Urinary 2 Flashcards
(62 cards)
1
Q
What are the indications for renal imaging?
A
Renal colic and renal stone disease >Diagnosis and follow up Haematuria Suspected renal mass UTIs Hypertension
2
Q
What imaging is used for kidneys?
A
Plain X-ray
USS
CT
3
Q
What are the clinical features of nephrourolithiasis?
A
Renal pain (fixed in loin) Ureteric colic (radiating to groin) Dysuria / haematuria / testicular or vulval pain Urinary infection Loin tenderness Pyrexia
4
Q
How do you investigate kidney stones?
A
Bloods, Urine analysis
Parathyroid hormone
Radiology
5
Q
What are the indications for surgery and renal stones?
A
Obstruction Recurrent gross haematuria Recurrent pain + infection Progressive loss of kidney function Patient occupation
6
Q
What are the indications for PCNL?
A
Large stone burden (risk of Steinstrasse) Associated PUJ stenosis. Infundibular stricture. Calyceal diverticulum. Morbid obesity or skeletal deformity. ESWL resistant stones e.g. Cystine. Lack of availability of ESWL.
7
Q
What are the complications of PCNL (surgery)?
A
Uncorrected coagulopathy.
Active Urinary Tract Infection.
Obesity or unusual body habitus unsuitable for X-ray tables.
Relative contraindications include small kidneys and severe perirenal fibrosis.
8
Q
What is ESWL, when is it used?
A
Extracorporeal wave lithotripsy
Not used as first line with stones greater than 2cms
Not as effective after 2 treatments
9
Q
What are the indications for ESWL?
A
Severe obstruction, uncontrollable pain, persistent haematuria, lack of progression, failed ESWL and patient occupation
10
Q
What are the complications of uteroscopy?
A
Minor complications: 0-30%
>Haematuria, fever, small ureteric perforation, minor vesico-ureteric reflux.
Major complications:
>Major ureteric perforation, ureteric avulsion, ureteral necrosis and stricture formation.
11
Q
What is the clinical presentation of bladder stones?
A
Suprapubic / groin / penile pain Dysuria, frequency, haematuria Urinary infection (persistent) Sudden interruption of urinary stream Usually secondary to outflow obstruction
12
Q
How do you treat bladder stones?
A
Endoscopically
Large stones with open excision
13
Q
What systemic diseaes affect the kidneys?
A
Diabetes mellitus Cardiovascular disease >Cardiac failure >Atheroembolism >Hypertension >Atheroscelrosis Infection Inflammation in blood vessels Myeloma Amyloidosis Drugs
14
Q
What drugs affect the kidneys?
A
Aminoglycosides ACEI Penicillamine NSAIDs Radiocontrast
15
Q
What are the types of vascalitis?
A
Aorta/large artery >Takayasu arteritis >Giant cell arteritis Medium artery >Polyarteritis nodosa >Kawasaki disease Small vessel >Wegener’s granulomatosis >Microscopic polyarteritis Churg-Strauss syndrome
16
Q
What is wegners granulomatosis?
A
Granulomatous inflammation in respiratory tract
Focal necroitising glomerulonephritis with crescents
Affects all age groups
17
Q
What is the clinical presentation of vasculitis?
A
Upper respiratory tract >Epistaxis, sinusitis >Cough, dyspnoea, haemoptysis >Pulmonary haemorrhage Kidney >- glomerulonephritis Joints > arthralgia, myalgia Eyes > scleritis Heart >pericarditis Systemic > fever, weight loss, vasculitic skin rash
18
Q
How do you diagnose vasculitis?
A
Yrine blood/protein Raised urea Low albumin, Raised Alk P Anaemia Hyperglobulinaemia Positive ANCA
19
Q
How do you diagnose multiple myeloma?
A
bone marrow aspirate
Serum para protein
urinnary Bence Jones protein
skeletal survey
20
Q
What are the complications of multiple myeloma?
A
cast nephropathy light chain nephropathy amyloidosis hypercalcaemia hyperuricaemia
21
Q
How do you diagnose multiple myeloma?
A
Urine protein, microscopic blood Elevated urea, creatinine + CRP Anaemia Raised alk P ANCA
22
Q
What are the clinical features of multiple myeloma?
