Renal/Urology guidelines

Question 1

UTI management

• non pregnant women
• pregnancy woman
• man

Answer 1

• 3d nitrofurantoin/trimethoprim
• 7d nitrofurantoin (even if asymptomatic)
• 7d nitro/trimethoprim

Question 2

Pyelonephritis Mx

Answer 2

cephalosporin 14d

Can also use quinolone (levofloaxin, ciprofloxacin)

Question 3

Prostatitis Mx

Answer 3

Quinolone 14d (levofloxacin, ciprofloxacin)

Question 4

UTI in children
<3m
>3m, lower UTI
>3m, upper UTI

Answer 4

<3m = admit if under 3m
>3m, lower UTI = treat as adult
>3m, upper UTI = admit for 10d cephalosporin

Question 5

timeline for needing CTKUB for renal stones

Answer 5

within 14 hours

Question 6

Mx of renal stone based on size

Answer 6

<0.5cm = expectant with alpha blocker (tamsulosin) or CCB (nifedipine)
<2cm = lithotripsy (uretoscopy if pregnant)
>2cm (or complex like staghorn) = percutaneous nephrolithotomy
Any size + infection/hydrocephalus

Question 7

2 main drugs for BPH and SE

Answer 7

tamsulosin (a2 blocker) - post hypotension, dizziness

finasteride (5a reductase inhibitor) - libido, erections, retrograde ejaculation, gynaecomastia

Question 8

do you need to do a biopsy for renal cancer

Answer 8

no, not if a nephrectomy is planned

CTCAP is good enough

Question 9

Mx of renal cancer
T1
T2+
chemotherapy
if is a transitional cancer of renal pelvis

Answer 9

T1 (<7cm in one kidney) = partial nephrectomy
T2+ = radical nephrectomy (without adrenals)
NO adjuvant chemo needed
If TCC, need to disconnect ureter at the bladder and remove it.

Question 10

when do you refer for prostate cancer

Answer 10

if craggy
if PSA above age specific range:
50-60 = 3
60-70 = 4
70+ = 5

Question 11

1st line investigation once referred for prostate cancer and how this leads on to definitive investigation

Answer 11

Multiparametric MRI, reported using the 5 point Likert scale:
1-2 –> discuss pros and cons of biopsy
3+ –> perform trans rectal biopsy TRUS and then grade using gleason score

Question 12

When can you do conservative treatment for prostate cancer and what does this entail

Answer 12

T1/T2 stage (local) AND

elderly + comorbid + 3/3 Gleason score (low).

This group needs active surveillance including re-biopsy

Question 13

Mx of prostate cancer

- T3/4 (advanced to local structures)

Answer 13

surgery + radiotherapy +/- hormone therapy

Question 14

Mx of prostate cancer

- Metastatic

Answer 14

Goserelin (GnRH agonist) + covering antiandrogen cytoperotone acetate

Question 15

1st line for testicular cancer

Answer 15

USS

Question 16

Mx of testicular cancer
always
seminoma
non-seminoma

Answer 16

Always = orchidectomy via inguinal approach
Seminoma = radiotherapy
Non-seminoma = chemotherapy

Question 17

Approaches to hydrocele operation if adult or child

Answer 17

adult has scrotal approach (Lords or Jaboulay)

child (if persisting beyond 2yrs) has inguinal approach

Question 18

Ix of varicocele

when do you operate

Answer 18

Ix = doppler studies
Mx = usually conservative. if pain or fertility issues, operate

Question 19

CKD management

• high phosphate
• low vit D
• anaemia
• hypertension
• tertiary hyperPTH

Answer 19

• use calcium based phosphate binders. Unless CKD bone disease is present in which case use Sevelamer (nonCabased)
• give activated vit D calcitriol/alfacalcidol
• IV iron or EPO
• ACEi is good (allowed a 30% rise in creatinine or 25% reduction in eGFR)
• parathyroidectomy of offending gland

Question 20

Stress incontinence Mx

Answer 20

C = pelvic floor exercises, 8r, 3x/day 3 weeks
M = duloxetine (SNRI)
S = retropubic tabe

Question 21

Urge incontinence Mx

Answer 21

C = bladder retraining
M = oxybutninin (antimuscarinic), mirabegron (B3) for old ladies worried about falls
S = botulinum toxin

Question 22

definition of AKI and stages

Answer 22

Stage 1 = <0.5ml/kg/hr, 50% (or 26umol) increase in creatinine in 48 hours
Stage 2 = 2x increase in creatinine or above for 12 hours
Stage 3 = 3x increase

Question 23

when do you do urine dip and renal USS for AKI

Answer 23

urine dip = always

renal USS = only if cause not known for AKI after 24 hours

Question 24

do you fluid resuscitate in AKI

Answer 24

If pre-renal, yes, but if ATN no.
Pre-renal: urinary sodium <30
ATN: urinary sodium >30

Question 25

What do you do FIRST if called to hyperkalaemia

Answer 25

do ECG and repeat VBG to check result

Question 26

When do you manage hyperK

Answer 26

If >6.5 or if ECG changes

Question 27

Mx and doses for hyper K

Answer 27

``` 1st = 10ml 10% calcium gluconate Then = 10U actrapid in 50ml of 50% glucose over 10 mins Consider = salbutamol. rectal Resonium. ```

Question 28

definition of nephrotic syndrome

Answer 28

>3g/24hr protein | hypoalbuminaemia (<30)

Question 29

Investigation findings for the following: - MNCS - FSGS - membranous - IgA - Post-strep (proliferative) - Rapid progressive

Answer 29

- MNCS = podocyte effacement on EM - FSGS = focal sclerosis and hyalinosis on light microscopy - membranous = subepithelial deposits 'spike and dome' - IgA = mesangial hypercellularity, +ve for IgA and C3 - Post-strep (proliferative) = low C3, high ASOT, endothelial proliferation and subepithelial humps - Rapid progressive = epithelial crescents

Question 30

AIN heptad

Answer 30

fever, eosinophilia, urinary white cell casts, rash

Question 31

General nephrotic syndrome Mx | General nephritic syndrome Mx

Answer 31

steroids + immunosuppression with membranous type also use ACEi/ARB Nephritic are usually self limiting or are caused by something systemic like GwPA so have special treatments

Question 32

Amyloidosis Ix (3)

Answer 32

Congo red stain shows apple green birefringence Serum amyloid precursor scan (SAP scan) Biopsy of rectal tissue

Question 33

Amyloidosis general Mx

Answer 33

Myoablative chemotherapy (as problem is often within the bone marrow)

Question 34

how do you screen for PCKD

Answer 34

USS

Question 35

How do you diagnose PCKS based on USS

Answer 35

``` <30 = two cysts either kidney 30-60 = two cysts both kidneys 60+ = four cysts both kidneys ```

Question 36

Mx of PCKD

Answer 36

tolvaptan (ADH receptor 2 antagonist) if CKD2/3 or rapidly progressing

Question 37

Peyronie's disease Ix and Mx

Answer 37

``` Ix = USS Mx = vitamin E and surgery ```