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Urinary System > Summary > Flashcards

Summary Flashcards

1
Q

Describe a UTI

A

Can have pyelonephritis, cystitis, prostatitis, and epididymis/ testis
In children can cause CRF
Usually bowel organisms like E. coli, proteus, klebsiella, and enterococcus

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2
Q

What are the symptoms of UTI in children?

A

Diarrhoea, excessive crying, fever, nausea, vomiting and not eating

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3
Q

What are the symptoms of a UTI in adults?

A

Flank pain, dysuria, cloudy offensive urine, urgency, chills, strangury and confusion in elderly
Acute pyelonephritis - pyrexia, poor localisation, loin tenderness signs of dehydration and turbid pain

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4
Q

What are the investigations for a UTI?

A

Urinalysis - blood, leucocytes and nitrates
Microbiology - bacteriuria >10^5
If man or child then consider US or IVU

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5
Q

What is the treatment for UTIs?

A

Fluids and antibiotics - amoxicillin, cephalosporin, and trimethoprim
Severe - IV antibiotics

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6
Q

Describe reflux nephropathy

A

Kidney damage or scarring caused from urine flowing backwards from bladder into kidneys - reflux and infection
UTIs in children

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7
Q

What is the treatment for reflux nephropathy?

A

Surgery

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8
Q

Describe minimal change disease

A

Type of non-proliferative glomerulonephritis - inflammation of glomerulus
Commonest form in children
Prognosis is favourable and underlying cause is unknown

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9
Q

What are the symptoms and signs of minimal change disease?

A

Sudden onset oedema in days
Nephrotic syndrome - oedema, nephrotic range proteinuria >3.5g or 350mg creatinine, hypoalbuminemia <35g/l, and dyslipidaemia
Haematuria, hypertension and proteinuria

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10
Q

What is the treatment for minimal change disease?

A

Prednisolone for 16 weeks
Once remission achieved then slow taper for 6 months
Initial relapse treated by steroids then further are with cyclophosphamide, cyclosporine, tacrolimus and others

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11
Q

Describe focal and segmental glomerulosclerosis

A

Type of non-proliferative glomerulonephritis
Is a syndrome of multiple disease
High chance progression to ESRD

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12
Q

What are the symptoms and signs of focal and segmental glomerulosclerosis?

A

Nephrotic syndrome - oedema, proteinuria >3.5g or 350mg of creatinine, hypoalbuminemia <35, and dyslipidaemia
Haematuria, proteinuria, and hypertension

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13
Q

What is the treatment of focal or segmental glomerulosclerosis?

A

Generally steroid resistant
Trial steroids for positive response
Alternative - cyclopsorin, cyclophosphamide and rituximab

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14
Q

Describe membranous nephropathy

A

Type of non-proliferative glomerulonephritis and commonest cause of nephrotic syndrome in adults
Majority of cases are idiopathic

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15
Q

What are the investigations for membranous nephropathy?

A

Serology markers - anti-phospholipase A2 receptor antibody and thrombospondin type 1
Renal biopsy - thickened glomerular basement membrane
Immunofluorescence - diffuse IgG uptake

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16
Q

What is the treatment for membranous nephropathy?

A

General measure for 6 months
Immuno-suppression if symptomatic - rising proteinuria and deteriorating renal function
Cyclophosphamide and steroids for 6 months
Tacrolimus and Rituximab

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17
Q

Describe IgA nephropathy

A

Type of proliferative glomerulonephritis - characterised by IgA deposition
Most common in 20-30s years

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18
Q

What is the symptoms of IgA nephropathy?

A

Microscopic haematuria, proteinuria, nephritic syndrome and IgA crescent glomerulonephritis
Nephritic - haematuria, dysmorphic RBCs, and cellular casts
Hypertension

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19
Q

What is the treatment for IgA nephropathy?

