Urology & Renal Medicine Flashcards by Sabine Jamal

Acute Urinary retention

sudden, painful inability to pass urine. Urological emergency

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Which surgical procedures are most likely to cause urinary retention?

NOF repair / hip replacement
Pelvic surgeries
Hernia repairs

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Macroscopic haematuria

visible blood in the urine

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Causes of painLESS haematuria

Malignancy

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Causes of painFULL haematuria

Malignancy
Infection
Stones
Trauma

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Malignancies that can cause macroscopic haematuria

renal tract, gynaecological, prostate, colon - enterovesicle fistula

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Most common benign tumour which can cause macroscopic haematuria

Angiomyolipoma (AMA)

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Causes of acute scrotal pain +/- swelling

torsion, epididymitis, orchitis, appendix testis torsion, testicular mass, hydrocele, spermatocele, varicocele, testicular rupture

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Differentials for loin pain

urolithiasis (stones - ureteric or renal colic), pyelonephritis, constipation, gynaecological, malignancy, MSK, traumatic

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Acceptable urine output

0.5 ml per kg per hour - works out to 30 ml per hour in a 70kg person

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What are the functions of the kidney? (Think: ABC)

A - acid, anaemia
B - bones (vitamin D)
C - clearance
D - drugs
E - electrolytes, eating (dietary restrictions in renal failure)
F - fluid (therefore BP)

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What three things must be included in MDRD calculations which can affect the result?

age, gender, ethnicity

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What is EDTA eGFR and when is it used?

measure of kidney function independent of creatinine and urea levels (because these two values can be deranged by various other pathologies)

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Which patient populations have naturally higher levels of creatinine production?

young
males
high muscle mass
heavier mass
ethnicity (black)

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How might a patient in renal failure present? (HINT: think of the functions of the kidneys)

Low eGFR therefore high creatinine 
Anaemia - treated with EPO and iron 
Deranged electrolytes - esp potassium 
Acidosis 
Renal osteodystropy and secondary hypoparathyroidsm - due to problems with vitamin D metabolism.
May have low urine output

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Name a type of classification for acute renal failure and briefly describe each one

Pre renal - decreased perfusion

Renal - intrinsic kidney injury

Post renal - obstruction

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List some of the causes of pre renal renal failure

Shock:

cardiogenic
hypovolaemic
septic
anaphylactic

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Name some of the causes of renal renal failure

Glomerulonephritis (eg autoimmune)
Infection - pyelonephritis 
Nephrotoxic agents (eg gentamicin)
Trauma 
Acute tubular necrosis 
Malignancy

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Name some of the causes of post renal renal failure

Renal calculus
Bladder malignancy
Stricture
BPH / Prostate cancer

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Describe the assessment of a patient in AKI

Full history and examination (should have occurred as bloods will be what highlights AKI)
Fluid assessment - will help determine cause if pre renal failure
Urinalysis - useful for all types, especially in determining between nephrotic and nephritic syndromes
USS - will help location obstruction in post renal failure

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What is the management of pre renal renal failure?

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Determine fluid status -

If overloaded = diuretics
If dry = fluids

What is the management of post renal renal failure?

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Catheter

Nephrostomy

Why is renal transplant the best treatment for renal failure?

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Transplant has the best prognosis and quality of life of all RRT - it is also very cost effective (especially compared to dialysis)

What are the three major causes of post transplant mortality (usually in the first three months)?

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Infection - fatal due to immunosuppression

Cardiovascular disease (stroke and MI) - multifactorial: pre operative cardiac risk factors (CKD, T2DM, HTN) but also immunosuppression adds further risk

Malignancy - particularly lymphoma and skin (again due to immunosuppression)

What are the renal causes for acute allograft dysfunction? (HINT: think RING)

Rejection Infection Nephrotoxic agents (esp NSAIDS and calcineurin inhibitors) Glomerulonephritis (esp autoimmune)

What is an important blood test if there are concerns about acut rejection?

