General Kidney/Urinary Disease Flashcards
What are the different organs that may be affected in apparent kidney/urinary diseases?
Kidneys
Ureters
Bladder
Bladder outflow tract - inc prostate, sphincters, foreskin
What are the general different types of disorders affecting the kidneys/urinary tract?
AKI CKD Ureteric disease Bladder disease - LUTS Bladder outflow disease - acute/chronic retention UTI
What are the various causes of renal disease?
Infection - pyelonephritis
Inflammation - glomerulonephritis, tubulointerstitial nephritis
Iatrogenic - nephrotoxicity, PCNL
Neoplasia
Trauma
Vascular - atheroma, hypertension, diabetes
Hereditary - polycystic kidney disease, nephrotic syndrome
What are the different causes of ureteric disease?
Infection - ureteritis Iatrogenic/trauma - cut during surgery Neoplasia (TCC, prostate causing blockage, other pelvic tumour/lymphadenopathy Hereditary - PUJ obstruction, VUJ reflux Obstruction - intraluminal (stone, clot) - intramural (scar, TCC) - extra-mural (pelvic mass, lymph nodes)
What are the different causes of bladder disease?
Infection - cystitis
Inflammation - e.g. interstitial cystitis
Iatrogenic/trauma
Neoplasia - TCC/SCC of bladder
Idiopathic - overactive bladder syndrome
Degenerative - chronic urinary retention
Neurological - neurogenic bladder dysfunction
What can cause bladder outflow disorders?
Infection/inflammation - prostatitis, balanitis Iatrogenic/trauma Neoplasia - prostate/penile cancer Idiopathic - chronic pelvic pain syndrome Obstruction - primary bladder neck obstruction - BPE - urethral stricture - meatal stenosis - phimosis
What are the risk factors/causes of UTIs?
Female (short urethra)
Sexual intercourse with poor voiding habits
Congenital abnormalities e.g. duplex kidney
Stasis of urine e.g. due to poor bladder emptying
Foreign bodies - catheters, stones
Oestrogen deficiency in post-menopausal
Fistula between bladder/bowel
Spermicide coated condoms/diaphragms
What are some systemic diseases that may cause renal disease?
Diabetes - most common single cause of end-stage renal failure
CVD
Infection - sepsis, infective endocarditis
Vasculitis
Myeloma
What are some drugs that can be nephrotoxic?
Aminoglycosides ACEis Penicillamine Gold NSAIDs Radiocontrast
What are common organisms in infective endocarditis that may affect the kidneys?
SA
Viridans streptococci
Enterococci
Leads to glomerulonephritis - immune complex formation
What are some symptoms/signs of renal disease?
Pain Pyrexia Haematuria Proteinuria Pyuria Palpable mass Renal failure
Define oliguria, anuria, polyuria, nocturia
Oliguria = output <0.5mL/kg/hour Anuria = no output (<100mL/24hr) Polyuria = output >3L/24hr Nocturia = waking up >1 per night Nocturnal polyuria = >1/3rd of total urine output at night
What are some symptoms/signs of chronic renal failure?
Tiredness Anaemia Oedema High BP Bone pain if renal bone disease Pruritus Nausea/vomiting SOB Pericarditis Neuropathy Coma
What are some symptoms/signs of ureteric disease?
Pain e.g. renal colic Pyrexia Haematuria Palpable mass i.e. hydronephrosis Renal failure (only if bilateral or only 1 kidney)
What are some symptoms/signs of bladder disease?
Pain (suprapubic) Pyrexia Haematuria LUTS (Storage, voiding) Recurrent UTIs Chronic urinary retention Urinary leak from vagina Pneumaturia
What is ‘LUTS’?
Storage LUTS
- frequency, nocturia, urgency, urge incontinence
Voiding LUTS
- poor flow, intermittency, terminal dribbling
Incontinence
- stress, urge, mixed, overflow, neurogenic, dribbling
What are some signs/symptoms of bladder outflow disease?
Pain - suprapubic or perineal Pyrexia Haematuria LUTS - voiding due to BPO, overflow/stress incontinence Recurrent UTIs Acute/chronic retention
What are the signs/symptoms of a UTI?
Presentation depends on organs affected
Fever Loin/flank pain/tenderness Suprapubic pain/tenderness Urinary frequency Urinary urgency Dysuria
What are some clinical signs that may be found on examination of someone with renal disease?
Hands - splinter haemorrhages, purpura, Raynaud’s
Face - scleritis, uveitis, nasal cartilage deformity, retinal vasculitis, hypertensive retinopathy
Skin - vasculitic rash, scleroderma
CVS - hypertension, murmur
Chest - crepitations, haemoptysis
Locomotor - joint swelling, tenderness
CNS - stroke, encephalopathy
What are the signs/symptoms of granulomatosis with polyangiitis (Wegener’s)? Why is this relevant in renal medicine?
URT
- epistaxis, nasal deformity, sinusitis, deafness
LRT
- cough, SOB, haemoptysis
- pulmonary haemorrhage
Kidney - glomerulonephritis Joints - arthralgia, myalgia Eyes - scleritis Heart - pericarditis Systemic - fever, weight loss, vasculitic skin rash
Systemic vasculitis that most commonly affects the respiratory tract and kidneys
What are the clinical features of multiple myeloma? Why is this relevant in renal medicine?
Clinical features
- markedly elevated ESR
- anaemia
- weight loss
- fractures
- infections
- back pain/cord compression
Renal failure in myeloma
- cast nephropathy - ‘myeloma kidney’
- light chain nephropathy
- amyloidosis
- hypercalcaemia
- hyperuricaemia
Important cause of renal disease
What general investigations might be done in suspected renal/urinary disease?
Urine/Plasma osmolality eGFR (creatinine) MSSU Urine dipstick - blood, leucocytes, proteins, nitrites Microbiology - urine culture USS, IVU, Isotope studies Biopsy
U+E FBC, CRP Erythropoietin Blood gases Alkaline Phosphatase Antibodies Bone scan General imaging
What test is used in vasculitis?
ANCA
C-ANCA = cytoplasmic
P-ANCA = perinuclear
How is myeloma diagnosed?
Diagnosed by
- bone marrow aspirate >10% clonal plasma cells
- serum paraprotein +/- immunoparesis
- urinary Bence-Jones protein (BJP)
- skeletal survey - lytic lesions
