good; although it can cause significant discomfort, the condition is benign. As the prostate gland grows in size, symptoms may become worse, warranting medication or surgery.

Answer 67

NON-BOTHERSOME - Watchful waiting - yearly follow up - Behavioural management programme - limit fluids, bladder training, treatment of constipation BOTHERSOME + NO SURGERY - Alpha blocker - terazosin, doxazosin, alfuzosin, tamsulosin, silodosin - Behavioural management programme - 5-alpha-reductase inhibitor - finesteride, dutasteride - Phosphodiesterase-5 (PDE-5) inhibitor - sildenafil, tadalafil, vardenafil - Anti-cholinergic agent - tolterodine, fesoterodine, oxybutynin, solifenacin - Combination! BOTHERSOME + SURGERY + PROSTATE VOLUME < 30g - Minimally invasive therapy: TUIP BOTHERSOME + SURGERY + PROSTATE VOLUME 30-80g - Minimally invasive therapy: PVP, PUL, TUMT, water vapour thermal therapy - Moderately invasive therapy: TURP, TUVP, laser vaporisation (HoLEP, ThuLEP, PVP) BOTHERSOME + SURGERY + PROSTATE VOLUME > 80g - Open prostatectomy or laser enucleation (HoLEP or ThuLEP)

Answer 68

Abnormalities of kidney structure of function, present for >3 months, with implications for health. Glomerular filtration rate < 60ml/min/1.73m^2. Presence of one or more of the markers of kidney damage: - Albuminuria - Proteinuria - Urine sediment abnormalities - e.g. haematuria - Electrolyte abnormalities due to tubular disorders - Abnormalities detected by histology - Structural abnormalities detected by imaging - History of kidney transplantation

Answer 69

Common causes: - DM - Hypertension - Glomerulonephritis - Chronic pyelonephritis - Medullary cystic kidney disease - Obstructive nephropathy - Obesity-related nephropathy - Ischaemic nephropathy - Acute uric acid nephropathy Risk factors: - DM - Hypertension - Age > 50 years - Childhood kidney disease - Smoking - Obesity - Black or Hispanic ethnicity - Family history of CKD - Autoimmune disorders - Male sex - Long-term use of NSAIDs - High uric acid levels

Answer 70

CKD is more common in people aged 65 years or older (38%) than in people aged 45–64 years (13%) or 18–44 years (7%). CKD is more common in women (15%) than men (12%). CKD is more common in non-Hispanic blacks (16%) than in non-Hispanic whites (13%) or non-Hispanic Asians (12%). About 14% of Hispanics have CKD.

Answer 71

- Fatigue - N&V - Pruritus - Restless legs - Anorexia - Infection-related glomerular disease - Oedema - Arthralgia - Enlarged prostate gland - Foamy-appearing urine - Coca-coloured urine

Answer 72

- Fatigue - N&V - Pruritus - Restless legs - Anorexia - Infection-related glomerular disease - Oedema - Arthralgia - Enlarged prostate gland - Foamy-appearing urine - Coca-coloured urine

Answer 73

1st line: - Renal chemistry - high renal creatinine, electrolyte abnormalities (metabolic acidosis develops) - Estimation of GFR- < 60ml?min/1.73m^2 - Serum cystatin C and cystatin C-based estimation of GFR - reduced muscle mass (overestimation), increased muscle mass (underestimation) - Urinalysis - haematuria, proteinuria - Urinary albumin - moderately increased [AER 30-300 mg/day; ACR 30-300 mg/g] - Renal ultrasound - small kidney size, presence of obstruction/hydronephrosis, kidney stones Consider: - Kidney biopsy - variable depending on aetiology - Plain Abdo XR - calcium-containing kidney stones - Abdo CT - reveal kidney stones, renal masses, cysts - Abdo MRI - mass lesions in kidney

Answer 74

Glomerular injury. Characterised by inflammatory changes in glomerular capillaries and glomerular basement membrane.

Answer 75

Can involve part or all of the glomeruli or the glomerular tuft. Inflammatory changes mostly immune mediated. Group of diseases: - Membranous GN - Minimal change disease - Focal and segmental glomerulosclerosis - Immunoglobulin A nephropathy - Rapidly progressive GN - vasculitis and anti-GBM disease - Lupus nephritis Risk factors: - Group A beta-haemolytic Streptococus - Respiratory infections - GI infections - HBV - HCV - Infective endocarditis - HIV - SLE - Systemic vasculitis - Hodgkin's lymphoma - Lung cancer - Colorectal cancer - Non-Hodgkin's lymphoma - Leukaemia - Thymoma - Haemolytic uraemic syndrome - Drugs - penicillamine, gold sodium thiomalate, NSAIDs, captopril, mitomycin C, cocaine, anabolic steroids

Answer 76

The mean age of prevalent and incident patients with GN from a systemic immunologic disease was 55.2 and 58.0 years, respectively. For primary GN, 41.7% of prevalent and 40.4% of incident patients were female; for GN from a systemic immunologic disease, 69.0% of prevalent and 58.0% of incident patients were female.

