Medical notes

This is a general term which describes a bacterial infection anywhere of the urinary tract. It is usually caused by an infection which arises from the enteric bacteria in the gut. It is also classified as uncomplicated (normal renal structure/function) or complicated (producing a structural/functional abnormality of urinary tract)   Risk factors Decreased urine flow – due to dehydration, or obstructions within the urinary tract Increased bacterial entry – due to sexual intercourse, incontinence Higher bacterial growth – diabetes, immunosuppression, catheter use, pregnancy Female – they have a less vertical urethra making bacterial travel easier Key tests Urine dipstick –

Epididymo-orchitis This is inflammation of the epididymis (and the testes)   Causes Bacteria, e.g., chlamydia, gonorrhea, E. coli Viruses, e.g., mumps (in teenage males) Drugs e.g., amiodarone Symptoms Acute onset tender swelling (confined to epididymis) Dysuria, sweats, fever   Management Treat the underlying cause, e.g., antibiotics if due to an STI   Testicular torsion This refers to twisting of the spermatic cord, usually in adolescents It can cut off the blood supply to the testes resulting in ischaemia   Symptoms Acute onset testicular pain Absence of the cremasteric reflex Abdominal pain, nausea and vomiting Prehn’s sign seen (where raising the

Renal Cell Carcinoma (RCC) This refers to a malignant proliferation of kidney cells. It can be sporadic which is associated with increased age, but it is also seen in young children (genetic causes). The most common form is a clear cell carcinoma as the cells look clear on histology   Symptoms Triad of painless hematuria, loin mass and lumbar pain Systemic symptoms e.g., weight loss, fever Paraneoplastic syndromes – due to hormone release, e.g., ACTH, renin, PrPTH Can cause a left-sided varicocele as the tumour may compress the left renal vein   Key tests Ultrasound and CT scan show a

Acute prostatitis This is acute inflammation of the prostate, which usually occurs in infection   Causes Young adults – Chlamydia trachomatis, Neisseria gonorrhoeae Older Adults – E. coli   Symptoms Dysuria, urinary frequency, and suprapubic pain Can cause urinary retention leading to pain and haematospermia Systemic symptoms, e.g., fevers   Key tests DRE gives tender prostate and secretions reveal bacteria   Management Antibiotics e.g. levofloxacin (Quinolone) or Trimethoprim   Benign prostatic hyperplasia (BPH) This refers to hyperplasia of the prostate which occurs with age and is common. It does not increase the risk of cancer, as it is the central

Polycystic kidney disease This is a genetic condition which leads to the development of multiple cysts on the kidneys. It exists as both autosomal dominant and recessive forms:   Autosomal dominant This occurs due to a mutation in the genes PKD1 (Chr 16), or PKD2 (Chr 4) Symptoms Clinically silent initially but gives symptoms in early adulthood  Hypertension (due to renin release), hematuria, cyst infection and kidney failure   Associations Liver cysts (most common extra-renal manifestation) Berry aneurysms in the brain Cardiovascular abnormalities (mitral valve prolapse, valve issues, aortic dissection)   Key tests Abdominal ultrasound is used to detect cysts

This refers to a group of signs and symptoms secondary to glomerular disease. It encompasses damage to the glomerular capillary wall due to a podocyte pathology, leading to abnormal function or podocyte injury/death. It increases permeability to plasma proteins, resulting in albumin loss in the urine. Symptoms Frothy urine – due to loss of protein in urine (>3 g/24 h) Oedema (in ankles, periorbital and scrotum) – this occurs secondary to hypoalbuminemia resulting in decreased oncotic pressure High risk of thrombosis – this is due to loss of endogenous anticoagulants (e.g., antithrombin III) and can give rise to complications including

This refers to a group of signs and symptoms secondary to glomerular disease. It reflects inflammatory damage to the glomerulus which increases the permeability to proteins and blood causing proteinuria and haematuria. Left untreated, it can progress to end-stage renal failure. Symptoms Haematuria Less proteinuria (< 3.5 g/24 h) Hypertension and blurred vision Oliguria – low urine output Azotemia – high urea/creatinine Can progress onto renal failure   Key tests Kidney biopsy    There are many specific conditions which give rise to nephritic syndrome, which have specific treatments:   IgA nephropathy This is most common cause of nephritic syndrome, called

