urological diseases Flashcards
(49 cards)
differential diagnoses for haematuria
renal stones UTI renal or bladder tumours trauma, eg biopsy PCKD IgA nephropathy
warfarin can make haematuria worse
what investigations would you do for haematuria
MSU U&E for renal causes flexible cystoscopy for bladder cancer USS CT urogram X-ray KUB for calcification
IVP
how do urological stones present?
- pain
- haematuria
what are the causes of urological stones?
metabolic (50%)= renal tubular acidosis, hyperparathyroidism, cystinuria
urological = lesions causing stasis
infection 15%
what can urological stones be made of?
calcium oxalate = predisposition is IBD, bowel resection
calcium phosphate: HPT
struvite = staghorn stones, associated with UTI’s, catheters etc
uric acid: predisposition is obesity, DM (treated with urinary alkalinisation
how do you manage urological stones?
increase fluid intake, reduce animal protein and sodium
treat infection
medical therapies include bendroflumethiazide, allopurinol, penicillamine
what is the surgical management if a stone is >5mm?
- ESWL
- laser removal of stone via ureter
- if blockage causing hydronephrosis = nephrostomy or stent, then removal of stone 6 weeks later
what are the types of kidney cancer?
renal cell carcinoma
transitional cell carcinoma
what is RCC
presents in 40-60s
haematuria, pain, palpable mass = clinical triad
management is resection or medical immunotherapy
what is TCC
> 45 years
haematuria, pain, LUTS
risk factors: smoking, DYES !! , bilharzia
management is surgical resection or intravesical chemotherapy
what is papillary necrosis
necrosis and shedding of medullary papillae
RF: analgesia, NSAIDs, diabetes
may cause obstruction and pyelonephritis
drainage and AB treatment
what is renal colic
severe, acute pain due to stone obstructing the ureter
how does a renal stone present
loin to groin pain nausea, vomiting occasional LUTs micro haematuria tachycardia and dehydration
what are common differentials for renal colic
pyelonephritis ectopic pregnancy appendicitis pancreatitis ruptured AAA MSK
what diagnostic tests should you do for renal colic
blood, FBCs, u&es, CRP
CALCIUM levels
non contrast CT abdo and pelvis
KUB x ray
USS = hydronephrosis
how do you manage renal colic
opiates or NSAIDs
hydration
<5mm pass alone
>5mm shockwave or uteroscopy
when should you never leave a renal stone?
patient is pyrexial
bilateral stone or reduced renal function
untreatable pain
stent or nephrostomy necessary
what is pyelonephritis?
Infection in the renal pelvis (join between kidney and ureter) and parenchyma (tissue)
what are RF for pyelonephritis?
Female, structural urological abnormalities and diabetes
what causes pyelonephritis (organisms that also cause UTIs)
Escherichia coli is the most common cause
Klebsiella
Enterococcus
Pseudomonas
how does pyelonephritis present
High fever and rigors
Loin to groin pain
Dysuria and urinary frequency
Haematuria
Other non-specific symptoms (e.g. vomiting)
Pain on bimanual palpation of the renal angle (over kidney)
what do you see on a urine dip for PN
Blood
Protein
Leukocyte esterase (produced by neutrophils)
Nitrite (gram negative organisms metabolise nitrates in the urine, which is normal to nitrites, which are not normally present)
how do you test for PN
USS
CT
Dimercaptosuccinic acid (DMSA) scans involves injecting radiolabelled DMSA, which builds up in the kidneys and when imaged using gamma cameras gives an indication of renal scarring. This is used in recurrent pyelonephritis to assess the damage.
how do you treat PN
Blood and urinary cultures
Broad spectrum antibiotics (e.g. co-amoxiclav) until culture and sensitivities are avaliable
Admission if systemically unwell or complicated
IV rehydration
Analgesia
Antipyretics