Answer 77

- Presence of risk factors - Haematuria - Oedema - Hypertension - Oliguria - Anorexia - Nausea - Malaise - Weight loss - Fever - Skin rash - Arthralgia - Haemoptysis - Abdominal pain - Sore throat - Hypervolaemia

Answer 78

- Presence of risk factors - Haematuria - Oedema - Hypertension - Oliguria - Anorexia - Nausea - Malaise - Weight loss - Fever - Skin rash - Arthralgia - Haemoptysis - Abdominal pain - Sore throat - Hypervolaemia

Answer 79

- Urinalysis and urine microscopy - haematuria, proteinuria, dysmorphic RBCs, leukocytes, RBC casts - Comprehensive metabolic profile - normal or renal failure, elevated liver enzymes, hypoalbuminaemia - GFR - normal or reduced - FBC - normocytic normochromic anaemia - Lipid profile - hyperlipidaemia or normal - Spot urine albumin:creatinine ratio (ACR) - normal or high (>220mg/mmol) - Ultrasound of kidneys - small kidneys or normal Consider: - ESR/CRP - elevated or normal - Complement levels - low or normal C3 in immune complex diseases - Rheumatoid factor - positive or normal (rheumatoid arthritis or cryoglobulinaemia) - Anti-neutrophil cytoplasmic antibody - positive or normal (pacui-immune or anti-GBM disease) - Anti-glomerular basement membrane (GBM) antibody - positive or normal ( anti-GBM, Goodpasture's) - Anti-streptolysin O antibody - high or rising titres indicate post-strep GN - Anti-hyaluronidase - high or rising titres indicate post-strep GN - Anti-DNAse - positive indicate post-strep GN - Anti-double-stranded DNA - positive (SLE) or normal - Anti-nuclear antibody - high titres = SLE - Cryoglobins - positive or normal (cryoglobulinaemia) - HCV and HBV serology - positive or normal - HIV serology - antibody to HIV or normal - Electrophoresis - monoclonal or polyclonal gammopathy or normal - Drug screen - positive or normal (if suspected drug or medication toxicity) - Renal biopsy - characteristic findings - Anti-phoshplipase A2 receptor antibodies - positive or nomral (idiopathic membranous GN) - CT Chest Abdo - normal or positive for malignancy (exclude in normal patients)

Answer 80

The presence of proteinuria (>3.5g / 24 hours), hypoalbuminaemia (<30g/L) and peripheral oedema. PROTEINURIA HYPOALBUMINAEMIA PERIPHERAL OEDEMA NB: Contrast to nephritic syndrome (AKI + hypertension + active urinary sediment of red cells/casts) = NEPHROTIC SYNDROME HAS NO CELLS OR CASTS IN URINE.

Answer 81

Causes: - Minimal change disease - Focal segmental glomerulosclerosis - Membranous nephropathy (most common cause in adults) - Diabetic nephropathy (both 1 and 2) - Amyloidosis PATHOPHYSIOLOGY There are 3 categories of proteinuria: glomerular, tubular, and overflow. Glomerular proteinuria develops when the components of the filtration barrier are disrupted by disease. The primary insult leading to the development of nephrotic syndrome is the development of high-grade glomerular proteinuria, and the heavier the protein loss the more likely the development of the full-blown syndrome and worsening of renal function. Patients become hypoalbuminaemic due to the urinary loss of albumin. The liver tries to compensate for this protein loss by increasing the synthesis of albumin, as well as other molecules including LDL and VLDL and lipoprotein(a), contributing to the development of lipid abnormalities including hypercholesterolaemia and hypertriglyceridaemia. Lipiduria occurs in the form of: lipid sediment, fatty casts, oval fat bodies, or free fat droplets in the urine (which appear as Maltese crosses under polarised light). Hypercoagulability results from the loss of inhibitors of coagulation in the urine and increased synthesis of procoagulatory factors by the liver. The oedema is due to a combination of a decrease in oncotic pressure from the hypoalbuminaemia, as well as a primary renal sodium retention in the collecting tubules. Patients with nephrotic syndrome are also at increased risk of infection due to loss of immunoglobulins and complement and other compounds being lost in the urine.

