Presentation of diseases of kidneys and urinary tract Flashcards
What are the parts of the upper urinary tract?
kidneys - parenchyma and pelvi-calyceal system
ureter = pelvi-ureteric junction, ureter and vesico-ureteric junction
What are the parts of the lower urinary tract?
bladder
bladder outflow tract - bladder neck, prostate, internal and external urethral sphincter, urethra, urethral meatus
List some renal diseases
trauma glomerulonephritis pyelonephritis iatrogenic - PCNL neoplasia - renal tumour renal calculi polycystic kidney disease nephrotic syndrome atherosclerosis
How do renal diseases present? symptoms
pain pyrexia haematuria proteinuria pyuria mass on palpation renal failure genetic testing?
What mg/day is proteinuria?
> 150
3 types of haematuria
frank
microscopic
dipstick
Microscopic haematuria is more than how many RBC per high power field?
3
Oliguria
urine output <0.5ml/kg/hour
Anuria
absolute or <100ml/24 hours
Polyuria
urine output >3l/24 hours
Nocturia
waking at night >1 time
Nocturnal polyuria
nocturnal urine output >1/3 of 24 hour output
How is AKI defined?
in stages
Name the stages of AKI
Risk injury failure loss end stage kidney disease
How can chronic renal failure present in terms of failure of normal kidney function
oedema, congestive heart failure electrolyte imbalanced blood pressure - hypertension erythropoietin, vitamin D bone pain tiredness, anaemia
What are the symptoms relating to advanced renal disease?
pruritus dyspnoea nausea/vomiting pericarditis neuropathy coma
Nature of ureteric disease
clots, stones, tumours BPE ureteritis PUJ obstruction, VUJ reflux hysterectomy TCC para-aortic lymphadenopathy
Examples of intraluminal ureteric diseases
clot, stone
Intramural ureteric diseases
TCC, scar tissue
Extra luminal ureteric diseases
pelvic mass, lymph nodes
How do ureteric diseases present?
palpable mass pyrexia pain - renal colic renal failure - bilateral haematuria
List bladder diseases
TCC of bladder or SCC UTI, cystitis urinary retention bladder rupture neurogenic bladder dysfunction
How do bladder diseases present?
pain - subrapubic pyrexia haematuria recurrent UTI pneumaturia chronic urinary retention urinary leak LUTS
What are the 3 categories of LUTS?
storage
voiding
incontinence
Storage LUTS
frequency, nocturia, urgency, urge incontinence
Voiding LUTS
poor flow, intermittent, dribbling - underactive bladder
Incontinence LUTS
stress, urge, mixed
Is there a higher risk of bladder or renal cancer in a patient with frank haematuria?
bladder
List some causes of LUTS
bladder pathology eg OAB, UTI, TCC
bladder outflow obstruction (BOO)
pelvic floor dysfunction
neurological causes
Supra pontine lesions causing LUTS
stroke, alzheimers, parkinsons
infra pontine supra sacral lesions causing LUTS
spinal cord injury, disc prolapse, spina bifida
Infra-sacral LUTS causes
cauda equine syndrome, MS, diabetes
Where is the micturition centre found?
pons
what sacral segments are involved in the micturition reflex?
S2-4
2 phases of micturition
filling and voiding
List some bladder outflow tract diseases
urethritis/prostatitis BPH, prostate cancer primary bladder neck pbstruction pelvic flow damage urethral injury
How does bladder outflow tract diseases present?
pain pyrexia haematuria LUTS recurrent UTI acute or chronic urinary retention
Define acute urinary retention
Painful inability to void with a palpable and percussible bladder
Residual volumes of acute urinary retention
500ml –> > 1l
Main risk factor for acute urinary retention
BPO
Other causes of acute urinary retention
alcohol excess
UTI
post operative
urethral stricture
Immediate treatment of acute urinary retention
catheterisation
Complications of catheterisation in acute urinary retention
post decompression haematuria UTI pathological diuresis renal failure electrolyte abnormalities
If acute urinary retention is due to BPE what should be started?
alpha blocker
arrange TURP
Define chronic urinary retention
painless, palpable and percussible bladder after voiding
Residual volumes for chronic urinary retention
400ml –> >2l
Main cause of chronic urinary retention
detrusor muscle inactivity
Primary causes of detrusor muscle inactivity
primary bladder failure
Secondary causes of detrusor muscle inactivity
BPO, longstanding BOO
How can chronic urinary retention present?
LUTS
complications eg UTI, bladder stones, overflow incontinence and obstructive renal failure
incidental
Treatment for chronic urinary retention
IV fluids
catheter
CISC
TURP
Complications of catheter in chronic urinary retention
UTI post decompression haematuria pathological diuresis electrolyte abnormalities persistent renal dysfunctions
Features of pathological diuresis
urine output >200ml/hr
postural hypotension
weight loss
electrolyte abnormalities
2 types of diuresis in high pressure chronic urinary retention
physiological <200ml/hr
pathological >200ml/hr
Define UTI
Infection affecting the urinary tract (bladder, kidneys, prostate, testis and epididymis)
What does a diagnosis of UTI allow?
microbiological findings
symptoms/signs
Microbiological diagnosis for UTI
bacterial count 10 to the power of 4 from MSSU specimen with no more than 2 species of micro-organisms
Symptoms/signs of UTI
at least 1 of fever, dysuria, pain, frequency and urgency
Uncomplicated and complicated UTI
uncomplicated - young, sexually active females
Factors to consider in UTI
age
gender
sexually active
co-morbidities eg diabetes, immunosuppression
Catheter
abnormal renal tract eg BOO, VU reflux, tumour
Type of organisms causing UTI
E.coli, staph aureus, pseudomonas, Klebsiella, proteus
Complications of UTI
sepsis AKI scarring of kidneys SCC of bladder acute urinary retention bladder/renal stones frank haematuria
investigations of UTI
urinary dipstick - MSSU/CSU cystoscopy residual bladder scan US kidney CT KUB renogram
Treatment of UTI
antibiotics
treat cause and complications
Emergencies related to UTI
Sepsis renal colic haematuria acute urinary retention iatrogenic injury chronic high pressure urinary retention hypercalcaemia