Renal Stones (Nephrolithiasis) This is the presence of a stone which can get lodged somewhere in the urinary tract. It usually in one of the 3 natural points of constriction – pelviureteric junction (PUJ), pelvic brim or vesicoureteric junction (VUJ). There are different types of stones Types of Kidney Stones Risk Factors Dehydration – this increases ion concentration of the urine Recurrent UTIs and foreign bodies which stagnate flow, e.g., stents/catheters Diet – may cause hypercalcaemia and certain foods also increase oxalate levels Underlying metabolic conditions (e.g., hyperparathyroidism)   Symptoms Writhing (colicky) pain which travels from “loin” to groin with

Acute Kidney Injury (AKI) This is a term which describes a rapid deterioration in renal function, which leads to increased serum urea and creatinine combined with a low urine output. It is very common, occurring in 50% of patients in intensive care units.   There are many different definitions of AKI but the widely used KDIGO criteria are: Rise in creatinine > 26 uM within 48 hours Rise in creatinine > 1.5 Å~ baseline value within 1 week Urine output < 0.5 ml/kg/h for more than 6 consecutive hours   Causes These can be divided into 3 categories: pre-renal, renal

Renal Cell Carcinoma (RCC) This refers to a malignant proliferation of kidney cells. It can be sporadic which is associated with increased age, but it is also seen in young children (genetic causes). The most common form is a clear cell carcinoma as the cells look clear on histology   Symptoms Triad of painless hematuria, loin mass and lumbar pain Systemic symptoms e.g., weight loss, fever Paraneoplastic syndromes – due to hormone release, e.g., ACTH, renin, PrPTH Can cause a left-sided varicocele as the tumour may compress the left renal vein   Key tests Ultrasound and CT scan show a

Acute prostatitis This is acute inflammation of the prostate, which usually occurs in infection   Causes Young adults – Chlamydia trachomatis, Neisseria gonorrhoeae Older Adults – E. coli   Symptoms Dysuria, urinary frequency, and suprapubic pain Can cause urinary retention leading to pain and haematospermia Systemic symptoms, e.g., fevers   Key tests DRE gives tender prostate and secretions reveal bacteria   Management Antibiotics e.g. levofloxacin (Quinolone) or Trimethoprim   Benign prostatic hyperplasia (BPH) This refers to hyperplasia of the prostate which occurs with age and is common. It does not increase the risk of cancer, as it is the central

This is a group of disorders which can affect various parts of the nephron, leading to specific symptoms. The symptoms reflect either an inability to reabsorb or excess reabsorption of solutes in the various segments.  Fanconi syndrome This is a disorder causing impairment of PCT function, preventing solute reabsorption. It can be either inherited or acquired.   Symptoms Glycosuria, aminoaciduria, uricosuria and phosphaturia Phosphate loss can cause bone demineralisation resulting in osteomalacia   Management Phosphate replacement is important   Bartter syndrome This is an inherited condition which results in an impairment of salt reabsorption in the thick ascending loop of

This is a general term which describes a bacterial infection anywhere of the urinary tract. It is usually caused by an infection which arises from the enteric bacteria in the gut. It is also classified as uncomplicated (normal renal structure/function) or complicated (producing a structural/functional abnormality of urinary tract)   Risk factors Decreased urine flow – due to dehydration, or obstructions within the urinary tract Increased bacterial entry – due to sexual intercourse, incontinence Higher bacterial growth – diabetes, immunosuppression, catheter use, pregnancy Female – they have a less vertical urethra making bacterial travel easier Key tests Urine dipstick –

This is a term which describes a rapid deterioration in renal function, which leads to increased serum urea and creatinine combined with a low urine output. It is very common, occurring in 50% of patients in intensive care units.   There are many different definitions of AKI but the widely used KDIGO criteria are: Rise in creatinine > 26 uM within 48 hours Rise in creatinine > 1.5 Å~ baseline value within 1 week Urine output < 0.5 ml/kg/h for more than 6 consecutive hours   Causes These can be divided into 3 categories: pre-renal, renal and post-renal:   Pre-renal