Answer 82

The most common cause in children is minimal change disease.[1] In adults, primary glomerular diseases are more frequent in males (55%), whereas secondary glomerular disease is more frequent in females (72%). The most common cause in younger adults is FSGS, followed by minimal change nephropathy. Membranous nephropathy is the most common cause in older people,[2][3] and diabetic nephropathy in adults with a history of long-standing diabetes.

Answer 83

- History of long-standing diabetes, end-organ damage, renal disease, malignancy, SLE, HIV infection, multiple myeloma, connective tissue diseases, amyloidosis - Medications - pamidronate, lithium, gold, penicillamine, NSAIDs, interferon alfa, heroin, mercury, formaldehyde - Oedema - Foamy urine - Symptoms suggestive of occult malignancy - cough, weight loss, night weats, tarry stools - Symptoms suggestive of SLE - rash, photosensitivity, arthralgias - Symptoms suggestive of Fabry's disease - painful neuropathy - Family history of Fabry's disease, amyloidosis, renal disease

Answer 84

- Mild oedema or severe oedema (anasara) - peri-orbital oedema - White banding of the nails from hypoalbuminaemia - Muehrcke's lines - Xanthelasmata - severe HCL - Weight gain due to simultaneous oedema with protein malnutrition lean body mass loss - Rash (SLE) - Easy bruising (amyloidosis) - Neuropathy (amyloidosis) - Haem-positive stool (GI malignancy) - Fundoscopic examination shows diabetic retinopathy

Answer 85

To establish a diagnosis of nephrotic syndrome, initial evaluation includes: - Careful history and physical examination - Quantification of proteinuria by either a 24-hour urine collection (normal <150 mg/day, nephrotic range >3.5 g/day) or alternatively a spot urine protein-to-creatinine ratio on a random urine specimen (this closely correlates with a 24-hour urine protein). - Urinalysis (fresh urine) with microscopy to check for the presence of cellular casts. - Urine should also be sent for urine protein electrophoresis ``` - Serological studies, including: auto-immune screen (ANA, complement screen, cryoglobulins) serum free light chains syphilis serology hepatitis B and C serology. ``` - Renal biopsy to determine the type of nephrotic syndrome

Answer 86

Part of a heterogeneous group of disorders characterised by: - RENAL CYSTS - SYSTEMIC AND EXTRARENAL MANIFESTATIONS

Answer 87

x2 TYPES: - Autosomal-dominant PKD - Autosomal recessive PKD RESULTS IN: - RENAL CYSTS - EXTRARENAL CYSTS - INTRACRANIAL ANEURYSMS - DOLICHOECTASIAS - elongated and distended arteries - AORTIC ROOT DILATION - ANEURYSMS - MITRAL VALVE PROLAPSE - ABDOMINAL WALL HERNIAS Risk Factors: - Family history of autosomal-dominant PKD - Family history of cerebrovascular event

Answer 88

More common = autosomal dominant PKD

Answer 89

- FHx of autosomal-dominant PKD or end-stage renal disease - FHx 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 - Chest pain

Answer 90

- FHx of autosomal-dominant PKD or end-stage renal disease - FHx 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 - Chest pain

Answer 91

1st line: - Renal ultrasound - <30 years = at least 2 uni/bilateral cysts, 30-59 yrs = 2 cysts in each kidney, >60 years = 4 cysts in each kidney - CT scan of abdomen / pelvis - absence of FHx: >10 cysts in each kidney; presence of FHx: <30 years of age - at least 2 unilateral or bilateral cysts; 30 to 59 years of age: 2 cysts in each kidney; >60 years of age: 4 cysts in each kidney - MRI of abdomen / pelvis - >10 cysts in each kidney - Urinalysis / Gram stain and urine culture - bacteriuria if UTI, microscopic haematuria, proteinuria, increased urinary albumin excretion - Serum electrolytes, urea, creatinine - normal or elevated - Fasting lipid profile - normal or elevated (prognostic marker) - ECG - LVH changes in setting of CV complications - CT scan of brain - positive for intracranial bleed in setting of ruptured intracranial aneurysm Consider: - Genetic testing - PKD1 or PKD2 mutation - Echocardiogram - mitral valve prolapse, aortic root dilation, diastolic dysfunction, LVH - 24 hour urine collection - low citrate, high uric acid, oxalate in setting of stones, proteinuria - KUB XR and tomogram - radiopaque stones on KUB, radiolucent identified on tomogram - Dual-energy CT - differences in attenuation values differentiate between stones if present - LP and cerebrospinal fluid analysis - elevated cerebrospinal fluid pressure or xanthochromia in setting of ruptured intracranial aneurysm - MR angiogram of brain - bleeding vessel or intracranial aneurysm identified - CRP - >5 mg/dL suggests infection - PET scan - increased uptake suggests infection

Answer 92

Resection from within the prostatic urethra. May be achieved using a variety of methods - e.g. electrocautery, laser.

