Lecture 12 - Presentation of Diseases of the Kidneys and Urinary Tract

Question 1

What are the two divisions of the urinary tract?

Answer 1

Upper urinary tract (kidneys + ureter)

Lower urinary tract (bladder + bladder outflow tract)

Question 2

What are the parts of the kidneys?

Answer 2

Parenchyma

Pelvi-calyceal system

Question 3

What are the parts of the ureters?

Answer 3

Pelvi-ureteric junction
Ureter
Vesico-ureteric junction

Question 4

What are the parts of the bladder outflow tract?

Answer 4

Bladder neck (intrinsic urethral sphincter)
Prostate
External urethral sphincter/pelvic floor
Urethra
Urethral meatus
Foreskin

Question 5

What things are on a surgical sieve?

Answer 5

Infection 
Inflammation 
Iatrogenic 
Neoplasia
Trauma
Degenerative
Congenital 
Genetic/hereditary 
Vascular
Endocrine
Failure 
Idiopathic

Question 6

Which drug is used for UTIs but CANNOT be used in renal failure?

Answer 6

Trimethoprim

Question 7

What are infectious renal diseases?

Answer 7

Pyelonephritis

Question 8

What are inflammatory renal diseases?

Answer 8

Glomerulonephritis

Tubulointerstitial nephritis

Question 9

What are iatrogenic causes of renal disease?

Answer 9

Nephrotoxicity

PNCL

Question 10

What are neoplasic causes of renal disease?

Answer 10

Renal tumours

Collecting system tumours

Question 11

What are vascular causes of renal disease?

Answer 11

Atherosclerosis
Hypertension
Diabetes

Question 12

What are hereditary causes of renal disease?

Answer 12

Polycystic kidney disease

Nephrotic syndrome

Question 13

How can renal diseases present?

Answer 13

Pain
Pyrexia
Haematuria
Proteinuria
Pyuria
Mass on palpation 
Renal failure

Question 14

Define proteinuria

Answer 14

Urinary protein excretion >150mg/day

Question 15

How many types of haematuria are there?

Answer 15

3 -
Macroscopic - gross/visible haematuria
Microscopic - visible on microscope
Dipstick positive - pick up on dipstick

Question 16

Define microscopic haematuria

Answer 16

3+ RBCs per high power field

Question 17

Define oliguria

Answer 17

Urine output <0.5ml/kg/hr

Question 18

Define anuria

Answer 18

Absolute anuria - no urine output

Relative anuria - <100,l/24h

Question 19

Define polyuria

Answer 19

Urine output >3L/24h

Question 20

Define nocturia

Answer 20

Waking up at night on 1+ occasion to urinate

Question 21

Define nocturnal polyuria

Answer 21

Nocturnal urine output >1/3 of total urine output in 24h

Question 22

What criteria is used to stage AKI?

Answer 22

RIFLE

Question 23

What does the R in RIFLE stand for?

Answer 23

RISK

Increase in serum creatinine level (1/5x) or decrease in GFR by 25% or UO <0.5ml/kg/h for 6 hours

Question 24

What does the I in RIFLE stand for?

Answer 24

Injury

Increase in serum creatinine level (2.0x) or decrease in GFR by 50%, or UO <0.5 mL/kg/h for 12 hours

Question 25

What does the F in RIFLE stand for?

Answer 25

Failure - Increase in serum creatinine level (3.0x), or decrease in GFR by 75%, or serum creatinine level >355μmol/L with acute increase of >44μmol/L; or UO <0.3 mL/kg/h for 24 hours, or anuria for 12 hours

Question 26

What does the L in RIFLE stand for?

Answer 26

Loss | Persistent ARF or complete loss of kidney function >4 weeks

Question 27

What does the L in RIFLE stand for?

Answer 27

End stage renal disease | Complete loss of kidney function >3 months

Question 28

List 6 functions of the kidney

Answer 28

``` Electrolyte homeostasis Acid-base homeostasis Regulation of vascular tone Body fluid homeostasis Endocrine functions Excretory functions ```

Question 29

How does chronic renal failure present?

Answer 29

``` Can be asymptomatic Fatigue Anaemia Oedema HTN Bone pain due to renal bone disease ```

Question 30

What are features of advanced renal failure?

Answer 30

``` Pruritus NV SoB Pericarditis Neuropathy Coma ```

Question 31

What kind of lesions may cause neurogenic bladder dysfunction?

Answer 31

Supra-pontine lesions (e.g. stroke, Alzheimer's, PD) Infrapontine suprasacral lesions (e.g. spinal cord injury, disc prolapse, spina bifida) Infra-sacral (e.g. MS, DM, CES)

Question 32

What part of the brain is responsible for bladder sensation and conscious inhibition of micturition?

Answer 32

Cortical centre of micturition

Question 33

Where is the micturition centre?

Answer 33

Pons

Question 34

What sacral segments are involved in the micturition reflex?

Answer 34

S2-4 (these relax the IUS, EUS and contract the detrusor)

Question 35

What are the two types of UTI?

Answer 35

Uncomplicated - sexually active female | Complicated - everyone else, always investigate!