Urinary Conditions Flashcards by Ellie McIntosh

Acute kidney injury (AKI) - crucial features

Increased creatinine
Decreased urine output
Duration - hours/days

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What are the risk factors for AKI?

Any acute illness
Infection
Diabetes

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What are the causes of AKI?

Pre-renal (most common, due to inadequate blood supply) - dehydration, hypotension, heart failure
Renal (intrinsic disease) - glomerulonephritis, interstitial nephritis, acute tubular acidosis
Post-renal (obstruction to the outflow of urine) - kidney stones, ureter/urethral strictures, enlarged prostate

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What investigations would be done if AKI was suspected?

Bloods - FBC, U&Es, creatinine, CRP, LFTs
Urinalysis
Ultrasound

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How is AKI managed?

Rehydration
Stop nephrotoxic medications
Relieve obstruction

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What are the complications of AKI?

AEIOU:
Acidosis (metabolic)
Electrolyte imbalance - hyperkalaemia
Intoxications
Fluid overload
Uraemic complications

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Chronic kidney disease

3 months

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What are the causes of CKD?

Diabetes
Hypertension
Age-related decline
Glomerulonephritis
Polycystic kidney disease

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What are the symptoms of CKD?

Asymptomatic
Pruritus
Loss of appetite
Nausea
Oedema
Pallor
Hypertension

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What are the stages of CKD?

1-5 (3 has a and b)
Stage 1 - GFR normal (90)
Stage 5 - GFR <15
Increases by 15 each time

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How is CKD managed?

Aim to slow disease progression
Optimise control of condition
ACE inhibitor
Renal replacement therapy (if CKD stage 5) - dialysis (haemodialysis, peritoneal), transplantation

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What are the complications of CKD?

Anaemia
Bone disease
CVS disease
Peripheral neuropathy

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What is the pathology of polycystic kidney disease?

Fluid filled cysts in the kidney

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What is the cause of polycystic kidney disease?

Autosomal dominant
Presents in early adult life
PKD-1 on chromosome 16
(is a recessive one too on different chromosome)

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What are the symptoms of polycystic kidney disease?

Dysuria
Loin pain
Haematuria
Polyuria
Increased BP

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How is polycystic kidney disease treated?

Symptomatic

Transplant

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What are the complications with polycystic kidney disease?

Liver/pancreatic cysts

Cerebral artery berry aneurysm

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What are predisposing factors for a urinary tract infection?

Sex - female
Stones
Foreign bodies
Congenital abnormalities
Bladder outflow obstruction

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Why are UTIs more common in females?

Shorter urethra
Moist environment
Close proximity to anus

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What are common pathogens in UTIs?

E.coli

Pseudomonas

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What are the symptoms of a UTI?

Cystitis - frequency, urgency, dysuria, suprapubic pain

Pyelonephritis - loin pain, nausea, fever, rigors

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When do you investigate a UTI further?

Male
Recurrent infections
Children
Pregnancy
Urinalysis (nitrates and leukocytes show infection), MSU, USS, KUB

How are UTIs treated?

Trimethroprim

Pyelonephritis - amoxicillin

What causes urinary stones?

Idiopathic
Infection
Obstruction
Hot climate
Hyperparathyroidism

What are most stones made of?

Calcium oxalate

What are the symptoms of stones?

Severe loin pain (10/10) Bladder/urethra - maybe haematuria Ureter - radiates to groin

What investigations would be done if stones were suspected?

Urinalysis - microscopic haematuria CT KUB - diagnostic IV urogram

How are urinary stones treated?

Analgesia Small stones normally pass on their own Extracorporeal shock wave lithotripsy Percutaneous nephrolithotomy

What are the complications of urinary stones?

Recurrence

What is the pathology of renal cell carcinoma?

Adenocarcinoma - clear cell

What are the symptoms of renal cell carcinoma?

``` Average age 70 Haematuria Loin pain Palpable mass Weight loss ```

Where does renal cell carcinoma commonly spread to?

Renal vein | IVC

How is renal cell carcinoma treated?

Nephrectomy

What are the risk factors for bladder cancer?

Smoking | Exposure to aromatic amines

What is the pathology of bladder cancer?

90% transitional cell carcinoma | The rest are squamous

What are the symptoms of bladder cancer?

Haematuria | Recurrent UTIs

What investigations would be done if bladder cancer was suspected?

Flexible cystography | CT

How is bladder cancer managed?

Superficial - endoscopic resection | Invasive - radical cystectomy

Benign prostatic hyperplasia

Affects men over 50

What are the symptoms of benign prostatic hyperplasia?

``` Hesitancy Poor stream Terminal dribbling Incomplete emptying Frequency Nocturia Urgency ```

How is benign prostatic hyperplasia investigated?

``` Digital rectal examination - enlarged prostate MSU Urinary flow rate Post-void residual volume PSA ```

How is benign prostatic hyperplasia treated?

Conservative - avoid caffeine, evening fluids Alpha blocker - tamsulon Surgery - transurethral removal of the prostate

What are the complications of benign prostatic hyperplasia?

Acute urinary retention Overflow incontinence ALI Bladder stones

What are the risk factors for prostate cancer?

Ageing | Family history - prostate, BRCA1, BRCA2

What are the symptoms of prostate cancer?

Storage and voiding problems Haematuria Hard nodular prostate on examination Can present with advanced disease - AKI, bone pain, spinal cord compression

What investigations would be done if prostate cancer was suspected?

PSA Trans-rectal ultrasound guided prostatic biopsy MRI

How is prostate cancer treated?

Active surveillance Radiotherapy If advanced - hormone manipulation (eg GnRH agonist goserelin)

What are the risk factors for testicular cancer?

Testicular maldescent Infertility Atrophic testes Previous cancer in contralateral testes

What is the pathology of testicular cancer?

Germ cell tumour

What are the symptoms of testicular cancer?

Painless lump | Potential tenderness, inflammation

What investigations would be done if testicular cancer was suspected?

MSU | Testicular ultrasound

How is testicular cancer managed?

Radical orchidectomy

Where does testicular cancer commonly metastasise to?

Lung Bone Liver