Answer 93

- Acute urinary retention - Failed voiding trials - Recurrent gross haematuria - Urinary tract infection - Renal insufficiency secondary to obstruction

Answer 94

- Bladder injury - Hemorrhage - primary, reactionary or secondary - Haematuria - Electrolyte abnormalities - Infection - Loss of erections (ED) - Painful or difficult urination - Retrograde ejaculation - goes into the bladder and not out the penis - Clot retention - Incontinence - TUR syndrome - seizures or cardiovascular collapse caused by hypervolaemia and hyponatremia due to absorption of glycine irrigation fluid - Urethral stricture

Answer 95

A narrowing of the renal artery lumen. Significant if >50% reduction in vessel diameter present. Ischaemic nephropathy - chronic reduction in glomerular filtration rate that occurs from a narrowing in the renal artery. Renovascular hypertension is hypertension mediated by high levels of renin and Angiotensin II, produced by an underperfused kidney supplied by a stenosed renal artery.

Answer 96

Due to atherosclerotic disease or fibromuscular dysplasia. Often presents with accelerated or difficult-to-control hypertension. Risk factors: - Dyslipidaemia - Smoking - Diabetes - Female sex

Answer 97

Image result for epidemiology of renal artery stenosis The prevalence of renal artery stenosis ranges from 14% to 42% in studies performed on patients with aortic (abdominal) or peripheral vascular disease (10–16). It is somewhat less (11% to 23%) in patients with documented coronary artery disease (17–19).

Answer 98

- Onset of hypertension age >55 years - History of accelerated, malignant or resistant hypertension - History of unexplained kidney dysfunction - History of unexplained kidney dysfunction - History of multi-vessel coronary artery disease - History of another peripheral vascular disease - Abdominal bruit - Sudden or unexplained recurrent pulmonary oedema - Onset of hypertension age < 30 years - Absence of family history of hypertension - History of AKI after ACE or ARB - History of unexplained congestive heart failure - Refractory angina - History of hypokalaemia

Answer 99

- Onset of hypertension age >55 years - History of accelerated, malignant or resistant hypertension - History of unexplained kidney dysfunction - History of unexplained kidney dysfunction - History of multi-vessel coronary artery disease - History of another peripheral vascular disease - Abdominal bruit - Sudden or unexplained recurrent pulmonary oedema - Onset of hypertension age < 30 years - Absence of family history of hypertension - History of AKI after ACE or ARB - History of unexplained congestive heart failure - Refractory angina - History of hypokalaemia

Answer 100

1st Line: - Serum creatinine - normal or elevated - Serum potassium - low or normal (hypokalaemia may suggest due to activation of RAAS) - Urinalysis and sediment evaluation - normal in absence of diabetic nephropathy or hypertensive glomerulosclerosis - Aldosterone-to-renin ratio - <20 (excludes primary aldosteronism as cause of hypertension and hypokalaemia) Investigations to consider: - Duplex ultrasound - >50% reduction in vessel diameter - Gadolinium-enhanced MRA - >50% reduction in vessel diameter - CT angiography - >50% reduction in vessel diameter - Conventional angiography - >50% reduction in vessel diameter - CO2 angiography - >50% reduction in vessel diameter - Non-contrast magnetic resonance angiography - >50% reduction in vessel diameter - Captopril radionuclide renal scan - delayed time to max radiotracer activity, asymmetry of peak activity of each kidney, marked cortical retention, marked reduction in cGFR

Answer 101

Aka. Nephrolithiasis or urolithiasis. The presence of crystalline stones (calculi) within the urinary system (kidneys and ureter).

Answer 102

Composed of varying amounts of crystalloid and organic matrix. Originate in kidney and pass down into the ureter. Risk factors: - Chronic dehydration - Diet - high salt intake - Obesity - Positive family history - Specific medicines - antacids, carbonic anhydrase inhibitors, sodium and calcium containing medications, vitamins C and D, protease inhibitors - Metabolic abnormalities - Male - Crystalluria - White ancestry - Warm climate

Answer 103

Adult men more commonly than adult women. | Common.

