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Year 2 Urinary (JK) > Presentation of diseases of kidneys and urinary tract > Flashcards

Presentation of diseases of kidneys and urinary tract Flashcards

1
Q

What are the parts of the upper urinary tract?

A

kidneys - parenchyma and pelvi-calyceal system

ureter = pelvi-ureteric junction, ureter and vesico-ureteric junction

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2
Q

What are the parts of the lower urinary tract?

A

bladder

bladder outflow tract - bladder neck, prostate, internal and external urethral sphincter, urethra, urethral meatus

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3
Q

List some renal diseases

A 
trauma 
glomerulonephritis 
pyelonephritis 
iatrogenic - PCNL
neoplasia - renal tumour 
renal calculi 
polycystic kidney disease 
nephrotic syndrome 
atherosclerosis
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4
Q

How do renal diseases present? symptoms

A 
pain
pyrexia 
haematuria 
proteinuria 
pyuria
mass on palpation 
renal failure 
genetic testing?
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5
Q

What mg/day is proteinuria?

A

> 150

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6
Q

3 types of haematuria

A

frank
microscopic
dipstick

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7
Q

Microscopic haematuria is more than how many RBC per high power field?

A

3

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8
Q

Oliguria

A

urine output <0.5ml/kg/hour

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9
Q

Anuria

A

absolute or <100ml/24 hours

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10
Q

Polyuria

A

urine output >3l/24 hours

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11
Q

Nocturia

A

waking at night >1 time

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12
Q

Nocturnal polyuria

A

nocturnal urine output >1/3 of 24 hour output

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13
Q

How is AKI defined?

A

in stages

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14
Q

Name the stages of AKI

A 
Risk 
injury 
failure 
loss 
end stage kidney disease
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15
Q

How can chronic renal failure present in terms of failure of normal kidney function

A 
oedema, congestive heart failure 
electrolyte imbalanced 
blood pressure - hypertension 
erythropoietin, vitamin D 
bone pain
tiredness, anaemia
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16
Q

What are the symptoms relating to advanced renal disease?

A 
pruritus 
dyspnoea 
nausea/vomiting 
pericarditis 
neuropathy 
coma
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17
Q

Nature of ureteric disease

A 
clots, stones, tumours 
BPE 
ureteritis 
PUJ obstruction, VUJ reflux 
hysterectomy 
TCC
para-aortic lymphadenopathy
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18
Q

Examples of intraluminal ureteric diseases

A

clot, stone

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19
Q

Intramural ureteric diseases

A

TCC, scar tissue

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20
Q

Extra luminal ureteric diseases

A

pelvic mass, lymph nodes

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21
Q

How do ureteric diseases present?

A 
palpable mass 
pyrexia 
pain - renal colic 
renal failure - bilateral 
haematuria
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22
Q

List bladder diseases

A 
TCC of bladder or SCC 
UTI, cystitis 
urinary retention 
bladder rupture 
neurogenic bladder dysfunction
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23
Q

How do bladder diseases present?

A 
pain - subrapubic 
pyrexia 
haematuria 
recurrent UTI 
pneumaturia 
chronic urinary retention 
urinary leak 
LUTS
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24
Q

What are the 3 categories of LUTS?

A

storage
voiding
incontinence

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25
Q

Storage LUTS

A

frequency, nocturia, urgency, urge incontinence

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26
Q

Voiding LUTS

A

poor flow, intermittent, dribbling - underactive bladder

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27
Q

Incontinence LUTS

A

stress, urge, mixed

28
Q

Is there a higher risk of bladder or renal cancer in a patient with frank haematuria?

A

bladder

29
Q

List some causes of LUTS

A

bladder pathology eg OAB, UTI, TCC
bladder outflow obstruction (BOO)
pelvic floor dysfunction
neurological causes

30
Q

Supra pontine lesions causing LUTS

A

stroke, alzheimers, parkinsons

31
Q

infra pontine supra sacral lesions causing LUTS

A

spinal cord injury, disc prolapse, spina bifida

32
Q

Infra-sacral LUTS causes

A

cauda equine syndrome, MS, diabetes

33
Q

Where is the micturition centre found?