A

High dose prednisolone and other immunosuppression drugs

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20
Q

Describe post infectious glomerulonephritis

A

Type of proliferative glomerulonephritis - immunological mediated glomerular injury
Follows 10-21 days after infection

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21
Q

What is the treatment for post infectious glomerulonephritis?

A

Antibiotics given for infection and supportive measures with control of fluids
Loop diuretics and anti-hypertensives

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22
Q

Describe anti-GBM disease

A

Type of proliferative glomerulonephritis - immune mediates pathology involving antibodies against GBM antigens
Possible lung haemorrhage

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23
Q

What is the investigations for Anti-GBM glomerulonephritis?

A

Anti-GBM antibodies in serum and kidney
IgG deposits on kidney biopsy

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24
Q

What is the treatment for anti-GBM glomerulonephritis?

A

Aggressive immunosuppression - steroids, steroids, plasma exchange and cyclophosphamide

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25
Describe acute kidney injury (AKI)
Rapid deterioration of kidney function Increases in serum creatinine by >26.5umol/l within 48hrs or >1.5x baseline which has occurred in prior 7 days Or urine volume is <0.5ml/kg/hr for 6 hrs
26
Describe chronic kidney disease (CKD)
Defined by either presence of kidney damage from abnormal blood, urine, or x-ray, or GFR<60 that is present for more than 3 months
27
What are the symptoms of chronic kidney disease?
Include anaemia, hypertension, SOB, itch + cramps, cognitive changes, GI symptoms, haematuria, change in urine output, proteinuria, and peripheral oedema
28
What is the treatment and management for CKD?
BP is most important Control proteinuria by ACE inhibitor Treat underlying cause Preparation for RRT - dialysis or renal transplant
29
Describe urolithiasis
Kidney stones are hard deposits of minerals and salts from inside the kidney Can be calcium oxalate, phosphate, calcium phosphate, uric acid and cystine
30
What are the symptoms of urolithiasis?
Renal pain (fixed to loin), ureteric colic (radiating to groin), dysuria, haematuria, urinary infection, loin tenderness, pyrexia, and testicular/ vulvar pain
31
What is the treatment for urolithiasis?
Surgery - open, endoscopic, and ESWL. PCNL - percutaneous nephrolithotomy Small stones - NSAIDs, fluids and alpha blockers
32
Describe benign prostatic hyperplasia
Benign enlargement of the prostate characterised by fibromuscular and glandular hyperplasia 50% of men at age of 60
33
What is the symptoms of BPH?
Moderate to severe LUTS Hesitancy, poor stream, terminal dribbling, incomplete, emptying, frequency, nocturia and urgency
34
What can BPH result in?
BPO - benign prostatic obstruction or bladder outflow obstruction (BOO)
35
Describe upper tract obstruction
Includes PUJ, ureter and VUJ Complications include infection, sepsis, and renal failure if bilateral
36
What are the causes of upper tract obstruction?
Stone, ureteric tumour, blood clot, fungal ball scar tissue, LNs, prostatic cancer, abdominal mass, and iatrogenic
37
What are the symptoms of upper tract obstruction?
Pain, frank, haematuria, and symptoms of complication Palpable mass and microscopic haematuria
38
What investigations are used for upper tract obstruction?
Abdominal renal US - hydro nephrosis and hydroureter CT-KUB - investigation of urinary renal stones and obstruction in emergency setting IVU, CT urogram and MAG-3 renogram
39
What is the treatment for upper tract obstruction?
Percutaneous nephrostomy insertion or retrograde stent insertion Treat underlying problem - stones by ureteroscopy and ureteric tumour by radical nephron-urethrectomy
40
Describe lower tract obstruction
Bladder outflow obstruction Includes bladder neck in men, prostate, urethra, foreskin, and urethral meatus
41
What are the symptoms of lower tract obstruction?
LUTS - voiding, storage and urinary incontinence Acute/ chronic urinary retention, sepsis, recurrent UTIs, frank haematuria, renal failure, and PV bleeding