A
Hands >splinter haemorrhages, purpura face >scleritis, uveitis, nasal cartilage deformity, retinal vasculitis, hypertensive retinopathy Skin >Vasculitic rash, scleroderma CVS >Hypertension, murmur Chest >Crepitations, haemoptysis Locomotor >Joint swelling, tenderness CNS >Stroke, encephalopathy
23
Q
What are the common sites of urinary tumours?
A
Epithelial lining
Bladder
24
Q
What is the pathology of bladder cancer?
A
Most often transitional cell carcinoma
If schistomosomiasis is endemic, squamous cell carcinoma
25
What are the risk factors for transitional cell carcinoma?
smoking (accounts for 40% of cases)
aromatic amines
non-hereditary genetic abnormalities (e.g. TSG incl. p53 and Rb)
26
What are the risk factors for squamous cell carcinoma?
Schistosomiasis (S. haematobium only)
chronic cystitis
cyclophosphamide therapy
pelvic radiotherapy
27
What are the symptoms of bladder cancer?
Visible often painless haematuria
Occasionaly symptoms due to invasive or metastatic disease
Recurrent UTI
Storage bladder symptoms
28
How do you investigate haematuria?
Urine culture
Cystourethroscopy
Upper tract imaging
>Intravenous urogram/US
29
How do you diagnose urothelial tumours?
IVU will miss some renal cell tumours
| USS alone will miss urothelial tumours of upper tracts
30
What are the different stages of bladder cancer?
G1 = Well diff. - commonly non-invasive
G2 = Mod. diff. - often non-invasive
G3 = Poorly diff. - often invasive
Carcinoma in situ (CIS) – non-muscle invasive but VERY aggressive (hence treated differently)
31
How do you treat low grade bladder cancer (no muscle involvement)?
endoscopic resection followed by single installation of intravesical chemotherapy (mitomycin C) within 24 hours
prolonged endoscopic follow up for moderate grade tumours
consider prolonged course of intravesical chemotherapy (6 weeks to 6 months) for repeated recurrences
32
How do you treat invasive bladder cancer?
Chemo + radio
| Or chemo + surgery
33
What are the symptoms of upper tract urothelial cancer?
Frank haematuria
Unilateral ureteric obstruction
Flank or loin pain
Symptoms of nodal or metastatic disease
34
What is UTUC?
Renal pelvis or collecting system most commonly, sometimes ureter
High grade multifocal unilateral
Endoscopic treatment
35
What are the renal tumours?
Benign : oncocytoma, angiomyolipoma
Malignant : renal adenocarcinoma
commonest adult renal malignancy
36
What are the histological subtypes of renal adenocarcinoma?
clear cell (85%)
papillary (10%)
chromophobe (4%)
Bellini type ductal carcinoma (1%)
37
What are the risk factors of renal adenocarcinoma?
```
Family history (autosomal dominant e.g. vHL, familial clear cell RCC, hereditary papillary RCC; can be bilateral and/or multifocal)
Smoking
Anti-hypertensive medication
Obesity
End-stage renal failure
Acquired renal cystic disease
```
38
What is the presentation of renal adenocarcinoma?
Asymptomatic (i.e. incidentally noted on imaging for unrelated symptoms) : 50%
‘Classic triad’ of flank pain, mass and haematuria : 10%
```
Paraneoplastic syndrome : 30%
anorexia, cachexia and pyrexia
hypertension, hypercalcaemia and abnormal LFTs
anaemia, polycythaemia and raised ESR
Metastatic disease : 30%
>bone, brain, lungs, liver
```
39
How do you investigate renal adenocarcinoma?
CT scan
Bloods
US, IVU, DMSA
40
How do you treat renal adenocarcinoma?
Surgical
Radio/chemoresistant (mets difficult to treat)
Immunotherapy
41
What are the predisposing factors to UTIs?
```
Immunosuppression
Steroids
Malnutrition
Diabetes
Female
Sexual intercouse
Congenital abnormalities
Stasis of urine
Foreign bodies (catheters, stones)
Oestrogen deficiency
Fistula between bladder and bowel
```
42
What organisms generally cause a UTI?