This is a general term which describes a bacterial infection anywhere of the urinary tract. It is usually caused by an infection which arises from the enteric bacteria in the gut. It is also classified as uncomplicated (normal renal structure/function) or complicated (producing a structural/functional abnormality of urinary tract)   Risk factors Decreased urine flow – due to dehydration, or obstructions within the urinary tract Increased bacterial entry – due to sexual intercourse, incontinence Higher bacterial growth – diabetes, immunosuppression, catheter use, pregnancy Female – they have a less vertical urethra making bacterial travel easier Key tests Urine dipstick –

This refers to a group of signs and symptoms secondary to glomerular disease. It reflects inflammatory damage to the glomerulus which increases the permeability to proteins and blood causing proteinuria and haematuria. Left untreated, it can progress to end-stage renal failure. Symptoms Haematuria Less proteinuria (< 3.5 g/24 h) Hypertension and blurred vision Oliguria – low urine output Azotemia – high urea/creatinine Can progress onto renal failure   Key tests Kidney biopsy    There are many specific conditions which give rise to nephritic syndrome, which have specific treatments:   IgA nephropathy This is most common cause of nephritic syndrome, called

This refers to a group of signs and symptoms secondary to glomerular disease. It encompasses damage to the glomerular capillary wall due to a podocyte pathology, leading to abnormal function or podocyte injury/death. It increases permeability to plasma proteins, resulting in albumin loss in the urine. Symptoms Frothy urine – due to loss of protein in urine (>3 g/24 h) Oedema (in ankles, periorbital and scrotum) – this occurs secondary to hypoalbuminemia resulting in decreased oncotic pressure High risk of thrombosis – this is due to loss of endogenous anticoagulants (e.g., antithrombin III) and can give rise to complications including

Acute Kidney Injury (AKI) This is a term which describes a rapid deterioration in renal function, which leads to increased serum urea and creatinine combined with a low urine output. It is very common, occurring in 50% of patients in intensive care units.   There are many different definitions of AKI but the widely used KDIGO criteria are: Rise in creatinine > 26 uM within 48 hours Rise in creatinine > 1.5 Å~ baseline value within 1 week Urine output < 0.5 ml/kg/h for more than 6 consecutive hours   Causes These can be divided into 3 categories: pre-renal, renal

We need to regulate potassium as it determines the resting membrane potential. – As the relative permeabilities of sodium and calcium are very low, K+ is the main determinant. – Normal extracellular [K+] = 4mM – Intracellular [K+] = 125mM – As the extracellular space much smaller than intracellular 16:24 litres, changes in [K+] extracellular affect Em greatly.   Why K+ changes The Potassium concentration can change for many reasons: – Changes in intake –> average of 100mM K+ eaten per day, but starvation may decrease this – Inability to absorb it –> inflammation of the bowel – Excessive loss –> 

We need to regulate pH as the function of enzymes and cell surface ion channels are affected by [H+]. – In addition, bone buffers [H+], so an increase in [H+] will demineralize bone – An acidosis also may lead to a potassium extracellular shift causing hyperkalaemia.   The main way body pH is controlled is by buffering [H+] ions by the bicarbonate buffer system. When [H+] ions are added, they are buffered by HCO3 ions and excreted by the lungs as CO2. However, this is not sustainable unless the kidneys also produce HCO3 ions to replace the ones that are lost.  

Testes These are the main male reproductive organs which are suspended in the scrotum on the pedicles of the spermatic cords. – These hang outside the body as the lower temperature is needed for effective spermatogenesis – They develop from the posterior abdominal wall and carry peritoneum as they migrate through the inguinal canal. – This peritoneum forms a double layer (tunica vaginalis) around the testes. – The residual connection to the peritoneal cavity is obliterated as the processus vaginalis. – Testes are also covered by outer fibrous tunica albuginea – At the head of the testis is the epididymis,

The kidneys lie with their hila at the level L1, with the right kidney being lower – Kidneys are retroperitoneal organs so access is often obtained from the back – The kidneys are enclosed in a fibrous capsule and embedded in perinephric fat.   The kidney is composed of an outer region called the cortex and a central medulla. – The medulla is formed of renal pyramids –> converge on calyces –> inner pelvis – The pelvis then continues on as the ureter carrying urine to the bladder.   Blood supply The kidney is perfused by the renal arteries, which