Answer 104

- Acute, severe flank pain - Previous episodes - N&V - Urinary frequency / urgency - Haematuria - Testicular pain - Obesity - Family history of nephrolithiasis - Precipitation medications - antacids, carbonic anhydrase inhibitors, sodium and calcium containing medications, vitamins C and D, protease inhibitors - Groin pain - Fever - Tachycardia - Hypotension - Costovertebral angle and ipsilateral flank tenderness - loin to groin!

Answer 105

- Acute, severe flank pain - Previous episodes - N&V - Urinary frequency / urgency - Haematuria - Testicular pain - Obesity - Family history of nephrolithiasis - Precipitation medications - antacids, carbonic anhydrase inhibitors, sodium and calcium containing medications, vitamins C and D, protease inhibitors - Groin pain - Fever - Tachycardia - Hypotension - Costovertebral angle and ipsilateral flank tenderness - loin to groin!

Answer 106

1st line: - Non-contrast helical CT scan (non-pregnant) - calcification seen in renal collecting system or ureter, hydronephrosis, perinephric stranding (indicative of inflammation or infection) - Renal ultrasound (pregnant or child) - calcification within the urinary tract, along with dilation - Urinalysis - leukocytes, nitrates, blood (majority), microscopic WBC/FBC or bacteria - FBC with differential - high WCC suggests pyelonephritis or urinary tract infection - Serum electorlytes, urea and creatinine - hypercalcaemia (hyperPTH), hyperuricaemia (gout) - Urine pregnancy test - negative Consider: - Stone analysis - stone composition - Plain abdominal radiograph (KUB) - calcification seen within the urinary tract - MRI - filling defect seen in the collecting system - Spot urine for cystine - cystinuria

Answer 107

INITIAL - acute renal colic, nonpregnant - Hydration - Analgesia - NSAIDs (ibuprofen, diclofenac), IV paracetamol, Morphine ACUTE 1) Confirmed renal or ureteric stone, with evidence of obstruction, non-pregnant WITH INFECTION - Urgent decompression via stent or percutaneous nephrostomy tube - Urgent antibiotic therapy - empirical broad-spectrum pending sensitivity results WITHOUT INFECTION - Urgent decompression 2) Confirmed renal stone, no evidence of obstruction, non-pregnant - Hydration - Analgesia - NSAIDs (ibuprofen, diclofenac), IV paracetamol, Morphine - Antibiotic therapy - depends on infection, patient factors, local resistance patterns - Watchful waiting if asymptomatic <5mm or 5-10mm and patient consent - Surgical intervention - shock wave lithotripsy, ureteroscopy, percutaneous nephrolithotomy 3) Confirmed ureteric stone, no evidence of obstruction, non-pregnant - Hydration - Analgesia - NSAIDs (ibuprofen, diclofenac), IV paracetamol, Morphine - Antibiotic therapy - depends on infection, patient factors, local resistance patterns - Medical expulsive therapy - alpha-blocker (tamsulosin or alfuzosin) for distal ureteric stones <10mm - Surgical intervention - shock wave lithotripsy, ureteroscopy, percutaneous nephrolithotomy 4) Pregnant - Specialist referral - ureteric strent or percutaneous nephrolithotomy tube if not controlled with oral analgesia or obstructing stone or infection - 48-80% of stones pass spontaneously during pregnancy ONGOING - following an acute episode, non-pregnant - Hydration - add lemon juice - Dietary modification - avoid high protein, lots of fruit & veg, - Alkalinisation - potassium citrate, sodium bicarbonate (dissolves uric acid stones) - Preventative medical therapy - potassium citrate, sodium bicarbonate, thiazide diuretics (>50% calcium oxalate, hypercalciuria), oxalate chelator (hyperoxaluria), cystinuria (thiol binding agent and potassium citrate)

Answer 108

- Abcess formation - Pyelonephritis - Urinary fistula formation - ureteral scarring - Ureteral stenosis - Ureteral perforation - Extravasation - Urosepsis - Obstruction

Answer 109

The usually quoted recurrence rate for urinary calculi is 50% within 5 years and 70% or higher within 10 years, although a large, prospective study published in 1999 suggested that the recurrence rate may be somewhat lower at 25-30% over a 7.5-year period.

Renal & Urology Flashcards

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