Generally bowel oganisms
| E coli mos common
43
How do UTIs transfer into the urinary tract?
```
Transurethral route
>Perurethral area contaminated
>>Recurrent UTIs, diaphragms, ? bubble baths
>Urethra to bladder
>>Intercourse, catheterisation
>Bladder (and up ureters)
Bloodstream
Lymphatics
```
44
What are the clinical features of UTIs in children?
```
Diarrhoea
Excessive crying
Fever
Nausea and vomiting
Not eating
```
45
What are the clinical features of UTIs in adults?
```
Flank pain
Dysuria (“like passing broken glass”)
Cloudy offensive urine
Urgency
Chills
Strangury
Confusion (very old people)
```
46
What are the clinical features of pyleonephritis?
```
Pyrexia
Poor localisation
Loin tenderness (renal angle)
Signs of dehydration
Turbid urine
```
47
How do you investigate a UTI?
MSSU (midstream sample of urine)
Urinalysis
Microbiology
>Identify organism so you can treat
48
How do you treat a UTI?
```
Fluids
Antibiotics
> Trimethoprim - first line
>Amoxicillin (3-5 day course or 3g x 2), >cephalosporin
Severe infections
>Intravenous antibiotics
```
49
What is reflux?
Urine going back to kidneys
| Often happens in children
50
How do you manage reflux?
Assess progression of reflux by USS
| Surgery if needed
51
What are the potential complications pf pyleonephritis?
```
Radiological diagnosis
Scarring & clubbing
Hypertension / CRF
Reflux
15% progress to renal failure
```
52
What are the risk factors of prostate cancer?
```
Age (old)
Ethnicity
Family history
Food?
Drugs
```
53
What is the presentation of prostate cancer
```
Mainly asymptomatic
If not, then often LUTS
diagnosed through PSA testing
>then digital rectal examination
>and prostate biopsies
PSA prostate specific not cancer specific
```
54
What is PSA?
```
Prostate specific antigen
A Serine protease - liquifies semen
half of 2.2 days
normal range of 0 to 4 µg/mL
levels increase with age
```
55
What can cause elevation of PSA?
```
UTI
chronic prostatitis
physiological
recent urological procedure, insurance
prostate cancer
BPH
```
56
How do you treat prostate cancer?
Immediate hormonal therapy is mainstay of treatment
Supportive treatment : e.g. palliative radiotherapy to bony metastases, colostomy, nephrostomy, zoledronic acid, palliative care support, etc.
Hormone refractory stage will be reached in 18-24 months of treatment
Oestrogen can be tried
Surgery possible
57
How does testicular cancer present?
```
Usually painless lump
Sometimes:
>Tender inflamed swelling
>history of trauma
>signs and symptoms for distant nodal metastases
```
58
What are the tumour markers for testicular cancer?
AFP (alpha-fetoprotein) (teratoma)
Beta-HCG (Human Chorionic Gonadotrophin) (seminoma)
LDH (Lactate dehydrogenase) (non-specific marker of tumour burden)
59
How do you diagnose testicular cancer?
ump in testes are testicular tumours until proven otherwise
look for tumour markers
perform testicular ultrasound and x-ray
60
What are the differentials for testicular cancer?
differentials
>infection
>epididymal cyst
>Missed testicular torsion
61
How do you treat testicular cancer?
```
orchidectomy
further treatment dependent on type
Low stage, negative markers
>Surveillance; or
>Adjuvant radiotherapy (SGCT only); or
>Prophylactic chemotherapy
Nodal disease, persistent tumour markers, or relapse on surveillance
>Combination chemotherapy (BEP); or
> Lymph node dissection (NSGCT only)
Metastases
>First-line chemotherapy
>Second-line chemotherapy
```
62
What is the pathology of testicular cancer?
Germ cell tumour (95%)
>Seminomatous GCT (classical, spermatocytic, or anaplastic) 30-40yrs
>Non-seminomatous GCT (teratoma, yolk sac, choriocarcinoma, mixed GCT) 20-30yrs
Non-GCT (sex cord/stromal):
>Leydig
>Sertoli
>Lymphoma rare
