Lecture 14 Presentation of Diseases of the Kidneys and Urinary Tract Flashcards
What does the upper urinary tract consist of
Kidneys
Ureter
Name the junctions of the ureter
Pelvi-ureteric
Vesico-ureteric
What does the lower urinary tract consist of
Bladder
Bladder outflow tract
What makes up the bladder outflow tract
Bladder neck Prostate External urethral sphincter/pelvic floor Urethra Urethral meatus Foreskin
Presentation of Renal Diseases
- Pain
- Pyrexia
- Haematuria
- Proteinuria
- Pyuria
- Mass on palpation
- Renal failure
In terms of mg/day what is the definition of proteinuria
Urinary protein excretion >150mg/day
How many types of haematuria are there
Three- macroscopic, microscopic and dipstick positive (Hb)
In terms of RBCs/high power field define microscopic haematuria
> 3 RBC per high power field
Define oliguria
Urine output <0.5ml/kg/hour
Define Anuria
Absolute anuria - No urine output; Relative anuria - <100ml/24 hours
Define Polyuria
Urine output >3L/24 hours
Define Nocturia
Waking up at night ≥1 occasion to micturate
Define Nocturnal Polyuria
Nocturnal urine output >1/3 of total urine output in 24 hours
What serum creatinine levels, GFR and UO would suggest a risk of AKI?
Increase in serum creatinine level (1.5x) or decrease in GFR by 25%, or UO <0.5 mL/kg/h for 6 hours
What serum creatinine levels, GFR and UO would suggest AKI?
Increase in serum creatinine level (2.0x) or decrease in GFR by 50%, or UO <0.5 mL/kg/h for 12 hours
What serum creatinine levels, GFR and UO would suggest AK 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
What serum creatinine levels, GFR and UO would suggest AK loss of function
Persistent ARF or complete loss of kidney function >4 weeks
What serum creatinine levels, GFR and UO would suggest End Stage Kidney Disease
complete loss of kidney function >3 months
Name the presentation of chronic renal failure
Can be asymptomatic Tiredness Anaemia Oedema High BP Bone pain Pruritus Nausea Dyspnoea Pericarditis Neuropathy Coma
Presentation of Ureteric Diseases
Pain(colic) Pyrexia Haematuria Palpable mass (hydronephrosis) Renal failure
Presentation of bladder disease
Pain
Pyrexia
Haematuria
– Storage- frequency, nocturia, urgency, urge incontinence
– Voiding- poor flow, intermittency, terminal dribbling
– Incontinence- stress, urge, mixed, overflow, neurogenic, dribbling
What is the risk of bladder cancer in a patient who presents with frank haematuria
25-30%
What is the risk of renal cancer in a patient who presents with frank haematuria
0.5-1.0%
Presentation of bladder outflow tract
• Pain (suprapubic or perineal)
• Pyrexia
• Haematuria
• Lower urinary tract symptoms (LUTS)
– Voiding- hesitancy, intermittency, poor flow, terminal dribbling, incomplete bladder emptying due to bladder outflow obstruction
– Overflow incontinence- characterized by the involuntary release of urine from an overfull urinary bladder, often in the absence of any urge to urinate
– Stress urinary incontinence- occurs when an activity such as coughing, sneezing, or exercising causes a small amount of urine to leak from the urethra, which is the tube urine passes through
• Recurrent UTIs
• Acute urinary retention
• Chronic urinary retention
