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48 Cards in this Set
- Front
- Back
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What are the features of frequency associated with anxiety? |
Long term and worse with stress and cold weather Normal UA |
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Define strangury |
Difficult and painful micturition with associated spasm |
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What usually causes the frequency passage of small amounts of urine and a sense of urgency? |
Inflammation |
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Key feature of urethritis |
Pain at the onset of micturition |
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Key feature of cystitis |
Pain at the end of micturition |
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Severe dysuria, pneumaturia and foul-smelling urine are features of... |
Vesicocolonic fistulas e.g. prostate cancer |
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Risk factors for UTI |
Age 15-44 (female) Women Sexually active (females) |
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Dysuria and discomfort is a common feature of what? |
Postmenopausal syndrome due to atrophic urethritis - urethra and lower bladder are oestrogen-dependent |
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Name 4 common differential diagnosis for dysuria |
UTI esp. cystitis (female) - 40% Urethritis - 40% Urethral syndrome (female) Vaginitis - 15% (most common cause in adolescents) |
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Name 4 not to be missed differential diagnosis for dysuria |
Neoplasia - bladder, prostate, urethra Severe infections - gonorrhea, non-specific urethritis, genital herpes Reactive arthritis Calculi e.g. bladder |
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Name 3 basic investigations for dysuria |
Dipstick UA Urine M/C/S Urethral swabs or first pass urine for STIs |
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When is macroscopic haematuria normal? |
Menstruating women Otherwise always abnormal |
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What are the two classifications of asymptomatic microscopic haematuria? |
1. Glomerular (from kidney parenchyma): common causes are IgA nephropathy and thin membrane disease 2. Non-glomerular (urological): common causes are bladder cancer, BPH and urinary calculi |
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Name 4 common urological cancers that cause haematuria |
Bladder (70%) Kidney (17%) Kidney pelvis or ureter (7%) Prostate (5) |
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Name 3 diagnosis painful haematuria is suggestive of |
Infection Calculi Kidney infarction |
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Name 4 diagnosis painless haematuria is suggestive of |
Infection Trauma Tumours Polycystic kidneys |
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Terminal haematuria is suggestive of |
Bleeding from the bladder |
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Haematuria in the first part of the stream suggests? |
Urethral or prostatic lesion |
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Name 4 most common cause of haematuria |
Infection - cystitis/ urethrotigonitis (female) - urethritis (male) - prostatitis Calculi - kidney, ureteric, bladder |
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Name 5 serious causes of haematuria |
Cardiovascular - kidney infartion -kidney vein thromboisis Neoplasia - kidney tumour - bladder, pelvis or ureter - prostate cancer Severe infections - infective endocarditis - kidney TB - acute glomerulonephritis |
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Name 5 general examinations to do for haematuria |
Signs of anaemia e.g. look for pallor Temp, BP, HR Cardiac exam - HS for murmurs (IE) or AF Ballot kidneys Palpate spleen Suprapubic palpation Prostate/ vagina exam |
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What is the significance of enlarged kidneys on exam in haematuria |
Kidney tumour Hydronephrosis Polycystic disease |
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What is splenomegaly suggestive of with haematuria? |
Bleeding disorder |
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What are the key initial investigations in haematuria? |
Dipstick UA Urine microscopy - formed RBCs in true haematuria, red cell casts in glomerular bleeding Urine culture |
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What are some appropriate blood tests for haeamtruia? |
FBC ESR EUCs Antistreptolysin O titres and serum complement levels if glomerularnephritis is suspected |
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What is the key radiological investigation for haematuria? |
Intravenous urogram/ pulogram (unless hx of iodine allergy, severe asthma or other contradiction - go to ultrasound as next choice) |
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What are 5 causes of pseudohaematuria? |
Anthocyanins in food e.g. beetroot, berries Red-coloured confectionery Porphyrins Free haemoglobin e.g. haemoglobinuria Myoglobin (red-black colour) Drugs e.g. pyridium, phenolphthalein - alkaline urine) |
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What is the most common cause of bladder cancer? |
Transitional cell carcinomas |
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Name 4 different treatments for bladder cancer |
Cease smoking (if applicable) Drink ample purified (no chlorine) water Intravesical BCG immunotherapy - for common carcinoma in situ Surgical resection |
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Name the 3 classifications of glomerulonephritis |
Nephritic syndrome: oedema + HTN + haematuria Nephrotic syndrome: oedema + hypoalbuminaemia + proteinuira Asymptomatic kidney disease |
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What are the 4 main causes of glomerulonephritis- nephritic syndrome? |
IgA nephropathy (commonest) Thin glomerular basement membrane disease (has an AD genetic link) Post-streptococcal glomerulonephritis Systemic vasculitis |
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How does IgA nephropathy usually present? |
Haematuria in young adult male Within 1-2 days of mucosal infection (usually throat, influenza, URTI) Persists for several days Can be incidental |
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What is the treatment of IgA nephropathy? |
Immediate specialist referral Immune suppression may be used |
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Post-streptococcal glmoerulonephritis diagnostic triad |
discoloured urine + peri-orbidal oedema + oliguria |
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What does acute post-strep glomerulonephritis typically present in? |
Children (>5 years) ATSI Usually following GABHS throat infection or impetigo (7-10 days) |
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What is the usual course for post-strep glomerulonephritis? |
Oliguria 2 days Oedema and HTN 2-4 days Invariably resolves Good long term prognosis |
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Name 5 specific tests for post-strep glomerulonephritis |
GABHS antigens Blood urea and creatinine C284 (complement) ASOT DNase B |
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Name 6 treatments for post-strep glomerulonephritis |
Hospital admission Strict fluid balance chart/ daily weighing Penicillin (if GABHS +ve) Fluid restrition Low protein, high carbohydrate, low salt diet Antihypertensives and diuretics PRN |
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What 3 aspects are important to follow up after a post-strep glomerulonephritis? |
Monitor BP Monitor kidney function Regular urinalysis (microscopic haematuria may last for years) |
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Define abnormal levels of proteinuria |
>150mg protein/24 hrs - adults >300 - childrent <100 normal Macroalbuminuria only detectable >300 |
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What is important abut microabluminuria in diabetes and why? |
Predictive of nephropathy Indication for early BP treatment - ACEi may slow development of overt nephropathy |
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What is the gold standard for measurement of proteinuria? |
24 hour collection |
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What is orthostatic proteinuria? |
Proteinuria after pt has been standard but absent from specimens obtained following recumbency for several hours e.g. early morning specimens 5-10% of people esp. adolescents No significance in majority and disappears Can foreshadow serious kidney disease |
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Name 5 consequences of heavy proteinuria (> 3g/24 hours) |
Oedema Intravascular volume depletion VTE Hyperlipidaemia Malnutrition |
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Nephrotic syndrome triad |
Proteinuria + generalised oedema + waxy pallor |
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What does nephrotic syndrome predispose patients to? |
Sepsis e.g. peritonitis, pylonephritis, thromboembolism |
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Name 6 causes of nephrotic syndrome |
Systemic kidney disease e.g. diabetes (1 in 3) 2 in 3: Idiopathic nephrotic syndrome Minimal change disease (commonest) Focal glomerular sclerosis Membranous nephropathy Membranoproliferative glomerulonephritis |
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Name 5 treatments for nephrotic syndrome |
Referal to renal physician or unit Diet: low fluid, high protein, low salt Diuretics Prednisolone Phenoxymethylpenecillin Aspirin |
