Genitourinary Hx

Front 1

change in urine colour

Back 1

red--> haematuria (urethral inflammation/trauma, prostatic disease--> beginning of urination,
-drugs (rifampicin) or beetroot, haemoglobinuria (RBC lysis), myoglobinuria
colour change on standing (porphyria)

Front 2

haematuria, frequency, dysuria

Back 2

loin or back pain, fevers, rigors, lower abdo pain and loin pain--> UTI or pyelonephritis
-vaginal discharge--> not UTI or pyelonephritis

Front 3

hesitancy, frequency, low stream, dribbling at end, pis-en-deux, painful desire to urinate each time

Back 3

obstructive (in men) --> BPH, prostate cancer--> ask about:
-fever
-rigors
-change in urine colour
-flank or loin pain
to determine UTI (increased risk)

Front 4

loin pain

Back 4

-radiates to symphysis pubis or perineum or testes
-colicky

Front 5

causes of acute renal failure (renal flow <20ml/hr or 400ml/day)

Back 5

over days:
prerenal-->1. fluid loss, blood loss
2. hypotension: HF, sepsis shock, drugs
3. renovasc disease (emboli, dissection, atheroma)
4. increased renal vasc resistance (hepatorenal syndrome)

renal: acute on chronic renal disease
acute renal disease
ATN secondary to toxins, ischemia, drugs, rhabdomyolysis, haemoglobinuria
tuberointerstitial disease
vascular disease
myeloma and pyelonephritis

postrenal:
urethral obstruction (total) at the bladder neck or more distal
ureteral (bilateral) obstruction (intraureteral or extraureteral)

causes of rapidly progressive failure (wks to mths)
-UT obstruction
-RPglomerulonephritis
-bilateral RAS, may be due to ACEi
-MM
-scleroderma
-malignant HTN
haemolytic uraemic syndrome

Front 6

urinary incontinence

Back 6

-pee after coughing or sudden rise in intraabdo pressure (stress incontinence women more common)
-intense urge to urinate then leakage in absence of cough or stressors (men and women)
-urinary freq nocturia, freq leakage of small amounts
-men with dribbling after incomplete urination (prostatic in men, obstructive and overflow incontinence)

Front 7

fatigue, lethargy, anorexia, malnutrition, pathological fractures, HTN and oliguria or hypotension and nocturia, kussmaul breathing, vomiting and nausea, anemia, arrhythmias

Back 7

CRF:
-uraemia--> lethargy, anorexia and malnutrition
-can't concentrate urine (dehydration or hypotension, nocturia)
-failure to excrete sodium: hypertension and oliguria
-hyperkalaemia and oliguria--> arrhythmias
-failed acid secretion--> metabolic acidosis
-failed hydroxylation of VitD3--> hyperphosphatemia, hypocalcemia and renal osteodystophy
-failed secretion of erythropoietin--> normocytic normochromic anaemia

Front 8

associations with renal failure

Back 8

-HTN
-pericarditis
-HF (IHD)
-PUD
-mental confusion
-constipation
-DM and neuropathy
-dialysis (haemo or peritoneal)

Front 9

What questions to ask of dialysis patients

Back 9

-what is their fluid restriction
-phosphate binding drugs prescribed, when to take relative to meals?
-how much weight does patient gain in b/w dialysis?
-pt still pass urine?
-compliance with recommended dietary restrictions?
-problems with peritonitis (recurrent) or vascular access for haemo

Front 10

questions to ask of renal transplant patients?

Back 10

-any complications?
-rejection episodes?
-is this the first transplant?
-problems with recurrent infection, urine leaks or SE of Tx
-recent RFTs and results
-immunosuppression SE ie cushings from steroids (HTN, obesity), cancer, nephrotoxicity from cyclosporin
-need to avoid skin exposure to sun and regular pap smears for women

Front 11

menstrual Hx

Back 11

-date of menarche
-regularity of periods over last few mths or years
-dysmenorrhea or menorrhagia
-date of last period
-vaginal discharge
-gravida and parity
-any complications of pregnancy (ie DM HTN)
-sexual Hx (contraception and impotence/ED)

Front 12

drug Hx

Back 12

-steroids, immunosuppresants
-dietary restrictions in CRF (phosphate, potassium, protein, fluid or salt)
-Tx UTIs and number of times treated
-NSAID use (worsen's renal fxn in already decreased function)

Front 13

PMHx

Back 13

-previous UTIs and Tx
-surgery (remove urinary stones, pelvic to fix incontinence in women or prostatism in men)
-urinalysis results (protein or haematuria)
-renal biopsy and gomerulonephritis
-DM, HTN, gout
-bedwetting past 3 yrs--> vesicoureteric reflux possible cause--> can lead to renal scarring
-bex or vincent's powder ingestion in elderly--> analgesic nephropathy--> urothelial malignancy (also cyclophosphamide use)
-vascular disease (renovascular disease risk)

Front 14

socHx

Back 14

how is patient coping with illness, dialysis (home or in hospital) work, social life, complications,
-how well informed they are about transplant
-dietary restrictions in dialysis

Front 15

FHx

Back 15

-polycystic kidney disease (AD)
-alport's syndrome (deafness and renal disease
-FHx DM, HTN