Hypospadias This is a developmental condition where the urethra opens on the under surface of the penis shaft, rather than the tip of the glans. It occurs when the urethral folds fail to close. Management Surgical correction is the definitive treatment   Epispadias This is a developmental condition where the urethra opens on the upper surface of the penis shaft, rather than tip of the glans. It can be due to wrong positioning of the genital tubercle.   Management Surgical correction   Balanitis This is acute inflammation of the foreskin and glans, usually due to infection Can also be due

Acute prostatitis This is acute inflammation of the prostate, which usually occurs in infection   Causes Young adults – Chlamydia trachomatis, Neisseria gonorrhoeae Older Adults – E. coli   Symptoms Dysuria, urinary frequency, and suprapubic pain Can cause urinary retention leading to pain and haematospermia Systemic symptoms, e.g., fevers   Key tests DRE gives tender prostate and secretions reveal bacteria   Management Antibiotics e.g. levofloxacin (Quinolone) or Trimethoprim   Benign prostatic hyperplasia (BPH) This refers to hyperplasia of the prostate which occurs with age and is common. It does not increase the risk of cancer, as it is the central

Acute prostatitis This is acute inflammation of the prostate, which usually occurs in infection   Causes Young adults – Chlamydia trachomatis, Neisseria gonorrhoeae Older Adults – E. coli   Symptoms Dysuria, urinary frequency, and suprapubic pain Can cause urinary retention leading to pain and haematospermia Systemic symptoms, e.g., fevers   Key tests DRE gives tender prostate and secretions reveal bacteria   Management Antibiotics e.g. levofloxacin (Quinolone) or Trimethoprim   Benign prostatic hyperplasia (BPH) This refers to hyperplasia of the prostate which occurs with age and is common. It does not increase the risk of cancer, as it is the central

Epididymo-orchitis This is inflammation of the epididymis (and the testes)   Causes Bacteria, e.g., chlamydia, gonorrhea, E. coli Viruses, e.g., mumps (in teenage males) Drugs e.g., amiodarone Symptoms Acute onset tender swelling (confined to epididymis) Dysuria, sweats, fever   Management Treat the underlying cause, e.g., antibiotics if due to an STI   Testicular torsion This refers to twisting of the spermatic cord, usually in adolescents It can cut off the blood supply to the testes resulting in ischaemia   Symptoms Acute onset testicular pain Absence of the cremasteric reflex Abdominal pain, nausea and vomiting Prehn’s sign seen (where raising the

Polycystic kidney disease This is a genetic condition which leads to the development of multiple cysts on the kidneys. It exists as both autosomal dominant and recessive forms:   Autosomal dominant This occurs due to a mutation in the genes PKD1 (Chr 16), or PKD2 (Chr 4) Symptoms Clinically silent initially but gives symptoms in early adulthood  Hypertension (due to renin release), hematuria, cyst infection and kidney failure   Associations Liver cysts (most common extra-renal manifestation) Berry aneurysms in the brain Cardiovascular abnormalities (mitral valve prolapse, valve issues, aortic dissection)   Key tests Abdominal ultrasound is used to detect cysts

Renal Cell Carcinoma (RCC) This refers to a malignant proliferation of kidney cells. It can be sporadic which is associated with increased age, but it is also seen in young children (genetic causes). The most common form is a clear cell carcinoma as the cells look clear on histology   Symptoms Triad of painless hematuria, loin mass and lumbar pain Systemic symptoms e.g., weight loss, fever Paraneoplastic syndromes – due to hormone release, e.g., ACTH, renin, PrPTH Can cause a left-sided varicocele as the tumour may compress the left renal vein   Key tests Ultrasound and CT scan show a

Renal Stones (Nephrolithiasis) This is the presence of a stone which can get lodged somewhere in the urinary tract. It usually in one of the 3 natural points of constriction – pelviureteric junction (PUJ), pelvic brim or vesicoureteric junction (VUJ). There are different types of stones Types of Kidney Stones Risk Factors Dehydration – this increases ion concentration of the urine Recurrent UTIs and foreign bodies which stagnate flow, e.g., stents/catheters Diet – may cause hypercalcaemia and certain foods also increase oxalate levels Underlying metabolic conditions (e.g., hyperparathyroidism)   Symptoms Writhing (colicky) pain which travels from “loin” to groin with