42
What is the treatment for lower tract obstruction?
Emergency - urethral or suprapubic catheterisation Treat underlying cause - BPE by TURP, phimosis by circumcision and meatal stenosis by dilatation
43
Describe acute urinary retention
Painful inability to void with palpable and precussable bladder Residuals vary from 500ml to 1l
44
What is the treatment for acute urinary retention?
Immediate treatment is catheterisation - urethral or suprapubic Treat underlying cause - main risk is BPO
45
Describe chronic urinary retention
Painless, palpable, and precussible bladder after voiding Often able to void but with residuals of between 400 ml to 2l depending on stage of condition
46
How does chronic urinary retention present?
Presents as LUTS Also can have complication like UTIs, bladder stones, overflow incontinence or obstructive renal failure
47
What is the treatment for chronic urinary retention?
Asymptomatic with low residuals - no need for treatment With symptoms or complications - immediate catheterisation followed by CISC if appropriate Subsequent treatment - long term catheter, CISC or TURP
48
Describe prostate cancer
Most common cancer for men in the UK 75% of deaths occur in men over the age of 75 Diagnosed through PSA testing (check again after 3 weeks), RE, MRI and biopsy
49
What are the symptoms and signs of prostate cancer?
Mostly asymptomatic and diagnosed by opportunistic PSA testing Weak stream, haematuria, hesitancy, frequency, urgency, and UTI Can metastasise to bone and LNs
50
What is the management and treatment for prostate cancer?
Watchful waiting RT Radical prostatectomy If locally advanced - hormone therapy followed by surgery. HT alone, or radiation after HT Metastatic - hormone therapy plus docetaxel chemo
51
Describe testicular cancer
One of the commonest cancers of young men Testicular germ cell neoplasia in-situ is a precursor lesion Peaks in 3rd decade
52
What is the presentation of testicular cancer?
Usually painless lump, less often tender swelling, history of trauma, and symptoms of metastatic disease - bone, chest and para-aortic LNs
53
Describe bladder cancer
Tumour type is most commonly transitional cell carcinoma (TCC) but there is also squamous cell Risk factors for TCC - smoking, amines and non-hereditary genetics RF for squamous - chronic cystitis, pelvic RT and cyclophosphamide therapy
54
What are the symptoms for bladder cancer?
Painless visible haematuria - most common Haematuria can be visible or microscopic Have recurrent UTIs and storage bladder symptoms
55
What is the treatment for bladder cancer?
Low grade non-muscle invasive - endoscopic resection with intravesical CT High grade non-muscle invasive - endoscopic resection, BCG therapy, and surgery Muscle invasive - neoadjuvant chemo, RT or radical surgery
56
Describe upper tract TCC
Renal pelvis or colleting system is commonest Tumours are often high grade and multifocal on one side High risk of local recurrence
57
What are the symptoms of upper tract TCC?
Frank haematuria, unilateral ureteric obstruction, flank/ loin pain and signs of metastatic disease
58
What is the treatment for upper tract TCC?
Most are treated by nephroureterectomy If unfit or bilateral then consider nephron sparing endoscopic treatment If unifocal and low grade - endoscopic treatment
59
Describe renal cancer
Malignant renal adenocarcinoma is commonest adult renal malignancy Most arise from proximal tubules Clear cell, papillary, chromophobe and bellini type ductal
60
What is the presentation of renal cancer?
Can be asymptomatic Classic triad is flank pain, mass and haematuria Paraneoplastic symptoms - anorexia, cachexia, pyrexia and hypertension Abnormal LFTs, anaemia and raised ESR
61
What is the investigations for renal cancer?
CT scan of abdomen and chest is mandatory Bloods - U+Es and FBS Optional - US and MAG-3 renogram
62
What is treatment for renal cancer?
Surgical - radical nephrectomy Laparoscopic radial nephrectomy is standard RCC is chemo and radio-resistant so receptor tyrosine kinase receptors and immunotherapy used

Urinary System (26 decks)

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