A

pons

34
Q

what sacral segments are involved in the micturition reflex?

A

S2-4

35
Q

2 phases of micturition

A

filling and voiding

36
Q

List some bladder outflow tract diseases

A 
urethritis/prostatitis 
BPH, prostate cancer 
primary bladder neck pbstruction
pelvic flow damage 
urethral injury
37
Q

How does bladder outflow tract diseases present?

A 
pain
pyrexia
haematuria 
LUTS
recurrent UTI 
acute or chronic urinary retention
38
Q

Define acute urinary retention

A

Painful inability to void with a palpable and percussible bladder

39
Q

Residual volumes of acute urinary retention

A

500ml –> > 1l

40
Q

Main risk factor for acute urinary retention

A

BPO

41
Q

Other causes of acute urinary retention

A

alcohol excess
UTI
post operative
urethral stricture

42
Q

Immediate treatment of acute urinary retention

A

catheterisation

43
Q

Complications of catheterisation in acute urinary retention

A 
post decompression haematuria
UTI 
pathological diuresis 
renal failure 
electrolyte abnormalities
44
Q

If acute urinary retention is due to BPE what should be started?

A

alpha blocker

arrange TURP

45
Q

Define chronic urinary retention

A

painless, palpable and percussible bladder after voiding

46
Q

Residual volumes for chronic urinary retention

A

400ml –> >2l

47
Q

Main cause of chronic urinary retention

A

detrusor muscle inactivity

48
Q

Primary causes of detrusor muscle inactivity

A

primary bladder failure

49
Q

Secondary causes of detrusor muscle inactivity

A

BPO, longstanding BOO

50
Q

How can chronic urinary retention present?

A

LUTS
complications eg UTI, bladder stones, overflow incontinence and obstructive renal failure
incidental

51
Q

Treatment for chronic urinary retention

A

IV fluids
catheter
CISC
TURP

52
Q

Complications of catheter in chronic urinary retention

A 
UTI 
post decompression haematuria 
pathological diuresis 
electrolyte abnormalities 
persistent renal dysfunctions
53
Q

Features of pathological diuresis

A

urine output >200ml/hr
postural hypotension
weight loss
electrolyte abnormalities

54
Q

2 types of diuresis in high pressure chronic urinary retention

A

physiological <200ml/hr

pathological >200ml/hr

55
Q

Define UTI

A

Infection affecting the urinary tract (bladder, kidneys, prostate, testis and epididymis)

56
Q

What does a diagnosis of UTI allow?

A

microbiological findings

symptoms/signs

57
Q

Microbiological diagnosis for UTI

A

bacterial count 10 to the power of 4 from MSSU specimen with no more than 2 species of micro-organisms

58
Q

Symptoms/signs of UTI

A

at least 1 of fever, dysuria, pain, frequency and urgency

59
Q

Uncomplicated and complicated UTI

A

uncomplicated - young, sexually active females

60
Q

Factors to consider in UTI

A

age
gender
sexually active
co-morbidities eg diabetes, immunosuppression
Catheter
abnormal renal tract eg BOO, VU reflux, tumour

61
Q

Type of organisms causing UTI

A

E.coli, staph aureus, pseudomonas, Klebsiella, proteus

62
Q

Complications of UTI

A 
sepsis
AKI 
scarring of kidneys 
SCC of bladder 
acute urinary retention 
bladder/renal stones 
frank haematuria
63
Q

investigations of UTI

A 
urinary dipstick - MSSU/CSU 
cystoscopy 
residual bladder scan 
US kidney
CT KUB 
renogram
64
Q

Treatment of UTI

A

antibiotics

treat cause and complications

65
Q

Emergencies related to UTI

A 
Sepsis
renal colic 
haematuria 
acute urinary retention 
iatrogenic injury 
chronic high pressure urinary retention 
hypercalcaemia

Year 2 Urinary (JK) (26 decks)

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