DSA - donor specific antigens

Which drugs can cause AKI? (HINT: think CANDA)

``` Contrast Aminoglycosides (gentamicin) NSAIDS Diuretics ACEi ```

Outline the presentation of chronic renal failure

``` Uraemia Sodium retention Protein loss Acidosis Hyperkalaemia Anaemia Vit D deficiency ```

List some of the risk factors for AKI

``` CDK Drugs Age Sepsis Dehydration Organ failure ```

Name some drugs that can cause AKI

``` Diuretics Tacrolismus ACEi NSAIDs Aminoglycosides (eg: gentamycin) Methotrexate Contrast Chemotherapy ```

List the causes of post-renal AKI (HINT: think SNIPPIN)

``` Stone Neoplasm Infection Prostatic hypertrophy Posterior urethral valves Inflammatory Neurological ```

What are the indications for dialysis in AKI? (HINT: think AEIOU)

``` Acidosis Electrolytes (refractory hyperkalaemia) Intoxications - drugs that can be removed by dialysis (eg: salicylates) Overload Uraemia ```

List some complications of chronic renal disease

``` Cardiovascular disease Renal osteodystrophy Fluid overload / oedema Hypertension Electrolyte disturbances Anaemia Let restlessness Sensory neuropathy ```

How would a patient in chronic renal failure present?

Low eGFR therefore high creatinine Anaemia - treated with EPO and iron Deranged electrolytes - esp potassium Acidosis Renal osteodystropy and secondary hypoparathyroidsm May have low urine output

At what stage of CKD do symptoms usually appear?

Stage 3 - when GFR falls below 40

List the features of polycystic kidney disease in adults (HINT: think MISSHAPES)

``` Mass - abdominal mass +/- pain Infection Stones Systolic hypertension Haematuria Aneurysms - berry aneurysms —> SAH Polyuria + nocturia Extra-renal cysts - usually hepatic Systolic murmur - mitral valve prolapse ```

Define: pis-en-deux

Urinary urgency shortly after voiding

Define: strangury

Severe pain and a strong desire to urinate

List some causes of urinary tract obstruction (HINT: split into - luminal, mural and extramural)

Luminal - stones, clots Mural - strictures, tumour Extra-mural - prostatic enlargement, pelvic tumour

List LUTS (lower urinary tract symptoms) in males

``` Frequency Hesitancy Poor stream Terminal dribbling Overflow incontinence ```

How can LUTS (lower urinary tract symptoms) in males be classified?

Filling (storage) / Irritative symptoms Voiding / Obstructive symptoms

List the cardinal filling (irritative) urinary symptoms in men

Frequency Urgency Dysuria (painful urination) Nocturia (excessive urination at night)

List the voiding (obstructive) urinary symptoms in men

``` Poor stream Hesitancy Terminal dribbling Incomplete voiding Urinary retention Overflow incontinence ```

List some causes of urinary retention (HINT: split into obstructive, neurological and myogenic)

OBSTRUCTIVE - - Mechanical: BPH, stricture, stones, constipation - Dynamic: drugs NEUROLOGICAL - pelvic surgery, MS, DM, spinal injury MYOGENIC - EtOH

Name and describe the two classifications of chronic urinary retention

High pressure - high detrusor pressure at the end of micturition due to bladder outflow obstruction Low pressure - low detrusor pressure at the end of micturition

How do you manage low pressure chronic urinary retention?

TURP

How do you manage high pressure chronic urinary retention?

Catheter

What are the three most common sites for urinary tract calculi?

PUJ (pelvic-ureteric junction) Pelvic brim (where the iliac vessels cross the ureters) VUJ (veso-ureteric junction)

What is the most common type of renal calculi?

Calcium oxalate

List some drugs associated with renal calculi

Loop diuretics, thiazides, antacids, steroids, theophylline, salicylate

List some of the complications associated with a TURP (HINT: think: immediate, early, late)

IMMEDIATE - haemorrhage EARLY - infection, clot retention LATE - retrograde ejaculation, ED, incontinence, urethral structure, BPH recurrence

How do you differentiate between BPH and Prostate Ca on PR?

BPH - smooth bilateral enlargement of prostate (therefore median sulcus is definable) Ca - "craggy", hard, irregular unilateral enlargement of prostate (therefore median sulcus is lost)

Urology & Renal Medicine Flashcards

(52 cards)